Urologie最新文献

Background: High-risk non-muscle-invasive bladder cancer (NMIBC) is most commonly treated with Bacillus Calmette-Guérin (BCG) as first-line therapy. However, in light of the ongoing BCG shortage in the United States, a significant need exists for alternative treatment options, both in the upfront setting as well as for patients with BCG-refractory disease. While radical cystectomy remains the gold standard for patients with BCG-refractory disease, many patients are unfit or unwilling to undergo this procedure. Several new agents, many with novel mechanisms of action, have been approved or are actively being investigated in this setting.

Materials and methods: Articles were chosen for review based on expert knowledge of the literature as well as on PubMed literature searches for the topics of focus. Appropriate articles were selected for inclusion by reviewing article titles, abstracts, and full texts.

Results: There is ample evidence for emerging therapies in BCG-refractory NMIBC including systemic immunotherapy and various intravesical options, such as chemotherapy, gene therapy, and novel drug delivery systems. Radical cystectomy, however, remains the gold standard. Response rates and duration of response vary across treatment modalities, with complete response rates at any time ranging from 41% to 82%. Radical cystectomy should still be recommended to patients with high-risk features given the risks of recurrence, progression, upstaging, and occult lymph node metastases.

Conclusion: While radical cystectomy remains the standard of care for patients with BCG-refractory disease, many patients are unable or unwilling to undergo the procedure. Several novel therapies have been recently approved or are currently being investigated with overall promising early results.

Mucinous prostate carcinoma (mucPCa) often evades detection by prostate-imaging reporting and data system (PI-RADS)-based multiparametric magnetic resonance imaging (MRI). We report a case in which atypical dynamic contrast kinetics served as the sole imaging clue leading to the diagnosis of aggressive mucPCa. Neither T2-weighted nor diffusion-weighted sequences suggested malignancy. Only a targeted MRI/ultrasonography (US) fusion biopsy confirmed an International Society of Urological Pathology (ISUP) grade 4 mucPCa. This case underscores the diagnostic limitations of standardized imaging protocols and highlights the critical importance of contrast enhancement in rare histological subtypes.

Rare urological tumors such as neuroendocrine prostate cancer, non-clear cell renal cell carcinoma, penile carcinoma, and non-urothelial bladder tumors are defined by low incidence, biological heterogeneity, and limited evidence-based treatment options. Molecular tumor boards (MTBs) have emerged as a key strategy to facilitate personalized therapy by integrating histopathological, genomic, and clinical data. This narrative review summarizes the current state of molecular approaches in rare urological malignancies, focusing on pathogenesis, clinical characteristics, and systemic treatment strategies. Special emphasis is placed on the potential of MTBs to identify relevant targets in aggressive or refractory cases and to initiate experimental treatments, such as antibody-drug conjugates (ADCs), immune checkpoint inhibitors (ICI), and molecularly targeted therapies. As tumor-agnostic approvals increase, comprehensive molecular profiling becomes essential, even in rare entities. MTBs thus represent an important tool for improving care in this complex patient population.

Background: Modern treatments in uro-oncology are increasingly based on therapeutics with complex metabolism in the human body and are associated with an increased risk of drug interactions.

Objective: This article provides an overview of the most prevalent mechanisms of drug interaction within uro-oncologic therapies and points towards their potential management.

Methods: Anti-cancer agents were compiled from the German National Guidelines for the respective indications. Metabolization pathways and potential for drug interactions for those therapeutic drugs as well as the most prevalent drugs for the treatment of concomitant conditions were collected through review of the German prescribing Information (Fachinfo®, www.fachinfo.de ) and an American-based drug information database (uptodate®, www.uptodate.com ). For the most frequent interactions, a pharmaceutical and medical assessment was performed.

Results: For most anti-cancer agents, metabolization via CYP isoenzymes and transport proteins like p‑glycoprotein play a significant role.

Conclusion: Especially interactions with CYP enzymes like 3A4 are critical as they have potential repercussions on efficacy, safety, and quality of life. Clinical management of concomitant oral anticoagulation or in therapeutically limiting comorbidities (like immunosuppression) are particularly challenging.

Background: Uro-oncological diseases have negative long-term consequences for physical, functional, psychological, and socioeconomic well-being. A common focus of palliative and integrative medicine is improving quality of life by alleviating symptoms.

Objectives: What treatment options are available for frequently occurring symptoms in uro-oncology patients?

Methods: Based on current literature and international guideline recommendations, an overview of palliative and integrative medical therapies and their significance in the management of advanced uro-oncological tumors is given.

Results: Palliative care treatment options combined with complementary medicine can effectively contribute to symptom relief. The foundation of tumor pain therapy is medication, which can be effectively supplemented with acupuncture, for example. Medication and relaxation exercises can also have synergistic effects on sleep disorders. A multiprofessional and interdisciplinary approach is also beneficial for the treatment of anxiety and depression, combining medication, psycho-oncological support, physiotherapy, social services, nutritional therapy, mindfulness exercises, meditative movement exercises, and so on. It is important that palliative and integrative medical support be offered early in the course of the illness. This support includes not only optimizing symptom relief but also communication with patients and their families and caregivers.

Conclusion: Palliative medicine and integrative medicine offer the chance to improve the quality of life and symptom management in advanced uro-oncological cancer.

Background: Geriatric patients undergoing uro-oncological treatments are particularly susceptible to complications in many organ systems. Prior to starting treatment, a careful risk-benefit analysis must be performed, taking into consideration the patient's remaining life expectancy and existing functional deficits. These should be weighed against the side effect profile of the planned treatment.

Objective: After an introduction of the three-step geriatric assessment to identify geriatric patients, systematically identify functional deficits, and evaluate them in depth, the example of androgen deprivation therapy (ADT) for prostate cancer will be used to demonstrate the specific risks associated with geriatric patients and how these can be assessed to reach a well-founded decision regarding ADT.

Materials and methods: Review of the geriatric assessment, side effects of ADT, and uro-geriatric considerations.

Conclusion: The classification of a patient as "geriatric" does not automatically mean treatment exclusion or the use of "best supportive care". On the other hand, treatment is often particularly risky given the limited compensatory abilities of geriatric patients and the possible loss of autonomy. The practitioner is faced with the task of estimating the risk knowing the individual functional deficits of the patient, but also knowing the special risks of the planned treatment, while being aware of the specific risks involved and modifying the treatment if necessary to ensure that the decision-making process is transparent across institutions and practitioners involved. Prophylactic treatment of treatable side effects is also advisable, such as the organization of reliable monitoring during treatment.