{"title":"Letter: The Blind Spot of Prostate-Specific Membrane Antigen Positron Emission Tomography Staging? Intraductal Carcinoma of the Prostate Is Overrepresented in Patients With No Uptake Pattern on Prostate-Specific Membrane Antigen Positron Emission Tomography and High-Grade Prostate Cancer.","authors":"Yubin Feng,Shuqing Zhou,Shiye Huang,Zekai Yu,Ziye Zhuang","doi":"10.1097/ju.0000000000004787","DOIUrl":"https://doi.org/10.1097/ju.0000000000004787","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"38 1","pages":"101097JU0000000000004787"},"PeriodicalIF":0.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-30DOI: 10.1097/ju.0000000000004836
D Chung,W Kassouf,R Agnihotram,H Alday,C Tajzler,A Eskandari,R Breau,G Kulkarni,P Chung,A Fairey,M Lodde,E Hyndman,N Alimohamed,R Rendon,P Black,J G Nayak
BACKGROUNDPatients with high-risk non-muscle invasive bladder cancer (NMIBC) require frequent surveillance and adjuvant intravesical therapy, which may be less accessible in rural area. Utilizing the Stats Canada Remoteness Index (RI), we sought to investigate the effect of rurality/remoteness on the presentation, management, and surveillance of high risk NMIBC and cancer specific outcomes such as survival and rate of progression.METHODSThe Canadian Bladder Cancer Information System (CBCIS) database was used to identify all patients diagnosed with high risk NMIBC (defined as HG Ta, any T1 disease, CIS) on initial transurethral resection of bladder tumor (TURBT). Using the manual classification method, rural areas were defined as a RI ≥ 0.15. Exclusion criteria included patients with non-urothelial histology, unknown T stage, or evidence of nodal or distant metastases at time of diagnosis.RESULTSAmong 2838 high-risk NMIBC patients, 71% were urban and 30% rural. Rural patients were more likely than urban patients to present with high grade (HG) T1 tumors (42% vs. 37%, p=0.059). Repeat TURBT was performed within 90 days for HG T1 disease in 29% of urban and 23% of rural patients (p=0.04). Rural patients were less likely than urban patients to receive induction BCG (52% vs. 69%, p<0.0001). 5-yr progression free survival to MIBC was significantly lower among rural patients (80% vs 85%; p=0.048).CONCLUSIONSRural patients with high-risk NMIBC were significantly less likely to meet quality indicator benchmarks for guideline concordant surveillance and management, although overall rates are low indicating a potential area of quality improvement efforts.
背景：高风险非肌肉浸润性膀胱癌（NMIBC）患者需要频繁的监测和辅助膀胱内治疗，这在农村地区可能更难获得。利用加拿大统计局偏远指数（RI），我们试图调查农村/偏远对高风险NMIBC的表现、管理和监测以及癌症特定结果（如生存率和进展率）的影响。方法使用加拿大膀胱癌信息系统（CBCIS）数据库，识别所有经尿道膀胱肿瘤初始切除术（TURBT）诊断为高危NMIBC（定义为HG Ta，任何T1疾病，CIS）的患者。采用人工分类方法，将农村地区定义为RI≥0.15。排除标准包括诊断时具有非尿路上皮组织学、未知T分期或有淋巴结或远处转移证据的患者。结果2838例NMIBC高危患者中，城市占71%，农村占30%。农村患者比城市患者更有可能出现高级别（HG） T1肿瘤（42%比37%，p=0.059）。29%的城市和23%的农村患者在90天内对HG T1疾病进行了重复TURBT治疗（p=0.04）。农村患者接受诱导BCG的可能性低于城市患者（52% vs. 69%, p<0.0001）。农村患者到MIBC的5年无进展生存率明显较低（80% vs 85%; p=0.048）。结论：农村高危NMIBC患者达到指南一致性监测和管理的质量指标基准的可能性明显较低，尽管总体率较低，表明质量改进工作的潜在领域。
{"title":"Outcomes Among Rural and Urban Patients with High-risk NMIBC: Results from the Canadian Bladder Cancer Information System (CBCIS).","authors":"D Chung,W Kassouf,R Agnihotram,H Alday,C Tajzler,A Eskandari,R Breau,G Kulkarni,P Chung,A Fairey,M Lodde,E Hyndman,N Alimohamed,R Rendon,P Black,J G Nayak","doi":"10.1097/ju.0000000000004836","DOIUrl":"https://doi.org/10.1097/ju.0000000000004836","url":null,"abstract":"BACKGROUNDPatients with high-risk non-muscle invasive bladder cancer (NMIBC) require frequent surveillance and adjuvant intravesical therapy, which may be less accessible in rural area. Utilizing the Stats Canada Remoteness Index (RI), we sought to investigate the effect of rurality/remoteness on the presentation, management, and surveillance of high risk NMIBC and cancer specific outcomes such as survival and rate of progression.METHODSThe Canadian Bladder Cancer Information System (CBCIS) database was used to identify all patients diagnosed with high risk NMIBC (defined as HG Ta, any T1 disease, CIS) on initial transurethral resection of bladder tumor (TURBT). Using the manual classification method, rural areas were defined as a RI ≥ 0.15. Exclusion criteria included patients with non-urothelial histology, unknown T stage, or evidence of nodal or distant metastases at time of diagnosis.RESULTSAmong 2838 high-risk NMIBC patients, 71% were urban and 30% rural. Rural patients were more likely than urban patients to present with high grade (HG) T1 tumors (42% vs. 37%, p=0.059). Repeat TURBT was performed within 90 days for HG T1 disease in 29% of urban and 23% of rural patients (p=0.04). Rural patients were less likely than urban patients to receive induction BCG (52% vs. 69%, p<0.0001). 5-yr progression free survival to MIBC was significantly lower among rural patients (80% vs 85%; p=0.048).CONCLUSIONSRural patients with high-risk NMIBC were significantly less likely to meet quality indicator benchmarks for guideline concordant surveillance and management, although overall rates are low indicating a potential area of quality improvement efforts.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"114 1","pages":"101097JU0000000000004836"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-28DOI: 10.1097/ju.0000000000004832
Kathryn H Gessner,Allison M Deal,Amir Feinberg,Shannon Myers,Katherine Poulos,Hillary Heiling,Sara Wobker,Pranav Akella,Marc A Bjurlin,Clayton Commander,Matthew I Milowsky,Matthew E Nielsen,Mathew Raynor,Angela B Smith,Eric Wallen,David C Johnson,William Y Kim,Hung-Jui Tan
PURPOSEDue to uncertainty on best management, a subset of patients with small renal masses suspicious for kidney cancer experience elevated decisional conflict. We hypothesize that pathologic information from renal mass biopsy may improve patient decision-making. In this study, we evaluate the impact of renal mass biopsy on decisional conflict for patients with clinical T1 renal masses.MATERIALS AND METHODSA comparative, non-randomized clinical trial was performed at a large tertiary cancer center. Patients with new clinical T1 renal masses were self-assigned to standard-of-care biopsy. We used difference-in-difference analyses to assess change in decisional conflict scale by receipt of renal mass biopsy.RESULTSAmong 250 participants, 25% underwent biopsy during initial decision-making period prior to definitive intervention. Biopsy was more common for patients with masses >4 cm vs. 0-2 cm (PR 2.41, 95% CI 1.20-4.82, p=0.01), high nephrometry score vs. low (PR 2.13, 95% CI 1.13-4.01, p=0.02), and higher maximizer-minimizer score (PR 1.02, 95% CI 1.00-1.05, p=0.04). On adjusted difference-in-difference analysis, there was a small, non-significant reduction in decisional conflict for subjects undergoing biopsy vs. no biopsy (-2.78, 95% CI -7.18-1.45, p=0.20). Among subgroups, difference-in-difference by biopsy was large for total decisional conflict score in patients who did not see an outside urologist (-6.22) and patients reporting lower communication scores (-8.24).CONCLUSIONSThough renal mass biopsy did not significantly decrease decisional conflict in all patients, biopsy reduced decisional conflict in certain patient subsets, demonstrating the importance of further investigating how to better support patients after renal mass diagnosis.
目的：由于对最佳治疗方法的不确定性，一小部分疑似肾癌的肾小肿块患者的决策冲突增加。我们假设肾肿块活检的病理信息可以改善患者的决策。在这项研究中，我们评估肾肿块活检对临床T1肾肿块患者决策冲突的影响。材料与方法在一家大型三级肿瘤中心进行了一项非随机对照临床试验。新出现临床T1肾肿块的患者自行进行标准护理活检。我们采用差异中差异分析来评估接受肾肿块活检后决策冲突量表的变化。结果在250名参与者中，25%的人在最终干预前的初始决策期接受了活检。活检在肿物为bbb40cm vs. 0- 2cm的患者中更为常见（PR为2.41,95% CI为1.20-4.82,p=0.01），肾测量评分高vs.低（PR为2.13,95% CI为1.13-4.01,p=0.02），最大-最小评分较高（PR为1.02,95% CI为1.00-1.05,p=0.04）。在调整后的差异分析中，接受活检的受试者与未接受活检的受试者在决策冲突方面有微小的、无显著性的减少（-2.78,95% CI -7.18-1.45, p=0.20）。在亚组中，未见外部泌尿科医生的患者（-6.22）和沟通评分较低的患者（-8.24），活检的总决策冲突评分差异很大。结论肾包块活检并不能显著减少所有患者的决策冲突，但在某些患者亚群中，活检减少了决策冲突，表明进一步研究如何更好地支持肾包块诊断后的患者的重要性。
{"title":"Impact of renal mass biopsy on decision-making experience for clinical T1 renal masses.","authors":"Kathryn H Gessner,Allison M Deal,Amir Feinberg,Shannon Myers,Katherine Poulos,Hillary Heiling,Sara Wobker,Pranav Akella,Marc A Bjurlin,Clayton Commander,Matthew I Milowsky,Matthew E Nielsen,Mathew Raynor,Angela B Smith,Eric Wallen,David C Johnson,William Y Kim,Hung-Jui Tan","doi":"10.1097/ju.0000000000004832","DOIUrl":"https://doi.org/10.1097/ju.0000000000004832","url":null,"abstract":"PURPOSEDue to uncertainty on best management, a subset of patients with small renal masses suspicious for kidney cancer experience elevated decisional conflict. We hypothesize that pathologic information from renal mass biopsy may improve patient decision-making. In this study, we evaluate the impact of renal mass biopsy on decisional conflict for patients with clinical T1 renal masses.MATERIALS AND METHODSA comparative, non-randomized clinical trial was performed at a large tertiary cancer center. Patients with new clinical T1 renal masses were self-assigned to standard-of-care biopsy. We used difference-in-difference analyses to assess change in decisional conflict scale by receipt of renal mass biopsy.RESULTSAmong 250 participants, 25% underwent biopsy during initial decision-making period prior to definitive intervention. Biopsy was more common for patients with masses >4 cm vs. 0-2 cm (PR 2.41, 95% CI 1.20-4.82, p=0.01), high nephrometry score vs. low (PR 2.13, 95% CI 1.13-4.01, p=0.02), and higher maximizer-minimizer score (PR 1.02, 95% CI 1.00-1.05, p=0.04). On adjusted difference-in-difference analysis, there was a small, non-significant reduction in decisional conflict for subjects undergoing biopsy vs. no biopsy (-2.78, 95% CI -7.18-1.45, p=0.20). Among subgroups, difference-in-difference by biopsy was large for total decisional conflict score in patients who did not see an outside urologist (-6.22) and patients reporting lower communication scores (-8.24).CONCLUSIONSThough renal mass biopsy did not significantly decrease decisional conflict in all patients, biopsy reduced decisional conflict in certain patient subsets, demonstrating the importance of further investigating how to better support patients after renal mass diagnosis.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"17 1","pages":"101097JU0000000000004832"},"PeriodicalIF":0.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-27DOI: 10.1097/ju.0000000000004828
Roy Elias,Adam K Aragaki,Jean H Hoffman-Censits,Noah M Hahn,David J McConkey,Burles A Johnson
PURPOSEIdentifying biomarkers to determine patients who benefit from immune checkpoint inhibitor (ICI) therapy is critical to avoid overtreatment. Thus, we determined whether tumor expression of a pan-B cell gene signature (BGS), and a CD8 T effector cell gene signature (CD8TGS), associated with greater overall survival (OS) in patients with high-risk muscle invasive urothelial carcinoma (MIUC) and circulating tumor DNA (ctDNA) (+) status on C1D1, who received adjuvant atezolizumab.MATERIALS AND METHODSWe used transcriptomic profiles derived from bulk RNA sequencing (RNAseq) of tumors, and plasma ctDNA, from patients in the IMvigor010 trial of adjuvant atezolizumab versus observation in resected high risk MIUC. Tumor RNAseq expression defined patient groups with high and low BGS and CD8TGS (e.g. B8T). We stratified patients by ctDNA status, then assessed OS based on receipt of atezolizumab. We interrogated tumor B8T in patients with MIUC who received neoadjuvant atezolizumab in the ABACUS trial.RESULTSPatients who had B8T Hi/Hi tumors had high OS, and adjuvant atezolizumab did not provide additional benefit. Conversely, in patients with B8T Hi/Lo tumors, atezolizumab associated with longer OS, regardless of ctDNA status. Neoadjuvant atezolizumab induced a high proportion of B8T Hi/Hi tumors at cystectomy.CONCLUSIONSWhile tumor B8T Hi/Hi was prognostic regardless of ctDNA status, B8T Hi/Lo was predictive for atezolizumab benefit independent of ctDNA status. Thus, the B8T identified patients with ctDNA(-) status who benefited, and patients who were ctDNA(+) who did not benefit, from adjuvant atezolizumab.
{"title":"Intratumoral expression of a composite B cell / CD8 T cell biomarker stratifies overall survival by ctDNA status and benefit from adjuvant immunotherapy in high risk, muscle invasive urothelial carcinoma.","authors":"Roy Elias,Adam K Aragaki,Jean H Hoffman-Censits,Noah M Hahn,David J McConkey,Burles A Johnson","doi":"10.1097/ju.0000000000004828","DOIUrl":"https://doi.org/10.1097/ju.0000000000004828","url":null,"abstract":"PURPOSEIdentifying biomarkers to determine patients who benefit from immune checkpoint inhibitor (ICI) therapy is critical to avoid overtreatment. Thus, we determined whether tumor expression of a pan-B cell gene signature (BGS), and a CD8 T effector cell gene signature (CD8TGS), associated with greater overall survival (OS) in patients with high-risk muscle invasive urothelial carcinoma (MIUC) and circulating tumor DNA (ctDNA) (+) status on C1D1, who received adjuvant atezolizumab.MATERIALS AND METHODSWe used transcriptomic profiles derived from bulk RNA sequencing (RNAseq) of tumors, and plasma ctDNA, from patients in the IMvigor010 trial of adjuvant atezolizumab versus observation in resected high risk MIUC. Tumor RNAseq expression defined patient groups with high and low BGS and CD8TGS (e.g. B8T). We stratified patients by ctDNA status, then assessed OS based on receipt of atezolizumab. We interrogated tumor B8T in patients with MIUC who received neoadjuvant atezolizumab in the ABACUS trial.RESULTSPatients who had B8T Hi/Hi tumors had high OS, and adjuvant atezolizumab did not provide additional benefit. Conversely, in patients with B8T Hi/Lo tumors, atezolizumab associated with longer OS, regardless of ctDNA status. Neoadjuvant atezolizumab induced a high proportion of B8T Hi/Hi tumors at cystectomy.CONCLUSIONSWhile tumor B8T Hi/Hi was prognostic regardless of ctDNA status, B8T Hi/Lo was predictive for atezolizumab benefit independent of ctDNA status. Thus, the B8T identified patients with ctDNA(-) status who benefited, and patients who were ctDNA(+) who did not benefit, from adjuvant atezolizumab.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"53 1","pages":"101097JU0000000000004828"},"PeriodicalIF":0.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145374089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-27DOI: 10.1097/ju.0000000000004827
Eric C Kauffman,Kieran Lewis,Ali Hajiran,Steven C Campbell
{"title":"Renal Histotripsy and the Role of the Urologist.","authors":"Eric C Kauffman,Kieran Lewis,Ali Hajiran,Steven C Campbell","doi":"10.1097/ju.0000000000004827","DOIUrl":"https://doi.org/10.1097/ju.0000000000004827","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"109 1","pages":"101097JU0000000000004827"},"PeriodicalIF":0.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145374090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-21DOI: 10.1097/ju.0000000000004820
Trinity J Bivalacqua,Alex Sankin,Mark Schoenberg
{"title":"Adopting the Fruits of Innovation: using new drugs to treat NMIBC.","authors":"Trinity J Bivalacqua,Alex Sankin,Mark Schoenberg","doi":"10.1097/ju.0000000000004820","DOIUrl":"https://doi.org/10.1097/ju.0000000000004820","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"28 1","pages":"101097JU0000000000004820"},"PeriodicalIF":0.0,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-17DOI: 10.1097/ju.0000000000004821
Andrew J Vickers,Christopher Jd Wallis,Karim Touijer
BACKGROUND AND OBJECTIVEThere is controversy about the decision of whether to perform a pelvic lymph node dissection (PLND) during radical prostatectomy for prostate cancer. While a recent randomized trial reported a reduced risk of metastasis for extended compared to limited PLND, some guidelines do not recommend PLND, at least partly on the basis that it raises the risk of complications such as lymphocele. We conducted a decision analysis of PLND. Our aim was to put varying numerical estimates on benefit, harm and uncertainty in order to determine whether, and under what conditions, PLND would do more good than harm.METHODSOur approach was to start first with a simple decision tree for PLND vs. no PLND during radical prostatectomy and then determine whether added complexity would be of benefit. We started by using inputs that were unfavorable to PLND - for instance, using an extremely high outlying rate of lymphocele and having no difference in metastasis rates beyond 10 years - aiming to vary these in sensitivity analyses.KEY FINDINGS AND LIMITATIONSDespite starting with unfavorable inputs for PLND, the expected utility of PLND was higher than that for no PLND across a broad range of scenarios, including giving a low subjective probability that PLND was of benefit, high risk of PLND complications, and PLND's reduction in locoregional metastases being considered irrelevant. PLND was also favored in patients with PSMA PET negative disease, a finding driven by the imperfect sensitivity of PSMA PET. The key limitation is that the findings do not apply to patients who have only a trivial risk of metastasis, such as patients with grade group 1 disease.CONCLUSIONS: AND CLINICAL IMPLICATIONSPLND should be the standard of care for patients undergoing radical prostatectomy for grade group 2 or higher disease.PATIENT SUMMARY: We conducted a decision analysis to determine whether patients undergoing radical prostatectomy should have a lymph node dissection. The decision analysis clearly supported an approach of doing a lymph node dissection, even in patients with a negative PSMA PET.
{"title":"Decision analysis of pelvic lymph node dissection during radical prostatectomy.","authors":"Andrew J Vickers,Christopher Jd Wallis,Karim Touijer","doi":"10.1097/ju.0000000000004821","DOIUrl":"https://doi.org/10.1097/ju.0000000000004821","url":null,"abstract":"BACKGROUND AND OBJECTIVEThere is controversy about the decision of whether to perform a pelvic lymph node dissection (PLND) during radical prostatectomy for prostate cancer. While a recent randomized trial reported a reduced risk of metastasis for extended compared to limited PLND, some guidelines do not recommend PLND, at least partly on the basis that it raises the risk of complications such as lymphocele. We conducted a decision analysis of PLND. Our aim was to put varying numerical estimates on benefit, harm and uncertainty in order to determine whether, and under what conditions, PLND would do more good than harm.METHODSOur approach was to start first with a simple decision tree for PLND vs. no PLND during radical prostatectomy and then determine whether added complexity would be of benefit. We started by using inputs that were unfavorable to PLND - for instance, using an extremely high outlying rate of lymphocele and having no difference in metastasis rates beyond 10 years - aiming to vary these in sensitivity analyses.KEY FINDINGS AND LIMITATIONSDespite starting with unfavorable inputs for PLND, the expected utility of PLND was higher than that for no PLND across a broad range of scenarios, including giving a low subjective probability that PLND was of benefit, high risk of PLND complications, and PLND's reduction in locoregional metastases being considered irrelevant. PLND was also favored in patients with PSMA PET negative disease, a finding driven by the imperfect sensitivity of PSMA PET. The key limitation is that the findings do not apply to patients who have only a trivial risk of metastasis, such as patients with grade group 1 disease.CONCLUSIONS: AND CLINICAL IMPLICATIONSPLND should be the standard of care for patients undergoing radical prostatectomy for grade group 2 or higher disease.PATIENT SUMMARY: We conducted a decision analysis to determine whether patients undergoing radical prostatectomy should have a lymph node dissection. The decision analysis clearly supported an approach of doing a lymph node dissection, even in patients with a negative PSMA PET.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"14 1","pages":"101097JU0000000000004821"},"PeriodicalIF":0.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1097/ju.0000000000004814
Paul Kokorowski,Nadine A Friedrich,Michael Luu,Alex Shiang,Sanjay Das,James Daniels,Stephen J Freedland,Brennan Spiegel,Timothy J Daskivich
PURPOSEShared decision making (SDM) for prostate cancer treatment requires active participation of patients and providers. While the physician's role has been studied extensively, the patient's role in SDM is poorly characterized. We sought to describe variation in patient participation and thematic content during consultations for localized prostate cancer.MATERIALS AND METHODS6,601 patient statements from 50 multispecialty consultations across 10 providers were analyzed for content and speech type using an open coding approach and then categorized into major themes. The proportion of patient words, statement types, and counts of statements described content. We used a Generalized Linear Mixed Model (GLMM) to identify predictors of words spoken, questions asked, and words related to SDM including sociodemographic data, decisional conflict score (DCA), and autonomy preference index scores (API).RESULTSPatients speech comprised a median of 19.9% (IQR 12.7%, 32.3%) of total words per consultation, with a broad range (1.8% to 51.1%). Coders identified 5 primary types of speech segments: Acknowledgements (27.7% of patient quotes), Expressions/Preferences (8.8%), Questions/Requests, (21.5%), Providing information (34.5%), and other (7.6%). There was a median of 18.5 (IQR 9, 32) patient questions per consultation, with a broad range (3 to 128). The median proportion of patient speech related to SDM (i.e. treatment preferences, treatment values, or decision-making process) was 3.4% (IQR 1.85%-6.74%). In multivariable models, only tumor risk was associated engagement in SDM (IRR 2.43, 95%CI 1.17-5.01 for favorable and IRR 2.23, 95%CI 1.11-4.47 for unfavorable/high), while otherwise there were no significant predictors of the number of patient words, questions asked, or statements related to SDM.CONCLUSIONSPatient participation in prostate cancer consultations was highly variable, with no consistent predictors. Minimal time is spent expressing preferences, values, or the decision-making process. Providers should adjust practices to ensure adequate participation, specifically prioritizing elicitation of values and preferences.
{"title":"Patient Participation in Consultations for Clinically Localized Prostate Cancer.","authors":"Paul Kokorowski,Nadine A Friedrich,Michael Luu,Alex Shiang,Sanjay Das,James Daniels,Stephen J Freedland,Brennan Spiegel,Timothy J Daskivich","doi":"10.1097/ju.0000000000004814","DOIUrl":"https://doi.org/10.1097/ju.0000000000004814","url":null,"abstract":"PURPOSEShared decision making (SDM) for prostate cancer treatment requires active participation of patients and providers. While the physician's role has been studied extensively, the patient's role in SDM is poorly characterized. We sought to describe variation in patient participation and thematic content during consultations for localized prostate cancer.MATERIALS AND METHODS6,601 patient statements from 50 multispecialty consultations across 10 providers were analyzed for content and speech type using an open coding approach and then categorized into major themes. The proportion of patient words, statement types, and counts of statements described content. We used a Generalized Linear Mixed Model (GLMM) to identify predictors of words spoken, questions asked, and words related to SDM including sociodemographic data, decisional conflict score (DCA), and autonomy preference index scores (API).RESULTSPatients speech comprised a median of 19.9% (IQR 12.7%, 32.3%) of total words per consultation, with a broad range (1.8% to 51.1%). Coders identified 5 primary types of speech segments: Acknowledgements (27.7% of patient quotes), Expressions/Preferences (8.8%), Questions/Requests, (21.5%), Providing information (34.5%), and other (7.6%). There was a median of 18.5 (IQR 9, 32) patient questions per consultation, with a broad range (3 to 128). The median proportion of patient speech related to SDM (i.e. treatment preferences, treatment values, or decision-making process) was 3.4% (IQR 1.85%-6.74%). In multivariable models, only tumor risk was associated engagement in SDM (IRR 2.43, 95%CI 1.17-5.01 for favorable and IRR 2.23, 95%CI 1.11-4.47 for unfavorable/high), while otherwise there were no significant predictors of the number of patient words, questions asked, or statements related to SDM.CONCLUSIONSPatient participation in prostate cancer consultations was highly variable, with no consistent predictors. Minimal time is spent expressing preferences, values, or the decision-making process. Providers should adjust practices to ensure adequate participation, specifically prioritizing elicitation of values and preferences.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"115 1","pages":"101097JU0000000000004814"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1097/ju.0000000000004815
Suhaib Abdulfattah,Nicole J Kye,Avi P Shah,Sahar Eftekharzadeh,Marina Quairoli,Emily Ai,Karl Godlewski,Katherine Fischer,Dana Weiss,Jason P Van Batavia,Christopher J Long,Stephen A Zderic,Mark Zaontz,Thomas F Kolon,Sameer Mittal,Arun K Srinivasan,Aseem R Shukla
PURPOSEThis study evaluates the clinical characteristics and predictors of febrile urinary tract infection in children with potentially persistent primary vesicoureteral reflux (VUR) who discontinued continuous antibiotic prophylaxis (CAP) without radiographic confirmation of reflux resolution. We hypothesize that many patients can safely discontinue CAP after toilet training and that a nomogram can predict the probability of febrile urinary tract infection (fUTI) following cessation.MATERIALS AND METHODSA retrospective review of an institutional VUR registry (2012-2018) identified children managed with CAP who subsequently discontinued prophylaxis. Patients with secondary VUR, underlying anatomic abnormalities, or inadequate follow-up were excluded. Demographics, clinical characteristics, and outcomes were analyzed. Multivariable Cox proportional hazards modeling identified predictors of post-cessation fUTI, and a nomogram was constructed. Model performance was evaluated using the concordance index (C-index) and time-dependent AUC (area under the ROC curve). A simplified clinical risk score was developed and validated.RESULTSAmong 876 children with primary VUR, 386 (44%) discontinued CAP without VCUG-confirmed resolution. Median age at cessation was 39 months, with a median follow-up of 44 months. Post-cessation, 345 (89%) remained free of fUTI; 41 (11%) developed fUTI. Multivariable analysis identified bowel and bladder dysfunction (HR=16.1, p<0.001) and high-grade VUR (HR=2.31, p=0.02) as independent risk factors for fUTI. The nomogram demonstrated a C-index of 0.77 and AUCs of 0.67, 0.80, and 0.77 at 1-, 3-, and 5-years, respectively. A simplified 3-year risk score stratified patients into low (n=305), moderate (n=66), and high (n=15) risk groups with good discrimination (C-index = 0.75, log-rank p<0.001).CONCLUSIONSCAP discontinuation is a viable strategy in select children with persistent VUR, particularly those without voiding dysfunction. A predictive nomogram provides a valuable tool for individualized decision-making. Prospective studies are warranted to refine risk stratification and optimize management strategies.
{"title":"A Risk Stratification Model to Predict Febrile Urinary Tract Infection After Cessation of Continuous Antibiotic Prophylaxis in Children with Known Vesicoureteral Reflux.","authors":"Suhaib Abdulfattah,Nicole J Kye,Avi P Shah,Sahar Eftekharzadeh,Marina Quairoli,Emily Ai,Karl Godlewski,Katherine Fischer,Dana Weiss,Jason P Van Batavia,Christopher J Long,Stephen A Zderic,Mark Zaontz,Thomas F Kolon,Sameer Mittal,Arun K Srinivasan,Aseem R Shukla","doi":"10.1097/ju.0000000000004815","DOIUrl":"https://doi.org/10.1097/ju.0000000000004815","url":null,"abstract":"PURPOSEThis study evaluates the clinical characteristics and predictors of febrile urinary tract infection in children with potentially persistent primary vesicoureteral reflux (VUR) who discontinued continuous antibiotic prophylaxis (CAP) without radiographic confirmation of reflux resolution. We hypothesize that many patients can safely discontinue CAP after toilet training and that a nomogram can predict the probability of febrile urinary tract infection (fUTI) following cessation.MATERIALS AND METHODSA retrospective review of an institutional VUR registry (2012-2018) identified children managed with CAP who subsequently discontinued prophylaxis. Patients with secondary VUR, underlying anatomic abnormalities, or inadequate follow-up were excluded. Demographics, clinical characteristics, and outcomes were analyzed. Multivariable Cox proportional hazards modeling identified predictors of post-cessation fUTI, and a nomogram was constructed. Model performance was evaluated using the concordance index (C-index) and time-dependent AUC (area under the ROC curve). A simplified clinical risk score was developed and validated.RESULTSAmong 876 children with primary VUR, 386 (44%) discontinued CAP without VCUG-confirmed resolution. Median age at cessation was 39 months, with a median follow-up of 44 months. Post-cessation, 345 (89%) remained free of fUTI; 41 (11%) developed fUTI. Multivariable analysis identified bowel and bladder dysfunction (HR=16.1, p<0.001) and high-grade VUR (HR=2.31, p=0.02) as independent risk factors for fUTI. The nomogram demonstrated a C-index of 0.77 and AUCs of 0.67, 0.80, and 0.77 at 1-, 3-, and 5-years, respectively. A simplified 3-year risk score stratified patients into low (n=305), moderate (n=66), and high (n=15) risk groups with good discrimination (C-index = 0.75, log-rank p<0.001).CONCLUSIONSCAP discontinuation is a viable strategy in select children with persistent VUR, particularly those without voiding dysfunction. A predictive nomogram provides a valuable tool for individualized decision-making. Prospective studies are warranted to refine risk stratification and optimize management strategies.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"72 1","pages":"101097JU0000000000004815"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-09DOI: 10.1097/ju.0000000000004709
Bryn M Launer,Ashley Pittman,Kelvin A Moses
{"title":"Identifying Risk of Progression Among Patients With Biochemical Recurrence Remains a Challenge.","authors":"Bryn M Launer,Ashley Pittman,Kelvin A Moses","doi":"10.1097/ju.0000000000004709","DOIUrl":"https://doi.org/10.1097/ju.0000000000004709","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"36 1","pages":"462-463"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：