Pub Date : 2024-04-01DOI: 10.1097/ju9.0000000000000136
M. Alkassis, Adrianna Lee, Omer Raheem
Ejaculatory duct obstruction is a well-known cause of infertility and many other symptoms, such as hematospermia and lower urinary tract symptoms. Diagnosis is made based on the medical history and a series of imaging tests identifying the obstructed ducts. Transurethral resection of the ejaculatory ducts is the mainstay treatment to release the obstruction. In this step-by-step surgical video, we will describe a novel technique using the holmium laser to incise the ejaculatory ducts in a patient with chronic lower urinary tract symptoms, hematospermia, and persistent urethral discharge. A pelvic MRI was obtained in workup of the above issues and identified a complex ejaculatory duct cyst. The patient consented for Holmium Laser Incision of Ejaculatory Duct. A holmium laser fiber was used through a 24F rigid cystoscope to unroof the ejaculatory duct cyst, resulting in the drainage of a dark brown fluid. Following unroofing of the cyst, the ejaculatory ducts were identified using a 17F rigid cystoscope and a 16F Foley catheter was inserted. The Foley catheter was removed on POD1, and the patient was able to void. His symptoms improved progressively with time and antibiotics. A repeat MRI was obtained several months postoperatively and showed the resolution of the cystic lesion. Holmium Laser Incision of Ejaculatory Duct is safe and feasible procedure allowing to treat ejaculatory duct obstruction without increased risk of complications.
{"title":"Holmium Laser Incision of Ejaculatory Duct (HoLIED): Surgical Procedure","authors":"M. Alkassis, Adrianna Lee, Omer Raheem","doi":"10.1097/ju9.0000000000000136","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000136","url":null,"abstract":"\u0000 \u0000 Ejaculatory duct obstruction is a well-known cause of infertility and many other symptoms, such as hematospermia and lower urinary tract symptoms. Diagnosis is made based on the medical history and a series of imaging tests identifying the obstructed ducts. Transurethral resection of the ejaculatory ducts is the mainstay treatment to release the obstruction. In this step-by-step surgical video, we will describe a novel technique using the holmium laser to incise the ejaculatory ducts in a patient with chronic lower urinary tract symptoms, hematospermia, and persistent urethral discharge.\u0000 \u0000 \u0000 \u0000 A pelvic MRI was obtained in workup of the above issues and identified a complex ejaculatory duct cyst. The patient consented for Holmium Laser Incision of Ejaculatory Duct. A holmium laser fiber was used through a 24F rigid cystoscope to unroof the ejaculatory duct cyst, resulting in the drainage of a dark brown fluid. Following unroofing of the cyst, the ejaculatory ducts were identified using a 17F rigid cystoscope and a 16F Foley catheter was inserted.\u0000 \u0000 \u0000 \u0000 The Foley catheter was removed on POD1, and the patient was able to void. His symptoms improved progressively with time and antibiotics. A repeat MRI was obtained several months postoperatively and showed the resolution of the cystic lesion.\u0000 \u0000 \u0000 \u0000 Holmium Laser Incision of Ejaculatory Duct is safe and feasible procedure allowing to treat ejaculatory duct obstruction without increased risk of complications.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"134 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140761856","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 : 2024-04-01DOI: 10.1097/ju9.0000000000000124
H. Otaola-Arca, Mario I. Fernández
{"title":"Editorial Comment: Duodenal Duplication Cyst Masquerading as Metastatic Nonseminomatous Germ Cell Tumor","authors":"H. Otaola-Arca, Mario I. Fernández","doi":"10.1097/ju9.0000000000000124","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000124","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"164 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140789309","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 : 2024-04-01DOI: 10.1097/ju9.0000000000000141
Shane Kronstedt, Eric A Singer
{"title":"Editorial Comment: Evaluating the Prognostic Variables for Overall Survival in Patients With Metastatic Renal Cell Carcinoma: A Meta-Analysis of 29,366 Patients","authors":"Shane Kronstedt, Eric A Singer","doi":"10.1097/ju9.0000000000000141","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000141","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"46 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766600","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 : 2024-04-01DOI: 10.1097/ju9.0000000000000134
Johnny C. Wang, Joel M. Vetter, Eric H. Kim, James T. Gross, Grant M. Henning
Biomarkers are often used in conjunction with MRI to improve the specificity of prostate cancer screening. Our objective was to evaluate the real-world utility of the 4Kscore test in the setting of MRI. We explored the association of the 4Kscore test with the decision to pursue prostate biopsy and its contribution to the accurate detection of clinically significant prostate cancer. We retrospectively analyzed patients undergoing the 4Kscore test and MRI for consideration of prostate biopsy. Multivariable logistic regression was used to model the association of 4Kscore with the decision to pursue biopsy. Receiver-operating characteristic curves were used to calculate the AUC of 4Kscore alone, PSA with MRI, and 4Kscore with MRI for detection of Gleason Grade Group ≥ 2 (GG ≥ 2) prostate cancer. Of 442 patients, 311 (70%) proceeded to biopsy. 4Kscore was associated with the decision to pursue biopsy for continuous (odds ratio [OR] 1.05 per 1-point increase in 4Kscore, 95% confidence interval [CI] 1.02-1.07; P < .001) and categorical (high-risk 4Kscore: OR 16.1, 6.62-39.3, P < .001; intermediate-risk 4Kscore: OR 6.89, 95% CI 3.15-15.1; P < .01) models. For the detection of GG ≥ 2 prostate cancer, the AUC of 4Kscore with MRI (AUC = 0.866) was superior to 4Kscore alone (AUC = 0.800, P < .001) and PSA with MRI (AUC = 0.792, P < .001). In patients with MRI, the 4Kscore is associated with the decision to pursue prostate biopsy and augments the accurate prediction of GG ≥ 2 prostate cancer. Our findings suggest 4Kscore provides independent information as an adjunct to MRI for real-world clinical decision making.
{"title":"The Clinical Impact of the 4Kscore Test on Prostate Biopsy Decision Making in the Setting of MRI","authors":"Johnny C. Wang, Joel M. Vetter, Eric H. Kim, James T. Gross, Grant M. Henning","doi":"10.1097/ju9.0000000000000134","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000134","url":null,"abstract":"\u0000 \u0000 Biomarkers are often used in conjunction with MRI to improve the specificity of prostate cancer screening. Our objective was to evaluate the real-world utility of the 4Kscore test in the setting of MRI. We explored the association of the 4Kscore test with the decision to pursue prostate biopsy and its contribution to the accurate detection of clinically significant prostate cancer.\u0000 \u0000 \u0000 \u0000 We retrospectively analyzed patients undergoing the 4Kscore test and MRI for consideration of prostate biopsy. Multivariable logistic regression was used to model the association of 4Kscore with the decision to pursue biopsy. Receiver-operating characteristic curves were used to calculate the AUC of 4Kscore alone, PSA with MRI, and 4Kscore with MRI for detection of Gleason Grade Group ≥ 2 (GG ≥ 2) prostate cancer.\u0000 \u0000 \u0000 \u0000 Of 442 patients, 311 (70%) proceeded to biopsy. 4Kscore was associated with the decision to pursue biopsy for continuous (odds ratio [OR] 1.05 per 1-point increase in 4Kscore, 95% confidence interval [CI] 1.02-1.07; P < .001) and categorical (high-risk 4Kscore: OR 16.1, 6.62-39.3, P < .001; intermediate-risk 4Kscore: OR 6.89, 95% CI 3.15-15.1; P < .01) models. For the detection of GG ≥ 2 prostate cancer, the AUC of 4Kscore with MRI (AUC = 0.866) was superior to 4Kscore alone (AUC = 0.800, P < .001) and PSA with MRI (AUC = 0.792, P < .001).\u0000 \u0000 \u0000 \u0000 In patients with MRI, the 4Kscore is associated with the decision to pursue prostate biopsy and augments the accurate prediction of GG ≥ 2 prostate cancer. Our findings suggest 4Kscore provides independent information as an adjunct to MRI for real-world clinical decision making.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"44 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763440","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 : 2024-04-01DOI: 10.1097/ju9.0000000000000138
Alan H. Bryce, E. D. Crawford, Neeraj Agarwal, Maha H. Hussain, H. Beltran, M. Cooperberg, D. Petrylak, Neal Shore, Daniel E Spratt, S. Tagawa, Emmanuel S. Antonarakis, Ana M. Aparicio, Andrew J. Armstrong, Thomas P. Boike, J. Calais, Michael A. Carducci, B. Chapin, M. S. Cookson, John W Davis, Tanya B Dorff, S. Eggener, Felix Y. Feng, Martin Gleave, Celestia Higano, Andrei Iagaru, Alicia K Morgans, Michael Morris, Katie S. Murray, Wendy L. Poage, M. Rettig, Oliver Sartor, H. Scher, Paul Sieber, E. Small, Sandy Srinivas, Evan Y. Yu, Tian Zhang, Phillip J. Koo
Management strategies for metastatic castration-resistant prostate cancer (mCRPC) have rapidly shifted in recent years. As novel imaging and therapeutic approaches have made their way to the clinic, providers are encountering increasingly challenging clinical scenarios, with limited guidance from the current literature. The US Prostate Cancer Conference (USPCC) is a multidisciplinary meeting of prostate cancer experts intended to address the many challenges of prostate cancer management. At the first annual USPCC meeting, areas of controversy and consensus were identified during a 2-day meeting that included expert presentations, full-panel discussions, and postdiscussion responses to questions developed by the USPCC cochairs and session moderators. This narrative review covers the USPCC expert discussion and perspectives relevant to mCRPC, including neuroendocrine/aggressive-variant prostate cancer (NEPC/AVPC). Areas of broad agreement identified among USPCC experts include the benefits of poly (ADP-ribose) polymerase (PARP) inhibitors for patients with BRCA1/2 mutations, the use of radioligand therapy in patients with prostate-specific membrane antigen (PSMA)–positive mCRPC, and the need for clinical trials that address real-world clinical questions, including the performance of novel therapies when compared with modern standard-of-care treatment. Ongoing areas of controversy and uncertainty included the appropriateness of PARP inhibitors in patients with non-BRCA1/2 mutations, the optimal definition of PSMA positivity, and systemic therapies for patients with NEPC/AVPC after progression on platinum-based therapies. The first annual USPCC meeting identified several areas of controversy in the management of mCRPC, highlighting the urgent need for clinical trials designed to facilitate treatment selection and sequencing in this heterogeneous disease state.
{"title":"Expert Perspectives on Controversies in Metastatic Castration-Resistant Prostate Cancer Management: Narrative Review and Report of the First US Prostate Cancer Conference Part 2","authors":"Alan H. Bryce, E. D. Crawford, Neeraj Agarwal, Maha H. Hussain, H. Beltran, M. Cooperberg, D. Petrylak, Neal Shore, Daniel E Spratt, S. Tagawa, Emmanuel S. Antonarakis, Ana M. Aparicio, Andrew J. Armstrong, Thomas P. Boike, J. Calais, Michael A. Carducci, B. Chapin, M. S. Cookson, John W Davis, Tanya B Dorff, S. Eggener, Felix Y. Feng, Martin Gleave, Celestia Higano, Andrei Iagaru, Alicia K Morgans, Michael Morris, Katie S. Murray, Wendy L. Poage, M. Rettig, Oliver Sartor, H. Scher, Paul Sieber, E. Small, Sandy Srinivas, Evan Y. Yu, Tian Zhang, Phillip J. Koo","doi":"10.1097/ju9.0000000000000138","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000138","url":null,"abstract":"\u0000 \u0000 Management strategies for metastatic castration-resistant prostate cancer (mCRPC) have rapidly shifted in recent years. As novel imaging and therapeutic approaches have made their way to the clinic, providers are encountering increasingly challenging clinical scenarios, with limited guidance from the current literature.\u0000 \u0000 \u0000 \u0000 The US Prostate Cancer Conference (USPCC) is a multidisciplinary meeting of prostate cancer experts intended to address the many challenges of prostate cancer management. At the first annual USPCC meeting, areas of controversy and consensus were identified during a 2-day meeting that included expert presentations, full-panel discussions, and postdiscussion responses to questions developed by the USPCC cochairs and session moderators.\u0000 \u0000 \u0000 \u0000 This narrative review covers the USPCC expert discussion and perspectives relevant to mCRPC, including neuroendocrine/aggressive-variant prostate cancer (NEPC/AVPC). Areas of broad agreement identified among USPCC experts include the benefits of poly (ADP-ribose) polymerase (PARP) inhibitors for patients with BRCA1/2 mutations, the use of radioligand therapy in patients with prostate-specific membrane antigen (PSMA)–positive mCRPC, and the need for clinical trials that address real-world clinical questions, including the performance of novel therapies when compared with modern standard-of-care treatment. Ongoing areas of controversy and uncertainty included the appropriateness of PARP inhibitors in patients with non-BRCA1/2 mutations, the optimal definition of PSMA positivity, and systemic therapies for patients with NEPC/AVPC after progression on platinum-based therapies.\u0000 \u0000 \u0000 \u0000 The first annual USPCC meeting identified several areas of controversy in the management of mCRPC, highlighting the urgent need for clinical trials designed to facilitate treatment selection and sequencing in this heterogeneous disease state.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"150 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140768827","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 : 2024-04-01DOI: 10.1097/ju9.0000000000000133
S. Odeh, Beatrice Tavelli, S. Joosten, Maureen J. Aarts, Thomas Kerkhofs, Joep G. H. van Roermund, T. Marcelissen, Leo J. Schouten, Andres Matoso, M. van Engeland, I. Samarska, K. Smits
In this study, we update 2 previously published systematic reviews on prognostic DNA methylation markers for renal cell carcinoma and provide a comprehensive overview of the latest markers and methylation signatures that merit further validation. We performed a systematic literature search of PubMed, EMBASE, and Web of Science including all studies published after our previous systematic review (ie, between March 2017 and December 2021). Data extraction and evaluation using the Reporting Recommendations for Tumor Marker Prognostic Studies criteria and the level of evidence was performed for all 58 included studies. DNA methylation markers were considered promising when findings were validated in more than one study or within multiple cohorts. We identified 11 promising single DNA methylation markers (ie, RUNX3, EVI2A, HHLA2, TACSTD2, KEAP1, LAG3, NSD1, ZNF492, GPR149, LEP, and LEPR), three multimarker panels (ie, (1) RAC2, PLCB2, VAV1 and PARVG; (2) NCKAP1L, EVI2A, and BATF; and (3) GREM1, GATA5, LAD1, NEFH, and NEURL) and 5 DNA methylation signatures. Remarkably, since our previous systematic review, only part of the markers recommended for validation were evaluated in subsequent validation efforts, emphasizing the lack of validation in this field. Validation studies for prognostic DNA methylation markers have been scarce despite previously published recommendations. Nevertheless, since then, other novel DNA methylation markers or signatures have been proposed as promising biomarkers emphasizing the current focus on expanding evidence instead of further building the evidence on specific markers with the aim of clinical translation.
在本研究中，我们更新了之前发表的两篇关于肾细胞癌预后DNA甲基化标志物的系统综述，并全面概述了值得进一步验证的最新标志物和甲基化特征。 我们对PubMed、EMBASE和Web of Science进行了系统性文献检索，包括上一篇系统综述之后（即2017年3月至2021年12月之间）发表的所有研究。我们采用《肿瘤标志物预后研究报告建议》标准和证据级别对所有58项纳入研究进行了数据提取和评估。当研究结果在一项以上的研究或多个队列中得到验证时，DNA甲基化标记被认为是有前景的。 我们确定了 11 个有前景的单一 DNA 甲基化标记物（即 RUNX3、EVI2A、HHLA2、TACSTD2、KEAP1、LAG3、NSD1、ZNF492、GPR149、LEP 和 LEPR）、3 个多标记物面板（即 (1)RAC2、PLCB2、VAV1 和 PARVG；(2) NCKAP1L、EVI2A 和 BATF；以及 (3) GREM1、GATA5、LAD1、NEFH 和 NEURL）和 5 个 DNA 甲基化特征。值得注意的是，自我们之前的系统综述以来，只有部分推荐验证的标记物在随后的验证工作中进行了评估，这凸显了该领域缺乏验证。 尽管之前发表了一些建议，但针对预后DNA甲基化标记的验证研究一直很少。尽管如此，此后又有其他新型 DNA 甲基化标记或特征被提出作为有前景的生物标志物，这强调了目前的重点是扩大证据，而不是进一步建立特定标记的证据，以实现临床转化。
{"title":"A Systematic Review on Prognostic DNA Methylation Markers for Renal Cell Carcinoma: Are We Moving Forward?","authors":"S. Odeh, Beatrice Tavelli, S. Joosten, Maureen J. Aarts, Thomas Kerkhofs, Joep G. H. van Roermund, T. Marcelissen, Leo J. Schouten, Andres Matoso, M. van Engeland, I. Samarska, K. Smits","doi":"10.1097/ju9.0000000000000133","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000133","url":null,"abstract":"\u0000 \u0000 In this study, we update 2 previously published systematic reviews on prognostic DNA methylation markers for renal cell carcinoma and provide a comprehensive overview of the latest markers and methylation signatures that merit further validation.\u0000 \u0000 \u0000 \u0000 We performed a systematic literature search of PubMed, EMBASE, and Web of Science including all studies published after our previous systematic review (ie, between March 2017 and December 2021). Data extraction and evaluation using the Reporting Recommendations for Tumor Marker Prognostic Studies criteria and the level of evidence was performed for all 58 included studies. DNA methylation markers were considered promising when findings were validated in more than one study or within multiple cohorts.\u0000 \u0000 \u0000 \u0000 We identified 11 promising single DNA methylation markers (ie, RUNX3, EVI2A, HHLA2, TACSTD2, KEAP1, LAG3, NSD1, ZNF492, GPR149, LEP, and LEPR), three multimarker panels (ie, (1) RAC2, PLCB2, VAV1 and PARVG; (2) NCKAP1L, EVI2A, and BATF; and (3) GREM1, GATA5, LAD1, NEFH, and NEURL) and 5 DNA methylation signatures. Remarkably, since our previous systematic review, only part of the markers recommended for validation were evaluated in subsequent validation efforts, emphasizing the lack of validation in this field.\u0000 \u0000 \u0000 \u0000 Validation studies for prognostic DNA methylation markers have been scarce despite previously published recommendations. Nevertheless, since then, other novel DNA methylation markers or signatures have been proposed as promising biomarkers emphasizing the current focus on expanding evidence instead of further building the evidence on specific markers with the aim of clinical translation.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"52 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140778295","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 : 2024-04-01DOI: 10.1097/ju9.0000000000000156
Aditya Bagrodia, John W. Davis
{"title":"From the Editor—April 2024: Elevating Scholarship for Patients with Rare Conditions","authors":"Aditya Bagrodia, John W. Davis","doi":"10.1097/ju9.0000000000000156","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000156","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"124 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140767182","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 : 2024-04-01DOI: 10.1097/ju9.0000000000000137
E. D. Crawford, Alan H. Bryce, Maha H. Hussain, Neeraj Agarwal, H. Beltran, M. Cooperberg, D. Petrylak, Neal Shore, Daniel E Spratt, S. Tagawa, Emmanuel S. Antonarakis, Ana M. Aparicio, Andrew J. Armstrong, Thomas P. Boike, J. Calais, Michael A. Carducci, B. Chapin, M. S. Cookson, John W Davis, Tanya B Dorff, S. Eggener, Felix Y. Feng, Martin Gleave, Celestia Higano, Andrei Iagaru, Alicia K Morgans, Michael Morris, Katie S. Murray, Wendy L. Poage, M. Rettig, Oliver Sartor, H. Scher, Paul Sieber, E. Small, Sandy Srinivas, Evan Y. Yu, Tian Zhang, Phillip J. Koo
Castration-sensitive prostate cancer (CSPC) is a complex and heterogeneous condition encompassing a range of clinical presentations. As new approaches have expanded management options, clinicians are left with myriad questions and controversies regarding the optimal individualized management of CSPC. The US Prostate Cancer Conference (USPCC) multidisciplinary panel was assembled to address the challenges of prostate cancer management. The first annual USPCC meeting included experts in urology, medical oncology, radiation oncology, and nuclear medicine. USPCC co-chairs and session moderators identified key areas of controversy and uncertainty in prostate cancer management and organized the sessions with multidisciplinary presentations and discussion. Throughout the meeting, experts responded to questions prepared by chairs and moderators to identify areas of agreement and controversy. The USPCC panel discussion and question responses for CSPC-related topics are presented. Key advances in CSPC management endorsed by USPCC experts included the development and clinical utilization of gene expression classifiers and artificial intelligence (AI) models for risk stratification and treatment selection in specific patient populations, the use of advanced imaging modalities in patients with clinically localized unfavorable intermediate or high-risk disease and those with biochemical recurrence, recommendations of doublet or triplet therapy for metastatic CSPC (mCSPC), and consideration of prostate and/or metastasis-directed radiation therapy in select patients with mCSPC. CSPC is a diverse disease with many therapeutic options and the potential for adverse outcomes associated with either undertreatment or overtreatment. Future studies are needed to validate and clinically integrate novel technologies, including genomics, AI, and advanced imaging, to optimize outcomes among patients with CSPC.
{"title":"Expert Perspectives on Controversies in Castration-Sensitive Prostate Cancer Management: Narrative Review and Report of the First US Prostate Cancer Conference Part 1","authors":"E. D. Crawford, Alan H. Bryce, Maha H. Hussain, Neeraj Agarwal, H. Beltran, M. Cooperberg, D. Petrylak, Neal Shore, Daniel E Spratt, S. Tagawa, Emmanuel S. Antonarakis, Ana M. Aparicio, Andrew J. Armstrong, Thomas P. Boike, J. Calais, Michael A. Carducci, B. Chapin, M. S. Cookson, John W Davis, Tanya B Dorff, S. Eggener, Felix Y. Feng, Martin Gleave, Celestia Higano, Andrei Iagaru, Alicia K Morgans, Michael Morris, Katie S. Murray, Wendy L. Poage, M. Rettig, Oliver Sartor, H. Scher, Paul Sieber, E. Small, Sandy Srinivas, Evan Y. Yu, Tian Zhang, Phillip J. Koo","doi":"10.1097/ju9.0000000000000137","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000137","url":null,"abstract":"\u0000 \u0000 Castration-sensitive prostate cancer (CSPC) is a complex and heterogeneous condition encompassing a range of clinical presentations. As new approaches have expanded management options, clinicians are left with myriad questions and controversies regarding the optimal individualized management of CSPC.\u0000 \u0000 \u0000 \u0000 The US Prostate Cancer Conference (USPCC) multidisciplinary panel was assembled to address the challenges of prostate cancer management. The first annual USPCC meeting included experts in urology, medical oncology, radiation oncology, and nuclear medicine. USPCC co-chairs and session moderators identified key areas of controversy and uncertainty in prostate cancer management and organized the sessions with multidisciplinary presentations and discussion. Throughout the meeting, experts responded to questions prepared by chairs and moderators to identify areas of agreement and controversy.\u0000 \u0000 \u0000 \u0000 The USPCC panel discussion and question responses for CSPC-related topics are presented. Key advances in CSPC management endorsed by USPCC experts included the development and clinical utilization of gene expression classifiers and artificial intelligence (AI) models for risk stratification and treatment selection in specific patient populations, the use of advanced imaging modalities in patients with clinically localized unfavorable intermediate or high-risk disease and those with biochemical recurrence, recommendations of doublet or triplet therapy for metastatic CSPC (mCSPC), and consideration of prostate and/or metastasis-directed radiation therapy in select patients with mCSPC.\u0000 \u0000 \u0000 \u0000 CSPC is a diverse disease with many therapeutic options and the potential for adverse outcomes associated with either undertreatment or overtreatment. Future studies are needed to validate and clinically integrate novel technologies, including genomics, AI, and advanced imaging, to optimize outcomes among patients with CSPC.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"310 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140758617","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 : 2024-03-01Epub Date: 2024-02-29DOI: 10.1097/ju9.0000000000000118
Deborah R Kaye, Karissa Tu, J Kelly Davis, Ada Campagna, Sharron L Docherty, Jeremy Kurnot, Tian Zhang, Daniel J George, Peter A Ubel
Introduction: Promising new treatments exist for advanced prostate cancer. Decision-making is complicated: there is minimal comparative effectiveness data; differing routes of administration, drug mechanisms-of-action and side effects; and significant price differences. These challenges contribute to variations in care and quality, treatment disparities, and lack of concordance with patient values. The aim of this study was to examine physician perspectives of factors influencing decision-making for first-line advanced prostate cancer treatments.
Methods: We conducted a qualitative descriptive study of physicians who treat patients with advanced prostate cancer from 09/2021-06/2022. Participants were purposively sampled from across the United States.
Results: Twenty-seven physicians participated. We identified seventeen domains and three overarching themes affecting physician decision-making for advanced prostate cancer care. The themes were: 1) physician and practice factors impact prescribing decisions, 2) health practice resource availability affects the likelihood patients will receive the recommended treatment, and that the treatment will be in-line with patients' values and 3) patient non-clinical factors influence physician decision-making, but patient values could be better incorporated into prescribing decisions. Based upon the analyses, we constructed a preliminary framework of clinician decision-making for advanced prostate cancer.
Conclusions: Physicians perceive non-clinical patient, physician, and practice factors impact decision-making. These factors, therefore, must be considered when implementing programs to optimize a physician's ability to provide quality cancer care, reduce health care disparities and patient financial burden and provide patient goal-concordant care. The preliminary theoretical model of clinician decision-making for advanced prostate cancer care may also be used to inform these efforts.
{"title":"Physician Perspectives on the Nonclinical Factors That Contribute to Decision-Making for Advanced Prostate Cancer Care: A Qualitative Study.","authors":"Deborah R Kaye, Karissa Tu, J Kelly Davis, Ada Campagna, Sharron L Docherty, Jeremy Kurnot, Tian Zhang, Daniel J George, Peter A Ubel","doi":"10.1097/ju9.0000000000000118","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000118","url":null,"abstract":"<p><strong>Introduction: </strong>Promising new treatments exist for advanced prostate cancer. Decision-making is complicated: there is minimal comparative effectiveness data; differing routes of administration, drug mechanisms-of-action and side effects; and significant price differences. These challenges contribute to variations in care and quality, treatment disparities, and lack of concordance with patient values. The aim of this study was to examine physician perspectives of factors influencing decision-making for first-line advanced prostate cancer treatments.</p><p><strong>Methods: </strong>We conducted a qualitative descriptive study of physicians who treat patients with advanced prostate cancer from 09/2021-06/2022. Participants were purposively sampled from across the United States.</p><p><strong>Results: </strong>Twenty-seven physicians participated. We identified seventeen domains and three overarching themes affecting physician decision-making for advanced prostate cancer care. The themes were: 1) physician and practice factors impact prescribing decisions, 2) health practice resource availability affects the likelihood patients will receive the recommended treatment, and that the treatment will be in-line with patients' values and 3) patient non-clinical factors influence physician decision-making, but patient values could be better incorporated into prescribing decisions. Based upon the analyses, we constructed a preliminary framework of clinician decision-making for advanced prostate cancer.</p><p><strong>Conclusions: </strong>Physicians perceive non-clinical patient, physician, and practice factors impact decision-making. These factors, therefore, must be considered when implementing programs to optimize a physician's ability to provide quality cancer care, reduce health care disparities and patient financial burden and provide patient goal-concordant care. The preliminary theoretical model of clinician decision-making for advanced prostate cancer care may also be used to inform these efforts.</p>","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1097/ju9.0000000000000105
Fernando J. Bianco, E. Luna, A. Lopez-Prieto, Pedro González, E. Gheiler, Ariel M. Kaufman, L. Avila, Giuseppe Maiolino
To evaluate the safety and tolerability profile of transperineal laser ablation (TPLA) for patients with benign prostatic hyperplasia in an office setting under sedative-free anesthesia, including the functional outcome results at 24 months. This is a prospective, single-center, dose range confirmatory trial involving 20 male patients. TPLA was performed by urologists in an office setting, using nonsedative local anesthesia. Self-administered nitrous oxide/oxygen dissociating gas was optional. Tolerability was assessed using a visual analog scale. Safety was evaluated by recording Grade 3 or worse adverse events within 30 days after the procedure. International Prostate Symptom Score, Sexual Health Inventory for Men, ejaculation function, and uroflowmetry parameters were assessed at 6, 12, and 24 months. All 20 procedures were performed as intended without request of cessation from any patient, who tolerated them very well, recording a median pain score of 2 (range 1-4). It is important to note that there was a rapid escalation of dose, and the last 18 consecutive patients were initiated at the maximal energy dose of 7 watts. No hospital transfers were recorded, and no urgent hospital admissions within 30 days post-procedure occurred. There was 1 Grade 3 complication registered during the 24-month study interval. We observed a statistically significant and sustained reduction in the median International Prostate Symptom Score at 6 months (6, 3-8), 12 months (3, 5-2), and 24 months (3, 2-4) when compared with baseline values (14, 12-17). Uroflowmetry parameters showed a similar trend. The median Sexual Health Inventory for Men values did not change significantly, and only approximately 10% of patients reported absence of anterograde ejaculation at 12 and 24 months. TPLA for benign prostatic hyperplasia is a safe and well-tolerated office-based procedure, with durable benefits on functional outcomes over 2 years of follow-up. Further studies are required to confirm these results. NCT04760483.
{"title":"Office-Based Transperineal Laser Ablation for Benign Prostatic Hyperplasia Under Local Anesthesia: 2-Year Results from a Dose Range Confirmatory Trial","authors":"Fernando J. Bianco, E. Luna, A. Lopez-Prieto, Pedro González, E. Gheiler, Ariel M. Kaufman, L. Avila, Giuseppe Maiolino","doi":"10.1097/ju9.0000000000000105","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000105","url":null,"abstract":"\u0000 \u0000 To evaluate the safety and tolerability profile of transperineal laser ablation (TPLA) for patients with benign prostatic hyperplasia in an office setting under sedative-free anesthesia, including the functional outcome results at 24 months.\u0000 \u0000 \u0000 \u0000 This is a prospective, single-center, dose range confirmatory trial involving 20 male patients. TPLA was performed by urologists in an office setting, using nonsedative local anesthesia. Self-administered nitrous oxide/oxygen dissociating gas was optional. Tolerability was assessed using a visual analog scale. Safety was evaluated by recording Grade 3 or worse adverse events within 30 days after the procedure. International Prostate Symptom Score, Sexual Health Inventory for Men, ejaculation function, and uroflowmetry parameters were assessed at 6, 12, and 24 months.\u0000 \u0000 \u0000 \u0000 All 20 procedures were performed as intended without request of cessation from any patient, who tolerated them very well, recording a median pain score of 2 (range 1-4). It is important to note that there was a rapid escalation of dose, and the last 18 consecutive patients were initiated at the maximal energy dose of 7 watts. No hospital transfers were recorded, and no urgent hospital admissions within 30 days post-procedure occurred. There was 1 Grade 3 complication registered during the 24-month study interval. We observed a statistically significant and sustained reduction in the median International Prostate Symptom Score at 6 months (6, 3-8), 12 months (3, 5-2), and 24 months (3, 2-4) when compared with baseline values (14, 12-17). Uroflowmetry parameters showed a similar trend. The median Sexual Health Inventory for Men values did not change significantly, and only approximately 10% of patients reported absence of anterograde ejaculation at 12 and 24 months.\u0000 \u0000 \u0000 \u0000 TPLA for benign prostatic hyperplasia is a safe and well-tolerated office-based procedure, with durable benefits on functional outcomes over 2 years of follow-up. Further studies are required to confirm these results.\u0000 \u0000 \u0000 \u0000 NCT04760483.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"84 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139966586","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}
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