BMC Urology最新文献

Purpose: To evaluate the performance of ChatGPT-4o in estimating International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) based on patients' natural language descriptions and full outpatient records, compared to actual questionnaire scores.

Materials and methods: This study included 91 patients, of whom 52 completed IPSS and 77 completed OABSS. ChatGPT-4o was prompted with verbatim symptom statements and full medical records written by a urologist. Predicted scores were compared to actual scores using paired t-tests, weighted Cohen's kappa for item-level agreement, Spearman's correlation for total scores, and Bland-Altman plots for bias. Diagnostic classifications (lower urinary tract symptoms [LUTS]: IPSS ≥8; overactive bladder [OAB]: OABSS ≥3 with urgency ≥2) were assessed using McNemar's test and receiver operating characteristic curve analysis.

Results: Mean IPSS scores estimated by ChatGPT-4o were statistically significantly lower than patient-reported scores (11.2 vs. 13.6, p = 0.006), whereas OABSS scores did not differ significantly between the two methods (6.99 vs. 6.86, p = 0.686). Diagnostic agreement was high: LUTS in 42 (actual) vs. 38 (GPT) patients, and OAB in 51 vs. 50 patients. Area under curve was 0.81 for IPSS and 0.91 for OABSS. Kappa values ranged from 0.23-0.81 (IPSS) and 0.44-0.71 (OABSS), with highest concordance in quality of life (QoL) and urgency incontinence. Spearman's correlation coefficient was 0.60 (IPSS) and 0.70 (OABSS). Accuracy was lower in first-visit patients.

Conclusions: GPT-4o estimated IPSS and OABSS with moderate but clinically acceptable accuracy. Its performance was comparable regarding diagnostic classification, particularly for QoL and OABSS. ChatGPT-4o may complement traditional questionnaires, particularly with missing or incomplete patient-reported data.

Purpose: Prostatic adenocarcinoma with neuroendocrine differentiation (PaNED) is distinct from treatment-related and de-novo neuroendocrine prostate carcinomas, yet remains under-investigated in treatment-naïve patients. This study aimed to evaluate the associations of NED extent, synaptophysin intensity score (SIS), and PD-L1 expression with other histomorphological features and prognosis in treatment-naïve PaNED.

Materials and methods: Seventeen patients with PaNED diagnosed between 2014 and 2024 were retrospectively analyzed. NED was classified as diffuse (≥ 30%) or focal (< 30%), and SIS was scored as weak (+ 1), moderate (+ 2), or strong (+ 3). PD-L1 expression was assessed using tumor proportion score (TPS, cut-off ≥ 1%) and combined positive score (CPS, cut-off ≥ 10). Clinicopathological data and survival outcomes were evaluated.

Results: The mean age was 65.2 ± 6.6 years, and 47.1% (n = 8) of the cases were Grade Group 5. Diffuse NED was observed in 70.6% of cases, and strong synaptophysin expression in 35.3%. PD-L1 TPS and CPS positivity were detected in 17.6% and 35.3% of patients, respectively. Neither NED extent nor percentage was significantly associated with PD-L1 expression or prognosis. A moderate negative correlation was found between SIS and PD-L1 CPS (rho = -0.48, p = 0.051). Strong synaptophysin expression was significantly associated with shorter overall survival (p = 0.031).

Conclusions: In treatment-naïve PaNED, higher SIS was correlated with lower PD-L1 CPS values, and strong synaptophysin expression was associated with poorer survival. Assessment of SIS in morphologically suspected neuroendocrine areas may provide additional prognostic information and help predict the PD-L1 response. Larger studies are required to validate these findings.

Introduction: The management of early-stage and adjuvant UC and RCC has undergone a paradigm shift with the availability of multiple treatment options. However, there is limited understanding about the treatment attributes preferred by patients and physicians in these settings in Asia-Pacific.

Methods: This cross-sectional web-based discrete choice experiment (DCE) survey aimed to assess treatment preferences for early-stage and adjuvant UC and RCC in Asia-Pacific. Participants were patients (aged ≥ 18 years, RCC: n=50, UC: n=50) and physicians (medical oncologists: n=46; urologists: n=44). The DCE included 8 attributes covering efficacy, risks of treatment-related adverse events (TRAEs), and mode of administration (MOA). Relative preference weights, relative importance (RI), and minimum acceptable benefit were analyzed using hierarchical Bayesian logistic regression.

Results: Both patients and physicians placed higher importance on efficacy attributes: one-year disease-free survival (DFS) (patients: RI=25.1%; physicians: RI=36.3%) and overall survival (OS) (patients: RI=27.6%; physicians: RI=22.1%). Among patients, this was followed by risks of treatment-related fatigue (RI=9.9%), and risk of long-term/permanent TRAEs (RI=9.4%). For physicians, it was risk of treatment-related skin rash (RI=8.5%) and risk of treatment-related fatigue (RI=8.0%). Patients would accept a 5-35% risk increase in treatment-related fatigue for 11.4% DFS/0.67-year OS increase, and a 1-15% risk increase in long-term/permanent TRAE (1%-15%) for 10.8% DFS/0.64-year OS increase. Physicians would accept 5-25% risk increases in treatment-related skin rash for 8.0% DFS/0.74-year OS increase and in fatigue for 6.1% DFS/0.56-year OS increase. Most patients (87-92%) and physicians (88-96%) would initiate earlier systemic treatment for UC/RCC than at the advanced or metastatic stage.

Conclusion: Patients and physicians valued efficacy attributes over TRAE-attributes. Both groups would trade higher risks for greater efficacy, though these trade-offs vary based on TRAE type. This indicates a need for shared decision-making for early-stage and adjuvant UC and RCC in Asia-Pacific.

Background: This study aimed to systematically compare the most recent guidelines from the European Association of Urology (EAU, 2025), American Urological Association (AUA, 2024), and National Comprehensive Cancer Network (NCCN, 2025) for the management of non-muscle invasive bladder cancer (NMIBC). The primary objective was to assess the degree of concordance and identify sources of divergence across 32 predefined clinical decision domains.

Materials and methods: This guideline concordance study was conducted according to PRISMA 2020 recommendations, evaluating full-text versions of the latest EAU, AUA, and NCCN guidelines. Thirty-two clinical domains encompassing the diagnostic, therapeutic, and follow-up aspects of NMIBC management were pre-defined based on literature review and expert consensus. Two independent reviewers classified each domain for each guideline as full concordance, partial concordance, or discordance, with discrepancies resolved by a third reviewer. Inter-guideline agreement was quantified using Cohen's and Fleiss' kappa coefficients.

Results: Among the 32 domains analyzed, full concordance was identified in 19 domains (59.4%), partial concordance in 12 domains (37.5%), and discordance in 1 domain (3.1%). Inter-guideline reliability was high, with Cohen's kappa values ranging from 0.83 to 0.94 across pairs and an overall Fleiss' kappa of 0.74, indicating substantial agreement among the three guidelines. Clinically meaningful differences were mainly related to risk-stratification criteria, the management of BCG-unresponsive disease, the selective use of urinary biomarkers, and the endorsement of conservative strategies for recurrent low-grade tumors.

Conclusion: Current international guidelines for NMIBC are highly consistent across the majority of clinical decision domains, providing a strong framework for evidence-based care. Residual differences reflect evolving evidence, regulatory environments, and the pace of integration of new diagnostics and therapeutics. Continued harmonization efforts and regular guideline updates are necessary to further optimize global NMIBC management.