Patrick T Gomella, Julie Solomon, Michael Ahdoot, Sandeep Gurram, Amir H Lebastchi, Elliot Levy, Venkatesh Krishnasamy, Michael T Kassin, Richard Chang, Bradford J Wood, W Marston Linehan, Mark W Ball
INTRODUCTION: Delayed bleeding is a potentially serious complication after partial nephrectomy (PN), with reported rates of 1%-2%. Patients with multiple renal tumors, including those with hereditary forms of kidney cancer, are often managed with resection of multiple tumors in a single kidney which may increase the risk of delayed bleeding, though outcomes have not previously been reported specifically in this population. The objective of this study was to evaluate the incidence and timing of delayed bleeding as well as the impact of intervention on renal functional outcomes in a cohort primarily made up of patients at risk for bilateral, multifocal renal tumors...
April 12, 2024: Urologic Oncology
Anis A Hamid, Christopher J Sweeney, Christopher Hovens, Niall Corcoran, Arun A Azad
Greater personalization of cancer medicine continues to shape therapy development and patient selection accordingly. The treatment of prostate cancer has evolved considerably since the discovery of androgen deprivation therapy. The comprehensive profiling of the prostate cancer genome has mapped the targetable molecular landscape of the disease and identified opportunities for the implementation of novel and combination therapies. In this review, we provide an overview of the molecular biology of prostate cancer and tools developed to aid prognostication and prediction of therapy benefit...
April 12, 2024: Urologic Oncology
Ian M McElree, Sarah L Mott, Helen Y Hougen, Vignesh T Packiam, Michael A O'Donnell, Ryan L Steinberg
INTRODUCTION: Nephroureterectomy is commonly performed for high-grade (HG) upper tract (UT) urothelial carcinoma (UC). However, some patients may benefit from a de-escalation of surgical management, particularly for noninvasive disease and carcinoma in situ (CIS). Bacillus Calmette-Guerin (BCG) is currently the only guideline-recommended endoluminal treatment option. Gemcitabine/Docetaxel (Gem/Doce) has shown promising efficacy as a treatment for noninvasive HG UTUC, though a comparison to BCG is lacking...
April 11, 2024: Urologic Oncology
Zhi-Yu Zhang, Jian-Hao Xu, Jiang-Lei Zhang, Yu-Xin Lin, Jun Ou-Yang
OBJECTIVE: Renal cell carcinoma (RCC) is a common malignant tumor with a high incidence in males and the elderly, and clear cell RCC (ccRCC) is the most common RCC subtype. ccRCC is highly metastatic with a poor prognosis. Therefore, it is crucial to obtain a detailed understanding of the molecular mechanism of ccRCC and to identify suitable biomarkers to realize early diagnosis and improve prognosis. METHODS: We analyzed data from the Cancer Genome Atlas, investigated the overall differential expression of CD276 in ccRCC, and evaluated the influence of CD276 on patient survival and prognosis...
April 9, 2024: Urologic Oncology
Gagan Prakash, Chloe E Peters, Gina Badalato, Lindsay A Hampson, Jay D Raman, Aditya Bagrodia
The emotional impact of surgical complications on urologists is a significant yet historically under-addressed issue. Traditionally, surgeons have been expected to cope with complications and their psychological effects in silence, perpetuating a culture of perfectionism and 'silent suffering.' This has left many unprepared to handle the emotional toll of adverse events during their training and early careers. Recognizing the gap in structured education on this matter, there is a growing movement to openly address and educate on the emotional consequences of surgical complications...
April 8, 2024: Urologic Oncology
Sukhad Kural, Garima Jain, Sakshi Agarwal, Parimal Das, Lalit Kumar
Bladder cancer (BCa) stands as prevalent malignancy of the urinary system globally, especially among men. The clinical classification of BCa into non-muscle invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) is crucial for prognosis and treatment decisions. However, challenges persist in current diagnostic methods like Urine cytopathology that shows poor sensitivity therefore compromising on accurately diagnosing and monitoring BCa. In recent years, research has emphasized the importance of identifying urine and blood-based specific biomarkers for BCa that can enable early and precise diagnosis, effective tumor classification, and monitoring...
April 8, 2024: Urologic Oncology
Daniel Triner, Stephanie Daignault-Newton, Udit Singhal, Michael Sessine, Robert T Dess, Megan E V Caram, Tudor Borza, Kevin B Ginsburg, Brian R Lane, Todd M Morgan
BACKGROUND: Patients with lymph node positive (pN+) disease found at the time of radical prostatectomy with pelvic lymphadenectomy for clinically localized prostate cancer (CaP) are at high risk of disease persistence and progression. Contemporary management trends of pN+ CaP are not well described. MATERIALS AND METHODS: Patients in the Michigan Urologic Surgery Improvement Collaborative (MUSIC) with clinically localized prostate cancer who underwent radical prostatectomy between 2012 and 2023 with cN0/pN+ disease were identified...
April 2, 2024: Urologic Oncology
Christopher J Staniorski, Michelle Yu, Danielle Sharbaugh, Michael G Stencel, John M Myrga, Benjamin J Davies, Jonathan G Yabes, Bruce Jacobs
PURPOSE: To evaluate patient and provider characteristics that predict persistent opioid use following radical cystectomy for bladder cancer including non-opioid naïve patients. METHODS: Patients undergoing cystectomy between July 2007 and December 2015 were identified using the SEER-Medicare database. Opioid exposure was identified before and after cystectomy using Medicare Part D data. Multivariable analyses were used to identify predictors of the primary outcomes: persistent opioid use (prescription 3-6 months after surgery) and postoperative opioid prescriptions (within 30 days of surgery)...
April 1, 2024: Urologic Oncology
Longchao Li, Jing Zhang, Xia Zhe, Min Tang, Li Zhang, Xiaoyan Lei, Xiaoling Zhang
PURPOSE: To compare biparametric magnetic resonance imaging (bp-MRI) radiomics signatures and traditional MRI model for the preoperative prediction of bladder cancer (BCa) grade. MATERIALS AND METHODS: This retrospective study included 255 consecutive patients with pathologically confirmed 113 low-grade and 142 high-grade BCa. The traditional MRI nomogram model was developed using univariate and multivariate logistic regression by the mean apparent diffusion coefficient (ADC), vesical imaging reporting and data system, tumor size, and the number of tumors...
March 30, 2024: Urologic Oncology
Brendan A Yanada, David Homewood, Brendan H Dias, Cindy Ogluszko, Niall M Corcoran
OBJECTIVES: The incidence of nonmetastatic castrate resistant prostate cancer (nmCRPC) is not well defined in contemporary practice. The aim of this study is to describe the incidence and patterns of treatment of nmCRPC over the last 6 years at a single high-volume Australian health institution. SUBJECTS AND METHODS: All men newly diagnosed with prostate cancer at Western Health, Melbourne from January 2016 to December 2021 were included in the study. Those diagnosed with nonmetastatic prostate cancer and treated with medical or surgical castration for biochemical failure post attempted curative therapy were retrospectively reviewed for signs of castration resistance using prostate specific antigen (PSA) and testosterone biochemical markers up until October 2022...
March 29, 2024: Urologic Oncology
Sima P Porten, Elizabeth Y Wang, Poonam Vohra, Peter R Carroll, Sholeh Jahanfard, Nam W Kim
BACKGROUND: The gold standard for detecting bladder cancer is cystoscopy with biopsy or transurethral resection confirming histologic diagnosis. URO17® employs a chromogenically labeled monoclonal antibody to keratin 17 (k17), an intermediate filament cytoskeleton molecule associated with bladder, pancreatic, and cervical cancers. Preliminary studies evaluating k17 demonstrated a high sensitivity and specificity for the detection of bladder cancer, supporting the need for further study...
March 28, 2024: Urologic Oncology
Zihong Wang, Jiayi Li, Pei Liu, Xianghui Xie, Hongcheng Song, Weiping Zhang
OBJECTIVE: This retrospective study aimed to construct and validate a nomogram for personalized prognostic assessment of favorable histology Wilms tumor (FHWT) based on clinical and pathological variables. METHODS AND MATERIALS: This was a retrospective study collected data from patients who underwent surgery for FHWT between March 2007 and November 2022 at Beijing Children's Hospital. Univariate and multivariate Cox proportional hazards regression analyses were conducted to determine the significance variables and constructed the nomogram in predicting event-free survival (EFS) in FHWT patients...
March 23, 2024: Urologic Oncology
Nicholas James Corsi, Alex Stephens, Marco Finati, Taylor Malchow, Chase Morrison, Matthew Davis, Keinnan Hares, Matthew P Corsi, Sohrab Arora, Giuseppe Chiarelli, Giuseppe Ottone Cirulli, Riccardo Autorino, Akshay Sood, Craig Rogers, Firas Abdollah
OBJECTIVE: The European POUT III randomized controlled trial provided level-one evidence that adjuvant platinum-based chemotherapy is the standard of care following nephroureterectomy (RNU) for locally invasive or node-positive upper tract urothelial carcinoma. We aim to assess this European randomized controlled trial's generalizability (external validity) to a North American cohort, using a nationwide database. MATERIALS AND METHODS: To compare trial patients with those seen in real-world practice, we simulated the trial inclusion criteria using data from the National Cancer Database (NCDB)...
March 23, 2024: Urologic Oncology
Jonathan Kanakaraj, Justin Chang, Lance J Hampton, Steven Christopher Smith
The evolution of classification of renal tumors has been impacted since the turn of the millennium by rapid progress in histopathology, immunohistochemistry, and molecular genetics. Together, these features have enabled firm recognition of specific, classic types of renal cell carcinomas, such as clear cell renal cell carcinoma, that in current practice trigger histologic-type specific management and treatment protocols. Now, the fifth Edition World Health Classification's new category of "Molecularly defined renal carcinomas" changes the paradigm, defining a total of seven entities based specifically on their fundamental molecular underpinnings...
March 21, 2024: Urologic Oncology
Gemma Scrimgeour, Kevin Turner
Adverse events have a profound impact on surgeons. This impact extends to physical and mental health, psychological wellbeing, and professional performance. Surgeons are ill prepared for these consequences of adverse events and are under-supported when they inevitably occur. Here we review the data on how adverse events affect surgeons. We explore the efforts made to date to both prepare surgeons before and support them after such events and we make recommendations regarding how this should and could be done better...
March 20, 2024: Urologic Oncology
Anna K Czech, Katarzyna Gronostaj, Jakub Frydrych, Kamil Polok, Jakub Fronczek, Przemyslaw Dudek, Lukasz Belch, Marcin Chlosta, Dominik Choragwicki, Tomasz Dymowski, Mateusz Ostachowski, Katarzyna Piatek-Koziej, Mikołaj Przydacz, Pawel Pyrkosz, Tomasz Wiatr, Marcin Wrozek, Piotr L Chlosta
PURPOSE: To evaluate the value of examination under anesthesia (EUA) in the assessment of bladder resectability during cystectomy. MATERIALS AND METHODS: This prospective study included consecutive patients undergoing cystectomy for bladder cancer at a single center between June 2017 and October 2020. EUA was conducted before cystectomy by two urologists who assessed the bladder for limited mobility. One examiner was blinded to the imaging results. Soft tissue surgical margin status in the pathological evaluation of a cystectomy specimen served as a measure of resectability...
March 19, 2024: Urologic Oncology
Divyangi Paralkar, Amir Akbari, Manju Aron
Prostate cancer is heterogeneous with varied pathologic features and presents with a wide spectrum of clinical manifestations from indolent to advanced cancer. Interrogation of the molecular landscape of prostate cancer has unveiled the complex genomic alterations in these tumors, which significantly impacts tumor biology. The documented array of chromosomal alterations, gene fusions, and epigenetic changes not only play a crucial role in oncogenesis and disease progression, but also impacts response and resistance to various therapeutic modalities...
March 19, 2024: Urologic Oncology
Ronac Mamtani, Konstantinos Tsingas, Ravi B Parikh, Dina Elsouda, Lisa Mucha, Rupali Fuldeore, Rebecca A Hubbard
BACKGROUND: Enfortumab vedotin (EV) monotherapy is approved for the treatment of advanced urothelial cancer as later-line therapy (post-immunotherapy and -platinum-chemotherapy) and as earlier-line therapy (cisplatin-ineligible, at least 1 prior therapy). We examined real-world EV monotherapy use, dose intensity and adherence across 280 US cancer clinics. METHODS: This postmarketing study used data from a nationwide (United States) deidentified patient-level electronic health record-derived database...
March 18, 2024: Urologic Oncology
Thomas Neerhut, Richard Grills, Rod Lynch, Patrick Daniel Preece, Kathryn McLeod
BACKGROUND: When compared with conventional external beam radiotherapy, hypofractionated radiotherapy has led to less treatment sessions and improved quality of life without compromising oncological outcomes for men with prostate cancer. Evidence has shown transurethral prostatic resection prior to brachytherapy and external beam radiotherapy is associated with worsening genitourinary toxicity. However, there is no review of genitourinary toxicity when TURP occurs prior to definitive hypofractionated radiotherapy...
March 18, 2024: Urologic Oncology
Sanjay Das, Michael Luu, Martha Terris, Zachary Klaassen, Christopher J Kane, Christopher Amling, Matthew Cooperberg, Lourdes Guerrios Rivera, William Aronson, Stephen J Freedland, Timothy J Daskivich
OBJECTIVES: To assess whether contemporary risks of biochemical recurrence (BCR) after radical prostatectomy (RP) in the AS era differ from historical estimates due to changes in tumor risk case mix and improvements in risk stratification. MATERIALS AND METHODS: We sampled 6,682 men who underwent RP for clinically localized disease between 2000 and 2017 from the VA SEARCH database. Kaplan Meier analysis was used to calculate incidence of BCR before and after 2010 overall and within tumor risk subgroups...
March 14, 2024: Urologic Oncology
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