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Purpose: Lutetium labelled prostate-specific membrane antigen radioligand therapy (Lu-PSMA RLT) has shown pleasing early results in management of high-volume metastatic castration resistant prostate cancer (mCRPC), but its role in the early treatment of men with only lymph node metastasis (LNM) is unknown. The aim was to assess the outcome of Lu-PSMA RLT earlier in the treatment of men with only LNM. Materials and Methods: Single institution retrospective review of men with only LNM on staging Ga-PSMA PET PSMA who proceeded with Lu-PSMA RLT. Results: There were 17 men with only LNM, including 13 with mCRPC and 3 who were both hormone and chemotherapy naïve. The median PSA was 3.7 (0.46–120 ng/mL). A PSA decline of ≥50% occurred in 10/17 (58.8%), decreasing to

Purpose Many studies identified that the preoperative neutrophil-to-lymphocyte ratio (PNLR) was associated with patient prognosis in non-muscle-invasive bladder cancer (NMIBC). We hypothesized that PNLR could be prognostic in patients with histological variants of NMIBC (VH-NMIBC). Materials and Methods This retrospective study included patients with VH-NMIBC admitted at our center between January 2009 and May 2019. The best cut-off value of NLR was measured by the receiver operating characteristic curve and Youden index. The Kaplan-Meier method and Cox proportional hazard regression models were employed to evaluate the association between PNLR and disease prognosis, including recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Results A total of 243 patients with VH-NMIBC were enrolled in our study. According to the Kaplan-Meier method results, patients with PNLR ≥2.2 were associated with poor RFS (p, Graphical Abstract

Neoadjuvant chemotherapy (NAC) prior to surgery and immune checkpoint therapy (ICT) have revolutionized bladder cancer management. However, stratification of patients that would benefit most from these modalities remains a major clinical challenge. Here, we combine single nuclei RNA sequencing with spatial transcriptomics and single-cell resolution spatial proteomic analysis of human bladder cancer to identify an epithelial subpopulation with therapeutic response prediction ability. These cells express Cadherin 12 (CDH12, N-Cadherin 2), catenins, and other epithelial markers. CDH12-enriched tumors define patients with poor outcome following surgery with or without NAC. In contrast, CDH12-enriched tumors exhibit superior response to ICT. In all settings, patient stratification by tumor CDH12 enrichment offers better prediction of outcome than currently established bladder cancer subtypes. Molecularly, the CDH12 population resembles an undifferentiated state with inherently aggressive biology including chemoresistance, likely mediated through progenitor-like gene expression and fibroblast activation. CDH12-enriched cells express PD-L1 and PD-L2 and co-localize with exhausted T-cells, possibly mediated through CD49a (ITGA1), providing one explanation for ICT efficacy in these tumors. Altogether, this study describes a cancer cell population with an intriguing diametric response to major bladder cancer therapeutics. Importantly, it also provides a compelling framework for designing biomarker-guided clinical trials., The identification of response biomarkers for surgery, chemotherapy and immune checkpoint therapy in bladder cancer is crucial. Here, single nuclei RNA sequencing and spatial profiling identify a cancer cell population expressing Neural Type Cadherin 2 that associates with distinct treatment outcomes.

Purpose To compare overall survivals (OSs) and cancer-specific survivals (CSSs) after robotic-assisted radical prostatectomy (RARP) and radiation therapy (RT), the latter of which has long been recommended primarily for elderly patients (≥75 years) with non-metastatic prostate cancer (PCa), given the Korean male life span of 79.7 years (2018). Materials and Methods Retrospective data for aged ≥75 years who underwent RARP or RT at seven tertiary hospitals were analyzed. To account for indication-related bias, inverse probability of treatment-weighting (IPTW) was applied before and after Cox regression. Results Of the 1,110 study subjects, 883 underwent RARP and 227 RT from 2007 to 2016. The differences between groups including the age (≥80 y; 25.4% vs. 32.8%; p=0.034), concomitant diabetes (14.9% vs. 22.9%; p=0.007), coronary heart disease (3.5% vs. 7.5%; p=0.015), and PCa risk stratification (high-risk; 18.2% vs. 59.7%; p, Graphical Abstract

Introduction Cabazitaxel multiple rechallenges may be a treatment option in heavily pretreated patients with metastatic castration‐resistant prostate cancer (mCRPC) who had a good initial response to cabazitaxel and who are still fit to receive it. Our objective was to assess the efficacy and toxicity of multiple rechallenges. Patients and methods We retrospectively identified 22 mCRPC patients previously treated with docetaxel and/or androgen receptor‐targeted agents who received multiple cabazitaxel rechallenges in 9 French centers. Cabazitaxel was initiated at a dose of 25 mg/m2 q3week. A reduced dose (20 mg/m2 q3w) or an alternative schedule (mainly 16 mg/m2 q2w) was increasingly used for subsequent rechallenges. Progression‐free survival, prostate‐specific antigen (PSA) response, best clinical response, and grade ≥3 toxicities were collected. Overall survival was calculated from various time points. Results Twenty‐two patients with an initial response to cabazitaxel were rechallenged at least twice. The median number of cabazitaxel cycles was 7 at first cabazitaxel treatment, 6 at first rechallenge, and 5 at subsequent rechallenges. Median progression‐free survival at first rechallenge was 9.6 months and 5.6 months at second rechallenge. Median overall survival was 50.9 months from the first cabazitaxel dose, 114.9 months from first life‐extending therapy initiation in mCRPC, and 105 months from mCRPC diagnosis. There was no cumulative grade ≥3 neuropathy or nail disorder and one case of febrile neutropenia. Conclusion Cabazitaxel multiple rechallenges may be a treatment option without cumulative toxicity in heavily pretreated patients having a good response to first cabazitaxel use and still fit to receive it. Novelty & Impact Statements Patients with metastatic castration‐resistant prostate cancer can be treated with Cabazitaxel after docetaxel and androgen receptor‐targeted agent. This chemotherapy can be used multiple times with efficacy and manageable toxicity., We assessed the efficacy and toxicity of multiple rechallenges with cabazitaxel for 22 patients with metastatic castration‐resistant prostate cancer (mCRPC). Median overall survival was 50.9 months from the first cabazitaxel dose, 114.9 months from first life‐extending therapy initiation in mCRPC, and 105 months from mCRPC diagnosis. Cabazitaxel rechallenge may be an effective option in heavily pretreated mCRPC patients with a good initial response to cabazitaxel and still fit to receive it, without cumulative grade ≥3 toxicity.

Purpose: Few studies have demonstrated the clinical significance of pretreatment serum albumin and globulin in prostate cancer (PCa). This study evaluated the association between the pretreatment albumin to globulin ratio (AGR) and clinicopathologic characteristics of nonmetastatic PCa in a large multicenter setting in Korea. Materials and Methods: This study involved 742 patients with nonmetastatic PCa who underwent radical prostatectomy (RP) in seven institutions between January 2011 and December 2012. The AGR was calculated as follows: albumin/(total protein−albumin). Patients were divided into low and high AGR groups by a cutoff value from a receiver operating characteristic curve analysis. Results: The best cutoff for the AGR was set at 1.53. The area under the curve of the AGR was 0.624 (95% confidence interval, 0.557–0.671; p

BACKGROUND: Darolutamide is a potent androgen-receptor inhibitor that has been associated with increased overall survival among patients with nonmetastatic, castration-resistant prostate cancer. Whether a combination of darolutamide, androgen-deprivation therapy, and docetaxel would increase survival among patients with metastatic, hormone-sensitive prostate cancer is unknown. METHODS: In this international, phase 3 trial, we randomly assigned patients with metastatic, hormone-sensitive prostate cancer in a 1:1 ratio to receive darolutamide (at a dose of 600 mg [two 300-mg tablets] twice daily) or matching placebo, both in combination with androgen-deprivation therapy and docetaxel. The primary end point was overall survival. RESULTS: The primary analysis involved 1306 patients (651 in the darolutamide group and 655 in the placebo group); 86.1% of the patients had disease that was metastatic at the time of the initial diagnosis. At the data cutoff date for the primary analysis (October 25, 2021), the risk of death was significantly lower, by 32.5%, in the darolutamide group than in the placebo group (hazard ratio 0.68; 95% confidence interval, 0.57 to 0.80; P

Prostate cancer (PCa) of high risk is one of the crucial problems in urological oncology. Radiation therapy (RT), along with radical prostatectomy, is an important component of the complex treatment of patients with high‑risk PCa. To improve the long‑term oncological results of RT dose escalation is advocated. Currently, dose escalation can be reached via external beam irradiation and interstitial RT techniques. The study included 109 patients with high‑risk PCa who underwent either external beam RT up to 76 Gy, or combined RT (external beam + interstitial RT) using 125I sources with long‑term androgen deprivation therapy. Comparative analysis of long‑term results of patients with high‑risk PCa treatment showed an improvement in 5‑year disease‑free survival rates after combined RT compared with external beam RT. Acute rectal toxicity was decreased in combined RT group compared to patients after external beam RT: 13.2 % and 46.4 %, respectively (p < 0.01).

Purpose The transient receptor potential vanilloid 6 (TRPV6) channel is overexpressed in prostate cancer and its silencing is known to inhibit the growth of LNCaP cells. However, the role of TRPV6 in the metastasis of prostate cancer cells and its relationship to the invasive markers, matrix metalloproteinase (MMP) and cathepsin B, is unclear. Thus, the present study was focused on understanding these tumor-related processes. Materials and Methods We performed a wound-healing assay and a Transwell migration and invasion assay to assess the migration and invasion of prostate cancer cells. Western blot analysis was used to measure the expression of cathepsin B, MMP2, and MMP9. Results TRPV6 siRNA significantly inhibited the proliferation of LNCaP prostate cancer cells. It also significantly attenuated the wound healing and migration capacities of LNCaP cells. Moreover, the invasiveness of LNCaP cells and the expression of MMP9 and cathepsin B in LNCaP cells were also significantly inhibited by TRPV6 siRNA. Conclusions The results indicate that TRPV6 may promote prostate cancer progression in association with MMP9 and cathepsin B, thereby validating further research into TRPV6 as a useful therapeutic target for local invasion or metastasis of advanced prostate cancer., Graphical Abstract

Purpose In large scale prospective studies, prostate-specific antigen (PSA)-screening not only decreased prostate cancer mortality, but also reduced biochemical recurrence (BCR) in patients undergoing radical prostatectomy (RP). We investigated the independent effect of the presence of PSA checked more than 1 year before diagnostic biopsy on the prognosis of patients undergoing RP in a real world setting without PSA-screening. Materials and Methods We reviewed the database of patients undergoing RP at Ajou University Hospital from March 1999 to May 2018. Clinicopathological features assessed were age, presence of lower urinary tract symptoms at presentation, presence of PSA checked over 1 year before biopsy, presence of PSA checked within 4 to 1 years of biopsy, last pre-biopsy PSA (pPSA), biopsy grade group (bGG), cT, cN, percentage of positive biopsy cores (PPBC), pathological GG (pGG), pT, pN, surgical margin, and index tumor diameter. The primary endpoint was BCR-free survival (BCRFS). Results Of 598 patients enrolled, 211 experienced BCR at the mean follow-up of 64±37 months. The 5-year and 10-year BCRFS were 62.8% and 53.9%, respectively. In multivariate analyses including clinical variables only, pPSA, bGG, cT, PPBC, and PSA within 4 to 1 years of biopsy independently affected BCRFS. In multivariate analyses including pathological variables only, pPSA, pGG, pT, pN, PSA checked over 1 year before biopsy and PSA checked within 4 to 1 years of biopsy independently affected BCRFS. Conclusions Patients who has checked PSA at least once beyond 1 year before diagnosis of prostate cancer show better BCRFS regardless of other factors., Graphical Abstract

Background To determine, using testicular germ cell cancer screening as an example, whether screening can also be effective for cancers with a good prognosis. Methods Based on the Dutch incidence, stage distribution, and survival and mortality data of testicular germ cell cancer, we developed a microsimulation model. This model simulates screening scenarios varying in screening age, interval, self‐examination or screening by the general practitioner (GP), and screening of a defined high‐risk group (cryptorchidism). For each scenario, the number of clinically and screen‐detected cancers by stage, referrals, testicular germ cell cancer deaths, and life‐years gained were projected. Results Annual self‐examination from age 20 to 30 years resulted in 767 cancers detected per 100,000 men followed over life‐time, of which 123 (16%) by screening. In this scenario, 19.2 men died from the disease, 4.7 (20%) less than without screening, and 230 life‐years were gained. Around 14,000 visits to the GP and 2080 visits to an urologist were required. This scenario resulted in the most favorable ratio between extra visits to the GP or urologist and deaths prevented (1418 and 116 respectively). Monthly screening, or screening until age 40 resulted in less favorable ratios. Self‐examination by only the high‐risk population prevented 1.0 death per 100,00 men in the general population. In all scenarios, 46–50 life‐years were gained for each testicular germ cell cancer death prevented. Conclusion Despite the good prognosis, self‐examination at young ages for testicular germ cell cancer could be considered., In this study, we describe possible screening strategies to screen for testicular germ cell cancer. With the use of a model calibrated to the Dutch situation, we simulated several screening strategies. We found that despite the good prognosis, self‐examination at young ages for testicular germ cell cancer could be considered.

Purpose Preoperative deep vein thrombosis (pre-DVT) is a risk of symptomatic venous thromboembolism (VTE) and a serious postoperative surgical complication. However, little is known about pre-DVT in patients undergoing surgery. This study aimed to investigate the incidence and screening criteria of pre-DVT in patients undergoing urological surgery. Materials and methods Between 2015 and 2017, 320 patients admitted to our hospital for urological surgery were included in this retrospective study. All patients underwent preoperative D-dimer testing. Patients with elevated D-dimer (≥1.0 μg/mL) levels underwent lower-limb compression ultrasonography (CUS). Clinical parameters were analyzed as predictors of pre-DVT, and modest cutoff value of D-dimer to predict pre-DVT were evaluated. Results Of 320 patients, preoperative elevated D-dimer levels and DVT were found in 81 (25.3%) and 20 (6.3%) patients, respectively. The positive predictive value (PPV) was 24.7% (20/81). ROC curve analysis revealed a cutoff D-dimer level of 1.8 μg/mL, yielding a PPV of 40.7% for pre-DVT among patients with elevated D-dimer levels. Preoperative DVT was detected in 16 (7.6%, n=210) patients with malignancy, 3 (5.7%, n=53) with adrenal tumors, and in 1 (1.8%, n=57) kidney donor. An age of >70 years was significantly associated with risk for pre-DVT (odds ratio, 2.81; 95% confidence interval, 1.12-7.19; p=0.0270). During a postoperative follow-up period of 90 days, no patient developed symptomatic VTE. Conclusions The incidence of pre-DVT was 6.3% in patients undergoing urological surgery. Elderly patients and/or a cutoff D-dimer level of 1.8 μg/mL might be good indications for pre-DVT screening by CUS.

Introduction Prostate cancer screening using prostate‐specific antigen (PSA) testing remains widespread. The prevalence of PSA testing in young men is unknown and may be an appropriate target for improving health care by decreasing low‐value testing in this age group. The purpose of this study was to determine PSA testing rates in men younger than current guidelines support. Materials and Methods Health Informational National Trends Surveys (HINTS) from 2011 to 2014 and 2017 were analyzed to establish the prevalence of PSA testing in young men and to evaluate the differences in testing rates based on race. Results The combined survey data included 5178 men, with 2393 reporting previous PSA screening. Of men ages 18–39, 7% recalled receipt of PSA testing. Twenty‐two percent of men between the ages of 40 and 44 had been tested. Among men under age 40, PSA testing was more common among black men (14%) compared to white men (7%), Hispanics (6%), and men of Asian descent (8%). Logistic regression modeling demonstrates that black men under the age of 40 were more likely to undergo PSA testing than other racial or ethnic groups (odds ratio 2.14; 95% CI 1.17, 3.93). Conclusions Current guidelines do not recommend routine PSA testing in average‐risk men under the age of 40. This study found that a significant number of young men are exposed to testing, with the greatest risk among black men. This suggests that there is an opportunity to improve the value of PSA testing by decreasing testing in young men., Health Informational National Trends Surveys were analyzed to establish the prevalence of PSA testing in young men and to evaluate the differences in testing rates based on race. We found that a significant number of young men are exposed to testing, with the greatest risk among black men. These results suggest there is an opportunity to improve the value of PSA testing by decreasing testing in young men, and thereby decrease premature exposure to the emotional and financial burden of false positives and the physical risks of diagnostic testing and treatment.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic is having significant effects on health services globally, including on urological surgery for which the British Association of Urological Surgeons (BAUS) has provided national guidance. Kent, Surrey and Sussex (KSS) is one of the regions most affected by COVID-19 in the UK to date. Methods: An anonymous online survey of all KSS urology trainees was conducted. The primary outcome was to assess the effects on urology services, both malignant and benign, across the region in the acceleration phase and at the peak of the pandemic compared to standard care. The second was to quantify the effects on urology training, especially regarding operative exposure. Results: There were significant decreases in urological services provided at the peak of the pandemic across KSS compared to standard care ( pConclusions: The COVID-19 pandemic has caused significant changes to urological surgery services and training in KSS, with heterogeneity across the region. We suggest further work to quantify the effects nationally. Level of evidence: 4.

Purpose: Previous studies have noted increased utilization of perioperative chemotherapy over time. The goal of this study was to determine trends in perioperative chemotherapy use within a contemporary population. Materials and Methods: The National Cancer Database was queried for patients diagnosed with cT2-4N0M0 urothelial muscle invasive bladder cancer from 2011 to 2015 and underwent subsequent radical cystectomy. We retrospectively analyzed factors associated with perioperative chemotherapy and evaluated overall treatment trends in the use of neoadjuvant and adjuvant chemotherapy. Linear regression, logistic regression, Cox regression, and Kaplan–Meier analysis were performed. Results: In total, 7,101 patients met inclusion criteria for analysis. The use of perioperative chemotherapy increased from 46.4% in 2011 to 57.2% in 2015 (p=0.003). Neoadjuvant chemotherapy use increased from 22.9% to 32.3% (p=0.007) over the time period analyzed, while adjuvant chemotherapy use experienced no significant change (23.5% to 24.9%, p=0.182). Logistic regression demonstrated that increased age and Charlson Comorbidity Index were predictors of not receiving chemotherapy (p

Purpose To describe a single-center 15-year experience of active surveillance (AS) for prostate cancer (PCa). Materials and Methods We retrospectively reviewed patients who underwent AS between 2003 and 2018. One hundred fifty-three patients were selected according to the following criteria: (1) biopsy Gleason pattern ≤3+4 with (2) ≤two positive core(s) and (3) ≤50% core involvement, clinical-stage ≤T2a, and prostate-specific antigen (PSA) ≤20 ng/mL. Follow-up included PSA measurement every six months, prostate biopsies at one year and then every 2–3 years, and MRI every year. Intervention was triggered by (1) Gleason score (GS) upgrading, (2) >two positive cores, or (3) PSA doubling-time in two positive cores (8.5%), abnormal PSA kinetics (11.9%), and patient preference (37.3%). Notably, 12 (25.5%) patients had pathologic GS ≥4+3 (unfavorable disease) and 3 (6.4%) patients had pathologic stage ≥T3a at radical prostatectomy. Median time to treatment-free survival was 19.5 months. Of the 59 patients who switched to intervention, biochemical recurrence was reported in only one (0.7%) patient. Conclusions AS is an available option for low-risk PCa in carefully selected patients. Further larger prospective studies are needed to determine the optimal criteria for AS, especially in Korean PCa patients., Graphical Abstract

Purpose To assess the efficacy and safety of docetaxel rechallenge in the salvage setting in metastatic castration-resistant prostate cancer (mCRPC) patients. Materials and methods Clinicopathologic data from patients treated with docetaxel rechallenge were collected from a single-center cancer registry. Among 227 patients who received first-line docetaxel for mCRPC between January 2011 and June 2019, 23 undergo rechallenge docetaxel after failure to androgen receptor targeting agents and/or cabazitaxel treatment. Endpoints included radiologic progression-free survival (PFS), treatment duration, and prostate-specific antigen (PSA) response and safety. Results Overall, 30%, 44%, 13%, and 13% of patients received docetaxel rechallenge as either the third, fourth, fifth, or sixth-line therapy, respectively, at a median of 23.6 months after stopping first-line docetaxel. With first-line docetaxel and rechallenge, median treatment duration was 6.4 and 3.3 months, respectively. With docetaxel rechallenge, PSA response was 35% (95% confidence interval [CI], 15% to 54%) and median PFS was 4.5 months (95% CI, 1.9 to 7.1 months). The median OS was 24.3 months (95% CI, 4.6 to 44.0 months). There were 7 severe adverse events (grade 3 or more) including anemia (8.7%), neutropenia, thrombocytopenia, leukopenia, diarrhea, and nausea (4.3% each). Conclusions Docetaxel rechallenge showed meaningful anti-tumor activity with acceptable toxicity in heavily pretreated patients with mCRPC.

Purpose To evaluate the usefulness of multiparametric magnetic resonance imaging (mpMRI) to avoid misclassification of patients with clinically significant prostate cancer (PCa) into active surveillance (AS). Materials and methods Patients with Gleason grade group (GG) 1 PCa on systematic biopsy who underwent mpMRI before radical prostatectomy (RP) were included. mpMRI and pathologic results were compared between the AS and NOT-AS candidates. Unfavorable disease was defined as the identification of T3-4 disease or GG upgrade in the RP specimen. We established an ideal cutoff Prostate Imaging Reporting and Data System (PI-RADS) score for predicting unfavorable disease, and analyzed the location of index lesions on mpMRI. Results PI-RADS scores were not significantly different between AS candidates (n=64) and NOT-AS candidates (n=136; p=0.629). Among 64 AS candidates, GG upgrading and unfavorable disease were diagnosed after RP in 24 (37.5%) and 25 (39.1%) patients, respectively. The rate of unfavorable disease was greater for patients with a PI-RADS score of 5 (83.3%) than in those with a score ≤4 (34.5%; p=0.030). Moreover, most PI-RADS 5 lesions in AS candidates were located in the anterior half of the prostate, with GG upgrading on targeted biopsy in 75.0% of cases. Conclusions Among the patients with GG 1 PCa, PI-RADS scores did not differ significantly between AS and NOT-AS candidates. Nonetheless, AS candidates with PI-RADS 5 lesions were diagnosed with unfavorable disease in >80% of RP specimens. Significant cancer located in the anterior half of the prostate including the transitional zone can be missed by systematic biopsy.

Introduction The coronavirus pandemic (COVID-19) had a significant impact on the global healthcare sector and provoked the current oncological care standards revision, including the standards in urological oncology All changes have affected directly the elective outpatient and inpatient surgical care through the search for a priority and evidence-based treatment option for urological cancer diseases during a tense epidemiological period Aim The aim of this study was to assess the short-term results and changes in the urological oncology service on the background of the COVID-19 pandemic first wave Materials and methods The outcomes of patients’ treatment in the oncourological surgical department of the FSBI «N N Petrov national medical research center of oncology» of the Ministry of Healthcare of the Russian Federation for the period from March 16 to May 18,2020 were analyzed 96 elective admissions (81 25% - male, 18 75% - female) were performed, of which an elective surgical treatment of a urological cancer was performed in 76 cases (79 2%) The endpoint of this study was the rate of mortality, associated with confirmed SARS-CoV-2 infection after surgery during the 30-day follow-up period Additionally, risk factors of SARS-CoV-2 infecting during the hospital stay period were analyzed Statistical analysis (Student's test, Mann-Whitney, Fisher's test, ROC-analysis) was performed using the STATISTICA software (version 10;StatSoft Inc , USA), JASP (version 0 11 1, Netherlands) Results Over the specified period, COVID-19 infection was detected in 11 5% of cases (n = 11), 12 8% of them were male (n = 10), 5 6% (n = 1) -female patients Mortality rate during the hospital stay period was 3 1% (n = 3), the rate during the 30-day follow-up period after discharge from the hospital was 2% (n = 2) The average patients’ length of stay before surgery in the group without a confirmed diagnosis of COVID-19 was 1 8 ± 1 7 days, after surgery - 7 3 ± 7 7 days The average length of stay for patients before surgery in the group with a confirmed diagnosis of COVID-19 was 2 2 ± 1 6 days, after surgery - 12 2 ± 8 9 days According to the ROC analysis results, the length of the postoperative period was the most significant risk factor for SARS-CoV-2 infecting in the hospital: with a postoperative period of more than 6 days, the risk of COVID-19 infecting was 79 7% (95% CI 0 058-0 743) Other risk factors for COVID-19 infection in the postoperative period (gender, ASA score, body mass index) did not show their significant influence Conclusion Carrying out urological cancer procedures on the background of the COVID-19 pandemic can only be carried out with a revision of the strategy for sorting clinical cases according to the severity of the underlying disease, with the strict adherence to clinical guidelines and the evidence-based medicine principles An additional option to reduce the burden on the healthcare system and reduce the likelihood of SARS-CoV-2 infection could be the fast track principles aimed at accelerated postoperative patient recovery Введение Пандемия коронавирусной инфекции (COVID-19) оказала существенное влияние на глобальный сектор здравоохранения и спровоцировала пересмотр действующих стандартов онкологической помощи, в том числе и в онкоурологии Все изменения напрямую коснулись плановых амбулаторных визитов и деятельности хирургических стационаров за счет поиска приоритетного и доказательного варианта лечения онкоурологических заболеваний в условиях напряженной эпидемиологической ситуации Целью данной работы явилась оценка краткосрочных результатов и изменений работы онкоурологической службы на фоне первой волны пандемии COVID-19 Материалы и методы Проанализированы результаты госпитализации пациентов в хирургическое отделение онкоурологии ФГБУ «НМИЦ онкологии им Н Н Петрова» Минздрава России за период с 16 марта по 18 мая 2020 года Всего выполнено 96 плановых госпитализаций (81,2% мужчин, 18,7% женщин), из которых плановое хирургическое лечение онкоурологической патологии выполнено у 76 (79,2%) пациентов Конечной точкой исследования стал 30-дневный период наблюдения с оценкой частоты летальных исходов с подтвержденными случаями SARS-CoV-2 после оперативного вмешательства Дополнительно были проанализированы факторы риска вероятности инфицирования SARS-CoV-2 в условиях стационара Статистический анализ (тест Стъюдента, Манна-Уитни, критерий Фишера, ROC- анализ) проведен с использованием программы «STATISTICA» (версия 10;StatSoft Inc , США),» JASP» (версия 0 11 1, Нидерланды) Результаты За указанный период времени инфекция COVID-19 выявлена у 11 (11,5%) пациентов, из них мужчин - 10 (12,8%), женщин - 1 (5,5%) Смертность за время госпитализации составила 3,1% случаев и 2,1% - после выписки из стационара в период 30-дневного наблюдения Средняя продолжительность пребывания пациента до операции в группе без подтвержденного диагноза COVID-19 составила 1,8 ±1,7 койко/дней, после операции - 7,3±7,7 Средняя продолжительность пребывания пациента до операции в группе с подтвержденным диагнозом COVID-19 составила 2,2 ±1,6 койко/дней, после операции -12,2 ±8,9 койко/дней По результатам ROC-анализа влияние продолжительности послеоперационного периода явилось наиболее значимым фактором риска инфицирования SARS-CoV-2 в стационаре: при продолжительности послеоперационного периода более 6- суток риск присоединения COVID-19 составляет 79,7% (ДИ 95% 0,058-0,743) Остальные факторы риска инфицирования COVID-19 в послеоперационном периоде (пол, физический статус пациента по классификации американского общества анестезиологов ASA, индекс массы тела) не показали своего значимого влияния Заключение Проведение онкоурологических вмешательств в условиях пандемии COVID-19 может быть осуществлено только при пересмотре стратегии сортировки клинических случаев по тяжести основного заболевания при строгом соблюдении клинических рекомендаций и доказательной медицинской базы Дополнительной опцией для снижения нагрузки на систему здравоохранение и уменьшение вероятности присоединения SARS-CoV-2 могут стать принципы ускоренного выздоровления (fast track), направленные на ускоренное послеоперационное восстановление пациентов

Purpose: The clinical impact of the platelet-to-lymphocyte ratio (PLR) on the prognosis of patients with metastatic renal cell carcinoma (mRCC) remains controversial. We investigated the associations between elevation of the PLR and disease prognosis in patients with synchronous mRCC. Materials and Methods: The data of 1,505 patients with synchronous mRCC were retrospectively analyzed. The entire cohort was stratified into two subgroups according to PLR. Kaplan–Meier and Cox proportional analyses were performed to investigate the possible associations between the PLR and disease prognosis. Results: There were 921 patients with a high PLR and 584 patients with a low PLR by use of the cutoff of 146. The patients with a high PLR had worse clinical characteristics in terms of advanced clinical stage (p

Objectives: To investigate whether serial prostate magnetic resonance imaging (MRI) may guide the utility of repeat targeted (TBx) and systematic biopsy (SBx) when monitoring men with low-risk prostate cancer (PCa) at 1-year of active surveillance (AS). Patients and Methods: We retrospectively included 111 consecutive men with low-risk (International Society of Urological Pathology [ISUP] Grade 1) PCa, who received protocolled repeat MRI with or without TBx and repeat SBx at 1-year of AS. TBx was performed in Prostate Imaging-Reporting and Data System (PI-RADS) score ≥3 lesions (MRI-positive men). Upgrading defined as ISUP Grade ≥2 PCa (I), Grade ≥2 with cribriform growth/intraductal carcinoma PCa (II), and Grade ≥3 PCa (III) was investigated. Upgrading detected by TBx only (not by SBx) and SBx only (not by TBx) was investigated in MRI-positive and -negative men, and related to radiological progression on MRI (Prostate Cancer Radiological Estimation of Change in Sequential Evaluation [PRECISE] score). Results: Overall upgrading (I) was 32% (35/111). Upgrading in MRI-positive and -negative men was 48% (30/63) and 10% (5/48) (P

Purpose: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is standard of care for muscle-invasive bladder cancer (MIBC). However, NAC is used in less than 20% of patients with MIBC. Our goal is to investigate factors that contribute to underutilization NAC to facilitate more routine incorporation into clinical practice. Materials and Methods: We identified 5,915 patients diagnosed with cT2-T3N0M0 MIBC who underwent RC between 2004 and 2014 from the National Cancer Database. Univariate and multivariable models were created to identify variables associated with NAC utilization. Results: Only 18.8% of patients received NAC during the study period. On univariate analyses, NAC utilization was more likely at academic hospitals, US South and Midwest (p

Purpose: The clinical behavior of prostate cancer differs by race and ethnicity; however, data on the Korean population are scarce. We assessed the long-term oncologic outcomes of clinically localized prostate cancer after radical prostatectomy in Korean men. Materials and Methods: We analyzed 786 clinically localized prostate cancer patients who underwent radical prostatectomy, from June 1993 to June 2008. Kaplan–Meier survival curve analysis and log-rank test were used to assess the oncologic outcomes. Results: The mean age of the patients was 64.9±6.6 years. Pelvic lymph node dissection was performed in 373 patients. Pathologic T and N stage cancer with local advancement and invasion were detected by radical prostatectomy in 307 and 22 patients, respectively. In total, 38 patients who underwent adjuvant therapy were excluded from the analysis of progression after biochemical recurrence (BCR), which occurred in 261 men. In total, 219 patients underwent salvage treatment. Local recurrence and distant metastasis occurred in 109 and 42 patients, respectively; 36 patients experienced metastasis with local recurrence. Castration-resistant prostate cancer developed in 22 patients, and overall and disease-specific mortality was noted in 148 and 23 patients, respectively. The median duration from operation to BCR, BCR to metastasis, and metastasis to disease-specific death was 25, 40, and 22 months, respectively. Conclusions: We demonstrated the long-term prognosis of localized prostate cancer after radical prostatectomy among Koreans. Our results differ from those reported in the Western literature, with a lower prevalence of distant metastasis and shorter time to metastasis after BCR.

Purpose: As prostate cancer (PCa) is the second most commonly diagnosed cancer worldwide, finding novel markers for prognosis is crucial. BRCA1-associated protein 1 (BAP-1), a nuclear-localized deubiquitinating enzyme, has been reported in several human cancers. However, its prognostic role in PCa remains unknown. Herein, we assessed the prognostic and clinicopathologic significance of BAP-1 in PCa. Materials and Methods: Seventy surgical specimens from radical prostatectomy cases were examined. Two cores per case were selected for construction of tissue microarrays (TMAs). After the exclusion of two cases because of tissue sparsity, BAP-1 immunohistochemical expression was evaluated in 68 cases of formalin-fixed, paraffin-embedded TMA tissue blocks. The immunohistochemical stain was scored according to proportion of nuclear staining: negative (

Purpose: To evaluate the impact of perioperative blood transfusion (PBT) on oncologic outcomes after surgery in patients with nonmetastatic renal cell carcinoma (RCC). Materials and Methods: This retrospective review included 2,329 patients who underwent partial or radical nephrectomy for localized RCC in a single institution from 2000 to 2014. PBT was defined as transfusion of allogeneic packed red blood cells (pRBCs) during nephrectomy or within the preoperative or postoperative hospitalization period. Oncologic outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS). Results: PBT was performed in 275 patients (11.8%). In the multivariable logistic regression analysis, symptomatic presentation, advanced age at surgery, higher preoperative serum creatinine, and lower preoperative hemoglobin were independent preoperative risk factors for PBT (all p

Objectives To document the management of advanced prostate cancer including diagnosis, prognosis, treatment, and care, in real‐world practice in Asia using the United in Fight against prOstate cancer (UFO) registry. Patients and Methods We established a multi‐national, longitudinal, observational registry of patients with prostate cancer presenting to participating tertiary care hospitals in eight Asian countries. A total of 3636 eligible patients with existing or newly diagnosed high‐risk localised prostate cancer (HRL), non‐metastatic biochemically recurrent prostate cancer (M0), or metastatic prostate cancer (M1), were consecutively enrolled and are being followed‐up for 5 years. Patient history, demographic and disease characteristics, treatment and treatment decisions, were collected at first prostate cancer diagnosis and at enrolment. Patient‐reported quality of life was prospectively assessed using the European Quality of Life‐five Dimensions, five Levels (EQ‐5D‐5L) and Functional Assessment of Cancer Therapy for Prostate Cancer questionnaires. In the present study, we report the first interim analysis of 2063 patients enrolled from study start (15 September 2015) until 18 May 2017. Results Of the 2063 enrolled patients, 357 (17%), 378 (19%), and 1328 (64%) had HRL, M0 or M1 prostate cancer, respectively. The mean age at first diagnosis was similar in each group, 56% of all patients had extracapsular extension of their tumour, 28% had regional lymph node metastasis, and 53% had distant metastases. At enrolment, 62% of patients had at least one co‐morbidity (mainly cardiovascular disease or diabetes), 91.8% of M1 patients had an Eastern Cooperative Oncology Group performance score of

Aim A comprehensive review of the literature on the current and future applications of artificial intelligence (AI) in the context of urological oncology. Method Four key areas of urological oncology were identified, and a comprehensive literature review was carried out in each area looking at the current and future applications of AI. These four areas included: Prostate cancer, Renal cancer, Bladder cancer, Robotic Surgery. Results In total, 63 primary research articles were reviewed across these four areas. For prostate, renal and bladder cancer, AI has already shown great promise in the areas of imaging and histopathology interpretation, predicting tumour grade, reducing inter-observer variability and identification of genomic biomarkers. For robotic surgery, AI has already demonstrated value in the assessment of operator skill and using this to predict surgical outcomes. However, some common limitations to the applicability of AI into clinical practice include an overwhelming predominance of small retrospective studies, concerns over the datasets and methodology of AI training, the complexity of AI algorithms being such that they become un-interpretable and the technological requirements and ethical considerations with so much confidential “big data.” Conclusions The potential for AI to improve clinical care is clearly unparalleled but there remain significant challenges to adoption into clinical practice. Future research will need to focus on the establishment of multi-institute open access databases and improved data collection and integration for improved training of AI algorithms and ultimately, for clinical applicability to be realised, there needs to be high-quality prospective randomised multi-institute studies.

Objective Previous research has indicated cognitive decline (CD) among testicular cancer patients (TCPs), even in the absence of chemotherapy, but little is known about the underlying pathophysiology. The present study assessed changes in cognitive functions and structural brain connectomes in TCPs and explored the associations between cognitive changes and endocrine status and hypothesized risk genotypes. Methods Thirty‐eight newly orchiectomized TCPs and 21 healthy controls (HCs) comparable to TCPs in terms of age and years of education underwent neuropsychological testing, structural MRI, and a biological assessment at baseline and 6 months later. Cognitive change was assessed with a neuropsychological test battery and determined using a standardized regression‐based approach, with substantial change defined as z‐scores ≤−1.64 or ≥1.64. MRI scans and graph theory were used to evaluate changes in structural brain connectomes. The associations of cognitive changes with testosterone levels, androgen receptor gene (AR) CAG repeat length, and genotypes (APOE, COMT, and BDNF) were explored. Results Compared with HCs, TCPs showed higher rates of substantial decline on processing speed and visuospatial ability and higher rates of substantial improvement on verbal recall and visuospatial learning (p, The present study confirms previous findings of domain‐specific cognitive decline in testicular cancer patients following orchiectomy, but also points to domain‐specific improvements. The results do not indicate changes in brain connectomes or endocrine status to be the main drivers of cognitive changes.

The COVID-19 pandemic has led to the suspension, termination or alteration of thousands of clinical trials as the health emergency escalated globally. Whilst the rapid suspension of certain clinical trials was necessary to ensure the safety of high-risk or vulnerable trial participants as well as healthcare workers, the long-term ramifications that this delay will have on the field of urologic oncology is unknown. The COVID-19 pandemic has highlighted the need to plan for and implement new strategies to advance our understanding of unmet areas of need in urologic oncology. The COVID-19 pandemic has led to the suspension, termination or alteration of thousands of clinical trials as the health emergency escalated globally. Whilst the rapid suspension of certain clinical trials was necessary to ensure the safety of high-risk or vulnerable trial participants as well as healthcare workers, the long-term ramifications that this delay will have on the field of urologic oncology is unknown. The COVID-19 pandemic has highlighted the need to plan for and implement new strategies to advance our understanding of unmet areas of need in urologic oncology.

Purpose To evaluate if preoperative sterile pyuria can be a prognostic factor for intravesical recurrence (IVR) and overall survival (OS)in patients with upper tract urothelial carcinoma (UTUC) undergoing surgery. Materials and methods We retrospectively reviewed the medical records of patients who were diagnosed with UTUC from October 2003 to December 2016 at Korea University Medical Center. Sterile pyuria was defined as urine containing five or more white blood cells per high-power field in the absence of bacteria in urine culture. We used a stepwise multivariable Cox proportional hazards model to assess the independent effects of the prognostic factors for IVR and OS. Results We investigated a total of 176 patients who were diagnosed with UTUC. Among them, 91 (51.7%) patients had preoperative sterile pyuria. There were no significant differences in the baseline characteristics between the pyuria and non-pyuria groups concerning tumor grade, T stage, tumor multiplicity, and recurrence history. However, there was a significant difference in the IVR between the two groups. In the multivariable analysis, preoperative sterile pyuria, diabetes mellitus, high-grade tumor, and lymphovascular invasion were revealed as independent risk factors for IVR, and only lymphovascular invasion was identified as an independent risk factor for OS. Conclusions Preoperative sterile pyuria is significantly associated with IVR in patients with UTUC undergoing surgery, but it is not associated with OS. Furthermore, diabetes mellitus, high-grade tumor, and lymphovascular invasion are also independent prognostic factors for these patients.

Purpose: We evaluated the prognostic association of pT2 subclassification with the oncological outcomes in patients with prostate cancer (PCa) who underwent radical prostatectomy (RP) in South Korea. Materials and Methods: We retrospectively reviewed 3,529 patients who underwent RP for pathologically organ-confined PCa between 2003 and 2017 at Seoul National University Bundang Hospital. We analyzed the differences in the rates of biochemical recurrence (BCR), overall survival (OS), and cancer-specific survival (CSS) between pT2 substages. Results: According to the 2002 TNM staging system, 362 (15.3%) and 2,000 patients (84.5%) had T2a (involving one-half or less of a unilateral lobe) and T2c (involving bilateral lobes) diseases. Four patients (0.2%) had T2b (involving more than one-half of a unilateral lobe) disease and none of them developed BCR. The mean follow-up period was 8.4±3.7 years and 175 patients (7.4%) had BCR. On multivariable analysis, pT2 subclassification (pT2a/b vs. pT2c) was not a significant predictor of BCR (p=0.224) or OS (p=0.311). Biochemical disease-free survival (p=0.091), OS (p=0.502), and CSS (p=0.063) showed no significant difference between pT2 substages. Conclusions: Our study revealed that the pT2 subclassification of PCa in Korean males provided no value for predicting BCR, OS, and CSS after RP, which agrees with recently reported results based on the updated 8th version of the American Joint Committee on Cancer (AJCC) TNM staging system.

Purpose This study aimed to identify prognostic factors for outcomes after radical nephroureterectomy among patients with upper urinary tract urothelial carcinoma (UTUC). Materials and methods We retrospectively reviewed 184 nonmetastatic cases of UTUC after radical nephroureterectomy, bladder cuffing, and/or partial cystectomy (2004-2016). Bladder recurrence-free survival (BRFS), disease progression-free survival (DPFS), and cancer-specific survival (CSS) were estimated. The prognostic values of clinicopathologic parameters were evaluated by using Cox logistic regression analysis. Results The median BRFS, DPFS, and CSS values were 19.0 months, 38.5 months, and 67.0 months, respectively. We identified cases of bladder recurrence (64 cases, 34.8%), disease progression (54 cases, 29.3%), and cancer-specific death (23 cases, 12.5%). BRFS was independently associated with lymphovascular invasion (hazard ratio [HR], 0.421); DPFS was associated with intravesical instillation (HR, 0.290), active smoking (HR, 0.367), synchronous bladder lesions (HR, 2.355), and pT2 (HR, 5.199) and pT3 and pT4 (HR, 13.281) stages; and CSS was associated with alkaline phosphatase levels (HR, 0.966). Among 123 cases without previous bladder cancer, DPFS was associated with intravesical instillation (HR, 0.264), multifocal ureteral tumors (HR, 4.823), and pT3 and pT4 stages (HR, 10.899), whereas CSS was associated with pTis (HR, 32.071). Conclusions Patients with the factors we identified should receive adjuvant intravesical/systemic chemotherapy and intensive surveillance.

Purpose To investigate the clinical utility of transperineal template-guided saturation prostate biopsy (TPB) for risk stratification after transrectal ultrasound (TRUS)-guided biopsy. Materials and methods We retrospectively reviewed 155 patients who underwent TPB after previously negative results on TRUS-guided biopsy (n=58) or who were candidates for active surveillance (n=97) fulfilling the PRIAS criteria between May 2017 and November 2018. The patients' clinicopathologic data were reviewed, and the detection of clinically significant cancer (CSC) and upgrading of Gleason grade were identified. Results The patients' median age and pre-TPB prostate-specific antigen (PSA) value were 65.0 years and 5.74 ng/mL, respectively. A median of 36 biopsy cores was obtained in each patient, with a median TPB core density of 0.88 cores/cm3. Of the 58 males with a previous negative result on TRUS-guided biopsy, prostate cancer (PCa) was detected in 17 males (29.3%), including 8 with CSC. Of the 97 patient candidates for active surveillance, upgrading of the Gleason grade was identified in 31 males (32.0%), 20 with a Gleason grade of 7 (3+4), 6 with a Gleason grade of 7 (4+3), and 5 with a Gleason grade of 8 (4+4). The overall complication rate was 14.8% (23/155), and there were no Clavien-Dindo grade 3 to 5 complications. Conclusions TPB helps to stratify the risk of PCa that was previously missed or underdiagnosed by TRUS-guided biopsy. TPB might be used as a diagnostic tool to determine risk classification and to help counsel patients with regard to treatment decisions.

Non-muscle-invasive bladder cancer (NMIBC) is the most common form of bladder cancer, with frequent recurrences and risk of progression. Risk-stratified treatment and surveillance protocols are often used to guide management. In 2017, BJUI reviewed guidelines on NMIBC from four major organizations: the American Urological Association/Society of Urological Oncology, the European Association of Urology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence. The present update will review major changes in the guidelines and broadly summarize new recommendations for treatment of NMIBC in an era of bacillus Calmette-Guerin shortage and immense novel therapy development.

Well-designed clinical trials in urological oncology help to guide treatment decisions and aid in counselling patients, ultimately serving to improve outcomes. Since the term evidence-based medicine was first used by Gordon Guyatt in 1991, a renewed emphasis on methodology, transparent trial design and study reporting has helped to improve clinical research and in turn, the landscape of medical literature. Novel clinical trial designs (including multi-arm, multistage trials, basket and umbrella studies and research from big data sources, such as electronic health records, administrative claims databases and quality monitoring registries) are well suited to advance innovation in urological oncology. Existing urological clinical trials are often limited by small numbers, are statistically underpowered and many face difficulties with accrual. Thus, efforts to improve trial design are of considerable importance. The development and use of standard outcome sets and adherence to reporting guidelines offer researchers the opportunity to guide value-oriented care, minimize research waste and efficiently identify solutions to the unanswered questions in urology cancer care. In this Review, Narayan and Dahm summarize innovations in clinical trial design that have led to practice-changing developments in the treatment of urological cancers and offer a perspective on improving trial design in the future.

Purpose: To investigate the changes in testosterone levels and rates of chemical castration following androgen-deprivation therapy (ADT) with goserelin, triptorelin, and leuprolide. Materials and Methods: We retrospectively reviewed the medical records of 125 patients with prostate cancer treated with luteinizing hormone-releasing hormone (LHRH) agonists between January 2009 and December 2015. Changes in testosterone concentration during 9 months of ADT with goserelin 11.34 mg, triptorelin 11.25 mg, and leuprolide 11.25 mg were analyzed using a mixed model. The number of patients with serum testosterone below castration levels defined as various values (

OBJECTIVE To evaluate the relationship between hospital volume and intermediate- and long-term patient survival for patients undergoing nephrectomy for renal cell carcinoma (RCC). PATIENTS AND METHODS Adult patients with RCC treated with nephrectomy between 2000 and 2010 were identified from the English Hospital Episode Statistics database and National Cancer Data Repository. Patients with nodal or metastatic disease were excluded. Hospitals were categorised into low- (LV

Background Early identification of early death for bladder cancer patients undergoing radical cystectomy based on the laboratory findings at the time of diagnosis could improve the overall survival. The study aimed to explore preoperative factors associated with higher risk of early death (within 1 year after surgery) for bladder cancer patients. Methods A total of 186 bladder cancer patients who underwent robot‐assisted radical cystectomy (RARC) were identified between October 2014 and May 2017. The probability of dying within 1 year after RARC was defined as the end point “early death.” Predictive factors including clinical features and laboratory findings at diagnosis were retrospectively collected. Results Median follow‐up time after RARC was 20.6 months (1.2‐43.7 months). Fifty‐one patients (27.4%) died during follow‐up and 31 within 1 year from surgery (1‐year mortality rate: 16.7%). All potentially prognostic factors were assessed on univariate analyses, which revealed the following factors as being associated with higher risk of early death within 1 year after RARC: older age (P = 0.004), advanced clinical stage (P = 0.005), presence of hydronephrosis (P = 0.021), higher fibrinogen (P = 0.007), higher PLR (P = 0.031), and lower PNI (P = 0.016). In a multivariate Cox proportional hazard regression model analysis, age >60 years (HR = 7.303, 95% CI 1.734‐30.764; P = 0.007) and fibrinogen ≥3.295 g/L (HR = 2.396, 95% CI 1.138‐5.045; P = 0.007) at diagnosis were independent prognostic factors of early death after RARC. Conclusion Age and preoperative elevated plasma fibrinogen level were independent predictors for 1‐year mortality after RARC. We believe that plasma fibrinogen levels may become a useful biomarker, which may help guide the treatment decision‐making process for patients with bladder cancer.

Purpose To prospectively evaluate the diagnostic yield of multiparametric magnetic resonance imaging (mpMRI)-fusion, transrectal ultrasound (TRUS)-guided prostate biopsies for detection of prostate cancer in an Asian population with a low incidence of prostate cancer. Materials and methods A total of 131 males with suspected prostate cancer were recruited to undergo fusion biopsy with the Artemis prostate fusion biopsy device (Eigen, Grass Valley, CA, USA). All patients underwent standard 12-core systematic biopsies in addition to biopsies targeted at the mpMRI-identified abnormal regions. Yield from the standard cores was compared with that from the targeted cores. Gleason scores of 4+3 or higher were considered significant. Results The mean age of the patients was 63.54±7.96 years and the mean prostate-specific antigen value was 9.75±5.35 ng/mL. A total of 36 patients had cancer, of which 3 (8.3%) were detected only on standard cores and 3 (8.3%) only on targeted cores. Of the clinically significant cancers (n=30), targeted biopsy detected a higher number (28/30, 93.3%) than standard biopsy (21/30, 70.0%). A total of 6 of 8 cancers (75.0%) that were insignificant on standard biopsy were upgraded to significant cancer on targeted cores. Conclusions Eight percent of cancers were detected only on MRI-TRUS fusion-targeted biopsies, whereas the method upgraded more than two-thirds of insignificant cancers to significant cancers. Fusion biopsies thus provide incremental information over standard TRUS biopsies in the diagnosis of significant prostate cancer in populations with a low incidence of prostate cancer.

Purpose An elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with adverse outcomes in various malignancies. However, its role in prognosticating testicular cancer (TC) has not been validated. We aim to study the relationship between NLR and TC. Materials and methods We retrospectively reviewed 160 patients with histological proven TC from January 2005 to June 2016. Youden's index was used to analyse NLR and a cut-off point of 3.0 was obtained, with statistical receiver operating characteristics of 0.755. Chi-square test, Kaplan-Meier (log rank test) and logistics regression models were used to predict NLR association with survival outcomes. Results Median age was 34 years old (range, 17-68 years old). There were 102 pure seminomas and 58 non-seminomatous germ cell tumours. Median follow-up period was 8 years (range, 2.5-17 years). NLR ≥3.0 was independently associated with lymph node involvement (p=0.031; odds ratio [OR], 2.91; 95% confidence interval [CI], 1.67-5.83; p=0.038; OR, 4.12; 95% CI, 1.26-6.51) and metastatic disease (p=0.041; OR, 2.48; 95% CI, 1.22-3.98; p=0.043; OR, 2.21; 95% CI, 1.17-3.65) in both seminomatous and non-seminomatous germ cell tumours, translating to a more advanced disease. Moreover, NLR ≥3.0 also predicts poorer cancer specific survival in these patients. Conclusions NLR can be an inexpensive haematological marker in predicting advanced TC staging and poorer survival outcome. NLR complements the traditional cancer staging by identifying a group of high risk patients who may benefit from multimodal treatment and closer surveillance to achieve long term survival.

Objectives To develop a consensus statement on current best practice of active surveillance (AS) in the UK, informed by patients and clinical experts. Subjects and Methods A consensus statement was drafted on the basis of three sources of data: systematic literature search of national and international guidelines; data arising from a Freedom of Information Act request to UK urology departments regarding their current practice of AS; and survey and interview responses from men with localized prostate cancer regarding their experiences and views of AS. The Prostate Cancer UK Expert Reference Group (ERG) on AS was then convened to discuss and refine the statement. Results Guidelines and protocols for AS varied significantly in terms of risk stratification, criteria for offering AS, and protocols for AS between and within countries. Patients and healthcare professionals identified clinical, emotional and process needs for AS to be effective. Men with prostate cancer wanted more information and psychological support at the time of discussing AS with the treating team and in the first 2 years of AS, and a named healthcare professional to discuss any questions or concerns they had. The ERG agreed 30 consensus statements regarding best practice for AS. Statements were grouped under headings: ‘Inclusion/Exclusion Criteria’; ‘AS follow-up protocol’ and ‘When to stop AS’. Conclusion Significant variation currently exists in the practice of AS in the UK and internationally. Men have clear views on the level of involvement in treatment decisions and support from their treating professionals when receiving AS. The Prostate Cancer UK AS ERG has developed a set of consensus statements for best practice in AS. Evidence for best practice in AS, and the use of multiparametric magnetic resonance imaging in AS, is still evolving, and further studies are needed to determine how to optimize AS outcomes

Purpose To determine whether the interactive visualisation of patient-specific virtual 3D models of the renal anatomy influences the pre-operative decision-making process of urological surgeons for complex renal cancer operations. Methods Five historic renal cancer patient pre-operative computed tomography (CT) datasets were retrospectively selected based on RENAL nephrectomy score and variety of anatomy. Interactive virtual 3D models were generated for each dataset using image segmentation software and were made available for online visualisation and manipulation. Consultant urologists were invited to participate in the survey which consisted of CT and volume-rendered images (VRI) for the control arm, and CT with segmentation overlay and the virtual 3D model for the intervention arm. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered. Results Twenty-five participants were recruited (54% response rate), with 19/25 having > 5 years of renal surgery experience. The median anatomical clarity score increased from 3 for the control to 5 for the intervention arm. A change in planned surgical approach was reported in 19% of cases. Virtual 3D models increased surgeon confidence in the surgical decisions in 4/5 patient datasets. There was a statistically significant improvement in surgeon opinion of the potential utility for decision-making purposes of virtual 3D models as compared to VRI at the multidisciplinary team meeting, theatre planning, and intra-operative stages. Conclusion The use of pre-operative interactive virtual 3D models for surgery planning influences surgical decision-making. Further studies are needed to investigate if the use of these models changes renal cancer surgery outcomes. Electronic supplementary material The online version of this article (10.1007/s11548-019-01913-5) contains supplementary material, which is available to authorized users.

Objectives To develop a risk classifier using urine‐derived extracellular vesicle (EV)‐RNA capable of providing diagnostic information on disease status prior to biopsy, and prognostic information for men on active surveillance (AS). Patients and Methods Post‐digital rectal examination urine‐derived EV‐RNA expression profiles (n = 535, multiple centres) were interrogated with a curated NanoString panel. A LASSO‐based continuation ratio model was built to generate four prostate urine risk (PUR) signatures for predicting the probability of normal tissue (PUR‐1), D'Amico low‐risk (PUR‐2), intermediate‐risk (PUR‐3), and high‐risk (PUR‐4) prostate cancer. This model was applied to a test cohort (n = 177) for diagnostic evaluation, and to an AS sub‐cohort (n = 87) for prognostic evaluation. Results Each PUR signature was significantly associated with its corresponding clinical category (P < 0.001). PUR‐4 status predicted the presence of clinically significant intermediate‐ or high‐risk disease (area under the curve = 0.77, 95% confidence interval [CI] 0.70–0.84). Application of PUR provided a net benefit over current clinical practice. In an AS sub‐cohort (n = 87), groups defined by PUR status and proportion of PUR‐4 had a significant association with time to progression (interquartile range hazard ratio [HR] 2.86, 95% CI 1.83–4.47; P < 0.001). PUR‐4, when used continuously, dichotomized patient groups with differential progression rates of 10% and 60% 5 years after urine collection (HR 8.23, 95% CI 3.26–20.81; P < 0.001). Conclusion Urine‐derived EV‐RNA can provide diagnostic information on aggressive prostate cancer prior to biopsy, and prognostic information for men on AS. PUR represents a new and versatile biomarker that could result in substantial alterations to current treatment of patients with prostate cancer.

Background Upper tract urothelial carcinoma (UTUC) is a rare urological cancer that is still an important public health concern in many areas around the world. Although UTUC has been linked to a number of risk factors, to our knowledge no systematic review has been published on the overall incidence and prevalence of de-novo UTUC. This review aimed to examine the global epidemiology of UTUC to provide clinicians and public health specialists a better understanding of UTUC. Methods A systematic search was conducted on MEDLINE, Embase, and the Web of Science using a detailed search strategy. Observational epidemiological studies describing the incidence and prevalence of de-novo UTUC in adults were included, and the Joanna Briggs Institute checklist was used for critical appraisal and data extraction of the studies selected. Results The systematic search identified 3506 papers, of which 59 papers were included for qualitative synthesis. The studies selected included data ranging from the years 1943 to 2018. A comprehensive qualitative synthesis of the data was performed. UTUC incidence generally varied according to age (higher with increasing age), sex (unclear), race (unclear), calendar time (increased, stable, or decreased according to region), geographical region (higher in Asian countries), occupation (higher in seamen and printers), and other population characteristics. Prevalence was only reported by one study, which showed UTUC to have the highest incidence of the rare urogenital cancers in Europe. Conclusion This systematic review highlights an increased incidence of UTUC in certain groups, including increasing age and certain occupations such as seamen. The incidence of UTUC also varies between certain geographical regions. The trend of UTUC incidence for sex, race, and calendar time is less clear due to a wide variety of metrics used by the studies identified. More studies are also required on the prevalence of UTUC to understand its disease burden. Trial registration This review was registered on PROSPERO (registration number CRD42019134255).

Purpose The current stratification of risk groups regarding recurrence and progression of non-muscle-invasive bladder cancer (NMIBC) is problematic. We aimed to assess the long-term outcome and risk of multiple, recurrent, and large (≥3 cm) Ta, G1/G2 tumors after transurethral resection of the bladder tumor (TURBT). Materials and Methods We categorized 1,621 patients with NMIBC who underwent TURBT into four risk groups according to the European Association of Urology (EAU) guidelines as follows: low-risk, intermediate-risk, high-risk, and study group. The overall, cancer-specific, disease recurrence-free, and disease progression-free survival rates were estimated by using the Kaplan–Meier method. Then, the impact of risk group was assessed by using a multivariable Cox regression model. Results The study group comprised 52 patients (3.2%) within a mean follow-up of 64.8 months. The disease recurred and progressed in 41 (78.8%) and 7 (13.5%) patients, respectively. Among the four groups, the study group showed the highest risk for 10-year recurrence after TURBT. The disease progression risk in the study group was between that of the intermediate- and high-risk groups. Cancer-specific and all-cause deaths occurred in one and four patients in the study group, respectively. The study group had a higher risk for disease recurrence than did the high-risk group; however, it did not have a higher risk for disease progression than in the high-risk group. Conclusions Multiple, recurrent, and large (≥3 cm) Ta, G1/G2 tumors carry a higher risk for disease recurrence, but not progression, than in the EAU high-risk group of NMIBC., Graphical Abstract

Purpose The negative correlation between BPH-size and incidence of prostate cancer (PCa) is well-documented in the literature, however the exact mechanism is not well-understood. The present study uses histo-anatomical imaging to study prostate volume in correlation to prostate capsule thickness, and glandular epithelial cell density within the peripheral zone (PZ). Materials and Methods Specimens were selected from radical prostatectomies ranging from 20 to 160 mL based on ease of anatomical reconstruction by the slides. A total of 60 patients were selected and underwent quantitative measurements of prostate capsule thickness and glandular epithelial density within the PZ using computer-based imaging software. Pearson's correlation and a stepwise multiple linear regression analysis was conducted to determine the relationship between these measured parameters and the clinical characteristic of these patients. Results Pearson's correlation analysis revealed a strongly significant, negative correlation between prostate volume and glandular epithelial cell density (r(58)=−0.554, p, Graphical Abstract

Purpose To compare the clinical outcome of males with low-risk and favorable intermediate-risk prostate cancer managed within a standardized modern protocol of active surveillance. Materials and Methods This was a prospective cohort study with strict and expanded active surveillance criteria in males with prostate cancer. Baseline assessment included multiparametric magnetic resonance imaging (mpMRI), extended systematic biopsy, and software-based MR-targeted biopsy. Follow-up included biannual prostate-specific antigen (PSA) check, mpMRI, and control biopsy once a year for the first 2 years, and afterward mpMRI every 2 years with additional tests as clinically indicated. The primary outcome was the transition rate to active treatment. Results A total of 51 patients were included: 17 (33%) and 34 (67%) followed protocols of strict (study arm 1) and expanded (study arm 2) active surveillance criteria, respectively. Median age and PSA were 65 years (IQR, 60–69 years) and 5.3 ng/mL (IQR, 4.5–7.7 ng/mL), respectively. At baseline, a median of 2 (IQR, 1–3) cores were positive out of 13 (IQR, 12–14) cores; 22 males (43%) had visible mpMRI lesions. Eight males (24%) in study arm 2 had Gleason score 3+4. After a median follow-up of 36 months (IQR, 24–48 mo), no patient in study arm 1 compared with 17 patients (33%) in arm 2 underwent active treatment (p, Graphical Abstract

PURPOSE: Nearly half of penile cancers are related to human papillomavirus (HPV) infection. Investigations of tumor- and HPV-specific T cell reactivity in regional lymph nodes (LNs) from patients with penile cancer are warranted. MATERIALS AND METHODS: In this study, single-cell suspensions from LNs and peripheral blood from 11 patients with penile cancer were stained with antibodies for lymphocyte markers and analyzed by fluorescence-activated cell sorting (FACS). DNA was extracted from the tumor tissue and HPV status was investigated by PCR. RESULTS: T-cell reactivity against autologous tumor-extract and against the HPV-vaccine Gardasil® was tested by flow-cytometric assay of specific cell-mediated immune response in activated whole blood (FASCIA). CD4+/CD8+ ratios were significantly lower in HPV positive LNs (p

Funder: Kidney Cancer UK, Funder: The Urology Foundation, Background: Kidney cancer is often asymptomatic, leading to proposals for a screening programme. The views of the public towards introducing a new screening programme for kidney cancer are unknown. The aim of this study was to explore attitudes towards kidney cancer screening and factors influencing intention to attend a future screening programme. Methods: We conducted an online population-based survey of 1021 adults aged 45–77 years. The main outcome measure was intention to attend four possible screening tests (urine, blood, ultrasound scan, low-dose CT) as well as extended low-dose CT scans within lung cancer screening programmes. We used multivariable regression to examine the association between intention and each screening test. Results: Most participants stated that they would be ‘very likely’ or ‘likely’ to undergo each of the screening tests [urine test: n = 961 (94.1%); blood test: n = 922 (90.3%); ultrasound: n = 914 (89.5%); low-dose CT: n = 804 (78.8%); lung CT: n = 962 (95.2%)]. Greater intention to attend was associated with higher general cancer worry and less perceived burden/inconvenience about the screening tests. Less worry about the screening test was also associated with higher intention to attend, but only in those with low general cancer worry (cancer worry scale ≤ 5). Compared with intention to take up screening with a urine test, participants were half as likely to report that they intended to undergo blood [OR 0.56 (0.43–0.73)] or ultrasound [OR 0.50 (0.38–0.67)] testing, and half as likely again to report that they intended to take part in a screening programme featuring a low dose CT scan for kidney cancer screening alone [OR 0.19 (0.14–0.27)]. Conclusion: Participants in this study expressed high levels of intention to accept an invitation to screening for kidney cancer, both within a kidney cancer specific screening programme and in conjunction with lung cancer screening. The choice of screening test is likely to influence uptake. Together these findings support on-going research into kidney cancer screening tests and the potential for combining kidney cancer screening with existing or new screening programmes.

Objectives To study whether androgen deprivation therapy (ADT), the mainstay treatment for advanced and disseminated prostate cancer, is associated with risk of dementia. Methods Risk of dementia in men with prostate cancer primarily managed with ADT or watchful waiting (WW) in the Prostate Cancer Database Sweden, PCBaSe, was compared with that in prostate cancer‐free men, matched on birth year and county of residency. We used Cox regression to calculate the hazard ratios (HRs) for Alzheimer's and non‐Alzheimer's dementia (vascular dementia, dementia secondary to other diseases or unspecified dementias) for different types and duration of ADT and oral antiandrogens (AAs) as well as for men managed with WW. Results A total of 25 967 men with prostate cancer and 121 018 prostate cancer‐free men were followed for a median of 4 years. In both groups 6% of the men were diagnosed with dementia. In men with prostate cancer, gonadotropin‐releasing hormone agonist treatment ( HR 1.15, 95% confidence interval [CI] 1.07–1.23) and orchiectomy (HR 1.60, 95% CI 1.32–1.93) were associated with an increased risk of dementia, as compared to no treatment in prostate cancer‐free men; however, this increase in risk was only observed for non‐Alzheimer's dementia and occurred from year 1–4 after start of ADT. No increase in risk for any type of dementia was observed for men treated with AAs or for men on WW. Conclusion This population‐based cohort study does not support previous observations of an increased risk of Alzheimer's dementia for men on ADT; however, there was a small increase in risk of non‐Alzheimer's dementia.