Category: Latest Articles

Editorial Board

September 9, 2020/by

Abstract

Objective

To provide a chronological overview of evolution of continent urinary diversion over the last fifty years and to highlight important milestones.

Methods

We performed an extensive literature review and analysed different forms of urinary diversion worldwide. After the work up of surgical techniques, we assessed advantages and disadvantages of assorted continent urinary diversion based on published long‐term follow‐up data.

Results

A wide variety of surgical options for continent urinary diversion is available and feasible to date, although consensus between urologists regarding the gold standard is still lacking. Several forms of orthotopic bladder substitutes and continent cutaneous urinary reservoirs have shown to provide excellent long‐term results.

Conclusion

The last 50 years of CUD have been a constant evolution and refinement of technique but the best surgical option remains unclear and there is no “one size fits all” concept, but rather tailor‐made concepts are necessary to ensure patient satisfaction.

Long‐term follow‐up after radiotherapy for prostate cancer with and without rectal hydrogel spacer: a pooled prospective evaluation of bowel‐associated quality of life

September 9, 2020/by

Objective

To evaluate the long‐term bowel‐associated quality of life (QOL) in men after radiotherapy (RT) for prostate cancer with and without the use of rectal hydrogel spacer.

Patients and Methods

The patients’ QOL was examined using the Expanded Prostate Cancer Index Composite (EPIC) and mean changes from baseline in EPIC domains were evaluated. A total of 215 patients from a randomised multi‐institutional trial of RT, with or without hydrogel spacer, with a QOL endpoint were pooled with 165 non‐randomised patients from a single institution with prospective QOL collection in patients with or without hydrogel spacer. The proportions of men with minimally important differences (MIDs) relative to pre‐treatment baseline in the bowel domain were tested using repeated measure logistic models with a pre‐specified threshold for clinically significant declines (≥5 equivalent to MIDx1 and ≥10 equivalent to MIDx2).

Results

A total of 380 men were evaluated (64% with spacer and 36% without) with QOL data being available for 199 men with >24 months of follow‐up [median (range) 39.5 (31–71.4) months]. Treatment with spacer was associated with less decline in average long‐term bowel QOL (89.4 for control and 94.7 for spacer) with differences at >24 months meeting the threshold of a MID difference between cohorts (bowel score difference from baseline: control = −5.1, spacer = 0.3, difference = −5.4; P < 0.001). When evaluated over time men without spacer were more likely to have MIDx1 (5 points) declines in bowel QOL (P = 0.01). At long‐term follow‐up MIDx1 was 36% without spacer vs 14% with spacer (P <0.001; odds ratio [OR] 3.5, 95% CI 1.7–6.9) while MIDx2 was seen in 19% vs 6% (P = 0.008; OR 3.6, 95% CI 1.4–9.1). The use of spacer was associated with less urgency with bowel movements (P = 0.002) and fewer loose stools (P = 0.009), as well as less bother with urgency (P = 0.007) and frequency of bowel movements (P = 0.009).

Conclusions

In this pooled analysis of QOL after prostate RT with up to 5 years of follow‐up, use of a rectal spacer was associated with preservation of bowel QOL. This QOL benefit was preserved with long‐term follow‐up.

Research Highlights

September 9, 2020/by

Abstract

To provide evidence‐based care, it is important for healthcare professionals to stay up to date with relevant medical literature. To overcome the barriers of high volume, time constraints and difficulty retaining information, some journals use social media (SoMe) sites, such as Twitter, to disseminate research. More recent strategies include creating visual abstracts and infographics, which combine images and text to graphically represent data (1). As the name suggests, visual abstracts summarise and simplify an article’s abstract and/or key messages.

Preoperative frailty and outcome in patients undergoing radical cystectomy

September 9, 2020/by

Abstract

Objectives

To assess whether free PSA ratio (FPSAR) at biochemical recurrence (BCR) can predict metastasis, castrate‐resistant PCa (CRPC), and cancer‐specific survival (CSS), following therapy for localized disease.

Methods

A single‐center retrospective cohort study (NCT03927287) including a discovery cohort composed of patients with an FPSAR after radical prostatectomy (RP) or radiotherapy (RT) between 2000‐2017. For validation, an independent biobank cohort of patients with biochemical recurrence (BCR) after RP was tested. Using a defined FPSAR cutoff, the metastasis‐free‐survival (MFS), CRPC‐free survival, and CSS were compared. Multivariable Cox models determined the association between posttreatment FPSAR, metastases, and CRPC.

Results

Overall, 822 patients (305 RP‐ and 363 RT‐treated patients and 154 biobank patients) were analyzed. In the RP cohort, a total of 272/305 (89.1%) and 33/305 (10.9%) had an FPSAR test incidentally and reflexively, respectively. In the RT cohort, 155/363 (42.7%) and 208/263 (57.3%) had an FPSAR test incidentally and reflexively, respectively. However, in the prospective biobank RP cohort, FPSAR testing was done on all samples of patients diagnosed with BCR. An FPSAR cutoff of 0.10 was determined using receiver‐operating characteristic‐analyses in both RP and RT cohorts. FPSAR<0.10 resulted in longer median MFS (14.8 vs. 9.3 years, and 14.8 vs. 13 years, respectively), and longer median CRPC‐free survival (median not reached vs. 9.9 years, and 20.7 vs. 13.8 years, respectively). Multivariable analyses showed that FPSAR>=0.10 was associated with increased metastasis in the RP cohort (HR 1.915 [95% CI 1.241‐2.955], and RT cohort (HR 1.754 [95% CI 1.112‐2.769]), and increased CRPC in the RP cohort (HR 2.470 [95% CI 1.493‐4.088]). Findings were validated in the biobank cohort.

Conclusions

Posttreatment FPSAR>=0.10 is associated with more aggressive disease, suggesting a potentially novel role for this biomarker.

The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia

September 9, 2020/by

Abstract

To provide evidence‐based care, it is important for healthcare professionals to stay up to date with relevant medical literature. To overcome the barriers of high volume, time constraints and difficulty retaining information, some journals use social media (SoMe) sites, such as Twitter, to disseminate research. More recent strategies include creating visual abstracts and infographics, which combine images and text to graphically represent data (1). As the name suggests, visual abstracts summarise and simplify an article’s abstract and/or key messages.

Digital frozen section of the prostate surface during radical prostatectomy: a novel approach to evaluate surgical margins

September 9, 2020/by

Abstract

To provide evidence‐based care, it is important for healthcare professionals to stay up to date with relevant medical literature. To overcome the barriers of high volume, time constraints and difficulty retaining information, some journals use social media (SoMe) sites, such as Twitter, to disseminate research. More recent strategies include creating visual abstracts and infographics, which combine images and text to graphically represent data (1). As the name suggests, visual abstracts summarise and simplify an article’s abstract and/or key messages.

Primary urethral cancer: treatment patterns and associated outcomes

September 9, 2020/by

Objective

To evaluate the long‐term bowel‐associated quality of life (QOL) in men after radiotherapy (RT) for prostate cancer with and without the use of rectal hydrogel spacer.

Patients and Methods

The patients’ QOL was examined using the Expanded Prostate Cancer Index Composite (EPIC) and mean changes from baseline in EPIC domains were evaluated. A total of 215 patients from a randomised multi‐institutional trial of RT, with or without hydrogel spacer, with a QOL endpoint were pooled with 165 non‐randomised patients from a single institution with prospective QOL collection in patients with or without hydrogel spacer. The proportions of men with minimally important differences (MIDs) relative to pre‐treatment baseline in the bowel domain were tested using repeated measure logistic models with a pre‐specified threshold for clinically significant declines (≥5 equivalent to MIDx1 and ≥10 equivalent to MIDx2).

Results

A total of 380 men were evaluated (64% with spacer and 36% without) with QOL data being available for 199 men with >24 months of follow‐up [median (range) 39.5 (31–71.4) months]. Treatment with spacer was associated with less decline in average long‐term bowel QOL (89.4 for control and 94.7 for spacer) with differences at >24 months meeting the threshold of a MID difference between cohorts (bowel score difference from baseline: control = −5.1, spacer = 0.3, difference = −5.4; P < 0.001). When evaluated over time men without spacer were more likely to have MIDx1 (5 points) declines in bowel QOL (P = 0.01). At long‐term follow‐up MIDx1 was 36% without spacer vs 14% with spacer (P <0.001; odds ratio [OR] 3.5, 95% CI 1.7–6.9) while MIDx2 was seen in 19% vs 6% (P = 0.008; OR 3.6, 95% CI 1.4–9.1). The use of spacer was associated with less urgency with bowel movements (P = 0.002) and fewer loose stools (P = 0.009), as well as less bother with urgency (P = 0.007) and frequency of bowel movements (P = 0.009).

Conclusions

In this pooled analysis of QOL after prostate RT with up to 5 years of follow‐up, use of a rectal spacer was associated with preservation of bowel QOL. This QOL benefit was preserved with long‐term follow‐up.

Two cycles of neoadjuvant chemotherapy improves survival in patients with high‐risk upper tract urothelial carcinoma

September 7, 2020/by

Abstract

Objectives

To assess the impact of two cycles of neoadjuvant chemotherapy (NAC) in patients who underwent nephroureterectomy for high‐risk cN0M0 upper tract urothelial carcinoma (UTUC), and to evaluate the efficacy of NAC in patients with localized disease (cT2 or lower).

Patients and Methods

We retrospectively analyzed high‐risk cN0M0 UTUC patients who received NAC followed by surgery, compared with a matched cohort who underwent initial surgery at Fujita Health University during 2005–2019. Baseline and tumor characteristics, overall survival (OS), cancer‐specific survival (CSS), and recurrence‐free survival (RFS) were compared between the cohorts. Cox proportional hazards models were used to identify predictors of survival.

Results

There were 117 and 67 patients in the study group and the control group, respectively. Significantly higher pathological downstaging (pDS) and lower lymphovascular invasion (LVI) were observed in the study group than in the control group (48% vs. 22%, p = 0.008 and 29% vs. 46%, p = 0.045, respectively). The NAC group had significantly better 5‐year OS (79% vs. 53%, p = 0.003), 5‐year CSS (84% vs. 66%, p = 0.008), and 5‐year RFS (80% vs. 61%, p = 0.001) than the control group. The OS benefit of NAC was observed even in patients with localized (cT2 or lower) disease (p = 0.019). Patients with LVI showed significantly worse CSS both in pathologically locally advanced (pT3 or higher) and in localized (pT2 or lower) tumors (p = 0.048 and p = 0.018, respectively). Multivariate analysis identified LVI, NAC, and pDS as independent predictors of OS. Male sex and post‐NAC LVI were identified as predictors of worse survival in patients who underwent NAC.

Conclusions

Two cycles of NAC improved the survival of high‐risk UTUC patients, even in patients with localized disease. Although two cycles of NAC appear to be effective in cN0M0 high‐risk UTUC including localized disease, additional larger sample‐size multicenter prospective studies comparing short‐course neoadjuvant chemotherapy regimens, followed by surgery, and surgery alone are required.

Benign Prostatic Hyperplasia‐ what do we know?

September 7, 2020/by

Abstract

Objectives

To assess the impact of two cycles of neoadjuvant chemotherapy (NAC) in patients who underwent nephroureterectomy for high‐risk cN0M0 upper tract urothelial carcinoma (UTUC), and to evaluate the efficacy of NAC in patients with localized disease (cT2 or lower).

Patients and Methods

We retrospectively analyzed high‐risk cN0M0 UTUC patients who received NAC followed by surgery, compared with a matched cohort who underwent initial surgery at Fujita Health University during 2005–2019. Baseline and tumor characteristics, overall survival (OS), cancer‐specific survival (CSS), and recurrence‐free survival (RFS) were compared between the cohorts. Cox proportional hazards models were used to identify predictors of survival.

Results

There were 117 and 67 patients in the study group and the control group, respectively. Significantly higher pathological downstaging (pDS) and lower lymphovascular invasion (LVI) were observed in the study group than in the control group (48% vs. 22%, p = 0.008 and 29% vs. 46%, p = 0.045, respectively). The NAC group had significantly better 5‐year OS (79% vs. 53%, p = 0.003), 5‐year CSS (84% vs. 66%, p = 0.008), and 5‐year RFS (80% vs. 61%, p = 0.001) than the control group. The OS benefit of NAC was observed even in patients with localized (cT2 or lower) disease (p = 0.019). Patients with LVI showed significantly worse CSS both in pathologically locally advanced (pT3 or higher) and in localized (pT2 or lower) tumors (p = 0.048 and p = 0.018, respectively). Multivariate analysis identified LVI, NAC, and pDS as independent predictors of OS. Male sex and post‐NAC LVI were identified as predictors of worse survival in patients who underwent NAC.

Conclusions

Two cycles of NAC improved the survival of high‐risk UTUC patients, even in patients with localized disease. Although two cycles of NAC appear to be effective in cN0M0 high‐risk UTUC including localized disease, additional larger sample‐size multicenter prospective studies comparing short‐course neoadjuvant chemotherapy regimens, followed by surgery, and surgery alone are required.

Histological comparison between predictive value of preoperative 3‐T multiparametric MRI and 68Ga‐PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer

September 7, 2020/by

Abstract

Objectives

To assess the impact of two cycles of neoadjuvant chemotherapy (NAC) in patients who underwent nephroureterectomy for high‐risk cN0M0 upper tract urothelial carcinoma (UTUC), and to evaluate the efficacy of NAC in patients with localized disease (cT2 or lower).

Patients and Methods

We retrospectively analyzed high‐risk cN0M0 UTUC patients who received NAC followed by surgery, compared with a matched cohort who underwent initial surgery at Fujita Health University during 2005–2019. Baseline and tumor characteristics, overall survival (OS), cancer‐specific survival (CSS), and recurrence‐free survival (RFS) were compared between the cohorts. Cox proportional hazards models were used to identify predictors of survival.

Results

There were 117 and 67 patients in the study group and the control group, respectively. Significantly higher pathological downstaging (pDS) and lower lymphovascular invasion (LVI) were observed in the study group than in the control group (48% vs. 22%, p = 0.008 and 29% vs. 46%, p = 0.045, respectively). The NAC group had significantly better 5‐year OS (79% vs. 53%, p = 0.003), 5‐year CSS (84% vs. 66%, p = 0.008), and 5‐year RFS (80% vs. 61%, p = 0.001) than the control group. The OS benefit of NAC was observed even in patients with localized (cT2 or lower) disease (p = 0.019). Patients with LVI showed significantly worse CSS both in pathologically locally advanced (pT3 or higher) and in localized (pT2 or lower) tumors (p = 0.048 and p = 0.018, respectively). Multivariate analysis identified LVI, NAC, and pDS as independent predictors of OS. Male sex and post‐NAC LVI were identified as predictors of worse survival in patients who underwent NAC.

Conclusions

Two cycles of NAC improved the survival of high‐risk UTUC patients, even in patients with localized disease. Although two cycles of NAC appear to be effective in cN0M0 high‐risk UTUC including localized disease, additional larger sample‐size multicenter prospective studies comparing short‐course neoadjuvant chemotherapy regimens, followed by surgery, and surgery alone are required.