The modified Makuuchi incision consists of a midline incision originating at the xiphoid process, extending caudally to the supra-umbilical region, then curving laterally as a "J/L" shape between the anterior superior iliac spine and the lowest rib. It affords not only ease of entry but also rapidity of closure, excellent exposure, and compatibility with prior abdominal incisions and any body habitus. Despite the potential benefits of the Makuuchi incision, it has had a limited role in urologic surgery. We present our experience with the utilization of the modified Makuuchi incision for large renal and adrenal tumors at our institution. Sixteen cases utilizing the Makuuchi incision for genitourinary tumors were reviewed, all performed by a single urologist at our tertiary care institution. Data collected included patient demographics and characteristics, intraoperative metrics, and postoperative course. Our cohort consisted of seven females and nine males; 12 patients underwent right-sided incision, and four underwent left-sided incision. Twelve patients (75%) had renal cell carcinoma, and four had adrenal pathology. There was renal vein invasion/inferior vena cava thrombus in eight patients (50%). Table 1 summarizes the averages and ranges for the following data points in our 16 cases: patient age, BMI, tumor size, operative time, estimated blood loss, return of bowel function, post-anesthesia care unit oral morphine milligram equivalents (OME), and length of stay. Table 2 lists tumor size, staging, and the level of venous thrombus. There were neither intraoperative complications nor any incision-related postoperative complications. The modified Makuuchi incision has been shown to be safe and feasible for large genitourinary tumors, with comparable outcomes to other incisions. Based on our cumulative operative experience, we conclude that the Makuuchi incision represents a feasible and adaptable surgical approach for complex urologic oncology cases and requires broad upper abdominal exposure.
Body mass index (BMI) does not distinguish between adipose and lean mass or capture central adiposity. Patients with urologic malignancies differ in age and body composition, which may influence how BMI reflects true adiposity. We evaluated the concordance between BMI and alternative adiposity measures-body fat percentage (BF%) and waist-to-hip ratio (WHR)-in a cohort of urologic cancers. We analyzed 5,909 patients diagnosed with kidney cancer, prostate cancer, or bladder cancer who underwent surgery between 2017 and 2022 in a prospective registry. Body composition was assessed using multifrequency bioelectrical impedance analysis. Concordance between BMI and BF% or WHR was evaluated using quadratic weighted kappa statistics. Overall, BMI showed moderate agreement with BF% (κ = 0.58) but poor agreement with WHR (κ = 0.25). BMI underestimated adiposity relative to BF% and overestimated it. Notably, BMI failed to identify central obesity as defined by WHR. Concordance varied across cancer types and muscle-mass strata. Limitations include the single-center design and cross-sectional analysis. BMI alone may not adequately reflect adiposity in patients with urologic cancers, particularly with respect to central adiposity. Alternative measures such as BF% and WHR may provide complementary information for assessing body composition. BMI alone may miss important fat patterns, especially abdominal fat. Additional measures such as body fat percentage and waist-to-hip ratio may help better understand body composition in patients with urologic cancers.
Urological telesurgery has moved from isolated demonstrations to multicentre and randomised evaluation. We mapped the public evidence after the first randomised trial and assessed whether implementation-critical details are visible in reports that readers can independently appraise. We performed a PRISMA-ScR evidence map and public-record audit of peer-reviewed human urological telesurgery reports available to 26 April 2026. Eligible reports described direct remote operative control across physically separate sites. Because brief abstracts and public summaries cannot reliably accommodate full implementation detail, full-text or publicly available full-text records were prespecified as the primary visibility analysis and short public records were analysed separately. Two reviewers independently coded IDEAL stage and predefined implementation-visibility items, with third-reviewer adjudication. Item-level frequencies were reported; no report-level score, total or ranking was calculated. Sixteen reports were included: eight full-text or public full-text records and eight short public records. Six reports were stage 1, seven stage 2a, two stage 2b and one stage 3; no stage 4 surveillance report was identified. In the primary full-text/public full-text analysis, network architecture and clinical outcomes were visible in 8/8 records; distance or site separation and quantitative latency in 7/8 each; advanced network metrics, backup or failover, on-site rescue or takeover planning and technical adverse events in 6/8 each; ethics or governance in 5/8; registration or protocol identifiers in 2/8; and cybersecurity or data-protection measures in 1/8. Short public records showed lower visibility for several implementation items, particularly backup or failover (1/8), governance (2/8), registration (1/8) and cybersecurity (0/8). Agreement was 168/176 (95.5%; Cohen kappa 0.91) for binary visibility items and 15/16 (93.8%; linearly weighted kappa 0.93) for IDEAL stage; nine extraction calls were adjudicated. A programme-cluster sensitivity analysis collapsed the 16 reports into seven visible programmes and retained the same main pattern: network architecture and clinical outcomes were visible in all clusters, whereas registration and cybersecurity were visible in one cluster each. Urological telesurgery has entered early comparative evaluation, including one randomised trial, but public implementation reporting remains uneven. The clearest residual visibility gaps in full-length records concern registration and cybersecurity; short public records are additionally constrained by format. A concise implementation-reporting box or supplement could improve reproducibility and external appraisal without implying that non-reporting equals poor clinical conduct.
The non-invasive assessment of renal masses remains a critical challenge in urologic oncology, where diagnostic uncertainty frequently causes overtreatment. Here, we develop RenalCLIP, a vision-language foundation model for precision oncology in kidney cancer. Utilizing 27,866 computed tomography scans from 8809 patients across diverse multi-center cohorts, we employ a two-stage pre-training strategy to align domain-specific visual and textual representations. RenalCLIP achieves enhanced performance and generalizability across ten core clinical tasks, spanning anatomical assessment, diagnostic classification, and survival prediction, significantly outperforming state-of-the-art general-purpose foundation models. Furthermore, RenalCLIP demonstrates strong data efficiency in diagnostic classification, achieving peak baseline performance using only 20% of the training data. The model also exhibits robust zero-shot diagnostic capabilities, effective image-text retrieval, and high-quality medical report generation. Our findings establish RenalCLIP as a powerful, generalizable tool to enhance diagnostic precision, refine prognostic stratification, and personalize the management of renal masses.
To evaluate the risk of urologic adverse events (UAE), including ureteral complications and urinary fistula, in women treated for cervical cancer to inform clinical decision-making and improve survivorship quality of life. Using the Merative MarketScan database (2011-2021), patients with cervical cancer were identified. Exclusions included <1 year pre-diagnosis enrollment, prior radiotherapy (RT), pre-existing UAE, or multiple gynecologic cancers. Patients were categorized by treatment: surgery alone, surgery + chemotherapy, radiation ± other therapies, no/local treatment, and chemotherapy or radiation alone (surrogate for metastatic disease). Healthy age-matched controls were used. Multivariate Cox models and Kaplan-Meier analyses estimated UAE risk over time. UAEs were stratified as low, intermediate and high-grade events. Among 96,522 patients (68990 cases and 27532 controls), higher rates of all UAE were observed in cervical survivors than controls (23.2% vs. 17.9%, p < 0.001). The highest risks of UAE were observed in patients with presumed non-metastatic disease who received radiation (low-grade UAE: HR 3.7, p < 0.001; intermediate-grade: HR 9.6, p < 0.001; high-grade UAE: HR 13.7, p<0.001, ureteral: HR 23.5, p<0.001, and fistula: HR 63.3, p<0.001). Cervical cancer treatment, particularly involving radiation, is associated with substantial risk high-grade UAE, ureteral and fistula complications. For young patients with localized and presumably curable disease, improved counseling, monitoring, and research to mitigate these highly morbid urologic complications is imminently warranted.
This study evaluated the quality and trustworthiness of large language model (LLM)-generated scientific and plain language summaries (PLS) from clinical oncology literature, focusing on faithfulness (absence of hallucinations), relevance, and readability. Ten LLM-generated scientific summaries and PLS from the INSIDE (artificial INtelligence to Support Informed DEcision making) prostate cancer dataset. For comparison, expert-written PLS from the BioLaySumm dataset were used. A panel of 5 LLMs and 3 human experts verified faithfulness. Verification was performed on original facts and facts modified with varying levels of error (subtle, moderate, contradictory). Readability was assessed using Flesch-Kincaid Reading Ease (FRE) scores. Fact verification against the summaries was ∼100%, confirming accurate fact extraction. LLM panel vs human panel agreement was substantial (kappa 0.67), outperforming agreement among the interhuman (0.43 [95% CI, 0.34-0.52]) and inter-LLM (0.40 [0.38-0.42]) panels. Large language model scientific summaries showed high faithfulness (88.9% [88.0-89.8]) and low hallucinations (9.6% [6.5-12.7]) compared to human-written PLS (61.6% [60.1-63.1] faithfulness; 40.6% [37.8- 43.4] hallucinations). The LLMs detected errors sensitively with scores decreasing as fact modifications became more severe. Finally, LLM-generated PLS were more readable than human-written versions (FRE 42.3 [interquartile range, IQR 35.27-49.41] vs 28.8 [IQR 21.02-36.18]). A panel of LLMs reliably assessed the faithfulness of scientific summaries to their original source and thus can help increase reliability for clinical use. The lower faithfulness in human-written PLS likely reflects extrinsic hallucinations added for context. The study demonstrates a novel approach to automatically assess the quality and trustworthiness of LLM-generated scientific and PLS via faithfulness, relevance, and readability.
High-risk biochemical recurrence (HR-BCR) of prostate cancer (PC) is a prostate-specific antigen (PSA)-only relapse state in which rapid PSA kinetics predict early metastatic progression. Variation in care pathways across Gulf Cooperation Council (GCC) systems supports the need for shared guidance. The HR-BCR Expert Alignment Meeting (BEAM) convened 11 GCC-based senior clinicians with expertise in genitourinary oncology, including medical oncology, urologic oncology, and radiation oncology representation. A writing committee reviewed evidence up to December 2025 and drafted 19 statements. A modified two-round Delphi process used an anonymous online survey in Round 1 and live QR code-enabled voting in Round 2. Consensus was predefined as ≥80% Agree, with abstentions included in the denominator. Of 19 initial statements, 17 reached final consensus after two Delphi rounds. The panel standardized BCR definitions after radical prostatectomy (PSA ≥0.2 ng/mL confirmed) and radiotherapy (PSA rise ≥2 ng/mL above nadir), and defined HR-BCR primarily by PSA doubling time ≤9 months. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) was endorsed as preferred restaging modality and considered sufficient for routine staging in EMBARK-aligned HR-BCR, where available. Management recommendations supported androgen receptor pathway inhibitors (ARPIs) plus androgen deprivation therapy (ADT) intensification for eligible patients, intermittent strategies with defined treatment-holiday and restart triggers, and proactive cardiovascular and bone protection. Enzalutamide plus ADT was endorsed as standard for eligible patients, with enzalutamide monotherapy as an evidence-based alternative for selected men. This expert-based consensus provides an evidence-aligned, GCC-relevant pathway to harmonize definition, staging, and management of HR-BCR and to facilitate timely, equitable implementation of contemporary care.
Opportunistic salpingectomy during concurrent abdominopelvic surgery has been shown to significantly reduce ovarian cancer risk. Uptake by non-gynecologic surgeons could increase population impact. We conducted a national survey of general and urologic surgeons using Michie et al.'s implementation framework of Capability, Motivation, Opportunity-Behaviour to understand understand current experience with opportunistic salpingectomy, and facilitators and barriers to adoption. An online survey was administered to Canadian general and urologic surgeons and postgraduate trainees from January-June 2024. A multivariable logistic regression model assessed relationship between demographic factors and motivation to adopt opportunistic salpingectomy. 269 surveys were completed by 226 general surgeons and 43 urologists. Although 88% reported motivation to perform opportunistic salpingectomy for cancer prevention, practice duration ≥21 years and province of practice were associated with decreased motivation. Only 44% were aware of recommendations endorsing the procedure, and 19% had performed it. Commonly reported barriers to adoption were Capability (consenting patients regarding permanent contraception and ovarian function, and intraoperative technique/complications), and Opportunity (reimbursement). A surgical video was the preferred method to learn salpingectomy by 94%, and patient consent handouts and intraoperative training by a gynecologist were facilitators. Most (92%) stated that opportunistic salpingectomy training should be offered to postgraduate trainees. Most general and urologic surgeons in Canada were unaware of and have not performed opportunistic salpingectomy but were motivated to offer it. Providing consent resources and training opportunities with gynecologist support, and addressing cultural and regulatory factors may improve uptake by surgeons and decrease ovarian cancer incidence.
Upper tract urothelial carcinoma (UTUC) presents a clinically important gap in urologic oncology: treatment intensity is determined before surgery, yet conventional preoperative risk stratification remains imperfect. Kidney-sparing surgery (KSS) is established for selected low-risk disease and is increasingly considered when renal preservation is clinically important, but safe selection depends on distinguishing technically manageable tumors from biologically unsuitable disease. Computed tomography urography (CTU), cytology, ureteroscopy, and ureteroscopic biopsy remain indispensable, although they describe anatomy and morphology more reliably than tumor biology. Urine-based liquid biopsy platforms, including DNA methylation, mutational, multiplex RNA, copy-number, and protein assays, appear most mature for noninvasive detection and preoperative triage. Plasma circulating tumor DNA (ctDNA), in contrast, appears more closely linked to biological upstaging, occult muscle-invasive or non-organ-confined disease, perioperative risk refinement, and molecular residual disease surveillance. This review follows the KSS decision chain from patient selection to postoperative monitoring. We emphasize that current evidence supports liquid biopsy as an adjunctive, decision-enhancing layer rather than a replacement for imaging, ureteroscopy, pathology, or multidisciplinary judgment. Future studies should move beyond isolated sensitivity and specificity estimates and test whether biomarker-informed pathways improve treatment allocation, renal preservation, surveillance burden, and oncologic outcomes.
Early detection of clinically significant prostate cancer (csPCa) remains a major challenge in urologic oncology. Although prostate-specific antigen (PSA) screening and systematic transrectal ultrasound- guided biopsy has historically been the main diagnostic approaches, these strategies are associated with both overdiagnosis of indolent disease and underdetection of clinically significant tumors. Recent advances in imaging technologies-including multiparametric magnetic resonance imaging (mpMRI), high-resolution micro-ultrasound (MUS), and prostate-specific membrane antigen positron emission tomography (PSMA PET)-have significantly improved the diagnostic pathway for prostate cancer. In parallel, artificial intelligence (AI)-based algorithms have emerged as promising tools for enhancing image interpretation and reducing diagnostic variability. This review aims to summarize current evidence regarding the diagnostic performance of micro- ultrasound, mpMRI, and PSMA PET in prostate cancer detection and to explore the potential role of artificial intelligence in integrating these imaging modalities to improve diagnostic accuracy. A systematic literature search was performed using PubMed and MEDLINE databases for articles published between January 2013 and December 2024. The following search strategy was employed using combinations of MeSH terms and keywords: ('prostate cancer' OR 'prostate neoplasm' OR 'prostatic carcinoma') AND ('micro-ultrasound' OR 'high-resolution micro-ultrasound' OR 'micro-US' OR 'PRI-MUS' OR 'ExactVu') OR ('multiparametric MRI' OR 'mpMRI' OR 'multi-parametric magnetic resonance imaging' OR 'PI-RADS') OR ('PSMA PET' OR 'prostate-specific membrane antigen' OR '68Ga-PSMA' OR '18F-DCFPyL' OR 'PSMA-11') OR ('artificial intelligence' OR 'machine learning' OR 'deep learning' OR 'radiomics' OR 'neural network'). Only English-language, peer-reviewed original research articles, systematic reviews, meta-analyses, and major consensus guidelines were included. Case reports, editorials, conference abstracts, and non-peer-reviewed publications were excluded. Two authors (A.R. and O.Z.) independently screened titles and abstracts for relevance. Full texts of potentially eligible articles were retrieved and assessed against predefined inclusion criteria: (1) evaluation of mpMRI, micro-ultrasound, or PSMA PET for prostate cancer detection, localization, or staging; (2) reported diagnostic accuracy metrics (sensitivity, specificity, AUC) or biopsy outcomes; (3) sample size ≥20 patients for original studies. Disagreements were resolved by consensus with a third author (M.B.). Reference lists of included articles were hand-searched for additional relevant studies. A narrative synthesis was conducted due to heterogeneity in study designs, populations, and outcome measures. Multiparametric MRI has become a cornerstone in prostate cancer diagnosis due to its high sensitivity for detecting clinically significant diseases and its role in guiding targeted biopsies. Micro-ultrasound, offering substantially higher spatial resolution than conventional ultrasound, has demonstrated promising diagnostic performance and may represent a cost-effective alternative or complement to in review mpMRI. Meanwhile, PSMA PET imaging has shown high sensitivity for identifying both intraprostatic lesions and metastatic disease. Emerging evidence suggests that combining these imaging modalities may significantly enhance detection rates. Furthermore, artificial intelligence techniques-including machine learning and deep learning algorithms-have shown potential in improving lesion detection, segmentation, and risk stratification in prostate imaging. The integration of multimodal imaging approaches with artificial intelligence represents a promising investigational strategy that may, following prospective validation, improve prostate cancer detection and characterization. Future prospective studies are needed to validate these technologies and define their optimal role in clinical practice.
With the rapid development of molecular biotechnology and in-depth exploration of bladder cancer (BC) oncogenic mechanisms, targeted therapy has emerged as a pivotal treatment modality for BC patients. This study employed bibliometric methods to analyze the research status and development trends of targeted therapy in BC both domestically and internationally, aiming to identify research hotspots and provide a reference for research layout in this area. A systematic search was conducted across renowned international and domestic databases, including Web of Science Core Collection (WoSCC), PubMed, Wanfang Database, and the Chinese National Knowledge Infrastructure (CNKI). The search period was limited to 1994-2024, with search terms including "bladder cancer", "targeted therapy", and their related derivatives. After screening, 912 English publications and 328 Chinese publications were included. WPS Excel (v12.1.0) was used to visualize trends in annual publication volume, and CiteSpace (v6.3.R1) was employed for a visual analysis of countries/regions, institutions, authors, journals, cited articles, and keywords related to the included publications. In the field of targeted therapy in BC, the annual publication volume has generally shown an upward trend over the past three decades for both English and Chinese publications, with a faster growth rate observed in English publications. For English publications, the most productive countries/regions, institutions, authors, and journals were the USA, University of Texas System, Dinney CPN, and Urologic Oncology-Seminars and Original Investigations, respectively. The most cited article was "Comprehensive Molecular Characterization of Urothelial Bladder Carcinoma" published in Nature. A cluster analysis of keywords revealed research hotspots such as "phase-ii trial", "cell line", and "EGF receptor". For Chinese publications, the most productive institutions, authors, and journals were the Second Hospital of Jilin University, Wang JS, and Chinese Journal of Urology, respectively. The most cited article was "Advances in the Treatment of High-Risk Non-Muscle-Invasive Bladder Cancer" published in Shandong Medical Journal. The cluster analysis of keywords identified research hotspots including "migration", "cell proliferation", and "drug resistance". Currently, Europe and America dominate the field of targeted therapy in BC. China can leverage its advantage in terms of patient population size to strengthen domestic and international collaborations, thereby enhancing its research influence in this field. Global research hotspots reveal the translational process of targeted therapy in BC from bench to bedside. Future research in this field will focus on drug management of targeted therapy for metastatic BC and overcoming drug resistance to targeted therapy.
Patient-reported outcome measures are increasingly used to assess symptoms, treatment tolerance, and quality of life (QoL) in oncology. Electronic patient-reported outcome measures (ePROM) offer advantages over paper questionnaires, but large-scale evidence using smartphone text messaging in clinical trials is limited. To evaluate the feasibility of collecting ePROM via smartphone text messages in a large-scale, multinational randomized controlled trial of patients receiving Bacillus Calmette-Guérin therapy for non-muscle-invasive bladder cancer. This methodological study was embedded in the North-REG Dwell Time study. During each instillation week, participants received a daily text message linking to a questionnaire assessing side effects. Four additional QoL questionnaires were distributed during the 1-year study period. Non-responders received 2 automated reminders. Patients were randomized into an intervention and control group that differed only in dwell time. All responses were transferred directly into a trial database. Feasibility was assessed by calculating overall response rates and separate response rates for daily side-effect and QoL questionnaires. Between February 2021 and November 2024, 242 participants were enrolled and 225 received at least one instillation. A total of 24,286 text messages were sent, corresponding to 15,485 initially activated questionnaires. The overall response rate was 95%. Response rates were 95% for daily side-effect questionnaires and 87% for QoL questionnaires. No significant differences were found between the intervention and control groups, regarding response rates. Smartphone text messaging is highly feasible for collecting ePROM in a multinational bladder cancer trial, yielding excellent response rates and enabling near real-time symptom monitoring with minimal recall bias.
Urothelial carcinoma (UC) is a significant global health challenge with heterogeneous clinical presentations from nonmuscle-invasive to metastatic disease. Circulating tumor DNA (ctDNA) has emerged as promising noninvasive biomarker for risk classification, treatment monitoring and recurrence detection. Systematic searches of PubMed identified 390 articles; 61 met inclusion criteria for plasma ctDNA analysis in UC. Independent dual screening, Joanna Briggs Institute assessment, and stratification by disease stage (nonmuscle-invasive bladder cancer [NMIBC], muscle-invasive bladder cancer [MIBC], metastatic urothelial carcinoma [mUC], and upper tract urothelial carcinoma [UTUC]) were performed. Simple pooled detection rates were calculated. ctDNA detection rates increased with disease advancement: NMIBC (53.2%), MIBC (47.6%), mUC (85.9%), and UTUC (50.5%). TERT promoter mutations predominated, followed by genomic alterations in TP53. Assays varied widely across studies with next-generation sequencing (22.4%) being most common. In NMIBC, ctDNA enabled risk stratification and recurrence detection. In MIBC, IMvigor010 demonstrated patients with positive ctDNA had worse overall survival (OS) (hazard ratio, 6.3); IMvigor011 showed that patients with negative ctDNA managed without adjuvant therapy had excellent outcomes (98% OS at 18 months). Post-surgical monitoring achieved 94%-100% sensitivity for recurrence with 96- to 131-day lead times. In mUC, KEYNOTE-361 showed ctDNA reductions at 6 weeks predicted improved OS (p < 10-4), whereas fibroblast growth factor receptor 3 mutations tracked resistance. Preoperative ctDNA fraction >2% in UTUC predicted worse OS (p < 10-3). ctDNA is a critical precision oncology tool in UC management, with TERT mutations as the predominant alteration. Stage-tailored strategies are emerging, including risk assessment in NMIBC, refining adjuvant decisions in MIBC, and treatment monitoring in mUC. Integration of ctDNA-guided approaches should proceed alongside prospective validation to ensure safe and effective adoption.
Clinical studies in muscle-invasive bladder cancer (MIBC) often enroll younger and fitter patients than those treated in routine practice, limiting generalizability. We developed a simple eligibility gap (EG) score to quantify baseline eligibility differences between clinical studies and real-world cohorts. Eight clinical studies and eight real-world datasets were analyzed. The EG score was based on three commonly reported determinants: age, Eastern Cooperative Oncology Group performance status (ECOG PS), and cisplatin eligibility, each scaled from 0 to 33.3 points (total range: 0-99.9). Higher scores indicate younger, fitter, and more cisplatin-eligible populations. Known-groups validity was assessed by comparing EG scores across prespecified study categories expected to differ in eligibility selectivity. Sensitivity analyses using alternative fixed weighting schemes and random-weight simulations were performed to examine score robustness. Baseline characteristics differed between clinical studies and real-world cohorts. Trial populations were generally younger, had better ECOG PS, and showed higher cisplatin eligibility than real-world cohorts. EG scores followed the expected ordering across prespecified study categories, with the highest values in cisplatin-fit trials (86), intermediate values in real-world cohorts (66), and the lowest values in cisplatin-unfit/refusal trials (44), consistent with known-groups validity. Domain-specific analyses showed larger differences in age and cisplatin eligibility than in ECOG PS. Across alternative weighting scenarios, rank correlations with the equal-weight model remained high (ρ = 0.976-0.994), and the expected category-level ordering was preserved. The EG score describes eligibility differences between clinical studies and real-world MIBC populations and may aid interpretation of trial evidence across heterogeneous populations.
While several environmental carcinogens are well-established in the development of bladder and kidney cancer, the role of microplastic exposure remains poorly understood. Micro- and nanoplastics (MNPs), often released during plastics manufacturing and recycling, are emerging pollutants that may carry carcinogenic additives or act as chemical vectors in air and water. Ohio-a major hub for plastics production-has experienced rising rates of bladder and kidney cancer, prompting an investigation into the spatial relationship between cancer incidence and exposure to plastics-processing waste. We conducted a geospatial epidemiological study using data from the Ohio Cancer Incidence Surveillance System (OCISS) from 2013 to 2021, alongside environmental exposure estimates derived from the Environmental Protection Agency (EPA's) Toxics Release Inventory (TRI) and Risk-Screening Environmental Indicators (RSEI) model. Chemicals were categorized into adjusted plastics-processing waste (APPW), known bladder and kidney carcinogens, and combined exposures. Incidence and exposure data were analyzed at the ZIP Code Tabulation Area (ZCTA) level using spatial statistics (Moran's I, bivariate Moran's I, and Mantel tests), local cluster detection, and spatial regression. Between 2013 and 2021, both bladder and kidney cancer incidence increased across Ohio, with notable geographic clustering of cases. Spatial analysis demonstrated that regions with higher environmental exposure to chemicals used in plastics-processing, particularly via air, had significantly higher rates of both cancers. Airborne bladder carcinogens showed the strongest spatial association with cancer incidence (bivariate Moran's I = 0.0510, P = 0.004; Mantel P < 0.001), followed by airborne microplastics (bivariate Moran's I = 0.0589, P = 0.007). Waterborne microplastics, while not spatially clustered on their own, were significantly associated with higher bladder and kidney cancer rates (kidney: bivariate Moran's I = 0.0940, P = 0.001). When combining all plastics-related exposures, spatial relationships remained robust, suggesting a cumulative effect. These patterns were most prominent in industrial ZIP codes, particularly in northern and southwestern Ohio. Our findings reveal significant spatial associations between plastics-related industrial emissions and both bladder and kidney cancer incidence in Ohio. These patterns suggest an environmental component to urologic cancer risk, with airborne exposures showing the strongest spatial alignment. The results warrant deeper mechanistic studies and targeted epidemiological investigations in high-exposure communities to further assess causality and inform public health interventions.
Reported outcomes of partial nephrectomy (PN) for cT2 renal cell carcinoma (RCC) have been variable. We aimed to examine outcomes of PN, compared to radical nephrectomy (RN) for cT2 RCC. Patients captured in the Canadian Kidney Cancer information system who underwent surgery for cT2 RCC between 2011 and 2023 were included. Clear cell, papillary, and chromophobe histologies were included. Multifocal tumors, and hereditary RCC syndromes were excluded. Groups were matched up to 1:4 based on tumor size, histology, grade and necrosis. Of 1778 cT2 patients, 60 PN patients were matched to 224 RN patients. Positive surgical margins were 8.6% for PN vs. 2.8% for RN (P = 0.06). Postoperative complications were 18.3% for PN vs. 9.8% for RN (P = 0.07). Pathological upstaging to T3 was similar (21.7% PN vs. 22.3% RN, P = 0.73). There were no statistically significant recurrence or survival outcomes, however there were non-significant trends in local recurrence (HR 2.07, 95%CI 0.86-5.0), cancer specific survival (HR 0.65, 95%CI 0.19-2.16), overall survival (HR 0.66, 95%CI 0.28-1.57) for PN vs. RN. PN better preserved eGFR (-15.5 [IQR 27.7] vs. -24.4 [IQR 21.5], P = 0.026). In a cohort of patients with non-metastatic cT2 RCC, PN has better preservation of renal function and may have a higher rate of perioperative complications and local recurrence. Acknowledging the presence of residual confounding, PN for T2 RCC is safe and provides acceptable oncological outcomes in well-selected patients.
Germ cell tumors (GCTs) are highly curable, yet a subset of patients with metastatic disease experience early death (ED) soon after starting first-line chemotherapy. These patients are underrepresented in trials, and risk factors remain unclear. We performed a retrospective multicenter cohort study including adults ( ≥ 18 years) with metastatic GCT who died within 3 months of completing their last cycle of first-line chemotherapy. Primary outcomes were cause and timing of death; secondary endpoints included clinical predictors of acute respiratory failure (ARF) and very early death ( ≤ 30 days). Among 102 patients (1.7% of treated cases), 69.6% had non-seminoma, 83.3% testicular primaries, and 67.6% poor-risk disease. Median time to death was 28 days (range, 2-179). Leading causes were ARF (34.1%), disease progression (16.7%), septic shock (15.7%), hemorrhage (12.7%), and cardiovascular events (4.0%). ARF correlated with > 50% lung involvement, dyspnoea, and haemoptysis, but not choriocarcinoma histology or bleomycin use. Mostly, ED (51%) was associated with liver metastases, massive lung involvement, β-hCG > 50,000 mIU/mL, ECOG 2-3, elevated neutrophil/lymphocyte ratio, and need for intensive care (all P < 0.05). Early death in metastatic GCT, though rare, remains a critical clinical issue. Early identification, adapted induction regimens, and optimized supportive care may help prevent avoidable mortality.
Accurate detection and local staging of prostate cancer (PCa) remain critical for treatment planning, yet head-to-head multimodal imaging comparisons remain limited. This study compared microultrasound (microUS), multiparametric magnetic resonance imaging (mpMRI), and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) for detecting clinically significant PCa (csPCa) and extraprostatic extension (EPE), using whole-mount histopathology (WMHP) as the reference standard. This retrospective study included patients who underwent microUS and mpMRI followed by radical prostatectomy between January 2023 and October 2024. A subset also underwent PSMA PET/CT. Detection of csPCa and EPE was assessed at the lesion and sector levels using WMHP as a reference. Detection rates and positive predictive values (PPVs) were compared using McNemar and chi-square tests, while sector-level area under the receiver operating characteristic curves (AUCs) were compared using the DeLong test. No statistically significant differences were observed between microUS and mpMRI or PSMA PET/CT for index lesion detection (0.90, 0.94, and 0.93, respectively) or csPCa detection (0.71, 0.78, and 0.72, respectively), although the study may have been underpowered to detect small differences. mpMRI had higher PPVs for csPCa than microUS (0.91 vs 0.77, p = 0.03). mpMRI achieved the highest sector-level AUCs for csPCa (0.73) and EPE (0.88). Across modalities, 15-18% of csPCa lesions were missed, which were non-index Grade Group 2 with Gleason pattern 4 ≤20%. The study is limited by its single-center retrospective design. MicroUS showed no statistically significant differences compared with mpMRI and PSMA PET/CT for detecting index and csPCa lesions, supporting a potential complementary role in resource-limited or MRI-contraindicated settings.
This mini-review synthesizes evidence from recent studies to provide an updated perspective on current applications, methodological challenges, and future directions for artificial intelligence (AI) in multiparametric magnetic resonance imaging (mpMRI) based prostate cancer (CaP) imaging. CaP remains the most frequently diagnosed noncutaneous malignancy among men worldwide and a leading cause of cancer-related mortality. mpMRI has become the reference imaging modality for detection, localization, and risk stratification, with the Prostate Imaging-Reporting and Data System (PI-RADS) improving standardization. However, inter-reader variability and the time-intensive nature of mpMRI interpretation persist, even among expert radiologists. AI, encompassing machine learning (ML) and deep learning (DL) methods, offers the potential to enhance CaP imaging by improving accuracy, consistency, and efficiency. Applications include automated lesion detection and segmentation, PI-RADS scoring standardization, and radiomics-based risk prediction. Radiomics enables the extraction of high-dimensional quantitative features from mpMRI, which, when integrated with clinical or genomic data, can improve predictive modeling for clinically significant CaP, extracapsular extension, and lymph node metastasis. Despite rapid advancements, challenges remain in data heterogeneity, generalizability, lack of standardized feature extraction, and limited external validation. The "black-box" nature of many DL models also complicates clinical trust and regulatory approval. Future directions include the integration of explainable AI, federated learning for privacy-preserving multi-institutional training, and real-time AI assistance during targeted biopsies or active surveillance.
Aggressive-variant prostate cancers (AVPCs) respond poorly to anti-androgen therapy but show sensitivity to taxane-platinum chemotherapy, though outcomes remain poor. We conducted a phase 2 trial testing induction cabazitaxel plus carboplatin (CabCarb) followed by olaparib maintenance versus observation in men with AVPC. The primary endpoint of improved progression-free survival (PFS) was not met, likely due to the study being underpowered after 38.5% of patients experienced early progression (ChemoPD) prior to randomization. No genomic alterations predicted ChemoPD; however, transcriptomic analysis revealed the enrichment of metabolic pathways, including arginine metabolism, in ChemoPD tumors. These findings were supported by metabolomics data from preclinical models. In AVPC models, arginine depletion with ADI-PEG20 enhanced CabCarb efficacy in vitro and in vivo. Together, these results provide insight into the heterogeneity of AVPCs and establish a rationale for novel combination treatment strategies to overcome chemotherapy resistance.