Urological Clinical Practice Research Articles

Testing Similarity of Parametric Competing Risks Models for Identifying Potentially Similar Pathways in Healthcare.

The identification of similar patient pathways is a crucial task in healthcare analytics. A flexible tool to address this issue are parametric competing risks models, where transition intensities may be specified by a variety of parametric distributions, thus in particular being possibly time-dependent. We assess the similarity between two such models by examining the transitions between different health states. This research introduces a method to measure the maximum differences in transition intensities over time, leading to the development of a test procedure for assessing similarity. We propose a parametric bootstrap approach for this purpose and provide a proof to confirm the validity of this procedure. The performance of our proposed method is evaluated through a simulation study, considering a range of sample sizes, differing amounts of censoring, and various thresholds for similarity. Finally, we demonstrate the practical application of our approach with a case study from urological clinical routine practice, which inspired this research.

Extracellular vesicles as novel uro-oncology biomarkers: insights toward clinical applications.

We discussed the challenges associated with the clinical application of extracellular vesicles and summarized their potential impact on oncological clinical practice in urology. Despite extensive research on extracellular vesicles, their clinical applications remain limited; this is likely to be because of small study cohorts, a lack of large-scale analyses, and the impact of variable extraction and storage methods on analysis outcomes. However, promising results have emerged from clinical trials targeting urinary extracellular vesicles in prostate cancer using ExoDx Prostate Test. The ExoDx Prostate Test has demonstrated its efficacy in diagnosing prostate cancer in previous studies and is the only FDA-approved kit for this purpose. Moreover, recent trials have investigated the use of the ExoDx Prostate Test to determine the optimal timing for biopsies in prostate cancer patients undergoing active surveillance. We summarized recent studies on the potential of extracellular vesicles in the management of urological cancers. Particularly, the diagnosis of prostate cancer using the ExoDx Prostate Test has yielded positive results in several clinical trials. Additionally, while there are other studies suggesting its efficacy, most of these are based on retrospective analyses. These findings warrant further large-scale studies to optimize extracellular vesicle-based diagnostic and monitoring strategies. Although further research is required, extracellular vesicles would be attractive for early detection and surveillance.

Abstract 815: Leveraging clinical workflow for rapid integration of social needs assessment in a urologic oncology clinical practice

Abstract Introduction: Social determinants of health and resulting social needs are known to impact cancer care, yet characterization of social needs within a specific clinic’s population remains in its infancy. We aim to characterize early findings from social needs screening in patients seen in a tertiary urologic oncology clinic. Methods: Screening was conducted using survey questions about specific domains of social needs (e.g., financial strain, unmet transportation needs, and food insecurity) that were integrated into new patient and annual follow-up questionnaires for all patients seen within a urologic oncology faculty clinic, starting in January 2023. Screening items were rapidly implemented into workflow by taking advantage of existing processes. Clinical and demographic data and screening responses were abstracted from the electronic medical record. Summary statistics were calculated. P value<0.05 was deemed statistically significant. Results: A total of 2305 patients were included (4% Non-Hispanic Black, 11% Asian American, 8% Latinx, and 63% Non-Hispanic White). Responses increased from 30 in January to 399 in October. Respondent mean age was 67 years [standard deviation (SD) 12.3] with 87.8% identifying as male. Roughly 13% screened positive for at least one social need (one positive 8.1%, two positive 3.4%, three positive 1.2%) with variations by domain [transportation 3.6%, food insecurity 5.4%, 10.2%] and race and ethnicity (Figure 1, p<0.001 for all). Conclusions: By leveraging the existing clinical workflow, rapid uptake of social needs screening demonstrates variations by social needs domains and race and ethnicity within a urologic oncology patient population. These efforts represent institutional action towards characterizing the burdens faced by our patient population and inform the design of interventions to address social needs within the catchment area, to improve clinical care and clinical trial participation. Citation Format: Samuel L. Washington, Kim F. Rhoads, Peter R. Carroll, Salma Shariff-Marco, June M. Chan. Leveraging clinical workflow for rapid integration of social needs assessment in a urologic oncology clinical practice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 815.

Emerging Use of Social Media in Clinical Urology Practice in the 21st Century: A Survey Study (Preprint)

Emerging Use of Social Media in Clinical Urology Practice in the 21st Century: A Survey Study (Preprint)

How to Integrate Prostate Cancer Biomarkers in Urology Clinical Practice: An Update.

Nowadays, the management of prostate cancer has become more and more challenging due to the increasing number of available treatment options, therapeutic agents, and our understanding of its carcinogenesis and disease progression. Moreover, currently available risk stratification systems used to facilitate clinical decision-making have limitations, particularly in providing a personalized and patient-centered management strategy. Although prognosis and prostate cancer-specific survival have improved in recent years, the heterogenous behavior of the disease among patients included in the same risk prognostic group negatively impacts not only our clinical decision-making but also oncological outcomes, irrespective of the treatment strategy. Several biomarkers, along with available tests, have been developed to help clinicians in difficult decision-making scenarios and guide management strategies. In this review article, we focus on the scientific evidence that supports the clinical use of several biomarkers considered by professional urological societies (and included in uro-oncological guidelines) in the diagnosis process and specific difficult management strategies for clinically localized or advanced prostate cancer.

Bioinformatics in urology - molecular characterization of pathophysiology and response to treatment.

The application of bioinformatics has revolutionized the practice of medicine in the past 20 years. From early studies that uncovered subtypes of cancer to broad efforts spearheaded by the Cancer Genome Atlas initiative, the use of bioinformatics strategies to analyse high-dimensional data has provided unprecedented insights into the molecular basis of disease. In addition to the identification of disease subtypes - which enables risk stratification - informatics analysis has facilitated the identification of novel risk factors and drivers of disease, biomarkers of progression and treatment response, as well as possibilities for drug repurposing or repositioning; moreover, bioinformatics has guided research towards precision and personalized medicine. Implementation of specific computational approaches such as artificial intelligence, machine learning and molecular subtyping has yet to become widespread in urology clinical practice for reasons of cost, disruption of clinical workflow and need for prospective validation of informatics approaches in independent patient cohorts. Solving these challenges might accelerate routine integration of bioinformatics into clinical settings.

Development of a predictive model for optimizing the selection of patients for second transurethral resection bladder

Background: Transurethral resection of bladder (TURB) is considered the gold standard treatment of non-muscle invasive bladder tumor (NMIBT). The urological clinical practice guidelines recommend second-TURB (re-TURB), in certain situations, to achieve a complete resection and appropriately stratify the tumor. Objective: To design a predictive model of residual tumor in re-TURB, to optimize patient selection and avoid unnecessary surgeries. Methods: Retrospective analysis of 413 NMIBT with a macroscopically complete TURB and identification of the muscle layer, with subsequent re-TURB (2-6 weeks), according to EAU Clinical Guidelines criteria, from January 2010 to December 2021. We have identified predictive variables of residual tumor through univariate and multivariate analysis using logistic regression. The evaluation of the exactitude of the predictive model has been made using AUC (area under curve-ROC curve). Results: Median age in the series was 74 (38-91) years old, and 86.7% were male. Tumors that required second-TURB were mostly primary (64.6%), stage T1 (84.5%), high grade (82.6%), multifocal (54.8%) and with a size less than 3 cm (73.1%). Residual tumor was found in 28.1% of re-TURB. The independent predictors factors of residual tumor identified were: recurrence tumor (OR 1.87; IQ 1.14-3.06, p=0.01) and multifocality tumors (OR 2.11; IQ 1.31-3.4; p=0.002). High-grade shows a trend to statistical signification as risk factor (p=0.07) and early administration of mitomycin-C behaved as an independent protector factor (OR 0.40; IQ 0.3-0.81; p=0.006). The predictive model shows an AUC=0.7 (IQ 0.62-0.73; p=0.0001). Conclusion: Our predictive model evaluates the probability of finding residual tumor in second-TURB with a 70% accuracy. This way, we could optimize the selection of patients in low risk of residual tumor, thus avoiding unnecessary surgeries.

TULA DUAL: Trans Urethral Laser Ablation of recurrent bladder tumors in outpatient setting

To the Editor, Bladder cancer (BCa) is the second most common cancer in urological clinical practice, after prostate adenocarcinoma. Usually occurs in patients between 60 and 70 years old, three times more frequently in men than women. About 75% of bladder cancer are pTa or pT1, even more frequently considering a population younger than 40 years old. Early detection is of paramount importance since allows to find tumors when they are still superficial and therefore with a better prognosis.

Creating an Inclusive Urology Practice.

Patients seeking urologic care come from diverse backgrounds. Therefore, clinics should strive for inclusivity to make all patients feel comfortable seeing a urologist. This review aims to outline and analyze literature relevant to the care of LGTBQIA+ (lesbian, gay, transgender/transexual, queer/questioning, intersex, asexual/allies, nonbinary/genderqueer +), racial and ethnic minorities, those who have disabilities, and those with a high body mass index (BMI). Although this review article presents the care of diverse communities separately, there is an overlap of the various social axes influencing healthcare outcomes. Healthcare workers should be open-minded to learning about evolving community needs. Creating a safe space for LGTBQIA+ requires understanding terminology, awareness of community-specific challenges and health risks, and changing heteronormative behaviors built into medicine. Specific clinical care delivery structural processes and patient-physician-centered practices can make a clinic welcoming for patients from underrepresented backgrounds and with disabilities. BMI surgical requirements may pose barriers to care, and if implemented, there should be assistance to reach specified weight goals. Creating an inclusive urology clinical practice takes time, but it can be achieved by building a collaborative team. Treating patients with consideration of their personal identities and social determinants of health will lead to better patient-center care and health outcomes.

Deep Learning-Based Screening of Urothelial Carcinoma in Whole Slide Images of Liquid-Based Cytology Urine Specimens.

Urinary cytology is a useful, essential diagnostic method in routine urological clinical practice. Liquid-based cytology (LBC) for urothelial carcinoma screening is commonly used in the routine clinical cytodiagnosis because of its high cellular yields. Since conventional screening processes by cytoscreeners and cytopathologists using microscopes is limited in terms of human resources, it is important to integrate new deep learning methods that can automatically and rapidly diagnose a large amount of specimens without delay. The goal of this study was to investigate the use of deep learning models for the classification of urine LBC whole-slide images (WSIs) into neoplastic and non-neoplastic (negative). We trained deep learning models using 786 WSIs by transfer learning, fully supervised, and weakly supervised learning approaches. We evaluated the trained models on two test sets, one of which was representative of the clinical distribution of neoplastic cases, with a combined total of 750 WSIs, achieving an area under the curve for diagnosis in the range of 0.984-0.990 by the best model, demonstrating the promising potential use of our model for aiding urine cytodiagnostic processes.

Telemedicine use in current urologic oncology clinical practice.

In the last fifteen years, there have been important technological advances in telehealth systems and urology, along with other specialties, has been a pioneer in the successful use of this medical care modality. Due to the COVID-19 pandemic, the use of telemedicine has been rapidly embraced by the urology community around the world. A review of the most relevant and updated articles on telemedicine and telehealth in urology has been carried out with the aim of better understanding how it has been implemented to date, as well as reviewing concepts, current regulations, health policies and recommendations for its implementation. A narrative review of the current literature published up to April 2022 on the use of telemedicine in urology was performed. From the search results, 42 publications were obtained for analysis. Telemedicine in urology has been shown to be useful in a variety of clinical scenarios within urological practice, from benign diseases to advanced cancers. This is due to the positive impact on medical consultation times, lower patient mobility costs, less work absenteeism and greater protection for both the patient and the doctor. The main limitations for the use of telemedicine lie in the impossibility of a correct physical examination, which is essential in certain situations, as well as the lack of accessibility to technology in disadvantaged populations and in elderly patients who have not adapted to the use of technology, as well as the lack of development of health policies to establish their implementation in some countries. Telemedicine is in full growth. There is much information in the current literature on the successful adoption of telemedicine for patients suffering from urological diseases. While the use and implementation of these new practices has been rapid in the urology community, more work is needed to bring more accessible specialty care to underserved and underdeveloped areas. Health policies must promote its development to reduce costs and increase access.

Ectopic ACTH syndrome complicated by hypercortisolism-associated urolithiasis. A case report.

We present an elusive case of an ectopic Cushing's syndrome mimicking an autoimmune syndrome induced by adjuvants (ASIA), complicated by rapidly progressive urolithiasis. A 30-year-old female with recent breast augmentation presented for easy bruising, night sweats, nocturia, fatigue, and weight gain. After fulfilling diagnostic criteria for ASIA, she underwent explantation, nonetheless, the patient worsened. Workup revealed an ACTH-dependent Cushing's syndrome with a neuroendocrine tumor in the right lung, confirmed by immunostaining after VAT-FNA. Management was complicated by urolithiasis and COVID-19 infection. She was rendered stone-free and subsequently underwent open lobectomy and mediastinal lymphadenectomy. Pathology confirmed an atypical ACTH-secreting pulmonary carcinoid tumor. She received radiotherapy and was free of recurrence at follow-up. • Nephrolithiasis is a frequent and underestimated complication of Cushing’s syndrome (CS), prevalence soars up to 50 % in adult patients with active CS, and 25% in cured patients in whom certain abnormalities contribute to stone recurrence • Ectopic ACTH secretion (EAS) is a less common cause of Cushing syndrome and is seen in 5 to 10% of cases with endogenous hypercortisolemia. Sudden and dramatic onset of CS often suggests an ectopic ACTH-secreting tumor. • There is no information in any urological clinical practice guideline in relation to management of nephrolithiasis in Cushing’s syndrome, follow-up in glucocorticoid-induced nephrolithiasis should be tailored to each patient.

MP16-11 VALIDATION OF A SINGLE ITEM SCREENING MEASURE OF UROLOGIC PATIENT FINANCIAL DISTRESS

You have accessJournal of UrologyCME1 May 2022MP16-11 VALIDATION OF A SINGLE ITEM SCREENING MEASURE OF UROLOGIC PATIENT FINANCIAL DISTRESS Daniel Au, Jared Starkey, Jessica Hamilton, Jeffery Thompson, and William Parker Daniel AuDaniel Au More articles by this author , Jared StarkeyJared Starkey More articles by this author , Jessica HamiltonJessica Hamilton More articles by this author , Jeffery ThompsonJeffery Thompson More articles by this author , and William ParkerWilliam Parker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002549.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Financial toxicity is an area of increasing focus in healthcare generally and within urologic practice. Patients with financial toxicity are more likely to forgo or delay care with negative clinical consequences. There is little guidance on how to identify patients with financial distress. The COmprehensive Score for financial Toxicity (COST) is a previously validated 12 item measure of healthcare associated financial toxicity. COST is scored from 0 to 44 with lower scores equaling worse financial toxicity. Given questionnaire burden and visit time limitations, multi-item surveys are difficult to utilize. This study aimed to validate a single item screening measure of financial toxicity among a cross section of urology patients. METHODS: All patients completing robotic assisted prostatectomy, transurethral resection of bladder tumor, radical cystectomy, holmium laser enucleation of prostate, intravesical chemodenervation, ureteroscopy laser lithotripsy, and ureteral stent exchange at a single academic medical center during study period were offered enrollment. 182 patients enrolled, peri-op COST surveys were obtained with the following single item measure: “Please indicate the number that best describes how much financial stress you have been experiencing in the past week, including today, on a scale from 0 (no financial distress) to 10 (extreme financial distress).” Pearson’s correlation coefficient compared single item performance to COST. RESULTS: Pre-operatively 69.2% (126), 23.6% (43), and 7.1% (13) of patients had COST scores indicating no/mild, moderate (COST 14-25), and severe (COST ≤13) financial toxicity respectively. Post-operatively 72.5% (132), 22.5% (41), and 5.9% (9) of patients had COST scores of no/mild, moderate, and severe financial toxicity respectively. Single item measure strongly correlated with COST (r=-0.80, 95% CI -0.73,-0.84) pre-op (Figure 1) and post-op (r=-0.75, 95% CI -0.68,-0.81). A cut point of single item score ≥5 had a 77% sensitivity and 85% specificity for moderate to severe financial toxicity. CONCLUSIONS: There are inadequate clinical support tools to assess patients for financial toxicity. Presence and degree of financial toxicity is a clinically relevant metric. This single item measure is a sensitive and practical screening tool for urologic clinical practice. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e279 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Au More articles by this author Jared Starkey More articles by this author Jessica Hamilton More articles by this author Jeffery Thompson More articles by this author William Parker More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP43-02 LESSONS LEARNED IN APPLYING DEEP LEARNING TO FACILITATE PROSTATE MR-US FUSION BIOPSY WORKFLOW

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP43)1 Sep 2021MP43-02 LESSONS LEARNED IN APPLYING DEEP LEARNING TO FACILITATE PROSTATE MR-US FUSION BIOPSY WORKFLOW Simon John Christoph Soerensen, Richard E. Fan, Wei Shao, Indrani Bhattacharya, Arun Seetharaman, Michael Borre, Alan Thong, Katherine To’o, Mirabela Rusu, and Geoffrey A. Sonn Simon John Christoph SoerensenSimon John Christoph Soerensen More articles by this author , Richard E. FanRichard E. Fan More articles by this author , Wei ShaoWei Shao More articles by this author , Indrani BhattacharyaIndrani Bhattacharya More articles by this author , Arun SeetharamanArun Seetharaman More articles by this author , Michael BorreMichael Borre More articles by this author , Alan ThongAlan Thong More articles by this author , Katherine To’oKatherine To’o More articles by this author , Mirabela RusuMirabela Rusu More articles by this author , and Geoffrey A. SonnGeoffrey A. Sonn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002064.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Targeted biopsy improves prostate cancer diagnosis. Accurate prostate gland segmentation on MRI is critical for accurate biopsy. Manual gland segmentation performed by urologists or radiologists is tedious and time-consuming. To address this clinical problem, we sought to develop a deep learning model to rapidly and accurately segment the prostate on MRI and to implement it as part of routine MR-US fusion biopsy in the clinic. METHODS: 905 subjects underwent multiparametric MRI at 29 institutions, followed by MR-US fusion biopsy at one institution. A urologic oncology expert segmented the prostate on axial T2-weighted MRI scans for all cases. We trained a deep learning model, ProGNet, on 805 cases. We retrospectively tested ProGNet on 100 independent internal and 56 external cases. We then prospectively implemented ProGNet as part of the fusion biopsy workflow for 11 patients. We compared ProGNet performance to two deep learning networks (U-Net and HED) and radiology technicians. The Dice similarity coefficient (DSC) was used to measure overlap with expert segmentations. The DSC is widely used to evaluate overlap in segmentation tasks; its value ranges from 0 to 1. A DSC of 1 indicates perfect overlap between segmentations, while 0 indicates no overlap. DSCs were compared using paired t-tests. We are expanding our model's use to provide gland segmentations for all biopsy cases as an initial step in the fusion biopsy workflow. RESULTS: ProGNet (DSC=0.92) outperformed U-Net (DSC=0.85, p<0.0001), HED (DSC=0.80, p<0.0001), and radiology technicians (DSC=0.89, p<0.0001) in the retrospective internal test set. In the prospective cohort, ProGNet (DSC=0.93) outperformed radiology technicians (DSC=0.90, p<0.0001). ProGNet took just 35 seconds per case (vs. 10 minutes for radiology technicians) to yield a clinically utilizable segmentation file. Figure 1 illustrates the step-by-step segmentation workflow at our institution. CONCLUSIONS: This is the first study to employ a deep learning model for prostate gland segmentation for targeted biopsy in routine urologic clinical practice, while reporting results and releasing the code online. Prospective and retrospective evaluations revealed increased speed and accuracy. Source of Funding: This work was supported by Stanford University (Departments of Radiology and Urology) and by the generous philanthropic support of donors to the Urologic Cancer Innovation Laboratory © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e781-e781 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon John Christoph Soerensen More articles by this author Richard E. Fan More articles by this author Wei Shao More articles by this author Indrani Bhattacharya More articles by this author Arun Seetharaman More articles by this author Michael Borre More articles by this author Alan Thong More articles by this author Katherine To’o More articles by this author Mirabela Rusu More articles by this author Geoffrey A. Sonn More articles by this author Expand All Advertisement Loading ...

Deep Learning Improves Speed and Accuracy of Prostate Gland Segmentations on Magnetic Resonance Imaging for Targeted Biopsy.

Purpose:Targeted biopsy improves prostate cancer diagnosis. Accurate prostate segmentation on magnetic resonance imaging (MRI) is critical for accurate biopsy. Manual gland segmentation is tedious and time-consuming. We sought to develop a deep learning model to rapidly and accurately segment the prostate on MRI and to implement it as part of routine magnetic resonance-ultrasound fusion biopsy in the clinic.Materials and Methods:A total of 905 subjects underwent multiparametric MRI at 29 institutions, followed by magnetic resonance-ultrasound fusion biopsy at 1 institution. A urologic oncology expert segmented the prostate on axial T2-weighted MRI scans. We trained a deep learning model, ProGNet, on 805 cases. We retrospectively tested ProGNet on 100 independent internal and 56 external cases. We prospectively implemented ProGNet as part of the fusion biopsy procedure for 11 patients. We compared ProGNet performance to 2 deep learning networks (U-Net and holistically-nested edge detector) and radiology technicians. The Dice similarity coefficient (DSC) was used to measure overlap with expert segmentations. DSCs were compared using paired t-tests.Results:ProGNet (DSC=0.92) outperformed U-Net (DSC=0.85, p <0.0001), holistically-nested edge detector (DSC=0.80, p <0.0001), and radiology technicians (DSC=0.89, p <0.0001) in the retrospective internal test set. In the prospective cohort, ProGNet (DSC=0.93) outperformed radiology technicians (DSC=0.90, p <0.0001). ProGNet took just 35 seconds per case (vs 10 minutes for radiology technicians) to yield a clinically utilizable segmentation file.Conclusions:This is the first study to employ a deep learning model for prostate gland segmentation for targeted biopsy in routine urological clinical practice, while reporting results and releasing the code online. Prospective and retrospective evaluations revealed increased speed and accuracy.

The "COVID-19 Pandemic Gap" and Its Influence on Oncologic Outcomes of Bladder Cancer.

Simple SummaryThe COVID-19 pandemic has had a major impact on the entire healthcare system, resulting in severe restrictions of nonemergency clinical services, as well as in the clinical practice of uro-oncology. We performed a retrospective analysis to evaluate outcomes of the COVID-19 pandemic resulting from delayed diagnosis, staging, and treatment of bladder cancer. We showed that the COVID-19 pandemic led to a deferred oncological diagnosis and treatment of bladder cancer. More attention is required to avoid adverse outcomes, with increased rates of advanced and aggressive tumors in patients with primary bladder cancer. Moreover, timely treatment is compulsory in those patients.Coronavirus-19 (COVID-19)-induced effects on deferred diagnosis and treatment of bladder cancer (BC) patients are currently not clarified. The aim of this study was to evaluate outcomes of the COVID-19 pandemic by considering its effects on tumor stage and grade, and to create feasible clinical triage decisions. A retrospective single-center analysis of all patients who underwent diagnostic and surgical procedures due to BC, during January 2019 and December 2020, was performed. Due to COVID-19 lockdowns, significantly fewer (diagnostic and therapeutic) endoscopic procedures were performed in the first 6 months of 2020 compared to 2019 (p = 0.002). In patients with a primary diagnosis of BC, a significant increase of high-grade tumors (p < 0.001), as well as advanced tumor stages (p = 0.014), were noticed during 2020 in comparison to 2019. On the contrary, patients with recurrent BC undergoing risk-adapted surveillance, depending on previous tumor histology, showed no adverse outcomes regarding tumor stage and grade when comparing the pre COVID-19 era with 2020. Thus, more awareness in clinical urologic practice is mandatory to avoid adverse consequences, with increased rates of advanced and aggressive tumors in patients with primary BC. In recurrent BC, an individual risk stratification in order to avoid worse outcomes during the COVID-19 pandemic seems to be justified.

Immunotherapy in Bladder Cancer: Present and Future

Bladder cancer (BC) continues to be a challenge in current urologic clinical practice. It is the seventh most frequently diagnosed tumor in men worldwide, and the eleventh, if we include both men and women.&#x0D; The treatment of non-muscle-invasive bladder cancer has limitations, starting with the approach: transurethral resection is not always complete, there can be failures or early recurrence after bacillus Calmette-Guérin (BCG) therapy, and side effects of treatment with BCG can force its suspension.&#x0D; In cases of muscle-invasive bladder cancer (MIBC), radical cystectomy is not always a treatment option due to important perioperative comorbidity. In patients with metastatic bladder tumors, the side effects of conventional chemotherapy, as well as tumor progression, have resulted in the need for developing new therapies. &#x0D; Advances in the knowledge of oncologic molecular biology have provided us with new therapeutic targets (such as cell cycle inhibitors), and specific drugs directed at them have been developed, through the use of monoclonal antibodies. At present, five drugs have been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of metastatic MIBC: atezolizumab, nivolumab, and pembrolizumab stand out for their wider use in clinical practice.&#x0D; The good results obtained in metastatic bladder cancer have led to the development of new lines of research for the use of those molecules at earlier disease stages and in neoadjuvant protocols. Likewise, numerous studies are being conducted on the combination of those new agents with conventional chemotherapy and radiotherapy to determine more adequate treatment regimens.&#x0D; The present review article concisely describes the current state of immunotherapy in relation to bladder cancer.&#x0D;

Inmunoterapia en Cáncer Vesical. Presente y Futuro

El cáncer vesical (BC) continúa siendo un reto en la práctica clínica urológica actual. Es el séptimo tumor más frecuente diagnosticado en varones a nivel mundial y el 11º si tenemos en cuenta ambos sexos.&#x0D; Ya desde el abordaje del tumor vesical no músculo invasivo (NMIBC) existen limitaciones en el tratamiento: resección transuretral no siempre completa, fracasos o recidivas precoces tras el tratamiento con BCG así como efectos secundarios que obligan a la suspensión de la misma.&#x0D; En el tratamiento del tumor vesical músculo invasivo (MIBC) la cistectomía radical no es una opción para todos los pacientes debido a la importante comorbilidad perioperatoria. En los pacientes con tumores vesicales metastásicos, los efectos secundarios de la quimioterapia convencional, así como la progresión tumoral, ha suscitado una necesidad de desarrollar nuevas líneas terapéuticas.&#x0D; Los avances en el conocimiento de la biología molecular oncológica, han posibilitado encontrar nuevas dianas terapéuticas (como los inhibidores del ciclo celular) y mediante el empleo de anticuerpos monoclonales, desarrollar fármacos específicos dirigidos contra ellas. Actualmente hay cinco fármacos aprobados por la FDA y la EMA para el tratamiento en el cáncer vesical musculoinvasivo metastásico, entre los cuales destacan atezolizumab, nivolumab y pembrolizumab por su mayor implantación en la práctica clínica.&#x0D; Los buenos resultados obtenidos en el cáncer vesical metastásico, han provocado el desarrollo de nuevas líneas de investigación para el empleo de estas moléculas en estadíos más precoces de la enfermedad y en protocolos de neoadyuvancia. Así mismo, se están realizando múltiples estudios sobre la combinación de estos nuevos agentes con quimioterapia convencional y radioterapia para determinar los esquemas de tratamiento más adecuados.&#x0D; En este trabajo recogemos de manera sucinta el estado actual de la inmunoterapia en el cáncer vesical.

Financial conflicts of interest between pharmaceutical companies and the authors of urology clinical practice guidelines in Japan.

In Japan, the authors of urology clinical practice guidelines (UCPG) used in patient-centered care are often targeted by pharmaceutical companies with financial payments. However, the financial relationship between UCPG authors and pharmaceutical companies remains unclear. This study aimed to determine the characteristics of industry payments to physicians that may influence recommendations in UCPG and to assess the transparency of payment disclosure. We considered 193 UCPG authors receiving payments from 79 companies between 2016 and 2017 and the 13 UCPG published by the Japanese Urological Association between 2015 and 2018. We determined 2-year combined mean and median payments to authors, total company payments, and associations between author attributes and payment values using multivariate negative binomial regression. Also, we assessed the extent of the financial disclosure policies among the 13 UCPG. Overall, 171 (88.6%) authors received payments with a combined value of $6,169,333. Median and mean payments were $7147 (interquartile range, $1512-$44,807) and $31,965 (standard deviation, $51,684), respectively. University professors working on multiple UCPG with new drug approvals were associated with higher payments. Twelve (92.3%) UCPG failed to disclose financial conflicts. While it remains unclear whether financial entanglements improperly influence the contents of UCPG, most Japanese authors received substantial payments from pharmaceutical companies with little or no disclosure. Because insufficient transparency in disclosure of these financial entanglements may compromise the integrity of UCPG, more rigorous regulation and greater disclosure of financial conflicts of interest are needed.

Trends in urologic oncology clinical practice and medical education under COVID-19 pandemic: An international survey of senior clinical and academic urologists

Objective: Ad-hoc guidelines for managing the COVID-19 pandemic are published worldwide. We investigated international applications of such policies in the urologic-oncology community. Methods: A 20-item survey was e-mailed via SurveyMonkey to 100 international senior urologic-oncology surgeons. Leaders’ policies regarding clinical/surgical management and medical education were surveyed probing demographics, affiliations, urologic-oncologic areas of interest, and current transportation restrictions. Data on COVID-19 burden were retrieved from the ECDC. Statistical analyses employed non-parametric tests (SPSS v.25.0, IBM). Results: Of 100 leaders from 17 countries, 63 responded to our survey, with 58 (92%) reporting university and/or cancer-center affiliations. Policies on new-patient visits remained mostly unchanged, while follow-up visits for low-risk diseases were mostly postponed, for example, 83.3% for small renal mass (SRM). Radical prostatectomy was delayed in 76.2% of cases, while maintaining scheduled timing for radical cystectomy (71.7%). Delays were longer in Europe than in the Americas for kidney cancer (SRM follow-up, P = 0.014), prostate cancer (new visits, P = 0.003), and intravesical therapy for intermediate-risk bladder cancer (P = 0.043). In Europe, COVID-19 burden correlated with policy adaptation, for example, nephrectomy delays for T2 disease (r = 0.5, P =0.005). Regarding education policies, trainees’ medical education was mainly unchanged, whereas senior urologists' planned attendance at professional meetings dropped from 6 (IQR 1−11) to 2 (IQR 0−5) (P < 0.0001). Conclusion: Under COVID-19, senior urologic-oncology surgeons worldwide apply risk-stratified approaches to timing of clinical and surgical schedules. Policies regarding trainee education were not significantly affected. We suggest establishment of an international consortium to create a directive for coping with such future challenges to global healthcare.