Urology

Deep Learning Model Noninferior to Radiologists in Detecting Clinically Significant Prostate Cancer at MRI – Radiology

10 Aug, 2024 | 21:31h | UTC

Study Design and Population: This retrospective study evaluated the performance of a deep learning (DL) model for detecting clinically significant prostate cancer (csPCa) using multiparametric MRI (mpMRI) images from 5215 patients (5735 examinations) with a mean age of 66 years. The study included patients who underwent prostate MRI between January 2017 and December 2019 at a single academic institution. The DL model was trained on T2-weighted, diffusion-weighted, and contrast-enhanced MRI sequences, with pathologic diagnosis as the reference standard.

Main Findings: The DL model achieved an area under the receiver operating characteristic curve (AUC) of 0.89 on the internal test set and 0.86 on an external test set, demonstrating noninferiority to radiologists, who had AUCs of 0.89 and 0.84, respectively. Additionally, the combination of the DL model and radiologists improved diagnostic performance (AUC of 0.89). Gradient-weighted class activation maps (Grad-CAMs) effectively localized csPCa lesions, overlapping with true-positive cases in 92% of internal test set and 97% of external test set cases.

Implications for Practice: The DL model showed comparable performance to experienced radiologists in detecting csPCa at MRI, suggesting its potential to assist radiologists in improving diagnostic accuracy and reducing interobserver variability. Future research should focus on integrating the model into clinical workflows and assessing its impact on biopsy targeting.

Reference: Cai JC, Nakai H, Kuanar S, et al. (2024). Fully Automated Deep Learning Model to Detect Clinically Significant Prostate Cancer at MRI. Radiology, 312(2): e232635. DOI: https://doi.org/10.1148/radiol.232635.

RCT: Impact of single PSA screening invitation on 15-year prostate cancer mortality – JAMA

25 May, 2024 | 19:01h | UTC

Study Design and Population: This study is a secondary analysis of the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP), which focused on the long-term effects of prostate-specific antigen (PSA) screening on prostate cancer mortality. It involved 415,357 men aged 50 to 69 years from 573 primary care practices across England and Wales. Participants were randomized to either receive a single invitation for a PSA screening or to a control group receiving standard practice without invitation. The follow-up period concluded on March 31, 2021, after a median duration of 15 years.

Main Findings: The intervention group, which received one PSA screening invitation, showed a prostate cancer mortality rate of 0.69% compared to 0.78% in the control group, translating to a rate ratio of 0.92 and demonstrating a statistically significant but modest reduction in death from prostate cancer. Additionally, the screening led to increased detection rates of low-grade and localized prostate cancer. However, there were no significant differences in detection of more advanced cancer stages between the two groups. All-cause mortality rates were similar across both groups.

Implications for Practice: While the introduction of a single PSA screening invitation was associated with a slight decrease in prostate cancer mortality over 15 years, the absolute reduction was small. These findings suggest that while PSA screening can detect cancer earlier, its impact on long-term survival is limited and should be weighed against the potential for overdiagnosis and overtreatment. Future strategies in prostate cancer screening might need to focus more on risk stratification and personalized screening approaches to maximize benefits and minimize unnecessary interventions.

Reference (link to abstract – $ for full-text):

Martin RM et al. (2024). Prostate-Specific Antigen Screening and 15-Year Prostate Cancer Mortality: A Secondary Analysis of the CAP Randomized Clinical Trial. JAMA, 331(17), 1460-1470. DOI: 10.1001/jama.2024.4011

AUA/ASCO/SUO Updated guidelines for muscle-invasive urothelial bladder cancer

1 May, 2024 | 21:40h | UTC

The 2024 update to the muscle-invasive bladder cancer (MIBC) guidelines provides a risk-assessed framework for the treatment of this high-risk patient group, which constitutes about 25% of all bladder cancer diagnoses. These guidelines, revised through the AUA amendment process, integrate new research findings from May 2020 to November 2023, involving a rigorous review of 3739 abstracts and 46 full-text articles. Key updates include refined protocols for neoadjuvant and adjuvant chemotherapy, radical cystectomy, and multi-modal bladder-preserving therapies. Recommendations are categorized based on evidence strength, ranging from high to low, and are supplemented by clinical principles and expert opinions in areas lacking robust data. This structured approach aims to enhance clinical outcomes by updating practitioners on optimal management strategies and emphasizing the need for ongoing research to refine these recommendations.

Reference (link to free full-text):

Holzbeierlein et al. (2024). Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/SUO GUIDELINE (2017; Amended 2020, 2024). Journal of Urology. DOI: https://doi.org/10.1097/JU.0000000000003981

The Lancet Commission: Global projections and recommendations for managing the increasing burden of prostate cancer

27 Apr, 2024 | 18:42h | UTC

The Lancet Commission’s report on prostate cancer highlights the expected doubling of annual cases from 1.4 million in 2020 to 2.9 million by 2040, driven by demographic changes and increased life expectancy. This comprehensive analysis divides the issue into epidemiology, diagnostics, management of localized and advanced disease, emphasizing disparities between high-income countries (HICs) and low- and middle-income countries (LMICs). Key findings indicate that late diagnoses are common, particularly in LMICs, leading to worse outcomes. The Commission advocates for significant changes in the diagnostic pathways and increased use of current technologies tailored to available resources to improve outcomes. Education and awareness programs are recommended to facilitate early detection and shift the treatment paradigm from palliative to curative, focusing on surgery and radiotherapy. Without decisive action, the global mortality from prostate cancer is set to rise, highlighting the need for urgent interventions across all countries, with a special focus on underserved populations.

Reference:

James, N.D., Tannock, I., N’Dow, J., Feng, F., Gillessen, S., Ali, S.A., et al. (2024). The Lancet Commission on prostate cancer: planning for the surge in cases. The Lancet, 404(10052), 1-29. DOI: https://doi.org/10.1016/S0140-6736(24)00651-2.

Consensus Paper | Surgical video data use, structure, and exploration (for research in AI, quality improvement, and education)

9 Aug, 2023 | 15:20h | UTC

SAGES consensus recommendations on surgical video data use, structure, and exploration (for research in artificial intelligence, clinical quality improvement, and surgical education) – Surgical Endoscopy

Guideline Synopsis | Diagnosis and management of priapism

21 Jul, 2023 | 13:47h | UTC

Diagnosis and Management of Priapism – JAMA (free for a limited period)

Original Guideline: The Diagnosis and Management of Recurrent Ischemic Priapism, Priapism in Sickle Cell Patients, and Non-Ischemic Priapism: An AUA/SMSNA Guideline – Journal of Urology

Podcast | Hematuria pearls

19 Jul, 2023 | 14:19h | UTC

#404 Hematuria with Dr. Derek Fine – The Curbsiders

RCT | Prostatic artery embolization improves symptoms more than combined medical therapy in BPH patients

18 Jul, 2023 | 13:34h | UTC

Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3, superiority trial – The Lancet Regional Health – Europe

Systematic Review | Ethical perspectives on surgical video recording for patients, surgeons and society

11 Jul, 2023 | 13:44h | UTC

Ethical perspectives on surgical video recording for patients, surgeons and society: systematic review – BJS Open

Podcast | Untangling catheter associated UTIs

10 Jul, 2023 | 13:21h | UTC

#402 Don’t Get Caught with a CAUTI – The Curbsiders

Cohort Study | Incidence and risk factors of postoperative urinary retention after inguinal hernia repair

7 Jul, 2023 | 16:11h | UTC

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) Study – JAMA Surgery (link to abstract – $ for full-text)

RCT | Brachytherapy alone sufficient for intermediate-risk prostate cancer, no FFP improvement with additional EBRT

7 Jul, 2023 | 16:06h | UTC

Effect of Brachytherapy With External Beam Radiation Therapy Versus Brachytherapy Alone for Intermediate-Risk Prostate Cancer: NRG Oncology RTOG 0232 Randomized Clinical Trial – Journal of Clinical Oncology (link to abstract – $ for full-text)

News Release: Addition of EBRT to brachytherapy did not improve outcomes for men with intermediate-risk prostate cancer, brachytherapy alone remains standard of care – NRG Oncology

Review | Surgical treatment options for male stress urinary incontinence

7 Jul, 2023 | 16:03h | UTC

A narrative review on surgical treatment options for male stress urinary incontinence – Translational Andrology and Urology

RCT | Substituting saline with balanced crystalloid solution reduces delayed graft function in kidney transplantation

30 Jun, 2023 | 14:56h | UTC

Summary: The BEST-Fluids study was a pragmatic, multicentre, double-blind, randomized controlled trial carried out across 16 hospitals in Australia and New Zealand, aimed at comparing the use of balanced crystalloid solution (Plasma-Lyte 148) and saline in deceased donor kidney transplantation. The sample size comprised of 808 participants, who were either adults or children of any age, with the primary outcome defined as delayed graft function (DGF) occurring within 7 days post-transplantation.

Findings from the trial revealed that the balanced crystalloid group experienced less DGF than the saline group, with 121 out of 404 participants (30%) and 160 out of 403 participants (40%), respectively. This result yields an adjusted relative risk of 0.74 and an adjusted risk difference of 10.1%.

The study suggests that balanced crystalloid solution significantly reduces the incidence of DGF compared to saline. As no significant safety concerns were raised during the trial, the researchers recommend the use of balanced crystalloid solution as the standard-of-care intravenous fluid in deceased donor kidney transplantation. However, the study doesn’t indicate any significant differences in graft failure or mortality rates, which calls for further research.

Article: Balanced crystalloid solution versus saline in deceased donor kidney transplantation (BEST-Fluids): a pragmatic, double-blind, randomised, controlled trial – The Lancet (free registration required)

Guideline | Management of adrenal incidentalomas

23 Jun, 2023 | 13:33h | UTC

European Society of Endocrinology Clinical Practice Guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors – European Journal of Endocrinology

#377 Adrenal Incidentalomas with Dr. William Young – The Curbsiders

[Abstract Only] Meta-Analysis: Natural History of Adrenal Incidentalomas With and Without Mild Autonomous Cortisol Excess

M-A | Increased risk of cognitive toxic effects and fatigue in prostate cancer treatment with second-generation antiandrogens

16 Jun, 2023 | 14:00h | UTC

Association of Second-generation Antiandrogens With Cognitive and Functional Toxic Effects in Randomized Clinical Trials: A Systematic Review and Meta-analysis – JAMA Oncology (link to abstract – $ for full-text)

Commentary: Second-Generation Antiandrogens and Cognitive and Functional Toxicity in Patients With Prostate Cancer – The ASCO Post

RCT | No change in delayed graft function with normothermic perfusion vs. cold storage in kidney transplants

13 Jun, 2023 | 14:00h | UTC

Normothermic machine perfusion versus static cold storage in donation after circulatory death kidney transplantation: a randomized controlled trial – Nature Medicine

Commentary on Twitter

In an open-label, randomized controlled trial, normothermic machine perfusion of kidneys from donation after circulatory death was found to be feasible and safe but did not reduce the rate of delayed graft function compared to static cold storage. https://t.co/faaAzK3bpc pic.twitter.com/iL7Je7Z7jO

— Nature Medicine (@NatureMedicine) June 2, 2023

Review | Screening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps

13 Jun, 2023 | 13:52h | UTC

Screening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps – BMJ Oncology

SR | Effectiveness of anticholinergic drugs for treating people with overactive bladder syndrome

12 Jun, 2023 | 13:41h | UTC

Oral anticholinergic drugs versus placebo or no treatment for managing overactive bladder syndrome in adults – Cochrane Library

Summary: Effectiveness of anticholinergic drugs for treating people with overactive bladder syndrome – Cochrane Library

Magnetic resonance imaging to evaluate kidney structure, function, and pathology: moving towards clinical application

7 Jun, 2023 | 13:57h | UTC

Magnetic Resonance Imaging to Evaluate Kidney Structure, Function, and Pathology: Moving Towards Clinical Application – American Journal of Kidney Diseases

M-A | Robot-assisted radical cystectomy versus open radical cystectomy

6 Jun, 2023 | 14:11h | UTC

Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials – European Urology

Commentary from the author on Twitter (thread – click for more)

Our meta-analysis of 8 RCTS comparing open (ORC) and robot-assisted radical cystectomy (RARC) is now online on @EUplatinum 1/6https://t.co/b9TYe2yd9Y @JimCatto @Jkurol @drtanws @DrTanWP @SWilliams_MD @SBoorjian @roboturoloog @dipenjparekh @nikhilvasdevuro @ProfShamimKhan1 pic.twitter.com/M4u0iXTuwN

— Pramit Khetrapal (@p_khetrapal) May 10, 2023