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BMC Urology Jun 2024Carcinoma in situ of the bladder is a high-grade cancer that originates in the superficial layer of the bladder. It has the potential to invade nearby organs, and it can...
BACKGROUND
Carcinoma in situ of the bladder is a high-grade cancer that originates in the superficial layer of the bladder. It has the potential to invade nearby organs, and it can spread through blood and lymphatic circulation to distant parts of the body.
CASE PRESENTATION
A 58-year-old non-smoker male presented with gross and microscopic hematuria. His family history included his father's recent bladder cancer. Initial investigations showed hematuria, inflammation, negative urine culture, digital rectal examination revealed an enlarged right lobe of the prostate, and an elevated Prostate-Specific Antigen level. Histopathological examination of samples taken from the bladder mucosa and the prostate confirmed urothelial carcinoma in situ in the bladder and prostate. Further evaluation revealed no other metastasis. The tumor was classified as T4aN0M0. The patient underwent radical cystoprostatectomy and histopathological examination showed that the tumor invading the muscularis propria of the bladder as well as the prostatic glands, but no malignancy was found in prostatic urethra and other areas. The patient was discharged three weeks post-operation and completed on adjuvant chemotherapy consisting of Gemcitabine, and Cisplatin to prevent of relapse. The patient is currently in a good healthy.
CONCLUSION
The occurrence of bladder cancer metastasizing to the prostate without involving the prostatic urethra is uncommon and requires precise diagnostic techniques for accurate tumor classification. Early management is advised to enhance the prognosis for the patient.
Topics: Humans; Male; Middle Aged; Urinary Bladder Neoplasms; Prostatic Neoplasms; Carcinoma in Situ; Urethra
PubMed: 38879527
DOI: 10.1186/s12894-024-01516-6 -
European Urology Focus Jun 2024Defining optimal therapeutic sequencing strategies in prostate cancer (PC) is challenging and may be assisted by artificial intelligence (AI)-based tools for an analysis...
BACKGROUND
Defining optimal therapeutic sequencing strategies in prostate cancer (PC) is challenging and may be assisted by artificial intelligence (AI)-based tools for an analysis of the medical literature.
OBJECTIVE
To demonstrate that INSIDE PC can help clinicians query the literature on therapeutic sequencing in PC and to develop previously unestablished practices for evaluating the outputs of AI-based support platforms.
DESIGN, SETTING, AND PARTICIPANTS
INSIDE PC was developed by customizing PubMed Bidirectional Encoder Representations from Transformers. Publications were ranked and aggregated for relevance using data visualization and analytics. Publications returned by INSIDE PC and PubMed were given normalized discounted cumulative gain (nDCG) scores by PC experts reflecting ranking and relevance.
INTERVENTION
INSIDE PC for AI-based semantic literature analysis.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
INSIDE PC was evaluated for relevance and accuracy for three test questions on the efficacy of therapeutic sequencing of systemic therapies in PC.
RESULTS AND LIMITATIONS
In this initial evaluation, INSIDE PC outperformed PubMed for question 1 (novel hormonal therapy [NHT] followed by NHT) for the top five, ten, and 20 publications (nDCG score, +43, +33, and +30 percentage points [pps], respectively). For question 2 (NHT followed by poly [adenosine diphosphate ribose] polymerase inhibitors [PARPi]), INSIDE PC and PubMed performed similarly. For question 3 (NHT or PARPi followed by Lu-prostate-specific membrane antigen-617), INSIDE PC outperformed PubMed for the top five, ten, and 20 publications (+16, +4, and +5 pps, respectively).
CONCLUSIONS
We applied INSIDE PC to develop standards for evaluating the performance of AI-based tools for literature extraction. INSIDE PC performed competitively with PubMed and can assist clinicians with therapeutic sequencing in PC.
PATIENT SUMMARY
The medical literature is often very difficult for doctors and patients to search. In this report, we describe INSIDE PC-an artificial intelligence (AI) system created to help search articles published in medical journals and determine the best order of treatments for advanced prostate cancer in a much better time frame. We found that INSIDE PC works as well as another search tool, PubMed, a widely used resource for searching and retrieving articles published in medical journals. Our work with INSIDE PC shows new ways in which AI can be used to search published articles in medical journals and how these systems might be evaluated to support shared decision-making.
PubMed: 38876943
DOI: 10.1016/j.euf.2024.05.022 -
American Society of Clinical Oncology... Jun 2024The management of renal cell carcinoma (RCC) has advanced significantly in the past two decades. Many promising functional imaging modalities such as radiolabeled tracer... (Review)
Review
The management of renal cell carcinoma (RCC) has advanced significantly in the past two decades. Many promising functional imaging modalities such as radiolabeled tracer targeting carbonic anhydrase IX and prostate-specific membrane antigen are under development to detect primary kidney tumors, stage systemic disease, and assess treatment response in RCC. Immune checkpoint inhibitors targeting PD-1 and cytotoxic T-cell lymphocyte-4 have changed the treatment paradigm in advanced RCC. Trials investigating novel mechanisms such as LAG-3 immune checkpoint inhibition, chimeric antigen receptor T-cell therapies, and T-cell engagers targeting RCC-associated antigens are currently ongoing. With the rapidly changing treatment landscape of RCC, the treatment sequence strategies will continue to evolve. Familiarity with the toxicities associated with the therapeutic agents and how to manage them are essential to achieve optimal patient outcomes. This review summarizes the recent developments of functional imaging and immunotherapy strategies in RCC, and the evidence supports treatment sequencing.
Topics: Humans; Carcinoma, Renal Cell; Immunotherapy; Kidney Neoplasms; Immune Checkpoint Inhibitors
PubMed: 38875505
DOI: 10.1200/EDBK_438658 -
BJUI Compass Jun 2024
PubMed: 38873347
DOI: 10.1002/bco2.324 -
Frontiers in Oncology 2024Prostate cancer (PCa) is one of the prevailing forms of cancer among men. At present, multiparametric MRI is the imaging method for localizing tumors and staging cancer....
INTRODUCTION
Prostate cancer (PCa) is one of the prevailing forms of cancer among men. At present, multiparametric MRI is the imaging method for localizing tumors and staging cancer. Radiomics plays a key role and hold potential for PCa detection, reducing the need for unnecessary biopsies, characterizing tumor aggression, and overseeing PCa recurrence post-treatment.
METHODS
Furthermore, the integration of radiomics data with clinical and histopathological data can further enhance the understanding and management of PCa and decrease unnecessary transfers to specialized care for expensive and intrusive biopsies. Therefore, the aim of this study is to develop a risk model score to automatically detect PCa patients by integrating non-invasive diagnostic parameters (radiomics and Prostate-Specific Antigen levels) along with patient's age.
RESULTS
The proposed approach was evaluated using a dataset of 189 PCa patients who underwent bi-parametric MRI from two centers. Elastic-Net Regularized Generalized Linear Model achieved 91% AUC to automatically detect PCa patients. The model risk score was also used to assess doubt cases of PCa at biopsy and then compared to bi-parametric PI-RADS v2.
DISCUSSION
This study explored the relative utility of a well-developed risk model by combining radiomics, Prostate-Specific Antigen levels and age for objective and accurate PCa risk stratification and supporting the process of making clinical decisions during follow up.
PubMed: 38873254
DOI: 10.3389/fonc.2024.1323247 -
Nature Medicine Jun 2024Despite recent therapeutic advances, metastatic castration-resistant prostate cancer (mCRPC) remains lethal. Chimeric antigen receptor (CAR) T cell therapies have...
Despite recent therapeutic advances, metastatic castration-resistant prostate cancer (mCRPC) remains lethal. Chimeric antigen receptor (CAR) T cell therapies have demonstrated durable remissions in hematological malignancies. We report results from a phase 1, first-in-human study of prostate stem cell antigen (PSCA)-directed CAR T cells in men with mCRPC. The starting dose level (DL) was 100 million (M) CAR T cells without lymphodepletion (LD), followed by incorporation of LD. The primary end points were safety and dose-limiting toxicities (DLTs). No DLTs were observed at DL1, with a DLT of grade 3 cystitis encountered at DL2, resulting in addition of a new cohort using a reduced LD regimen + 100 M CAR T cells (DL3). No DLTs were observed in DL3. Cytokine release syndrome of grade 1 or 2 occurred in 5 of 14 treated patients. Prostate-specific antigen declines (>30%) occurred in 4 of 14 patients, as well as radiographic improvements. Dynamic changes indicating activation of peripheral blood endogenous and CAR T cell subsets, TCR repertoire diversity and changes in the tumor immune microenvironment were observed in a subset of patients. Limited persistence of CAR T cells was observed beyond 28 days post-infusion. These results support future clinical studies to optimize dosing and combination strategies to improve durable therapeutic outcomes. ClinicalTrials.gov identifier NCT03873805 .
Topics: Humans; Male; Prostatic Neoplasms, Castration-Resistant; Aged; Middle Aged; Antigens, Neoplasm; Immunotherapy, Adoptive; GPI-Linked Proteins; Neoplasm Proteins; Receptors, Chimeric Antigen; Neoplasm Metastasis; T-Lymphocytes; Prostate-Specific Antigen
PubMed: 38867077
DOI: 10.1038/s41591-024-02979-8 -
Minerva Urology and Nephrology Jun 2024Urine is a promising biological fluid for prostate cancer (PCa) diagnostics due to its non-invasive collection and wide range of biomarkers. The aim of this study was to...
BACKGROUND
Urine is a promising biological fluid for prostate cancer (PCa) diagnostics due to its non-invasive collection and wide range of biomarkers. The aim of this study was to assess the role of urinary PSA (uPSA) and urinary Zinc (uZinc) as biomarkers for the diagnosis of PCa in combination with routine parameters of standard of care (SOC - blood PSA, abnormal DRE, age) and MRI in patients candidates for prostate biopsy.
METHODS
Urine samples after prostatic massages were collected from men with suspected PCa scheduled for prostate biopsy. Quantification of uPSA was performed by ECLIA platform and confirmed by ELISA assay, while uZinc measurement was evaluated by ICP-MS and confirmed by colorimetric in vitro assay. Six multivariate logistic regression analysis were performed to assess diagnostic performance of uPSA and uZinc (urine), SOC and MRI alone, and combination of MRI+SOC, MRI+urine and SOC+MRI+urine. The discriminative power of the logistic models was assessed by calculating the area under the receiver operating characteristic (ROC) curves (AUC).
RESULTS
Two hundred thirty-eight patients were included in the analysis; 145 of them were diagnosed with PCa. Urine test showed a better discrimination of HS from CP, in respect of uPSA and uZinc alone, both for PCa of any grade and Gleason Score ≥7 (4+3) (AUC 0.804 and 0.823 respectively). ROC curve combining SOC+MRI+urine showed an AUC=0.882, that is statistically different from SOC or MRI alone, or MRI+SOC (P=0.0001, P=0.0001, and P=0.008 respectively). PCa risk algorithm designed considering SOC+MRI+urine results in potential reduction of 57% of unnecessary biopsies compared to the current standard parameters.
CONCLUSIONS
The loss of uPSA and Zinc production and secretion during neoplastic transformation of the prostate could potentially represent a hallmark of PCa. Its combination with age, PSA and DRE, as well as with mpMRI could represent an interesting approach to improve the diagnostic accuracy of PCa.
Topics: Humans; Male; Prostatic Neoplasms; Aged; Prostate-Specific Antigen; Zinc; Middle Aged; Early Detection of Cancer; Biomarkers, Tumor; Magnetic Resonance Imaging
PubMed: 38864687
DOI: 10.23736/S2724-6051.24.05783-5 -
The World Journal of Men's Health May 2024Biomarkers predicting clinically significant prostate cancer (sPC) before biopsy are currently lacking. This study aimed to develop a non-invasive urine test to predict...
PURPOSE
Biomarkers predicting clinically significant prostate cancer (sPC) before biopsy are currently lacking. This study aimed to develop a non-invasive urine test to predict sPC in at-risk men using urinary metabolomic profiles.
MATERIALS AND METHODS
Urine samples from 934 at-risk subjects and 268 treatment-naïve PC patients were subjected to liquid chromatography/mass spectrophotometry (LC-MS)-based metabolomics profiling using both C18 and hydrophilic interaction liquid chromatography (HILIC) column analyses. Four models were constructed (training cohort [n=647]) and validated (validation cohort [n=344]) for different purposes. Model I differentiates PC from benign cases. Models II, III, and a Gleason score model (model GS) predict sPC that is defined as National Comprehensive Cancer Network (NCCN)-categorized favorable-intermediate risk group or higher (Model II), unfavorable-intermediate risk group or higher (Model III), and GS ≥7 PC (model GS), respectively. The metabolomic panels and predicting models were constructed using logistic regression and Akaike information criterion.
RESULTS
The best metabolomic panels from the HILIC column include 25, 27, 28 and 26 metabolites in Models I, II, III, and GS, respectively, with area under the curve (AUC) values ranging between 0.82 and 0.91 in the training cohort and between 0.77 and 0.86 in the validation cohort. The combination of the metabolomic panels and five baseline clinical factors that include serum prostate-specific antigen, age, family history of PC, previously negative biopsy, and abnormal digital rectal examination results significantly increased AUCs (range 0.88-0.91). At 90% sensitivity (validation cohort), 33%, 34%, 41%, and 36% of unnecessary biopsies were avoided in Models I, II, III, and GS, respectively. The above results were successfully validated using LC-MS with the C18 column.
CONCLUSIONS
Urinary metabolomic profiles with baseline clinical factors may accurately predict sPC in men with elevated risk before biopsy.
PubMed: 38863374
DOI: 10.5534/wjmh.230344 -
Urology Journal Jun 2024Prostate-specific antigen (PSA) bounce is a common phenomenon that can be observed in patients of prostate cancer treated by radiotherapy. However, the clinical,...
PURPOSE
Prostate-specific antigen (PSA) bounce is a common phenomenon that can be observed in patients of prostate cancer treated by radiotherapy. However, the clinical, pathological, or dosimetric predictors and clinical significance of PSA bounce in stereotactic body radiotherapy (SBRT) patients is still unknown.
METHODS
Between August 2006 to December 2015, 74 prostate cancer patients were treated by SBRT with Cyberknife at two medical centers. The prescription dose was 35-37.5 Gy in 5 fractions. Follow-up PSA tests were more frequently performed in one hospital than the other (median 4 vs. 10 times for initial one year). PSA bounce was defined as a rise of 0.2 ng/mL followed by a decline to or below previous nadir.
RESULTS
A total of 74 patients, PSA bounce was observed in 41 patients (55.4%). On univariate analysis, the treated medical center (p = 0.02), PSA follow-up frequency (p = 0.01), patient age (p < 0.01), and total prescription dose (p = 0.03) were significant clinical factors to predict the incidence of PSA bounce, while in multivariable analysis only the PSA follow-up frequency, and patient age remains significant.
CONCLUSION
PSA bounce was seen in a significant proportion of patients after Cyberknife SBRT. The PSA follow-up test frequency, and patient age were significant factors that were correlated with the incidence of PSA bounces in this study.
PubMed: 38863321
DOI: 10.22037/uj.v21i.8119 -
International Journal of Clinical and... 2024Magnetic resonance imaging (MRI)/ultrasound targeted biopsy has frequently been used together with a 12-core systematic biopsy for prostate cancer screening in the past...
BACKGROUND
Magnetic resonance imaging (MRI)/ultrasound targeted biopsy has frequently been used together with a 12-core systematic biopsy for prostate cancer screening in the past few years. However, the efficacy of targeted biopsy compared to systematic biopsy, as well as its clinical-histologic correlation, has been assessed by a limited number of studies and is further investigated in this study.
DESIGN
We collected 960 cases with both targeted and systematic prostate biopsies from 04/2019 to 04/2022 (Table 1). We compared cancer detection rates between targeted and systematic prostate biopsies in different grade groups. Correlations with the size of prostate lesions, prostate-specific antigen (PSA) level, and Prostate Imaging-Reporting and Data System (PI-RADS) scale were also analyzed for each of these biopsy methods.
RESULTS
Among the 960 men who underwent targeted biopsy with systematic biopsy, prostatic adenocarcinoma was diagnosed in 652 (67.9%) cases. 489 (50.9%) cases were diagnosed by targeted biopsy and 576 (60.0%) cases were diagnosed by systematic biopsy. In the 384 cases diagnosed negative by systematic biopsy, targeted biopsy identified cancer in 76 (8%) cases. Systematic biopsy was able to detect 163 cancer cases that were missed by targeted biopsy. Systematic biopsy detected more grade group 1 cancers compared to targeted biopsy. However, for higher grade cancers, the differences between the cancer detection rates of targeted biopsy and systematic biopsy became negligible. Targeted biopsy upgraded the grade group categorized by systematic biopsy in several cases (3.8%, 7.0%, 2.6%, 1.1% and 0.9% in Grade Groups 1, 2, 3, 4, and 5 respectively). Targeted biopsy was more likely to detect cancer in larger lesions (13.17 mm VS 11.41 mm, P=0.0056) and for higher PI-RADS scales (4.19 VS 3.68, P<0.0001). The cancers detected by targeted biopsy also had higher PSA levels (10.38 ng/ml VS 6.39 ng/ml, P=0.0026).
CONCLUSION
Targeted biopsy with systematic biopsy improved cancer detection rate compared to systematic biopsy alone. Targeted biopsy is not more sensitive for grade groups 1, 4, or 5 cancers but is as sensitive as systematic biopsy for detecting grade group 2 and 3 cancers. Targeted biopsy is more effective at detecting cancers when patients have larger lesions, higher PI-RADS scales, and higher PSA levels.
PubMed: 38859919
DOI: 10.62347/JHYY2053