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IMPORTANCE: Prostate magnetic resonance imaging (MRI) is increasingly integrated within the prostate cancer (PCa) early detection pathway. OBJECTIVE: To systematically evaluate the existing evidence regarding screening pathways incorporating MRI with targeted biopsy and assess their diagnostic value compared with prostate-specific antigen (PSA)–based screening with systematic biopsy strategies. DATA SOURCES: PubMed/MEDLINE, Embase, Cochrane/Central, Scopus, and Web of Science (through May 2023). STUDY SELECTION: Randomized clinical trials and prospective cohort studies were eligible if they reported data on the diagnostic utility of prostate MRI in the setting of PCa screening. DATA EXTRACTION: Number of screened individuals, biopsy indications, biopsies performed, clinically significant PCa (csPCa) defined as International Society of Urological Pathology (ISUP) grade 2 or higher, and insignificant (ISUP1) PCas detected were extracted. MAIN OUTCOMES AND MEASURES: The primary outcome was csPCa detection rate. Secondary outcomes included clinical insignificant PCa detection rate, biopsy indication rates, and the positive predictive value for the detection of csPCa. DATA SYNTHESIS: The generalized mixed-effect approach with pooled odds ratios (ORs) and random-effect models was used to compare the MRI-based and PSA-only screening strategies. Separate analyses were performed based on the timing of MRI (primary/sequential after a PSA test) and cutoff (Prostate Imaging Reporting and Data System [PI-RADS] score ≥3 or ≥4) for biopsy indication. RESULTS: Data were synthesized from 80 114 men from 12 studies. Compared with standard PSA-based screening, the MRI pathway (sequential screening, PI-RADS score ≥3 cutoff for biopsy) was associated with higher odds of csPCa when tests results were positive (OR, 4.15; 95% CI, 2.93-5.88; P ≤ .001), decreased odds of biopsies (OR, 0.28; 95% CI, 0.22-0.36; P ≤ .001), and insignificant cancers detected (OR, 0.34; 95% CI, 0.23-0.49; P = .002) without significant differences in the detection of csPCa (OR, 1.02; 95% CI, 0.75-1.37; P = .86). Implementing a PI-RADS score of 4 or greater threshold for biopsy selection was associated with a further reduction in the odds of detecting insignificant PCa (OR, 0.23; 95% CI, 0.05-0.97; P = .048) and biopsies performed (OR, 0.19; 95% CI, 0.09-0.38; P = .01) without differences in csPCa detection (OR, 0.85; 95% CI, 0.49-1.45; P = .22). CONCLUSION AND RELEVANCE: The results of this systematic review and meta-analysis suggest that integrating MRI in PCa screening pathways is associated with a reduced number of unnecessary biopsies and overdiagnosis of insignificant PCa while maintaining csPCa detection as compared with PSA-only screening.

We evaluate the predictive and prognostic value of insulin-like growth factor-I (IGF-1), IGF binding protein-2 (IGFBP-2) and -3 (IGFBP-3) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).

Background: Health services should anticipate the changing pattern of illnesses associated with population aging to promote healthy aging. Aim: We aimed to evaluate health indices and chronic illnesses and their relationship with functional independence in community Syrian refugees & Jordanian elderly. Methods: A stratified sample of 1,718 community older adults aged ≥ 60-year-old from four major Jordanian governorates was interviewed in this cross-sectional study. Katz Index of Independence in Activities of Daily Living was utilized to assess functional status. Data were analyzed using STATA 15. Results: Despite the similarities in baseline function, Syrian refugees had more multimorbidities but less active health insurance, accessibility to healthcare services and availability of medications and medical devices than Jordanians. Two-thirds had multimorbidities; with heart diseases, musculoskeletal conditions, hypertension, and diabetes being the most commonly reported chronic illnesses. Females had significantly more multimorbidities, and functional dependence, yet less education, income and accessibility to healthcare services. The mean Katz Index score was 4.99 ± 1.61. Significant predictors of functional dependence included increasing age, lower level of education, and some chronic illnesses. Conclusion: National inclusive plans to support vulnerable older adults especially refugees and older women, provide health insurance, enhance access to health care facilities, and manage chronic medical illnesses comprehensively are urgently needed to improve independence of community-living older adults and to promote healthy aging.

•To date, the prognostic role of prior bladder cancer (BCa) among patients with upper tract urothelial carcinoma (UTUC) is still poorly addressed.•We aimed to investigate the role of prior BCa on any recurrence (aR), distant metastasis (DM), and bladder recurrence following RNU among low-grade (LG) and high-grade (HG) UTUC patients.•We retrospectively analyzed a multicenter cohort of 1,580 patients treated with radical nephroureterectomy (RNU) for UTUC. Median follow-up was 4 years.•The Kaplan-Meier curves were applied to assess aR, DM, and bladder recurrence, computed from the time of RNU. Multivariable Cox models were generated to predict the risk of aR, DM, and bladder recurrence. All analyses were stratified by tumor grade (LG and HG), site of recurrence (aR, DM, and bladder recurrence), and prior history of BCa (no prior BCa, non-muscle-invasive [NMIBC], and muscle-invasive bladder cancer [MIBC]).•Both LG and HG UTUC patients with prior BCa had a significantly increased risk of aR and bladder recurrence on multivariable Cox models, compared to individuals with no prior BCa.•The main strength of our paper is represented by the fact that this is the first study in which analyses were stratified according to both UTUC grade and muscle-invasiveness of prior BCa history. Additionally, our cohort represent the largest cohort available in literature that evaluates the role of prior BCa on aR after RNU for UTUC.•The present study is limited by its retrospective design and the lack of some information on prior BCa, such as multifocality or previous intravesical therapy.

Degarelix is associated with high rates of injection site reaction. The US Food and Drug Administration approved relugolix, an oral gonadotropin-releasing hormone (GnRH) antagonist, for the treatment of advanced prostate cancer patients.

This study aimed to evaluate the concordance in tumor stage and grade between ureteroscopic (URS) biopsy and radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC).

BACKGROUND: Patients undergoing intestinal urinary diversion (IUD) may have a higher risk of osteoporosis and risk of fractures due to metabolic acidosis and decrease of intestinal absorption surface.OBJECTIVE: We performed a systematic review of the available literature on the impact of IUD on bone demineralization.METHODS: We systematically searched PubMed®, for original articles published before April 2020. Primary end points were the risk of fracture and loss of bone density. Secondary outcomes were the metabolic changes in biochemical and urine parameters related to calcium metabolism and histological changes.RESULTS: Our electronic search identified a total of 2417 articles. After a detailed review, we selected 11 studies that addressed the impact of IUD on bone health in 10369 patients. The risk of bone fracture was studied in 3 articles, showing a higher risk in the IUD population. Of the 9 articles evaluating the relation between intestinal urinary diversion and bone density, 5 did find a positive association. One article evaluated the bone metabolism at a cellular level after IUD showing a decrease in bone turnover in this population. Three of the eight studies reporting data on serum parameters related to calcium and phosphate metabolism showed differences. Finally, a correlation between concentration of pyridolines in urine and loss of bone density was found in two of the three studies.CONCLUSIONS: Although published data on BMD are contradictory, patients undergoing IUD seem to be at higher risk of bone fractures. Our finding support the need to implement accessible strategies on osteoporosis screening and prevention in IUD patients.

Patients undergoing intestinal urinary diversion (IUD) may have a higher risk of osteoporosis and risk of fractures due to metabolic acidosis and decrease of intestinal absorption surface. We performed a systematic review of the available literature on the impact of IUD on bone demineralization. We systematically searched PubMed®, for original articles published before April 2020. Primary end points were the risk of fracture and loss of bone density. Secondary outcomes were the metabolic changes in biochemical and urine parameters related to calcium metabolism and histological changes. Our electronic search identified a total of 2417 articles. After a detailed review, we selected 11 studies that addressed the impact of IUD on bone health in 10369 patients. The risk of bone fracture was studied in 3 articles, showing a higher risk in the IUD population. Of the 9 articles evaluating the relation between intestinal urinary diversion and bone density, 5 did find a positive association. One article evaluated the bone metabolism at a cellular level after IUD showing a decrease in bone turnover in this population. Three of the eight studies reporting data on serum parameters related to calcium and phosphate metabolism showed differences. Finally, a correlation between concentration of pyridolines in urine and loss of bone density was found in two of the three studies. Although published data on BMD are contradictory, patients undergoing IUD seem to be at higher risk of bone fractures. Our finding support the need to implement accessible strategies on osteoporosis screening and prevention in IUD patients.

The objective of this study was to evaluate the performance of different tumor diameters for identifying ≥ pT2 upper tract urothelial carcinoma (UTUC) at radical nephroureterectomy.

Female patients with bladder cancer (BCa) have had more advanced disease than their male counterparts at diagnosis and have experienced worse oncologic outcomes. However, the effect of gender on the chemotherapeutic response and oncologic outcomes after radical cystectomy (RC) and perioperative chemotherapy remains to be elucidated. We performed a systematic literature search to identify eligible studies that had investigated the effect of gender on the chemotherapeutic response and oncologic outcomes after RC and perioperative chemotherapy. We identified 15 studies reported from 2008 to 2019. For the patients who had received neoadjuvant chemotherapy (NAC), female gender was not associated with a complete response (pooled odds ratio [OR], 0.94; 95% confidence interval [CI], 0.69-1.26) nor a complete or partial response (pooled OR, 0.96; 95% CI, 0.73-1.27). In addition, women experienced had less upstaging (pooled OR, 0.3; 95% CI, 0.14-0.68) at RC compared with their male counterparts. Moreover, female patients who had undergone RC and NAC were likely to have better disease recurrence and cancer-specific mortality rates than were the male patients (pooled hazard ratio [HR], 0.66 and 95% CI, 0.44-0.98; and pooled HR, 0.49 and 95% CI, 0.29-0.81, respectively). For the patients who had undergone adjuvant chemotherapy, female gender was not associated with overall mortality (pooled HR, 1.15; 95% CI, 0.7-1.89), disease recurrence (pooled HR, 0.95; 95% CI, 0.74-1.23), or cancer-specific mortality (pooled HR, 1.07; 95% CI, 0.81-1.43). Female patients with BCa seem to benefit more from NAC than do their male counterparts. This potential differential sensitivity of female BCa to cisplatin-based combination chemotherapy might help close the gender gap in BCa, suggesting that gender could be a biomarker to help select the best systemic therapy for patients with advanced BCa.

Background: Salvage lymph node dissection (sLND) for nodal recurrence in prostate cancer (PCa) patients with biochemical recurrence (BCR) is still not recommended in current guidelines, because of the diagnostic inaccuracy of current conventional imaging. To assess the performance of [68Ga] Ga-prostate-specific membrane antigen conjugate 11 positron emission tomography (PSMA-PET) in detecting PCa lymph node metastasis using pathologic confirmation through sLND. Methods: Literature search was conducted using the MEDLINE, SCOPUS, Web of Science, and Cochrane Library on November 11th, 2018 to identify the eligible studies. Studies were eligible if they investigated the diagnostic performance of PSMA-PET before sLND in PCa patients with BCR and reported the number of true positive, false positive, false negative, and true negative on a lesion-based and/or field-based analyses to compare with histopathologic findings in sLND specimens. Results: Fourteen studies published between 2015 and 2018 comprising 462 patients were selected in this systematic review and meta-analysis. The positive predictive value of PSMA-PET before sLND on a patient-based analysis ranged between 0.70 and 0.93. The pooled sensitivity using lesion-based and field-based analyses were 0.84 (95%CI: 0.61–0.95) and 0.82 (95%CI: 0.72–0.89), respectively. The pooled specificity using lesion-based and field-based analyses were 0.97 (95%CI: 0.95–0.99) and 0.95 (95%CI: 0.70–0.99), respectively. The diagnostic odds ratio using lesion-based and field-based analyses were 189 (95%CI: 39–920) and 82 (95%CI: 8–832), respectively. Conclusions: PSMA-PET before sLND provided highly accurate performance with clinically relevant high positive and negative predictive values for detecting lymph node disease in patients with BCR after local treatment with curative intent for PCa. PSMA-PET can identify the patients who are likely to benefit from sLND and possibly direct to lesion or region-based dissection.

The purpose of this study was to investigate the prevalence and prognostic value of the polymorphic variant (1245A>C), a single nucleotide polymorphism (SNP) of the HSD3B1 gene, in the tumors of patients with castration-resistant prostate cancer (CRPC).

Although the supporting evidence for the oncological benefits of therapeutic systemic agents with respect to metastatic sites is not yet strong enough to provide a recommendation in advanced or metastatic urothelial carcinoma, clinicians may take into account tumor organotropism only in discussion with the patient fully informed on the optimal treatment decision to be taken.

Serum cholinesterase is associated with poor oncologic outcome in patients with advanced cancer such as muscle invasive bladder cancer. In this retrospective study, we found that serum cholinesterase is significantly associated with disease recurrence in patients with non–muscle-invasive bladder cancer.

We assessed the effect of time to recurrence on cancer-specific mortality in 331 patients who experienced recurrence after surgical intervention for renal cell carcinoma. Shorter time to disease recurrence was independently associated with higher cancer mortality and showed a steep drop in the likelihood of cancer mortality as the time to recurrence increased from 3 months to 3 years.

IMPORTANCE: Studies investigating the association of cigarette smoking with prostate cancer incidence and outcomes have revealed controversial results. OBJECTIVE: To systematically review and analyze the association of smoking status with biochemical recurrence, metastasis, and cancer-specific mortality among patients with localized prostate cancer undergoing primary radical prostatectomy or radiotherapy. DATA SOURCES: A systematic search of original articles published between January 2000 and March 2017 was performed using PubMed, MEDLINE, Embase, and Cochrane Library databases in March 2017. STUDY SELECTION: Observational studies reporting Cox proportional hazards regression or logistic regression analyses were independently screened. DATA EXTRACTION AND SYNTHESIS: This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions. Available multivariable hazard ratios (HRs) and corresponding 95% CIs were included in quantitative analysis. A risk-of-bias assessment was completed for nonrandomized studies. MAIN OUTCOMES AND MEASURES: Prespecified outcomes of interest were biochemical recurrence, metastasis, and cancer-specific mortality. RESULTS: A total of 5157 reports were identified, of which 16 articles were selected for qualitative analysis and 11 articles were selected for quantitative analysis. All included studies were observational and nonrandomized and comprised a total of 22 549 patients. Overall, 4202 patients (18.6%) were current smokers. The overall median follow-up was 72 months. Current smokers had a statistically significantly higher risk of biochemical recurrence (HR, 1.40; 95% CI, 1.18-1.66; P < .001 [10 studies]), as did former smokers (HR, 1.19; 95% CI, 1.09-1.30; P < .001 [7 studies]). Current smokers were also at a higher risk of metastasis (HR, 2.51; 95% CI, 1.80-3.51; P < .001 [3 studies]) and cancer-specific mortality (HR, 1.89; 95% CI, 1.37-2.60; P < .001 [5 studies]), whereas former smokers were not (metastasis: HR, 1.61; 95% CI, 0.65-3.97; P = .31 [2 studies]; cancer-specific mortality: HR, 1.05; 95% CI, 0.81-1.37; P = .70 [4 studies]). CONCLUSIONS AND RELEVANCE: Current smokers at the time of primary curative treatment for localized prostate cancer are at higher risk of experiencing biochemical recurrence, metastasis, and cancer-specific mortality.

Smoking is associated with prostate cancer mortality and disease progression after treatment for clinically nonmetastatic prostate cancer with curative intent. We investigated the effect of smoking on biochemical recurrence and metastasis in a retrospective cohort of 214 radiation-recurrent prostate cancer patients who underwent salvage radical prostatectomy. High cumulative smoking exposure was associated with the biologic and clinical aggressiveness of prostate cancer and was an independent predictor of biochemical recurrence after adjusting for established clinicopathologic features. These data support the body of evidence that smoking is detrimental beyond the initial diagnosis of prostate cancer, even when the disease is more advanced.

Using a population-based cohort, data from 50,598 patients treated with radical prostatectomy and pelvic lymph node dissection were used to externally validate our pathologic nodal staging score model. This model allows for quantification of the likelihood that a pathologically node-negative patient will not have lymph node metastasis after surgery.

We assessed the expression of N-cadherin (a cell–cell adhesion molecule) in 433 bladder cancer patients who had undergone radical cystectomy and pelvic lymph node dissection. We found that N-cadherin is expressed in ∼40% of patients, and it was associated with features of aggressive disease and worse recurrence-free survival.

We evaluated the predictive and prognostic role of preoperative thrombocytosis (TC) in upper tract urothelial carcinoma. Records of 2492 patients undergoing radical nephroureterectomy between 1990 and 2008 were retrospectively analyzed. Preoperative TC predicts non–organ-confined disease (P < .001) and lymph node metastases (P < .001) at radical nephroureterectomy. Among other biomarkers, TC could benefit preoperative risk stratification and help guide treatment decisions.

The neutrophil-to-lymphocyte ratio is associated with poor outcomes in patients with muscle-invasive bladder cancer. We found that the neutrophil-to-lymphocyte ratio is independently associated with disease recurrence and progression in patients with non–muscle-invasive bladder cancer.

Blood transfusion (BT) has been found to be related to worse survival outcomes in patients treated with many major urologic and nonurologic surgeries. The immunosuppressive effect of BT was advocated to explain this effect. We evaluated here the pattern and incidence of recurrence after radical cystectomy (RC), stratifying according to BT. We found that no difference in pattern and incidence in recurrence after RC was evident for patients with BT when compared with those who did not receive BT. New high quality data are required to explain the association between BT and survival in RC patients described in previous literature.

The importance of a correct histologic variant classification in the decision making of bladder cancer patients have been recently highlighted by the new World Health Organization classification of the urothelial tract. Histologic variants at the time of radical cystectomy is a common finding, accounting for almost 30% of specimens, yet only pure histologic variants but not mixed histologic variants are associated with worse survival compared to pure urothelial cancer. Physicians should consider this parameter when counseling surgical patients.

Objectives The clinical course of coronavirus disease 2019 (COVID-19) infection is often aggressive, with unfavorable outcomes for those with comorbidities such as type 2 diabetes mellitus (T2DM). We aimed to assess the prevalence and risk factors of COVID-19 infection, mortality, and post-infection lung fibrosis in patients with COVID-19 infection who had T2DM.Methods In this cross-sectional study, we included adult patients with T2DM who attended an endocrinology clinic and underwent testing for COVID-19 infection.Results Among 1039 included patients, the mean age was 59.5 ± 11.0 years and 429 (41.3%) were men. Overall, 87.1% of patients had received COVID-19 vaccination and 32.3% had confirmed COVID-19 infection. The COVID-19-related mortality was 3.0% and rate of post-COVID-19 lung fibrosis was 19.1%. Vaccination was associated with lower COVID-19-related mortality (odds ratio [OR]: 0.03, 95% confidence interval [CI]: 0.0–0.3) and post-COVID-19 lung fibrosis risk (OR: 0.3, 95% CI: 0.1–0.9).Conclusion Patients with T2DM exhibited a high prevalence of COVID-19 infection and associated mortality. However, COVID-19 vaccines were beneficial in reducing the risks of COVID-19-related mortality and post-infection lung fibrosis in these patients. COVID-19 vaccines and boosters are recommended for patients with T2DM. Further studies involving larger study populations are necessary to validate these findings.

•Fit elderly patients with high-risk UTUC may benefit equally from NAC and RNU as their younger counterparts•Cisplatin-based chemotherapy results in the highest pathologic response rates across both age groups•Elderly, cisplatin-ineligible patients, experienced the worst response rates after non-cisplantin-based NAC and might therefore benefit rather from immediate RNU

Recent meta-analyses on checkpoint inhibitors in cancer report conflicting data regarding the association of patient gender with inhibitor efficacy. In advanced kidney cancer, checkpoint inhibitors have shown improved outcomes in first- and second-line settings compared with standard of care, but the role of patient gender on treatment outcome is unclear. We aimed to assess the efficacy of immunotherapy according to patient gender in advanced kidney cancer.

The purpose of this study was to compare the efficacy of 2 bacillus Calmette-Guérin (BCG) strains, BCG-Tice and BCG-Moreau, in the treatment of non–muscle-invasive bladder cancer (NMIBC).