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Consumer technology in the form of personal computers, mobile devices, and wearable technology, despite current underutilization, has the potential to greatly enhance the practice of urologic oncology and the surgical care of bladder cancer patients, particularly through the dissemination of educational videos, telemedicine, and the use of wearable technology for patient monitoring. A comprehensive healthcare application can unite all of these features, providing curated educational videos at different timepoints in surgical care, facilitating communication between the patient and the care team, and interfacing with wearable technology and other peripherals to allow for nonintrusive patient monitoring to help facilitate early identification of complications and to follow post-operative patient progress. Here we seek to review the available literature on this topic, discuss our institutional experience, and provide future perspectives in the perioperative management of bladder cancer patients. [ABSTRACT FROM AUTHOR]

In patients with intermediate-risk non-muscle–invasive bladder cancer (IR NMIBC), measurable disease by marker lesions provides an opportunity to assess on-target efficacy of novel therapies. FGFR3/2 alterations are frequent in NMIBC and FGFR inhibition may be beneficial to patients with IR NMIBC with FGFR3/2 alterations. Erdafitinib is an oral selective pan-FGFR tyrosine kinase inhibitor approved to treat locally advanced or metastatic urothelial cancer in adults with FGFR3/2 alterations who have progressed during or following ≥1 line of platinum-containing chemotherapy. We report a longer follow-up of an exploratory marker lesion cohort of patients with IR NMIBC (Cohort 3) from the multicohort phase 2 THOR-2 study (NCT04172675) of erdafitinib in patients with NMIBC with FGFR3/2 alterations. Patients were ≥18 years, with histologically confirmed IR NMIBC with FGFR3/2 alterations and recurrent IR disease. All previous tumors must have been grade 1-2, Ta/T1, with no previous carcinoma in situ, a <5% risk of progression for 2 years, and a >50% risk of recurrence using the EORTC risk calculator. Patients had all visible bladder tumors resected by transurethral resection except for one 5-10mm marker tumor. Patients received oral erdafitinib at 6 mg daily in 28-day cycles. Surveillance cystoscopy was performed at 3 months and if complete response (CR) was achieved, urine cytology was performed. Patients with partial response (PR) or CR ≤3 months after starting treatment continued erdafitinib for maximum 2 years or until high-risk disease recurrence, intolerable toxicity, consent withdrawal, investigator decision, or study closure. Exploratory end points included CR rate,;duration of response (DOR), best overall response, and safety. At data cutoff (27-Jun-2023; median follow-up 10.0 months), 18 patients were enrolled (median age: 63.5 years [range, 47-77]; tumor stage: n=13 Ta, n=5 not staged) and received erdafitinib for median duration 7.1 months (range, 0.7-17.4). Fifteen patients had CR (CR rate, 83.3%); 2 had PR (11.1%); median time to response was 1.15 months; 1 had high grade recurrence (Table). In 17 responders, median DOR was 12.8 months, with 12 responses ongoing, 3 censored, 2 ending with recurrence (1 low-grade; 1 high-grade) (Figure). Most common treatment-emergent adverse events (TEAEs): hyperphosphatemia (100%; n=18), diarrhea (83.3%; n=15), dry mouth (72.2%; n=13), dry skin (50.0%; n=9), dysgeusia (50.0%; n=9). Grade 3 TEAEs (n=1 each): abdominal pain, diarrhea, dysuria, and gastritis. Seven grade 1 treatment-related central serous retinopathy events were reported in 3 (16.7%) patients; events resolved in 1 patient (ongoing in 2). Three (16.7%) patients discontinued due to treatment-related TEAEs. No deaths were reported. In this marker lesion study of an FGFR-targeted therapy, erdafitinib demonstrated efficacy in all treated patients with IR NMIBC with FGFR alterations. Safety data were consistent with the known safety profile of erdafitinib. [ABSTRACT FROM AUTHOR]

Objective: To compare complication rates, perioperative outcomes, and survival after radical cystectomy (RC) in patients with prior abdominal or pelvic radiation therapy (RT) vs those without an RT history.Materials and Methods: We retrospectively reviewed patients undergoing RC for urothelial carcinoma between January 2008 and January 2016. Patients were stratified by receipt of RT, and differences in complications (any, minor, and major) at 30 and 90 days, as well as estimated blood loss, length of surgery, length of hospital stay, and pathologic stage, were compared. Recurrence-free, cancer-specific, and overall survival were compared using the Kaplan-Meier method and log-rank test.Results: We identified 518 patients who underwent RC between 2008 and 2016. Of these patients, 55 (11%) had a history of RT. There were no significant differences in complication rates (66% vs 69%, P= .80) between patients who did not and patients who did have a history of RT. Similarly, there were no differences in any perioperative or pathologic outcome by receipt of prior RT (all P>.05). Meanwhile, at a median follow-up of 26 (interquartile range 13-46) months among patients alive at last follow-up, no differences in survival were observed by prior RT (P= .08).Conclusion: Among patients with a history of prior abdominal or pelvic RT treated at a tertiary referral center, there was no difference in complication rates, perioperative, or pathologic outcomes. Importantly, no differences in survival were noted by prior RT receipt. Therefore, our data support the use of RC, when indicated, in patients with a prior history of abdominal or pelvic RT. [ABSTRACT FROM AUTHOR]

After radical cystectomy (RC), patients are at risk for complications including infections. The expansion of myeloid-derived suppressor cells (MDSCs) after surgery may contribute to the lower resistance to infection. Immune response and postoperative complications were compared in men consuming either specialized immunonutrition (SIM; n = 14) or an oral nutrition supplement (ONS; n = 15) before and after RC. MDSC count (Lin− CD11b+ CD33+) was significantly different between the groups over time ( p = 0.005) and significantly lower in SIM 2 d after RC ( p < 0.001). MDSC count expansion from surgery to 2 d after RC showed a weak association with an increase in infection rate 90 d after surgery ( p = 0.061). Neutrophil:lymphocyte ratio was significantly lower in SIM compared with ONS 3 h after the first incision ( p = 0.039). Participants receiving SIM had a 33% reduction in postoperative complication rate (95% confidence interval [CI], 1–64; p = 0.060) and a 39% reduction in infection rate (95% CI, 8–70; p = 0.027) during late-phase recovery. The small sample size limits the study findings. Patient summary Results show that the immune response to surgery and late infection rates differ between radical cystectomy patients receiving specialized immunonutrition versus oral nutrition supplement in the perioperative period. Trial registration ClinicalTrials.gov NCT01868087 . [ABSTRACT FROM AUTHOR]

Background: Several biologic mechanisms, including inflammation and immune changes, have been proposed to explain the role of obesity in prostate cancer (CaP) progression. Compared to men of a healthy weight, overweight and obese men are more likely to have CaP recurrence post-prostatectomy. Obesity is related to inflammation and immune dysregulation; thus, weight loss may be an avenue to reduce inflammation and reverse these immune processes.Objectives: This study explores the reversibility of the biological mechanisms through intentional weight loss using a comprehensive weight management program in men undergoing prostatectomy. Outcomes include blood and tissue biomarkers, microtumor environment gene expression, inflammation markers and Dietary Inflammatory Index (DII) scores.Methods: Twenty overweight men undergoing prostatectomy participated in this study. Fifteen men chose the intervention and 5 men chose the nonintervention group. The intervention consisted of a comprehensive weight loss program prior to prostatectomy and a weight maintenance program following surgery. Prostate tissue samples were obtained from diagnostic biopsies before the intervention and prostatectomy samples after weight loss. Blood samples and diet records were collected at baseline, pre-surgery after weight loss and at study end after weight maintenance. Immunohistochemistry and NanoString analysis were used to analyze the tissue samples. Flow cytometry was used to assess circulating immune markers. Inflammation markers were measured using Luminex panels.Results: The intervention group lost >5% body weight prior to surgery. DII scores improved during the weight loss intervention from baseline to pre-surgery (P = 0.002); and between group differences were significant (P = 0.02). DII scores were not associated with IL-6 nor hsCRP. In the intervention, CXCL12, CXCR7, and CXCR4 (C-X-C motif chemokine ligand/receptor) and Ki67 expression decreased in the prostate tissue from biopsy to surgery (P = 0.06), yet plasma CXCL12 increased during the same timeframe (P = 0.009). The downregulation of several genes (FDR<0.001) was observed in the intervention compared to the non-intervention. Changes in immune cells were not significant in either group.Conclusion: This feasibility study demonstrates that in overweight men with localized CaP, weight loss alters blood, and tissue biomarkers, as well as tumor gene expression. More research is needed to determine the biological and clinical significance of these findings. [ABSTRACT FROM AUTHOR]

Background: Prior studies have demonstrated declines in androgen levels in men with cancer and patients undergoing anesthesia and surgery. In this study, we hypothesized that decreased serum androgen levels are prevalent in male patients undergoing radical cystectomy (RC) for bladder cancer and that it persists in the postoperative period. We characterized perioperative androgen hormonal profiles and examined for associated changes indicative of sarcopenia on computed tomography scans in men undergoing RC.Methods: We implemented a prospective observational trial in men with newly diagnosed non-metastatic bladder cancer undergoing RC. Baseline pre-operative total testosterone (TT), free testosterone (FT), and luteinizing hormone (LH) were obtained on morning lab draws with 30 days of surgery. TT and FT were then repeated on postoperative days (POD) 2, 3, 30, and 90. The threshold for normal TT was defined as >300 ng/dl, consistent with the AUA Guidelines for Evaluation and Management of Testosterone Deficiency. We evaluated postoperative changes in weight and psoas muscle cross-sectional area using computed tomography scans to assess for sarcopenic changes.Results: Univariable statistical analysis was performed. 25 patients were enrolled. The mean patient age was 68.9 years. The mean pre-operative TT was 308 ng/dl, and 12/23 (52.5%) patients had low testosterone. Mean TT onPOD 2 and 3 were 166 ng/dl and 161 ng/dl, respectively (range 24-345). 19/20 (95%) of men who had morning lab draws had decreased TT. The mean TT at 30 days was 253 ng/dl with 37.5% of men having low TT. Mean TT at 90 days was 306 ng/dl. The mean FT levels were 43 ng/dl, 29.25 ng/dl, 28.2 ng/dl, 40.89 ng/dl, and 42.62 ng/dl at baseline, POD 2, POD 3, POD 30, and POD 90, respectively. Mean LH at baseline was 9.9 IU/L. Average weight loss at 30- and 90- days postop was -4.29 and -4.38 kilograms, respectively. Weight loss was persistent with only 3/23 (13%) returning to their presurgery weight by 90 days. Despite significant declines in weight and perioperative TT, no significant differences in psoas muscle cross-sectional area were observed (net change -92 mm2, P= 0.13) CONCLUSIONS: Perioperative disruption of androgen levels is prevalent in men undergoing RC. Our trial demonstrates a pre-op, immediate postop, 30- and 90-day postoperative prevalence of low TT of 52%, 95%, 63%, and 37.5%, respectively. Significant changes in baseline weight were noted, although no significant changes in psoas muscle cross-sectional area were observed, limiting conclusions regarding a link between changes in androgens and sarcopenia in this setting. [ABSTRACT FROM AUTHOR]