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Purpose: In patients with prostate cancer (PCa), focal therapy with High-Intensity Focused Ultrasound (HIFU) combined with benign prostatic hyperplasia (BPH) surgery has been used to improve immediate post-operative voiding symptoms. Our study aimed to evaluate the functional outcomes of patients undergoing simultaneous holmium laser enucleation of the prostate (HoLEP) + HIFU and compare them to those who underwent HoLEP for bladder outlet obstruction secondary to BPH. Methods: We performed retrospective review of patients who underwent HoLEP + HIFU or HoLEP between June 2017 and May 2024. The nearest neighbor method with age and prostate volume were used to propensity match HoLEP + HIFU patients with HoLEP only patients in a 1:2 ratio. Demographics, functional characteristics, and complications of patients who underwent HoLEP + HIFU were compared with patients undergoing only HoLEP for BPH. Results: A total of 99 patients were analyzed, of which 33 patients underwent combined HIFU with HoLEP. Patients undergoing HIFU + HoLEP experienced higher rates of acute urinary retention (p = 0.016) and transient urinary incontinence, along with a delayed recovery of full continence, compared to those who underwent HoLEP alone. Postoperative urinary tract infection (UTI), urethral stricture, bladder neck stenosis (BNS), and continence rate were similar between the groups. Conclusion: Patients undergoing HoLEP + HIFU seems to have a higher risk of post-operative acute urine retention and delayed recovery from transient urinary incontinence, compared to HoLEP alone. The addition of HIFU to HoLEP does not influence the rate of UTI, urethral stricture, BNS, or improvement of voiding parameters up to one year follow up. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we built clinical- and radiomics-based models to predict lesions/patients at low risk based on a combined clinical-genomic classification system. Eighty-three multi-parametric MRI exams from 78 men were analyzed. Several models for lesion classification were built using a minimal clinical variables subset and radiomic features from the lesion and normal tissues. The models were also evaluated for patient classification. In all cases, the radiomic features improved the performance. To the best of our knowledge, this is the first study to demonstrate that machine learning radiomics-based models can predict patients' risk using combined clinical-genomic classification. The utilization of multi-parametric MRI (mpMRI) in clinical decisions regarding prostate cancer patients' management has recently increased. After biopsy, clinicians can assess risk using National Comprehensive Cancer Network (NCCN) risk stratification schema and commercially available genomic classifiers, such as Decipher. We built radiomics-based models to predict lesions/patients at low risk prior to biopsy based on an established three-tier clinical-genomic classification system. Radiomic features were extracted from regions of positive biopsies and Normally Appearing Tissues (NAT) on T2-weighted and Diffusion-weighted Imaging. Using only clinical information available prior to biopsy, five models for predicting low-risk lesions/patients were evaluated, based on: 1: Clinical variables; 2: Lesion-based radiomic features; 3: Lesion and NAT radiomics; 4: Clinical and lesion-based radiomics; and 5: Clinical, lesion and NAT radiomic features. Eighty-three mpMRI exams from 78 men were analyzed. Models 1 and 2 performed similarly (Area under the receiver operating characteristic curve were 0.835 and 0.838, respectively), but radiomics significantly improved the lesion-based performance of the model in a subset analysis of patients with a negative Digital Rectal Exam (DRE). Adding normal tissue radiomics significantly improved the performance in all cases. Similar patterns were observed on patient-level models. To the best of our knowledge, this is the first study to demonstrate that machine learning radiomics-based models can predict patients' risk using combined clinical-genomic classification. [ABSTRACT FROM AUTHOR]

Simple Summary: The human microbiome has become an increasingly important area of study in recent years, with growing evidence suggesting that it plays a critical role in numerous diseases, including those affecting the urinary tract. However, the specific role of the microbiome in malignant urologic diseases remains largely unknown. Our study aimed to synthesize current evidence regarding the relationship between the microbiome and these urologic conditions, such as prostate, bladder, kidney, penile, and testicular cancer. Our systematic review of 37 studies provides an up-to-date overview of the microbiome's role in urologic health concerns. Using the present study as a guide, future studies have potential for microbiome-focused interventions to offer hope for presently unexplained medical conditions. The microbiome, once considered peripheral, is emerging as a relevant player in the intricate web of factors contributing to cancer development and progression. These often overlooked microorganisms, in the context of urological malignancies, have been investigated primarily focusing on the gut microbiome, while exploration of urogenital microorganisms remains limited. Considering this, our systematic review delves into the complex role of these understudied actors in various neoplastic conditions, including prostate, bladder, kidney, penile, and testicular cancers. Our analysis found a total of 37 studies (prostate cancer 12, bladder cancer 20, kidney cancer 4, penile/testicular cancer 1), revealing distinct associations specific to each condition and hinting at potential therapeutic avenues and future biomarker discoveries. It becomes evident that further research is imperative to unravel the complexities of this domain and provide a more comprehensive understanding. [ABSTRACT FROM AUTHOR]

Focal therapy (FT) has recently gained popularity for the treatment of localized prostate cancer (PCa). FT achieves cancer control by targeting the lesions or the regions of the cancer and avoids damage to the surrounding tissues thus minimizing side effects which are common to the radical treatment, such as urinary continence and sexual function, and bowel-related side effects. Various ablative methods are used to deliver energy to the cancerous tissue. We review the different modalities of treatment and the current state of FT for PCa. [ABSTRACT FROM AUTHOR]

Renal cell carcinoma, particularly the most common clear cell type, is one of the most aggressive of urological cancers with significant risk of metastatic spread. It also has a propensity for venotropism with a proportion of tumors developing thrombi up to the right atrium. The response with newly adopted targeted therapy has been considered to be in the evolutionary stage with no clear role with respect to debulking or reducing the size of the inferior vena cava (IVC) thrombus. We describe a case of a right-sided metastatic RCC with Level IV thrombus initially managed with Pazopanib followed by Nivolumab and Adalimumab followed by cytoreductive nephrectomy and IVC thrombectomy in the post-targeted therapy setting with complete curative response. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the performance of mpMRI and the 4Kscore test together for the detection of significant prostate cancer. Material and methods We selected a consecutive series of men who were referred for evaluation of prostate cancer at an academic institution and underwent mpMRI and the 4Kscore test. The primary outcome was the presence of Gleason 7 or higher cancer on biopsy of the prostate. We used logistic regression and Decision Curve Analysis to report the discrimination and clinical utility of using mpMRI and the 4Kscore test for prostate cancer detection. We modeled the probability of harboring a Gleason 7 or higher prostate cancer based on the 4Kscore test and mpMRI findings. Finally, we examined various combinations and sequences of mpMRI and the 4Kscore test and assessed the impact on biopsies avoided and cancers missed. Results: Among 300 men who underwent a 4Kscore test and mpMRI, 149 (49%) underwent a biopsy. Among those, 73 (49%) had cancer, and 49 (33%) had Gleason 7 cancer. The area under the curve (AUC) for using the 4Kscore test and mpMRI together 0.82 (0.75–0.89) was superior to using the 4Kscore 0.70 (0.62–0.79) or mpMRI 0.74 (0.66–0.81) individually (p = 0.001). Similarly, decision analysis revealed the highest net benefit was achieved using both tests. Conclusions: The 4Kscore test and mpMRI results provide independent, but complementary, information that enhances the prediction of higher-grade prostate cancer and improves patient’s selection for a prostate biopsy. Prospective trials are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Corrigendum to "Metastatic Renal Cell Carcinoma with Level IV Thrombus: Contemporary Management with Complete Response to Neoadjuvant Targeted Therapy" In the article titled "Metastatic Renal Cell Carcinoma with Level IV Thrombus: Contemporary Management with Complete Response to Neoadjuvant Targeted Therapy" [1], the last sentence in the Abstract should be corrected from "We describe a case of a right-sided metastatic RCC with Level IV thrombus initially managed with Pazopanib followed by Nivolumab and Adalimumab followed by cytoreductive nephrectomy and IVC thrombectomy in the post-targeted therapy setting with complete curative response" to "We describe a case of a right-sided metastatic RCC with Level IV thrombus initially managed with neoadjuvant targeted therapy followed by cytoreductive nephrectomy and IVC thrombectomy in the post-targeted therapy setting with complete curative response". 1 Bhat A., Nahar B., Venkatramani V., Banerjee I., Kryvenko O. N., Parekh D. J., Metastatic renal cell carcinoma with level IV thrombus: contemporary management with complete response to neoadjuvant targeted therapy, Case Reports in Urology, 2019, 2019, 5, 7102504, 10.1155/2019/7102504. [Extracted from the article]

The progression of prostate cancer through serial biopsies in patients on active surveillance is a multifaceted process, with grade and volume progression offering unique perspectives on disease advancement. The Decipher genomic classifier has been recognized as a valuable tool for predicting disease progression. This study examines the relationship between the Decipher score, and other GRID signatures and pathways, and grade and volume progression in prostate cancer patients, utilizing data collected prospectively from the Miami Active Surveillance Trial (MAST). We scrutinized 224 baseline samples from 124 unique patients participating in the MAST database. Progression was categorized into grade progression, volume progression, and no progression. For patients with multiple samples, the sample with the highest Decipher score was selected. We also evaluate the association between 11 prognostic signatures, including the Decipher score and an average genomic risk score combining the 11 signatures and 20 pathways available from the Decipher GRID. Out of the baseline samples, 60 demonstrated grade progression, 51 volume progression, and 113 showed no progression. We found that the Decipher was not associated to our trial definition of progression, that combined grade and volume progression however we did find a statistically significant difference in Decipher scores from patients who experience grade progression (p=0.0005) as compared to volume progression (p=0.92) when comparing them with patients with no progression(Figure 1). A heat map evaluating prognostic signatures and pathways available on the Decipher grid found that the majority of prognostic signatures including the Decipher score and the average risk model were more associated with grade progression compared to volume or no progression. (Figure 2) Our findings suggest that the Decipher score has a stronger correlation with grade progression than volume progression in prostate cancer patients. This highlights the potential of genomic classifiers like Decipher in enhancing our understanding of disease progression and in tailoring personalized treatment strategies. Further prospective studies are required to validate these findings. [ABSTRACT FROM AUTHOR]

Prostate cancer is heterogeneous and multi-focal, and biopsy sampling often under-samples the tumor or samples different tumor foci. Such multiple sampling may cause molecular heterogeneity that leads to an underestimation of risk. Consequently, this impacts treatment decision making and management in localized prostate cancer.Herein, we evaluate the degree of variability in genetic alterations, and genomic risk between different biopsy cores with respect to the sampling method (mpMRI vs template). Methods A total of 348 biopsy samples from 156 patients from the Miami MRI selection for Active Surveillance versus Treatment (MAST) trial (NCT02242773) were used in this study. Across the whole time-course, all biopsy cores with successful gene expression profiling were categorized by mpMRI targeted (110 samples) or template (187 samples) sampling. Cores of higher Gleason score from each group were selected.;Variation in expression was analyzed across biopsy samples from same patients. The Decipher genomic score was statistically different across template or targeted biopsy in unpaired analysis (p=0.02), but no difference in paired analysis. Of the different molecular pathways, there was no difference regarding gene expression between both groups, except for E2F transcription factor.MRI targeted biopsy Decipher genomic score did not vary according to PIRADS score (p=0.6). Angiogenesis pathway, E2F transcription factor pathway, G2/M checkpoint pathway were highly expressed in PIRADS 5 lesions, whereas estrogen response signaling was lower in PIRADS 5. mpMRI sampling could lead to could result in better genomic assessment for prostate cancer, however, radiologic lesion scoring is not correlated to the genomic risk. [ABSTRACT FROM AUTHOR]