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Simultaneous Prostate Target Biopsy Integrated With Radical Prostatectomy: A Pilot Study Omitting Preoperative Systematic Biopsy

Tae Young PARK ; Jae Young HWANG ; Seong Woo YUN ; Chang Wan HYUN ; Sung Goo YOON ; Seung Bin KIM ; Tae Il NOH ; Ji Sung SHIM ; Min Goo PARK ; Seok Ho KANG ; Sung Gu KANG

Journal of Urologic Oncology.2024;22(3):196-200. doi:10.22465/juo.244800240012

Purpose: This study evaluates the viability of a new method that employs transperineal targeted biopsy with frozen section analysis immediately followed by robot-assisted radical prostatectomy (RARP), bypassing the traditional systematic biopsy deemed essential by current guidelines. Materials and Methods: Patient selection was based on the following inclusion criteria: those who underwent magnetic resonance imaging (MRI)-ultrasound fusion-targeted biopsy with frozen section analysis and concurrent RARP. Eligibility also required features indicative of Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesion on multiparametric MRI, along with one of these additional criteria: (1) MRI evidence suggesting extracapsular extension (ECE) with a prostate-specific antigen (PSA) level >10 ng/mL, or (2) a PSA level > 20 ng/mL. Results: Twelve patients were enrolled in this study according to inclusion criteria. The median age (interquartile range) was 73.5 (69.5–75.3) years and PSA was 22.9 (17.0–29.9) ng/mL. Three patients had PI-RADS 5 lesions, and 9 had PI-RADS 5 lesions with findings of ECE. In all cases, the diagnosis based on frozen sections confirmed adenocarcinoma. Following confirmation, each patient underwent immediate RARP. According to the final pathology report, 2 patients had International Society of Urological Pathology (ISUP) grade 2 disease, 7 patients had ISUP grade 3, 1 had ISUP grade 4, and 2 had ISUP grade 5 disease. Four patients had stage pT2 disease, 3 had stage pT3a, and 5 had stage pT3b. The median immediate reporting time of the target biopsy frozen section was 20 (19.3–24.5) minutes. No perioperative complications related to target biopsy were observed. Conclusion For patients with a strong suspicion of prostate cancer and a PI-RADS 5 lesion, integrating simultaneous prostate frozen target biopsy with radical prostatectomy may offer a feasible treatment alternative, obviating the necessity for a preoperative systematic biopsy.

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A Machine Learning Model for Prostate Cancer Prediction in Korean Men

Sukjung CHOI ; Beomgi SO ; Shane OH ; Hongzoo PARK ; Sang Wook LEE ; Geehyun SONG ; Jong Min LEE ; Jung Ki JO ; Seon Hyeok KIM ; Si Eun LEE ; Eun-Bi CHO ; Jae Hung JUNG ; Jeong Hyun KIM

Journal of Urologic Oncology.2024;22(3):201-210. doi:10.22465/juo.244800400020

Purpose: Unnecessary prostate biopsies for detecting prostate cancer (PCa) should be minimized. Therefore, this study developed a machine learning (ML) model to predict PCa in Korean men and evaluated its usability. Materials and Methods: We retrospectively analyzed clinical data from 928 patients who underwent prostate biopsies at Kangwon National University Hospital between May 2013 and May 2023. Of these, 377 (41.6%) were diagnosed with PCa, and 551 (59.4%) did not have cancer. For external validation, clinical data from 385 patients aged 48–89 years who underwent prostate biopsies from September 2005 to September 2023 at Wonju Severance Christian Hospital were also included. Twenty-two clinical features were used to develop an ML model to predict PCa. Features were selected based on their contributions to model performance, leading to the inclusion of 15 features. A meta-learner was constructed using logistic regression to predict the probability of PCa, and the classifier was trained and validated on randomly extracted training and test sets at an 8:2 ratio. Results: The prostate health index, prostate volume, age, nodule on digital rectal examination, and prostate-specific antigen were the top 5 features for predicting PCa. The area under the receiver operating characteristic curve (AUC) of the meta-learner logistic regression model was 0.89, and the accuracy, sensitivity, and specificity were 0.828, 0.711, and 0.909, respectively. Our model also showed excellent prediction performance for high-grade PCa, with a Gleason score of 7 or higher and an AUC of 0.903. Furthermore, we evaluated the performance of the model using external cohort clinical data and achieved an AUC of 0.863. Conclusions Our ML model excelled in predicting PCa, specifically clinically significant PCa. Although extensive cross-validation in other clinical cohorts is needed, this ML model is a promising option for future diagnostics.

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Editorial for JUO 2024 Vol. 22 No. 3 - Rethinking Urologic Oncology Surgery

Cheol KWAK

Journal of Urologic Oncology.2024;22(3):185-187. doi:10.22465/juo.24edi003

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Correction: Addendum of Informed Consent Statements

Journal of Urologic Oncology.2024;22(3):281-281. doi:10.22465/juo.2024.err03

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Expression of Concern: Rare Ewingoid Dedifferentiated Liposarcoma of the Spermatic Cord Causing Testicular Artery Compression: A Case Report

Journal of Urologic Oncology.2024;22(3):282-282. doi:10.22465/juo.2024.concern04

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Trimodal Therapy in the Treatment of Muscle-Invasive Bladder Cancer

Yongsoo JO ; Hyeong Dong YUK

Journal of Urologic Oncology.2024;22(3):256-267. doi:10.22465/juo.244801000050

This review examines the evolution, clinical efficacy, and future directions of trimodal therapy (TMT) as a bladder-preserving treatment option for muscle-invasive bladder cancer. A nonsystematic literature search was conducted on PubMed in October 2024 using the following keywords: “muscle invasive bladder cancer,” “bladder preservation,” “trimodal therapy,” “chemoradiotherapy,” and “radiation therapy.” Papers published between 2000 and 2024 were included, and original articles, reviews, and editorials written in English were selected. Relevant studies were organized and cited in the analysis. TMT, which consists of transurethral resection of the bladder tumor, chemotherapy, and radiotherapy, demonstrated comparable oncologic outcomes to radical cystectomy (RC) in terms of 5-year overall survival (36%–74%) and cancer-specific survival (50%–82%). Long-term data from multiple studies indicate that TMT can preserve bladder function while maintaining acceptable survival rates. The recent integration of immune checkpoint inhibitors with TMT shows promise, further improving tumor control and expanding the eligible patient population. However, standardized protocols and long-term follow-up data are still lacking. TMT serves as an effective alternative to RC in selected patients, offering similar oncologic outcomes while preserving quality of life. Further research is needed to establish standardized protocols and to refine patient selection criteria to optimize treatment outcomes.

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Exploring the Evolving Role of Metastasectomy in Advanced Renal Cell Carcinoma

Jongkyou KWON ; Sungun BANG ; Kang Su CHO

Journal of Urologic Oncology.2024;22(3):228-236. doi:10.22465/juo.244800980049

In the treatment of metastatic lesions in advanced renal cell carcinoma (RCC), no clear consensus exists regarding whether immunotherapy should be combined with surgical resection or metastasectomy. Systemic therapies have significantly improved outcomes for advanced RCC patients and extended both progression-free and overall survival. However, complete disease eradication with drug therapy alone remains rare, and this limitation has renewed interest in metastasectomy for metastatic RCC. Although robust evidence is still lacking, many researchers have suggested that aggressive surgical approaches involving metastasectomy may improve survival in selected patients by controlling the cancer burden through the resection of primary and metastatic lesions. Novel immunotherapies have transformed solid tumor treatment, prompting a reevaluation of the role of metastasectomy. Recent studies have shown promise in combining systemic therapies with metastasectomy for metastatic RCC, emphasizing the need for further research and individualized, multidisciplinary approaches.

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The Current Role of Metastasis-Directed Therapy for Oligometastatic Renal Cell Carcinoma

Hyung Joon KIM

Journal of Urologic Oncology.2024;22(3):224-227. doi:10.22465/juo.244800960048

Approximately 20% of newly diagnosed renal cell carcinoma (RCC) cases exhibit synchronous metastases, while 20% to 40% of initially localized RCC cases subsequently develop distant metastases after surgical intervention. In the management of oligometastatic RCC with a restricted number of metastatic sites, metastasis-directed therapy (MDT) plays a crucial role within the multimodal therapeutic framework. MDT, which encompasses surgical metastasectomy and stereotactic body radiation therapy (SBRT), seeks to prolong survival and increase quality of life by offering an interruption of systemic therapy. Research has demonstrated that complete metastasectomy is essential for attaining an optimal survival advantage. The criteria for patient selection remain ambiguous; nonetheless, it is crucial to consider the location of metastases and patient risk stratification. SBRT is demonstrably successful in RCC and is being progressively utilized in oligometastatic RCC. The sequencing of advanced systemic agents with comprehensive local treatment of primary and metastatic sites for oligometastatic RCC has demonstrated potential.

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Artificial Intelligence: The Latest Advances in the Diagnosis of Bladder Cancer

Satyendra SINGH ; Ram Mohan SHUKLA

Journal of Urologic Oncology.2024;22(3):268-280. doi:10.22465/juo.244800540027

Bladder cancer remains a significant health challenge. Early and accurate diagnoses are crucial for effective treatment and improved patient outcomes. In recent years, artificial intelligence (AI) has emerged as a powerful tool in the medical field, showing great promise in advancing the bladder cancer diagnosis. This review explores the current state and potential of AI technologies, including machine learning algorithms, deep learning networks, and computer vision, in enhancing the diagnostic process for bladder cancer. AI systems can analyze vast amounts of data from various sources, such as medical imaging, genomic data, and electronic health records, enabling the identification of subtle patterns and biomarkers that may indicate the presence of bladder cancer. These systems have demonstrated high accuracy in detecting cancerous lesions in imaging modalities such as cystoscopy, ultrasonography, and computed tomography scans, often surpassing human performance. Moreover, AI-driven diagnostic tools can assist in risk stratification, predicting disease progression, and personalizing treatment plans, thereby contributing to more targeted and effective therapies.

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Early Experience of the Single-Port Robotic Transvesical Radical Prostatectomy: Case Series

Jae Hoon CHUNG ; Hwanik KIM ; Woo Jin BANG ; Cheol Young OH ; Jin Seon CHO

Journal of Urologic Oncology.2024;22(3):188-195. doi:10.22465/juo.244800740037

Purpose: This study evaluated the feasibility and safety of single-port transvesical robotic radical prostatectomy. Materials and Methods: Four patients underwent a transvesical robotic radical prostatectomy using a singleport robotic system. The procedure involved a 2.5-cm suprapubic incision to access the anterior bladder wall, which was incised by approximately 2 cm. Utilizing a floating-docking technique. Results: All surgeries were successfully completed without the need for additional ports or open conversion. Intraoperative complications were not observed. The median (interquartile range, IQR) console time was 159 (96–198) minutes. The median (IQR) estimated blood loss was 350 (300–700) mL. The median (IQR) duration for Foley catheter removal and patient discharge postsurgery was 7.5 (6–10) days. None of the patients experienced total incontinence after Foley catheter removal, and at 1-month postsurgery, all patients used only a safety pad. Pathology revealed positive surgical margins in 2 patients (both with pT3a and pT3b), with one of these patients having a persistent prostate-specific antigen level of 0.48 ng/mL at 1-month postsurgery. Additionally, 2 patients experienced gross hematuria within 2-week postdischarge. Conclusion This series demonstrates that single-port robotic transvesical radical prostatectomy is a feasible procedure with favorable perioperative functional outcomes. This offers the advantage of rapid continence recovery without oncological disadvantages.

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