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  • 1.
    Abreu-Mendes, Pedro
    et al.
    Department of Urology, Centro Hospitalar Universitário do São João, Porto, Portugal.
    Baranowski, Andrew P.
    National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation Trust, University College London, London, UK.
    Berghmans, Bary
    Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
    Borovicka, Jan
    Department of Gastroenterology/Hepatology, School of Medicine, Cantonal Hospital of St. Gallen, University of St. Gallen, St. Gallen, Switzerland.
    Cottrell, Angela M.
    Royal Devon and Exeter Hospital, Exeter, UK.
    Dinis-Oliveira, Paulo
    Department of Urology, Centro Hospitalar Universitário do São João, Porto, Portugal.
    Elneil, Sohier
    National Hospital for Neurology and Neurosurgery, University College Hospital, London, UK.
    Hughes, John
    The James Cook University Hospital, Middlesbrough, UK.
    Messelink, Bert E. J.
    Department of Urology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
    Tidman, Victoria
    National Hospital for Neurology and Neurosurgery, University College Hospital, London, UK.
    Pinto, Rui
    Department of Urology, Centro Hospitalar Universitário do São João, Porto, Portugal.
    Tornic, Jure
    Kantonsspital Winterthur, Winterthur, Switzerland.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Parsons, Brian A.
    Royal Devon and Exeter Hospital, Exeter, UK.
    Zumstein, Valentin
    Department of Urology, School of Medicine, Cantonal Hospital of St. Gallen, University of St. Gallen, St. Gallen, Switzerland.
    Engeler, Daniel S.
    Department of Urology, School of Medicine, Cantonal Hospital of St. Gallen, University of St. Gallen, St. Gallen, Switzerland.
    Myofascial Pelvic Pain: Best Orientation and Clinical Practice. Position of the European Association of Urology Guidelines Panel on Chronic Pelvic Pain2023Ingår i: European Urology Focus, E-ISSN 2405-4569, Vol. 9, nr 1, s. 172-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    CONTEXT: Despite the high prevalence of a myofascial pain component in chronic pelvic pain (CPP) syndromes, awareness and management of this component are lacking among health care providers.

    OBJECTIVE: To summarize the current state of the art for the management of myofascial pain in chronic primary pelvic pain syndromes (CPPPS) according to scientific research and input from experts from the European Association of Urology (EAU) guidelines panel on CPP.

    EVIDENCE ACQUISITION: A narrative review was undertaken using three sources: (1) information in the EAU guidelines on CPP; (2) information retrieved from the literature on research published in the past 3 yr on myofascial pelvic pain; and (3) expert opinion from panel members.

    EVIDENCE SYNTHESIS: Studies confirm a high prevalence of a myofascial pain component in CPPPS. Examination of the pelvic floor muscles should follow published recommendations to standardize findings and disseminate the procedure. Treatment of pelvic floor muscle dysfunction and pain in the context of CPP was found to contribute to CPP control and is feasible via different physiotherapy techniques. A multidisciplinary approach is the most effective.

    CONCLUSIONS: Despite its high prevalence, the myofascial component of CPP has been underevaluated and undertreated to date. Myofascial pain must be assessed in all patients with CPPPS. Treatment of the myofascial pain component is relevant for global treatment success. Further studies are imperative to reinforce and better define the role of each physiotherapy technique in CPPPS.

    PATIENT SUMMARY: Pain and inflammation of the body's muscle and soft tissues (myofascial pain) frequently occurs in pelvic pain syndromes. Its presence must be evaluated to optimize management for each patient. If diagnosed, myofascial pain should be treated.

  • 2. Dabestani, Saeed
    et al.
    Beisland, Christian
    Stewart, Grant D.
    Bensalah, Karim
    Gudmundsson, Eirikur
    Lam, Thomas B.
    Gietzmann, William
    Zakikhani, Paimaun
    Marconi, Lorenzo
    Fernandéz-Pello, Sergio
    Monagas, Serenella
    Williams, Samuel P.
    Torbrand, Christian
    Powles, Thomas
    Van Werkhoven, Erik
    Meijer, Richard
    Volpe, Alessandro
    Staehler, Michael
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Bex, Axel
    Long-term Outcomes of Follow-up for Initially Localised Clear Cell Renal Cell Carcinoma: RECUR Database Analysis2019Ingår i: European Urology Focus, E-ISSN 2405-4569, nr 5, s. 857-866Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Optimal follow-up (FU) strategy to detect potentially curable (PC) recurrences after treatment of localised clear cell renal cell carcinoma (ccRCC) is unclear. This study retrospectively analysed a large international database to determine recurrence patterns and overall survival (OS), as part of a wider project to issue recommendations on FU protocols.

    OBJECTIVE: To analyse associations between RCC recurrences in patients with ccRCC, their risk group stratifications, treatments, and subsequent outcomes.

    DESIGN, SETTING, AND PARTICIPANTS: Nonmetastatic ccRCC patients treated with curative intent between 1 January 2006 and 31 December 2011, with at least 4 yr of FU, were included. Patient, tumour and recurrence characteristics, Leibovich score, and management and survival data were recorded. Isolated local, solitary, and oligometastatic (three or fewer lesions at a single site) recurrences were considered PC, while all others were probably incurable (PI).

    INTERVENTION: Primarily curative surgical treatment of ccRCC while at recurrence detection metastasectomy, systemic therapy, best supportive care, or observation.

    OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Incidence, time to recurrence (TTR), and OS were measured. Competing risk analysis, Kaplan-Meier, and Cox regression models were used.

    RESULTS AND LIMITATION: Of 1265 patients with ccRCC, 286 had a recurrence, with 131 being PC and 155 PI. Five-year cumulative risks of recurrence for low- (n=53), intermediate- (n=105), and high-risk (n=128) patients were, respectively, 7.2%, 23.2%, and 61.6%, of whom 52.8%, 37.1%, and 30.5% were PC, respectively. Median TTR was 25.0 for PC patients versus 17.3 mo for PI patients (p=0.004). Median OS was longer in PC compared with that in PI patients (p<0.001). Competing risk analysis showed highest risk of ccRCC-related death in younger and high-risk patients. Limitations were no data on comorbidities, retrospective cohort, and insufficient data excluding 12% of cohort.

    CONCLUSIONS: Low-risk group recurrences are rare and develop later. Treatment of recurrences with curative intent is disappointing, especially in high-risk patients. An age- and risk score-dependent FU approach is suggested.

    PATIENT SUMMARY: We analysed data from eight European countries, and found that the incidence of the kidney cancer recurrence and patient survival correlated with clinical factors known to predict cancer recurrence reliably and age. We conclude that these factors should be used to design follow-up strategies.

  • 3.
    Devlies, Wout
    et al.
    Department of Urology, UZ Leuven, Leuven, Belgium.
    de Jong, Joep J.
    Department of Urology, Erasmus University Medical Center, Rotterdam, Netherlands.
    Hofmann, Fabian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Bruins, Harman Max
    Department of Urology, Zuyderland Medical Center, Sittard-Geleen/Heerlen, Netherlands.
    Zuiverloon, Tahlita C.M.
    Department of Urology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
    Smith, Emma Jane
    EAU Guidelines Office, Arnhem, Netherlands.
    Yuan, Yuhong
    Department of Medicine, McMaster University, ON, Hamilton, Canada.
    van Rhijn, Bas W.G.
    Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
    Mostafid, Hugh
    Department of Urology, Royal Surrey Hospital, Guildford, United Kingdom.
    Santesso, Nancy
    Department of Health Research Methods Evidence and Impact, McMaster University, ON, Hamilton, Canada.
    Violette, Phil
    Department of Surgery, McMaster University, ON, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Hamilton, Canada.
    Omar, Muhammad Imran
    Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom.
    The diagnostic accuracy of cystoscopy for detecting bladder cancer in adults presenting with haematuria: a systematic review from the european association of urology guidelines office2024Ingår i: European Urology Focus, E-ISSN 2405-4569, Vol. 10, nr 1, s. 115-122Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Context: Haematuria can be macroscopic (visible haematuria [VH]) or microscopic (nonvisible haematuria [NVH]), and may be caused by a number of underlying aetiologies. Currently, in case of haematuria, cystoscopy is the standard diagnostic tool to screen the entire bladder for malignancy.

    Objective: The objective of this systematic review is to determine the diagnostic test accuracy of cystoscopy (compared with other tests, eg, computed tomography, urine biomarkers, and urine cytology) for detecting bladder cancer in adults.

    Evidence acquisition: A systematic review of the literature was performed according to the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for diagnostic test accuracy studies’ checklist. The MEDLINE, Embase, Cochrane CENTRAL, and Cochrane CDSR databases (via Ovid) were searched up to July 13, 2022. The population comprises patients presenting with either VH or NVH, without previous urological cancers. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).

    Evidence synthesis: Overall, nine studies were included in the qualitative analysis. Seven out of nine included trials covered the use of cystoscopy in comparison with radiological imaging. Overall, sensitivity of cystoscopy ranged from 87% to 100%, specificity from 64% to 100%, positive predictive value from 79% to 98%, and negative predictive values between 98% and 100%. Two trials compared enhanced or air cystoscopy versus conventional cystoscopy. Overall sensitivity of conventional white light cystoscopy ranged from 47% to 100% and specificity from 93.4% to 100%.

    Conclusions: The true accuracy of cystoscopy for the detection of bladder cancer within the context of haematuria has not been studied extensively, resulting in inconsistent data regarding its performance for patients with haematuria. In comparison with imaging modalities, a few trials have prospectively assessed the diagnostic performance of cystoscopy, confirming very high accuracy for cystoscopy, exceeding the diagnostic value of any other imaging test.

    Patient summary: Evidence of tests for detecting bladder cancer in adults presenting with haematuria (blood in urine) was reviewed. The most common test used was cystoscopy, which remains the current standard for diagnosing bladder cancer.

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  • 4.
    Kartasalo, Kimmo
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12, S-17177 Stockholm, Sweden.;Tampere Univ, Fac Med & Hlth Technol, Tampere, Finland..
    Bulten, Wouter
    Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Pathol, Med Ctr, Nijmegen, Netherlands..
    Delahunt, Brett
    Univ Otago, Wellington Sch Med & Hlth Sci, Dept Pathol & Mol Med, Wellington, New Zealand..
    Chen, Po-Hsuan Cameron
    Google Hlth, Palo Alto, CA USA..
    Pinckaers, Hans
    Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Pathol, Med Ctr, Nijmegen, Netherlands..
    Olsson, Henrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12, S-17177 Stockholm, Sweden..
    Ji, Xiaoyi
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12, S-17177 Stockholm, Sweden..
    Mulliqi, Nita
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12, S-17177 Stockholm, Sweden..
    Samaratunga, Hemamali
    Aquesta Uropathol, Brisbane, Qld, Australia.;Univ Queensland, Brisbane, Qld, Australia..
    Tsuzuki, Toyonori
    Aichi Med Univ, Sch Med, Dept Surg Pathol, Nagakute, Aichi, Japan..
    Lindberg, Johan
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12, S-17177 Stockholm, Sweden..
    Rantalainen, Mattias
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12, S-17177 Stockholm, Sweden..
    Wählby, Carolina
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Avdelningen för visuell information och interaktion. Uppsala universitet, Science for Life Laboratory, SciLifeLab.
    Litjens, Geert
    Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Pathol, Med Ctr, Nijmegen, Netherlands..
    Ruusuvuori, Pekka
    Tampere Univ, Fac Med & Hlth Technol, Tampere, Finland.;Univ Turku, Canc Res Unit, Inst Biomed, Turku, Finland.;Univ Turku, FICAN West Canc Ctr, Turku, Finland.;Turku Univ Hosp, Turku, Finland..
    Egevad, Lars
    Karolinska Inst, Dept Oncol & Pathol, Stockholm, Sweden..
    Eklund, Martin
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12, S-17177 Stockholm, Sweden..
    Artificial Intelligence for Diagnosis and Gleason Grading of Prostate Cancer in Biopsies-Current Status and Next Steps2021Ingår i: European Urology Focus, E-ISSN 2405-4569, Vol. 7, nr 4, s. 687-691Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Diagnosis and Gleason grading of prostate cancer in biopsies are critical for the clinical management of men with prostate cancer. Despite this, the high grading variability among pathologists leads to the potential for under-and overtreatment. Artificial intelligence (AI) systems have shown promise in assisting pathologists to perform Gleason grading, which could help address this problem. In this mini-review, we highlight studies reporting on the development of AI systems for cancer detection and Gleason grading, and discuss the progress needed for widespread clinical implementation, as well as anticipated future developments. Patient summary: This mini-review summarizes the evidence relating to the validation of artificial intelligence (AI)-assisted cancer detection and Gleason grading of prostate cancer in biopsies, and highlights the remaining steps required prior to its widespread clinical implementation. We found that, although there is strong evidence to show that AI is able to perform Gleason grading on par with experienced uropathologists, more work is needed to ensure the accuracy of results from AI systems in diverse settings across different patient populations, digitization platforms, and pathology laboratories.

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    FULLTEXT01
  • 5. Pedersen, Marie
    et al.
    Stafoggia, Massimo
    Weinmayr, Gudrun
    Andersen, Zorana J.
    Galassi, Claudia
    Sommar, Johan
    Forsberg, Bertil
    Olsson, David
    Oftedal, Bente
    Krog, Norun H.
    Aamodt, Geir
    Pyko, Andrei
    Pershagen, Goran
    Korek, Michal
    De Faire, Ulf
    Pedersen, Nancy L.
    Odiaeresi, Claes-Goran
    Fratiglioni, Laura
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Sorensen, Mette
    Eriksen, Kirsten T.
    Tjonneland, Anne
    Peeters, Petra H.
    Bueno-de-Mesquita, Bas
    Vermeulen, Roel
    Eeftens, Marloes
    Plusquin, Michelle
    Key, Timothy J.
    Jaensch, Andrea
    Nagel, Gabriele
    Concin, Hans
    Wang, Meng
    Tsai, Ming-Yi
    Grioni, Sara
    Marcon, Alessandro
    Krogh, Vittorio
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Ranzi, Andrea
    Cesaroni, Giulia
    Forastiere, Francesco
    Tamayo, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    Stayner, Leslie T.
    Kogevinas, Manolis
    Nieuwenhuijsen, Mark J.
    Sokhi, Ranjeet
    de Hoogh, Kees
    Beelen, Rob
    Vineis, Paolo
    Brunekreef, Bert
    Hoek, Gerard
    Raaschou-Nielsen, Ole
    Is There an Association Between Ambient Air Pollution and Bladder Cancer Incidence? Analysis of 15 European Cohorts2018Ingår i: European Urology Focus, E-ISSN 2405-4569, Vol. 4, nr 1, s. 113-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Ambient air pollution contains low concentrations of carcinogens implicated in the etiology of urinary bladder cancer (BC). Little is known about whether exposure to air pollution influences BC in the general population. Objective: To evaluate the association between long-term exposure to ambient air pollution and BC incidence. Design, setting and participants: We obtained data from 15 population-based cohorts enrolled between 1985 and 2005 in eight European countries (N = 303 431; mean follow-up 14.1 yr). We estimated exposure to nitrogen oxides (NO2 and NOx), particulate matter (PM) with diameter <10 mu m (PM10), <2.5 mu m (PM2.5). between 2.5 and 10 mu m (PM2.5-10). PM2.5 absorbance (soot), elemental constituents of PM, organic carbon, and traffic density at baseline home addresses using standardized land-use regression models from the European Study of Cohorts for Air Pollution Effects project. Outcome measurements and statistical analysis: We used Cox proportional-hazards models with adjustment for potential confounders for cohort-specific analyses and meta-analyses to estimate summary hazard ratios (HRS) for BC incidence. Results and limitations: During follow-up, 943 incident BC cases were diagnosed. In the meta-analysis, none of the exposures were associated with BC risk. The summary HRs associated with a 10-mu g/m(3) increase in NO2 and 51-mu g/m(3) increase in PM2.5 were 0.98 (95% confidence interval [CI] 0.89-1.08) and 0.86 (95% CI 0.63-1.18), respectively. Limitations include the lack of information about lifetime exposure. Conclusions: There was no evidence of an association between exposure to outdoor air pollution levels at place of residence and risk of BC. Patient summary: We assessed the link between outdoor air pollution at place of residence and bladder cancer using the largest study population to date and extensive assessment of exposure and comprehensive data on personal risk factors such as smoking. We found no association between the levels of outdoor air pollution at place of residence and bladder cancer risk.

  • 6. Pedersen, Marie
    et al.
    Stafoggia, Massimo
    Weinmayr, Gudrun
    Andersen, Zorana J.
    Galassi, Claudia
    Sommar, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Olsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oftedal, Bente
    Krog, Norun H.
    Aamodt, Geir
    Pyko, Andrei
    Pershagen, Göran
    Korek, Michal
    De Faire, Ulf
    Pedersen, Nancy L.
    Östenson, Claes-Göran
    Fratiglioni, Laura
    Sørensen, Mette
    Eriksen, Kirsten T.
    Tjønneland, Anne
    Peeters, Petra H.
    Bueno-de-Mesquita, Bas
    Vermeulen, Roel
    Eeftens, Marloes
    Plusquin, Michelle
    Key, Timothy J.
    Jaensch, Andrea
    Nagel, Gabriele
    Concin, Hans
    Wang, Meng
    Tsai, Ming-Yi
    Grioni, Sara
    Marcon, Alessandro
    Krogh, Vittorio
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Ranzi, Andrea
    Cesaroni, Giulia
    Forastiere, Francesco
    Tamayo, Ibon
    Amiano, Pilar
    Dorronsoro, Miren
    Stayner, Leslie T.
    Kogevinas, Manolis
    Nieuwenhuijsen, Mark J.
    Sokhi, Ranjeet
    de Hoogh, Kees
    Beelen, Rob
    Vineis, Paolo
    Brunekreef, Bert
    Hoek, Gerard
    Raaschou-Nielsen, Ole
    Is there an association between ambient air pollution and bladder cancer incidence?: Analysis of 15 European cohorts2018Ingår i: European Urology Focus, E-ISSN 2405-4569, Vol. 4, nr 1, s. 113-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Ambient air pollution contains low concentrations of carcinogens implicated in the etiology of urinary bladder cancer (BC). Little is known about whether exposure to air pollution influences BC in the general population.

    OBJECTIVE: To evaluate the association between long-term exposure to ambient air pollution and BC incidence.

    DESIGN, SETTING, AND PARTICIPANTS: We obtained data from 15 population-based cohorts enrolled between 1985 and 2005 in eight European countries (N=303431; mean follow-up 14.1 yr). We estimated exposure to nitrogen oxides (NO2 and NOx), particulate matter (PM) with diameter <10μm (PM10), <2.5μm (PM2.5), between 2.5 and 10μm (PM2.5-10), PM2.5absorbance (soot), elemental constituents of PM, organic carbon, and traffic density at baseline home addresses using standardized land-use regression models from the European Study of Cohorts for Air Pollution Effects project.

    OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We used Cox proportional-hazards models with adjustment for potential confounders for cohort-specific analyses and meta-analyses to estimate summary hazard ratios (HRs) for BC incidence.

    RESULTS AND LIMITATIONS: During follow-up, 943 incident BC cases were diagnosed. In the meta-analysis, none of the exposures were associated with BC risk. The summary HRs associated with a 10-μg/m(3) increase in NO2 and 5-μg/m(3) increase in PM2.5 were 0.98 (95% confidence interval [CI] 0.89-1.08) and 0.86 (95% CI 0.63-1.18), respectively. Limitations include the lack of information about lifetime exposure.

    CONCLUSIONS: There was no evidence of an association between exposure to outdoor air pollution levels at place of residence and risk of BC.

    PATIENT SUMMARY: We assessed the link between outdoor air pollution at place of residence and bladder cancer using the largest study population to date and extensive assessment of exposure and comprehensive data on personal risk factors such as smoking. We found no association between the levels of outdoor air pollution at place of residence and bladder cancer risk.

  • 7. Reza, Mariana
    et al.
    Ohlsson, Mattias
    Kaboteh, Reza
    Anand, Aseem
    Franck-Lissbrant, Ingela
    Damber, Jan-Erik
    Widmark, Anders
    Thellenberg-Karlsson, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Budaeus, Lars
    Steuber, Thomas
    Eichenauer, Till
    Wollmer, Per
    Edenbrandt, Lars
    Tragardh, Elin
    Bjartell, Anders
    Bone Scan Index as an Imaging Biomarker in Metastatic Castration-resistant Prostate Cancer: A Multicentre Study Based on Patients Treated with Abiraterone Acetate (Zytiga) in Clinical Practice2016Ingår i: European Urology Focus, E-ISSN 2405-4569, Vol. 2, nr 5, s. 540-546Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Abiraterone acetate (AA) prolongs survival in metastatic castration-resistant prostate cancer (mCRPC) patients. To measure treatment response accurately in bone, quantitative methods are needed. The Bone Scan Index (BSI), a prognostic imaging biomarker, reflects the tumour burden in bone as a percentage of the total skeletal mass calculated from bone scintigraphy.

    Objective: To evaluate the value of BSI as a biomarker for outcome evaluation in mCRPC patients on treatment with AA according to clinical routine.

    Design, setting, and participants: We retrospectively studied 104 mCRPC patients who received AA following disease progression after chemotherapy. All patients underwent whole-body bone scintigraphy before and during AA treatment. Baseline and follow-up BSI data were obtained using EXINI Bone(BSI) software (EXINI Diagnostics AB, Lund, Sweden).

    Outcome measurements and statistical analysis: Associations between change in BSI, clinical parameters at follow-up, and overall survival (OS) were evaluated using the Cox proportional hazards regression models and Kaplan-Meier estimates. Discrimination between variables was assessed using the concordance index (C-index).

    Results and limitations: Patients with an increase in BSI at follow-up of at most 0.30 (n = 54) had a significantly longer median survival time than those with an increase of BSI >0.30 (n = 50) (median: 16 vs 10 mo; p = 0.001). BSI change was also associated with OS in a multivariate Cox analysis including commonly used clinical parameters for prognosis (C-index = 0.7; hazard ratio: 1.1; p = 0.03). The retrospective design was a limitation.

    Conclusions: Change in BSI was significantly associated with OS in mCRPC patients undergoing AA treatment following disease progression in a postchemotherapy setting. BSI may be a useful imaging biomarker for outcome evaluation in this group of patients, and it could be a valuable complementary tool in monitoring patients with mCRPC on second-line therapies.

    Patient summary: Bone Scan Index (BSI) change is related to survival time in metastatic castration-resistant prostate cancer (mCRPC) patients on abiraterone acetate. BSI may be a valuable complementary decision-making tool supporting physicians monitoring patients with mCRPC on second-line therapies.

  • 8.
    Sandgren, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Westerlinck, Philippe
    Jonsson, Joakim
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Blomqvist, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Thellenberg Karlsson, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Nyholm, Tufve
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik. Department of Immunology, Genetics, and Pathology, Medical Radiation Science, Uppsala University, Uppsala, Sweden.
    Dirix, Piet
    Imaging for the Detection of Locoregional Recurrences in Biochemical Progression After Radical Prostatectomy: A Systematic Review2019Ingår i: European Urology Focus, E-ISSN 2405-4569, Vol. 5, nr 4, s. 550-560Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Context: Local and regional recurrence after radical prostatectomy (RP) can be treated using salvage radiotherapy (SRT). If the recurrence can be delineated on diagnostic imaging, this could allow for increasingly individualized SRT.

    Objective: This systematic review aimed at evaluating the evidence regarding the usefulness of positron emission tomography (PET) and magnetic resonance imaging (MRI) in identifying local and regional recurrences, with the aim to further individualize the SRT treatment.

    Evidence acquisition: A systematic PubMed/Medline search was conducted in December 2015. Studies included were imaging studies of post-RP patients focusing on local and/or regional recurrence where sensitivity and specificity of MRI or PET were the primary end points. Only studies using biopsy, other histological analysis, and/or treatment follow-up as reference standard were included. Quality Assessment of Diagnostic Accuracy Studies-2 was used to score the study quality. Twenty-five articles were deemed of sufficient quality and included in the review.

    Evidence synthesis: [11C]Acetate had the highest pooled sensitivity (92%), while [11C]choline and [18F]choline had pooled sensitivities of 71% and 84%, respectively. The PET tracer with highest pooled specificity was [11C]choline (86%). Regarding MRI, MR spectroscopy combined with dynamic contrast enhanced (DCE) MRI showed the highest pooled sensitivity (89%). High pooled sensitivities were also seen using multiparametric MRI (84%), diffusion-weighted MRI combined with T2-weigthed (T2w) imaging (82%), and DCE MRI combined with T2w imaging (82%). These also showed high pooled specificities (85%, 89%, and 92%, respectively).

    Conclusions: Both MRI and PET have adequate sensitivity and specificity for the detection of prostate cancer recurrences post-RP. Multiparametric MRI, using diffusion-weighted and/or DCE imaging, and the choline-labeled tracers showed high pooled sensitivity and specificity, although their ranges were broad.

    Patient summary: After reviewing imaging studies of recurrent prostate cancer after prostatectomy, we concluded that choline positron emission tomography and diffusion-weighted magnetic resonance imaging can be proposed as the current standard, with high sensitivity and specificity.

  • 9.
    Sandgren, Kristina
    et al.
    Umea Univ, Dept Radiat Sci, S-90185 Umea, Sweden.
    Westerlinck, Philippe
    Iridium Canc Network, Dept Radiat Oncol, Antwerp, Belgium.
    Jonsson, Joakim H.
    Umea Univ, Dept Radiat Sci, S-90185 Umea, Sweden.
    Blomqvist, Lennart
    Umea Univ, Dept Radiat Sci, S-90185 Umea, Sweden;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Karlsson, Camilla Thellenberg
    Umea Univ, Dept Radiat Sci, S-90185 Umea, Sweden.
    Nyholm, Tufve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Medicinsk strålningsvetenskap. Umea Univ, Dept Radiat Sci, S-90185 Umea, Sweden.
    Dirix, Piet
    Iridium Canc Network, Dept Radiat Oncol, Antwerp, Belgium;Ctr Oncol Res CORE, Dept Mol Imaging Pathol Radiotherapy & Oncol MIPR, Antwerp, Belgium.
    Imaging for the Detection of Locoregional Recurrences in Biochemical Progression After Radical Prostatectomy: A Systematic Review2019Ingår i: European Urology Focus, E-ISSN 2405-4569, Vol. 5, nr 4, s. 550-560Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Context

    Local and regional recurrence after radical prostatectomy (RP) can be treated using salvage radiotherapy (SRT). If the recurrence can be delineated on diagnostic imaging, this could allow for increasingly individualized SRT.

    Objective

    This systematic review aimed at evaluating the evidence regarding the usefulness of positron emission tomography (PET) and magnetic resonance imaging (MRI) in identifying local and regional recurrences, with the aim to further individualize the SRT treatment.

    Evidence acquisition

    A systematic PubMed/Medline search was conducted in December 2015. Studies included were imaging studies of post-RP patients focusing on local and/or regional recurrence where sensitivity and specificity of MRI or PET were the primary end points. Only studies using biopsy, other histological analysis, and/or treatment follow-up as reference standard were included. Quality Assessment of Diagnostic Accuracy Studies-2 was used to score the study quality. Twenty-five articles were deemed of sufficient quality and included in the review.

    Evidence synthesis

    [11C]Acetate had the highest pooled sensitivity (92%), while [11C]choline and [18F]choline had pooled sensitivities of 71% and 84%, respectively. The PET tracer with highest pooled specificity was [11C]choline (86%). Regarding MRI, MR spectroscopy combined with dynamic contrast enhanced (DCE) MRI showed the highest pooled sensitivity (89%). High pooled sensitivities were also seen using multiparametric MRI (84%), diffusion-weighted MRI combined with T2-weigthed (T2w) imaging (82%), and DCE MRI combined with T2w imaging (82%). These also showed high pooled specificities (85%, 89%, and 92%, respectively).

    Conclusions

    Both MRI and PET have adequate sensitivity and specificity for the detection of prostate cancer recurrences post-RP. Multiparametric MRI, using diffusion-weighted and/or DCE imaging, and the choline-labeled tracers showed high pooled sensitivity and specificity, although their ranges were broad.

    Patient summary

    After reviewing imaging studies of recurrent prostate cancer after prostatectomy, we concluded that choline positron emission tomography and diffusion-weighted magnetic resonance imaging can be proposed as the current standard, with high sensitivity and specificity.

  • 10. Silagy, Andrew W.
    et al.
    Sanchez, Alejandro
    Manley, Brandon J.
    Bensalah, Karim
    Bex, Axel
    Karam, Jose A.
    Ljungberg, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Shuch, Brian
    Hakimi, A. Ari
    Harnessing the Genomic Landscape of the Small Renal Mass to Guide Clinical Management2019Ingår i: European Urology Focus, E-ISSN 2405-4569, Vol. 5, nr 6, s. 949-957Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Context: Small renal masses (SRMs; tumors <4 cm) encompass a diagnostic and therapeutic challenge. Genomic profiling has the potential to improve risk stratification and personalize treatment selection.

    Objective: Herein, we review the evidence regarding the utility, challenges, and potential implications of genomic profiling in the management of SRMs.

    Evidence acquisition: Pertinent publications available on PubMed database pertaining to kidney cancer, tumor size, genomics, and clinical management were reviewed.

    Evidence synthesis: Compared with larger tumors, SRMs range from benign to lethal, necessitating strategies for improved treatment selection. Recent advances in the molecular characterization of renal cell carcinoma have improved our understanding of the disease; however, utility of these tools for the management of SRMs is less clear. While intratumoral heterogeneity (ITH) reduces the accuracy and reliability of sequencing, relative genomic uniformity of SRMs somewhat lessens the impact of ITH. Therefore, renal mass biopsy of SRMs represents an appealing opportunity to evaluate how incorporation of molecular profiles may improve management strategies.

    Conclusions: Ongoing research into the genomic landscape of SRMs has advanced our understanding of the spectrum of disease aggressiveness and may hold promise in matching disease biology to treatment intensity.

    Patient summary: Small renal masses are a clinical challenge, as they range from benign to lethal. Genomic profiling may eventually improve treatment selection, but more research is needed.

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