Publications by authors named "Luis A Kluth"
Purpose: To exam five-year overall survival (OS) of upper urinary tract urothelial carcinoma (UTUC) patients versus age- and sex-matched population-based controls.
Methods: Within Surveillance, Epidemiology, and End Results database (2004-2020), we identified newly diagnosed (2004-2015) UTUC patients. Relying on Social Security Administration Life Tables (2004-2020) age- and sex- matched population-based controls were simulated (Monte Carlo simulation).
: To quantify inpatient palliative care use over time and to test whether patient or hospital characteristics represent determinants of inpatient palliative care use in patients with metastatic penile cancer. : Relying on the National Inpatient Sample database (2006-2019), we identified 1017 metastatic penile cancer patients. Estimated annual percentage change analyses and multivariable logistic regression models addressing inpatient palliative care use were fitted.
View Article and Find Full Text PDFObjective: To quantify the effect of chemotherapy (CHT) in locally advanced female primary urethral cancer (fPUC).
Methods: In the Surveillance, Epidemiology and Ends Results (SEER) database (2000-2021), we identified 295 fPUC patients with locally advanced stage treated with local therapy (surgery or radiation or both) with or without CHT. Multivariable Cox regression models addressed cancer specific mortality free survival (CSM).
Endoscopic ablation versus nephroureterectomy in localized low-grade upper tract urothelial carcinoma: a comparison in terms of cancer-specific and other-cause mortality.
World J Urol
April 2025
Purpose: Guidelines recommend endoscopic ablation in select upper urinary tract urothelial carcinoma (UTUC) patients. To test for differences in cancer-specific mortality (CSM) and other-cause mortality (OCM) in localized non-invasive low-grade UTUC with tumor size < 2 cm treated with endoscopic ablation vs. radical nephroureterectomy.
View Article and Find Full Text PDFObjective: To investigate the association between the interval from biopsy to radical prostatectomy (RP) and biochemical recurrence (BCR) in prostate cancer patients.
Methods: Within a tertiary-care database (01/2014 to 06/2023), D'Amico intermediate- and high-risk prostate cancer patients were stratified according to interval from biopsy to RP (≤3 vs. >3-≤6 months).
Objectives: To examine critical care therapy rates after cytoreductive nephrectomy in metastatic kidney cancer patients.
Design, Setting, And Patients: Relying on the National Inpatient Sample (2000-2019), we addressed critical care therapy use (total parenteral nutrition, invasive mechanical ventilation, renal replacement therapy, percutaneous endoscopic gastrostomy tube insertion, and tracheostomy) and in-hospital mortality in surgically treated metastatic kidney cancer patients. Estimated annual percentage changes and multivariable logistic regression models were fitted.
To test for rates of inpatient palliative care (IPC) in metastatic testicular cancer patients receiving critical care therapy (CCT). Within the Nationwide Inpatient Sample (NIS) database (2008-2019), we tabulated IPC rates in metastatic testicular cancer patients receiving CCT, namely invasive mechanical ventilation (IMV), percutaneous endoscopic gastrostomy tube (PEG), dialysis for acute kidney failure (AKF), total parenteral nutrition (TPN) or tracheostomy. Univariable and multivariable logistic regression models addressing IPC were fitted.
View Article and Find Full Text PDFSurvival differences in rare histological prostate cancer (PCa) subtypes relative to age-matched population-based controls are unknown. Within Surveillance, Epidemiology, and End Results database (2004-2020), newly diagnosed (2004-2015) PCa patients were identified. Relying on the Social Security Administration Life Tables (2004-2020) with 5 years of follow-up, age-matched population-based controls (Monte Carlo simulation) were simulated for each patient.
View Article and Find Full Text PDFTrends and Disparities in Inpatient Palliative Care Use in Metastatic Renal Cell Carcinoma Patients Receiving Critical Care Therapy.
Clin Genitourin Cancer
February 2025
Purpose: Temporal trends in and predictors of inpatient palliative care use in patients with metastatic renal cell carcinoma (mRCC) undergoing critical care therapy are unknown.
Methods: Relying on the National Inpatient Sample (2008-2019), we identified mRCC patients undergoing critical care therapy, namely invasive mechanical ventilation, percutaneous endoscopic gastrostomy tube insertion, dialysis for acute kidney failure, total parenteral nutrition, or tracheostomy. Estimated annual percentage changes (EAPC) analyses and multivariable logistic regression models addressed inpatient palliative care use.
Objective: To evaluate the impact of a standardized antibiotic stewardship protocol on three subsequent endpoints in patients undergoing urethroplasty.
Methods: Men undergoing bulbar substitution urethroplasty between January 2009 and December 2016 were stratified by urine culture (UCx) at the time of surgery (sterile non-sterile) and were subjected to a standardized algorithm for urinalysis and antimicrobial therapy. We performed quantitative and qualitative exploration of UCx results and the microbial spectrum.
Article Synopsis
- The study investigated the relationship between lymphovascular invasion (LVI) and perineural invasion (PNI) in prostate cancer patients who underwent radical prostatectomy and their rates of biochemical recurrence (BCR).
- Results from 822 patients showed that those with LVI had a five-year BCR-free survival rate of 62%, while those with PNI had a rate of 64%, both lower than their counterparts without these invasions.
- After adjusting for factors like age, PSA levels, and tumor stage, the association between LVI and PNI with BCR became insignificant, indicating that tumor stage and Gleason Grade were more critical predictors of recurrence.
Adult Prostate Sarcoma: Demographics, Treatment Patterns, and Survival.
Ann Surg Oncol
December 2024
Article Synopsis
- This study analyzed the clinicopathologic characteristics and treatment patterns of adult prostate sarcoma patients using data from the Surveillance, Epidemiology, and End Results database between 2004 and 2020.
- Among 125 patients, the most common subtype was leiomyosarcoma (36%), with rhabdomyosarcoma (14%) being more likely to present at a metastatic stage compared to other types.
- The overall median survival was 27 months, with treatment approaches differing significantly based on the subtype; metastatic disease was linked to higher mortality rates, while stromal sarcoma had a lower overall mortality risk.
Article Synopsis
- The study focuses on improving follow-up care for patients with testicular cancer to detect relapses early by analyzing different imaging methods used for relapse detection in a large cohort of patients (1175 enrolled) from the Swiss Austrian German Testicular Cancer Cohort Study.
- Key findings included that 76% of analyzed patients had stage I disease, with a high 5-year relapse-free survival rate of 90.1%. Cross-sectional imaging of the abdomen was found to be the most effective method for detecting relapses, especially abdominal CT scans.
- The researchers proposed updated follow-up schedules emphasizing abdominal imaging while reducing reliance on chest X-rays, aiming to guide clinicians in future patient management strategies.
Background And Objective: Currently available post hoc phase 3 trial-derived data suggest better cancer-control outcomes in apalutamide-treated metastatic hormone-sensitive prostate cancer (mHSPC) patients achieving an (ultra)low prostate-specific antigen (PSA) nadir. This study aims to validate ultralow PSA nadir cutoffs.
Methods: Relying on an institutional prostate cancer database, 107 eligible patients were yielded.
Article Synopsis
- Simulation-based training in urology is becoming increasingly important, and a study assessed its impact on the surgical confidence of residents after a workshop focused on ureteroscopy (URS) and transurethral resection of the bladder (TURB).
- The workshop involved 40 participants, and results showed that while men generally reported higher surgical confidence before and after the session, both genders experienced an increase in confidence after the training.
- Despite achieving similar surgical performance outcomes, women were less confident in performing URS tasks compared to men, indicating a gap that could be addressed through targeted support and training.
Regional Differences in Stage III Nonseminoma Germ Cell Tumor Patients Across SEER Registries.
Clin Genitourin Cancer
October 2024
Purpose: We investigated regional differences in patients with stage III nonseminoma germ cell tumor (NSGCT). Specifically, we investigated differences in baseline patient, tumor characteristics and treatment characteristics, as well as cancer-specific mortality (CSM) across different regions of the United States.
Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018), patient (age, race/ethnicity), tumor (International Germ Cell Cancer Collaborative Group [IGCCCG] prognostic groups) and treatment (systemic therapy and retroperitoneal lymph dissection [RPLND] status) characteristics were tabulated for stage III NSGCT patients, according to 12 SEER registries representing different geographic regions.
Rates of Systemic Therapy for Metastatic Bladder Cancer Are Lower in Unmarried Males and Females.
Clin Genitourin Cancer
October 2024
Objective: Systemic therapy is guideline-recommended for metastatic urothelial carcinoma of the urinary bladder (UCUB). Unmarried status represents an important barrier to treatment access in many primaries. The importance of married status is unknown in the context of systemic therapy in metastatic UCUB and was addressed in the current study.
View Article and Find Full Text PDFObjective: To test for differences in recovery of lower urinary tract symptoms (LUTS) between patients with storage-positive vs -negative symptoms after laser enucleation of the prostate (LEP).
Patients And Methods: Consecutive storage-positive (severe storage symptoms, International Prostate Symptom Score [IPSS] storage subscore >8) vs storage-negative patients treated with LEP (November 2017-September 2022) within our tertiary-care database were identified. Mixed linear models tested for changes in IPSS and quality of life (QoL) at 1, 3 and 12 months after LEP.
Article Synopsis
- Metachronous metastatic prostate cancer (mmPCa) patients exhibit different characteristics and outcomes compared to DeNovo metastatic patients, influenced by primary cancer features like Gleason score (GS) and stage.
- A study of 341 mmPCa patients found that higher Gleason scores and more advanced stages were linked to earlier onset of metastatic disease and significantly affected overall survival (OS) rates.
- The research concluded that longer intervals between initial prostate cancer diagnosis and the onset of mmPCa are associated with better overall survival, highlighting the importance of grading and staging in treatment outcomes.
Article Synopsis
- The study investigates the differences in overall survival (OS) between patients with metastatic hormone-sensitive prostate cancer (mHSPC) based on whether their condition was "De Novo" (newly diagnosed) or "secondary" (progressed from previous conditions), and their disease volume (high vs. low).
- The research used a database of 504 mHSPC patients, finding that those with De Novo high volume mHSPC had shorter time to develop metastatic castration resistant prostate cancer (mCRPC) and worse OS compared to secondary and low volume cases.
- The results highlight that patients with De Novo high volume mHSPC have a more challenging prognosis even when treated with intensified combination therapies, and this trend
Background: To test for differences in organ-confined pathological tumor stage (pT) and intermediate International Society of Urological Pathologists (ISUP) grade vs. nonorgan confined pT stage and high ISUP grade and biochemical recurrence (BCR) after radical prostatectomy (RP).
Methods: Relying on a tertiary-care database, prostate cancer patients undergoing RP between January 2014 and December 2021 were stratified according to their combination of pT stage and ISUP grade in RP specimens (pT2 ISUP4/5 vs.
Article Synopsis
- Biochemical recurrence (BCR) is when prostate-specific antigen (PSA) levels rise after prostate cancer treatment, and this study aimed to examine factors like age, body mass index (BMI), and prostate volume related to BCR post-radical prostatectomy (RP).
- Within a group of 821 patients who had RP from January 2014 to June 2023, the study analyzed their characteristics and found that only higher prostate volume was significantly linked to increased BCR rates, while age and BMI showed no significant association.
- The results suggest that patients with higher prostate volume should receive more careful monitoring after surgery due to their increased risk of BCR.
Background And Objective: With approval of novel systemic therapies within the past decade for metastatic hormone-sensitive (mHSPC) and castration-resistant (mCRPC) prostate cancer, patients may receive several therapy lines. However, the use of these treatments is under an ongoing change. We investigated contemporary treatment trends and progression-free (PFS) and overall (OS) survival of different therapy lines.
View Article and Find Full Text PDFRare histological prostate cancer subtypes: Cancer-specific and other-cause mortality.
Prostate Cancer Prostatic Dis
September 2025
Background: To assess cancer-specific mortality (CSM) and other-cause mortality (OCM) rates in patients with rare histological prostate cancer subtypes.
Methods: Using the Surveillance, Epidemiology, and End Results database (2004-2020), we applied smoothed cumulative incidence plots and competing risks regression (CRR) models.
Results: Of 827,549 patients, 1510 (0.