[Update guideline on prostate cancer-balancing act between evidence and healthcare reality].

The update of the guideline on prostate cancer has been and continues to be discussed in all its facets, even with passion.One source of the dispute about some of the content of the current guideline is undoubtedly the lack of precision with which terms were introduced in the past and are still communicated incorrectly and vaguely to this day.In this article, the Professional Association of German Urology (BvDU) discusses five key points with professional policy relevance and where the implementation of the guideline meets the reality of care.

[Androgen receptor-targeted therapies - avoid clinically relevant interactions].

Pharmacotherapy of older patients requires special attention to drug interactions, based on an increase in morbidity and elevated need for polypharmacy. Especially for drugs with a narrow therapeutic index, interactions may require dose adjustments, discontinuation or switching of co-medication. These interactions are frequently based on pharmacokinetic alterations of drug metabolism via the cytochrome P450 (CYP) enzyme system, mainly via CYP3A4.

[PSA in the extreme range-an expression of an unfavorable prognosis? : A review of course and treatment of prostate cancer with prostate-specific antigen (PSA) values in the three-to-four-digit range].

Background: Extremely high baseline prostate-specific antigen (bPSA) values in the range of 100 to ≥ 1000 ng/ml prior to the start of systemic therapy pose a challenge, as they can lead to the impression of a very unfavorable prognosis.

Objective: We investigated factors influencing 5‑year overall survival (5-yOS) and the treatment modalities of patients with bPSA levels ≥ 100 ng/ml using retrospective data.

Materials And Methods: We defined items from a limited initial collective, which we then used for a query in the UroCloud database.

Results of the Prospective Randomized UroFollow Trial Comparing Marker-guided Versus Cystoscopy-based Surveillance in Patients with Low/Intermediate-risk Bladder Cancer.

Background And Objective: A growing body of evidence suggests that the intensity of current follow-up in non-muscle-invasive bladder cancer (NMIBC) patients greatly exceeds clinical necessities. The UroFollow trial investigated the diagnostic accuracy of marker-based follow-up in patients with low/intermediate-risk NMIBC against the standard of care (SOC) for noninferiority (margin: <20%).

Methods: Patients with Ta low- and high-grade (G1-2) NMIBC were randomized to the SOC or 6-monthly marker-based follow-up (algorithm comprising urine markers and ultrasound; marker-based surveillance regimen [MA]).

Improving quality of care for cancer patients through oncological second opinions in a Comprehensive Cancer Center: adherence to second-opinion therapy recommendations.

Purpose: Receiving treatment in certified oncological centers and obtaining a second medical opinion has been proven to enhance both the quality and cost-effectiveness of care for oncological patients. Interdisciplinary care optimizes the treatment of oncological patients by validating the diagnosis and treatment recommendation, emphasizes translational research, and applies oncological therapies in a more target-oriented manner. This study aims to examine the extent of patient adherence to second medical opinions provided at the Comprehensive Cancer Center Erlangen-Metropolitan Area Nuremberg (CCC Erlangen-EMN) and investigates how specific patient characteristics such as age, gender, and type of cancer diagnosis influence the likelihood of adhering to a second opinion.

Contemporary real-world treatment in metastatic hormone-sensitive prostate cancer: US, four European countries, and UK.

Aim: To characterize contemporary global real-world metastatic hormone-sensitive prostate cancer (mHSPC) treatment, guideline concordance, trends, and potential trend drivers.

Materials And Methods: Retrospective data from the Ipsos Global Oncology Monitor database for the United States, Germany, France, Spain, Italy, and the United Kingdom were used for descriptive analysis of mHSPC patients, treating physicians, and treatment utilization. Statistical testing of differences among treatment cohorts for the final study period was conducted.

Change of the guards-Looking back at Michael Droller: Visionary and supporter-The perspective of the International Bladder Cancer Network.

Objective: Professor Michael Droller is stepping down as Editor-in-chief of Urologic Oncology: Seminars and Original Investigations, a journal that he co-founded. This manuscript describes his relation with the International Bladder Cancer Network (IBCN) and reviews his impact on the development of this association.

Material And Methods: Reviewing its 25-year long history, the IBCN reconsiders Michael Droller´s relevance for the unexpected development of the association and highlights his contributions.

Cardiovascular Safety of GnRH Agonist-Based Androgen Deprivation Therapy in a Real-World Setting: Results from a Prospective Cohort Study (LEAN).

Introduction: LEAN is a prospective, multicenter, noninterventional, German cohort study in patients with locally advanced and metastatic hormone-sensitive prostate cancer (PC). This analysis explores the efficacy and safety of leuprorelin in patients with PC and an indication for androgen deprivation therapy (ADT) in routine practice.

Methods: Safety assessment focused on the incidence of major adverse cardiovascular (CV) events (MACEs; a composite of all-cause death, myocardial infarction, or stroke) over the 12-month study period.

Tivozanib Monotherapy in the Frontline Setting for Patients with Metastatic Renal Cell Carcinoma and Favorable Prognosis.

Purpose Of Review: In this review, we discuss which patients with metastatic clear cell renal cell carcinoma (mRCC) may be most suitable for frontline tyrosine kinase inhibitor (TKI) monotherapy, a treatment option supported by emerging long-term efficacy data including overall survival and quality of life. We specifically focus on tivozanib, a potent and selective inhibitor of vascular endothelial growth factor receptor, which has comparable efficacy to other single-agent TKIs in frontline treatment for mRCC while exhibiting fewer off-target side effects.

Recent Findings: Combination therapy with TKIs and checkpoint inhibitors (CPIs) and CPI/CPI combination therapies, as well as TKI monotherapy are recommended frontline treatment options for mRCC.

Real-world use of androgen-deprivation therapy intensification for metastatic hormone-sensitive prostate cancer: a systematic review.

Objective: To conduct a systematic literature review of real-world data (RWD) studies to summarise treatment patterns among men with metastatic hormone-sensitive prostate cancer (mHSPC). While androgen-deprivation therapy (ADT) is a primary treatment strategy for mHSPC, ADT intensification with androgen receptor pathway inhibitors (ARPIs) and/or chemotherapy is recommended by current guidelines and has improved clinical outcomes in the last decade.

Methods: We searched electronic databases (PubMed; Excerpta Medica dataBASE [EMBASE]) for eligible studies (retrospective or prospective observational RWD studies examining mHSPC treatment patterns) between database inception and July 2023, and manually screened the past 2 years of relevant conference proceedings.

[Androgen deprivation as initial and backbone therapy for prostate carcinoma cancer : A retrospective data analysis from urological practices in Germany].

Background: The aim of this study was to determine the proportion of patients with prostate cancer (PCa) who remained on primary androgen deprivation therapy (ADT) after starting treatment for castration-resistant prostate cancer (CRPC) and to describe their treatment patterns.

Materials And Methods: The study comprises a retrospective analysis of 609,308 patients in urological practices in Germany from 2011 to 2020 based on anonymized secondary data from the UROscience webserver. PCa patients were eligible for inclusion if they received ADT after a 6-month prescription-free pre-index period.

Simulation of the effects of molecular urine markers in follow-up of patients with high-risk non-muscle invasive bladder cancer.

A plethora of urine markers for the management of patients with bladder cancer has been developed and studied in the past. However, the clinical impact of urine testing on patient management remains obscure. The goal of this manuscript is to identify scenarios for the potential use of molecular urine markers in the follow-up of patients with high-risk non-muscle-invasive BC (NMIBC) and estimate potential risks and benefits.

Real-world treatment of metastatic hormone-sensitive prostate cancer in the USA, Europe and Asia.

To characterize real-world patients with metastatic hormone-sensitive prostate cancer (mHSPC) and treating physicians and evaluate treatment trends and baseline concordance versus guidelines internationally. Retrospective, cross-sectional data from the Ipsos Global Oncology Monitor database 2018-2020 were used for descriptive analysis of mHSPC patients, treating physicians and treatment utilization. Among the 6198 mHSPC patients from five countries, the most common treatment was either androgen deprivation therapy (ADT) monotherapy or first-generation androgen receptor inhibitor + ADT.

Sunitinib for Metastatic Renal Cell Carcinoma: Real-World Data from the STAR-TOR Registry and Detailed Literature Review.

Introduction: We evaluated the effectiveness and safety profile of the tyrosine kinase inhibitor sunitinib in patients with advanced or metastatic renal cell carcinoma (a/mRCC) in a real-world setting.

Methods: We analyzed data of adult a/mRCC patients treated with sunitinib. Data were derived from the German non-interventional post-approval multicenter STAR-TOR registry (NCT00700258).

[Individualized precision medicine].

Spectacular advances have been made in personalized medicine , which has rapidly revolutionized our traditional understanding of disease diagnosis and treatment. Molecular testing of tissue and liquid samples using next generation sequencing has developed into a key technology in this scenario. It can be used for both the determination of biomarkers for diagnostic, prognostic and predictive purposes, as well as the possible improvement of treatment outcome through the use of targeted therapies and the avoidance of therapies in the event of special resistance situations.

[Another encroachment on our liberal profession-The German Federal Ministry of Health continues to stubbornly ignore the self-government].

Overall, the German healthcare system is shaped by numerous players and institutions. With the state medical associations as public corporations for self-governance and the Heilberufsgesetz (German Health Professions Act), professional practice, professional representation and professional jurisdiction are regulated at the state level. The Joint Federal Committee ("Gemeinsame Bundesausschuss"), the highest decision-making body of joint self-governance in the German health care system, plays a central role.

Sarcopenia assessments as predictors of overall survival in patients with metastatic renal cell carcinoma.

Background: Sarcopenia represents an important prognostic marker in tumor patients. However, measurement methods and threshold values are not uniformly defined. The aim of this study is therefore to determine the prognostic value of current definitions of sarcopenia in patients with metastatic renal cell carcinoma treated with tyrosine-kinase-inhibitors (TKIs).

25 years International Bladder Cancer Network (IBCN): The past, the present, and the future.

In 1997 an international group of scientists organized a meeting in Barcelona, Spain, to discuss the use of biomarkers in the management of patients with bladder cancer. This meeting was the offspring of an - initially informal - group that finally resulted in the foundation and incorporation of the International Bladder Cancer Network (IBCN) e.V.

Cell-Free DNA Sequencing Reveals Gene Variants in DNA Damage Repair Genes Associated with Prognosis of Prostate Cancer Patients.

In the present study, we further analyzed the data obtained in our previous study, where we investigated the cell-free DNA (cfDNA) of 34 progressive prostate cancer patients via targeted sequencing. Here, we studied the occurrence and prognostic impact of sequence variants according to their clinical pathological significance (CPS) or their functional impact (FI) in 23 DNA damage repair (DDR) genes with a focus on the ATM serine/threonine kinase gene (ATM). All patients had at least one DDR gene with a CPS or FI variant.