Renal surgery following HIF-2α antagonist therapy: Surgical indications, outcomes and growth kinetics.

Background: The development of HIF-2α antagonists marked an advancement in the treatment of localized VHL-deficient kidney cancer; however, their impact on subsequent surgical interventions remains unexplored. This study investigated the indications for and outcomes of patients undergoing renal surgery after exposure to HIF-2α antagonists and the growth rates (GR) of their index renal tumors.

Design, Setting, And Participants: We performed a retrospective analysis of patients who underwent renal surgery at a single institution following or during treatment with a HIF-2α antagonist.

Small cell carcinoma of the bladder: Review of pathogenesis, presentation, and management.

Small cell carcinoma of the bladder (SCCB) is a rare, aggressive malignancy that accounts for less than 1% of all bladder cancers. In this report, we highlight the clinical manifestations of SCCB (including epidemiology, cystoscopic and imaging findings), summarize insights into the molecular mechanisms underlying its pathophysiology, detail current methods of staging, review local and systemic treatment, and explore novel agents currently in clinical development. Most of the regimens used for SCCB treatment are extrapolated from small cell lung cancer, a more common cancer that shares the neuroendocrine and aggressive clinical phenotype of SCCB.

Augmented reality assisted MRI/US fusion for non-rectal fully trans-perineal prostate biopsy.

Augmented reality (AR) technologies enable the superimposition of imaging upon a patient in real time with three dimensional instrument tracking during procedures. We sought to demonstrate the feasibility of using an AR system (XR90, MediView XR Inc., Cleveland, OH) to fuse a pelvic multi-parametric magnetic resonance image segmentation with ultrasound to perform a non-rectal, fully trans-perineal (FTP), AR-assisted prostate biopsy.

Novel Biopsy Gun Impacts Biopsy Sample Quality and Quantity.

Purpose: A biopsy gun featuring alternated serrated cutting edges was designed to improve core stability and tissue acquisition. This study aimed to assess the impact upon core biopsy tissue quantity and quality of a serrated core gun (SUREcore prime, Uro-1).

Materials And Methods: 18G serrated core gun was compared with 18G conventional gun (Maxcore, Becton Dickinson), in both ex vivo (bovine liver, N = 30) and in vivo (swine liver and kidney, N = 24) models.

A multimodal automated deep learning-based model for predicting biochemical recurrence of prostate cancer following prostatectomy from baseline MRI, Presurgical clinical covariates.

Purpose: To develop a multimodal deep learning-based AI algorithm and investigate its ability to predict BCR of PCa after radical prostatectomy (RP) using MRI and clinical data.

Methods: PCa patients (n = 311) underwent prostate MRI prior to RP between January 2008 and December 2018. For each patient, CAPRA-S was calculated.

Top advances of the year: Bladder cancer.

Looking back at 2024, the authors highlight the top five clinical advances in bladder cancer (urothelial carcinoma), from: (1) novel drug-delivery mechanisms in intravesical therapy for nonmuscle-invasive bladder cancer and muscle-invasive bladder cancer (MIBC); (2) immune checkpoint inhibition (ICI) as adjuvant and (3) perioperative therapy in MIBC; (4) circulating tumor DNA as a biomarker in MIBC; to (5) a new standard of care in first-line metastatic urothelial carcinoma. TAR-200 is a new intravesical drug-delivery system that enables controlled release of gemcitabine but may be used with other anticancer drugs to treat nonmuscle-invasive bladder cancer and MIBC. Two phase 3 studies of adjuvant ICI (nivolumab and pembrolizumab) have both reported a doubling of disease-free survival in patients with high-risk MIBC receiving therapy.

Predictive Clinical Features in Germline Testing for Renal Cell Carcinoma.

Objective: To characterize the frequency of germline alterations in a potentially enriched renal cell carcinoma (RCC) population, including early onset (EO), bilateral multifocal (BMF), or those with a family history of renal cancer (FRC).

Methods: We identified 380 consecutive patients referred with a new diagnosis of a renal mass without a personal or family history of a hereditary RCC syndrome, of which 245 underwent a germline genetic panel and were included in the analysis. The predictive accuracy of 3 clinical enrichment features (EO, BMF, and FRC) and the likelihood of identifying a pathogenic/likely pathogenic variant were assessed.

Clinical, Pathologic, and Genetic Correlates of Nuclear Grade in von Hippel-Lindau-associated Renal Cell Carcinoma.

Objective: To evaluate the proportion of von Hippel-Lindau (VHL) patients with high-grade disease and analyze the association of clinical, pathologic, and genetic factors with high-grade disease.

Methods: Clear cell renal cell carcinoma (ccRCC) specimens resected from VHL patients between 2006 and 2021 at the National Cancer Institute were evaluated. Pathologic, demographic, and genetic data were obtained from clinical records.

Understanding the Metabolic Effects of Surgically Induced Renal Ischemia in Humans: A Temporal Approach.

: Thousands of nephrectomies are performed annually in the United States, but the short-term metabolic effects of surgically induced renal ischemia remain unclear. The conventional metabolic markers used to characterize post-surgical renal function, such as creatinine and GFR, are measured in the serum but do not provide metabolic information about the renal parenchyma itself. We aimed to characterize the immediate metabolic effects of surgical ischemia on renal parenchyma within a temporal framework.

Artificial intelligence-generated apparent diffusion coefficient (AI-ADC) maps for prostate gland assessment: a multi-reader study.

Objective: To compare the quality of AI-ADC maps and standard ADC maps in a multi-reader study.

Materials And Methods: Multi-reader study included 74 consecutive patients (median age = 66 years, [IQR = 57.25-71.

Evaluating Artificial Intelligence-Assisted Prostate Biparametric MRI Interpretation: An International Multireader Study.

Variability in prostate biparametric MRI (bpMRI) interpretation limits diagnostic reliability for prostate cancer (PCa). Artificial intelligence (AI) has potential to reduce this variability and improve diagnostic accuracy. The objective of this study was to evaluate impact of a deep learning AI model on lesion- and patient-level clinically significant PCa (csPCa) and PCa detection rates and interreader agreement in bpMRI interpretations.

A phase 2 study of sacituzumab govitecan with or without atezolizumab in rare genitourinary tumors (SMART) - design and rationale.

Sacituzumab govitecan (SG) is a TROP2-directed antibody-drug conjugate with a payload of SN-38, a topoisomerase inhibitor. SG monotherapy has demonstrated activity in multiple solid tumors, including metastatic breast and bladder cancer. Rare tumors of the genitourinary tract often exhibit aggressive clinical behavior yet lack effective treatment options.

Bevacizumab and Erlotinib in Hereditary and Sporadic Papillary Kidney Cancer.

Background: Hereditary leiomyomatosis and renal-cell cancer (HLRCC) is an inherited disorder characterized by germline pathogenic variants in the gene encoding fumarate hydratase and an increased risk of papillary renal-cell carcinoma. No effective therapy is known for patients with advanced HLRCC-associated papillary renal-cell carcinoma, and most patients die from progressive disease.

Methods: In this open-label, phase 2 study, we evaluated the efficacy of bevacizumab (10 mg per kilogram of body weight every 2 weeks) and erlotinib (150 mg once daily) in patients with advanced HLRCC-associated or sporadic papillary renal-cell carcinoma.

Under Pressure: A Quality Improvement Initiative to Reduce Rhabdomyolysis and Hospital-Acquired Pressure Injuries Following Retroperitoneal Surgery.

Introduction: Present a retrospective quality improvement analysis assessing the incidence and factors associated with elevated creatine kinase (CK) levels, clinical rhabdomyolysis, and hospital-acquired pressure injuries (HAPIs) following complex retroperitoneal surgeries before and after the implementation of The Pink Pad for intraoperative positioning.

Methods: We performed a retrospective analysis of 364 patients who underwent renal or retroperitoneal surgery in the lateral decubitus position between July 2018 through July 2023. The 2 cohorts-pre-and post-Pink Pad utilization-were analyzed, each with 2.

Impact of AI-Generated ADC Maps on Computer-Aided Diagnosis of Prostate Cancer: A Feasibility Study.

Rationale And Objectives: To evaluate the impact of AI-generated apparent diffusion coefficient (ADC) maps on diagnostic performance of a 3D U-Net AI model for prostate cancer (PCa) detection and segmentation at biparametric MRI (bpMRI).

Material And Methods: The study population was retrospectively collected and consisted of 178 patients, including 119 cases and 59 controls. Cases had a mean age of 62.

Feasibility and perioperative outcomes of re-operative retroperitoneal robotic partial nephrectomy.

Purpose: To present our experience with re-operative retroperitoneal partial nephrectomy (Re-RetroPN), evaluate its feasibility and safety, and compare perioperative outcomes, including renal function metrics, pathology, and complication rates, between patients that underwent Re-RetroPN and those that underwent re-operative transperitoneal robotic partial nephrectomy (Re-TransPN).

Methods: A retrospective cohort study was conducted identifying patients who underwent re-operative robotic partial nephrectomy (PN) at our institution from January 2008 to December 2024. Demographic, clinical, perioperative, and pathological data were recorded and analyzed.

E-VIRTUE: a study of enfortumab vedotin with or without pembrolizumab in rare genitourinary tumors-design and rationale.

NCT06041503 (ClinicalTrials.gov).

Research-based clinical deployment of artificial intelligence algorithm for prostate MRI.

Purpose: A critical limitation to deployment and utilization of Artificial Intelligence (AI) algorithms in radiology practice is the actual integration of algorithms directly into the clinical Picture Archiving and Communications Systems (PACS). Here, we sought to integrate an AI-based pipeline for prostate organ and intraprostatic lesion segmentation within a clinical PACS environment to enable point-of-care utilization under a prospective clinical trial scenario.

Methods: A previously trained, publicly available AI model for segmentation of intra-prostatic findings on multiparametric Magnetic Resonance Imaging (mpMRI) was converted into a containerized environment compatible with MONAI Deploy Express.

Longitudinal Evaluation of Clear-cell Renal Cell Carcinoma in von Hippel-Lindau Disease.

Background And Objective: An understanding the natural history of von Hippel-Lindau (VHL) disease-associated renal cell carcinoma (RCC) is critical to the development of optimal clinical management approaches and interpretation of trial results for comparable populations and endpoints. Our aim was to describe the natural progression of disease in patients with VHL RCC.

Methods: This was a natural history study involving 244 patients with VHL with ≥10-mm renal tumor(s) who were evaluated and managed at the US National Cancer Institute between 2004 and 2020.

Urinary leak after partial nephrectomy: Insights from a cohort with hereditary, multifocal, and reoperative cases.

Purpose: To identify risk factors, surgical considerations, and management strategies associated with urinary leak (UL) following partial nephrectomy (PN) in a cohort that includes a significant number of patients with hereditary renal cancer syndromes, multiple tumors, and a history of prior PNs.

Material And Methods: A retrospective chart review was conducted selecting patients who underwent PN at our institution from January 2006 to December 2023 was performed. Clinical, demographic, surgical characteristics, and management strategies were recorded and analyzed.

A phase II study of lurbinectedin with or without avelumab in small cell carcinoma of the bladder (laser)-design and rationale.

Small cell carcinoma of the bladder is a rare, aggressive malignancy accounting for less than 1% of all bladder malignancies. Treatment regimens are drawn from the small cell lung cancer (SCLC) literature, with platinum and etoposide commonly used in the first-line setting. Unfortunately, responses are generally short-lived, and most patients relapse.

Antibody-drug conjugates in rare genitourinary tumors: review and perspectives.

Purpose Of Review: Rare cancers of the genitourinary (GU) tract are often clinically aggressive yet have few or no standard-of-care treatments. Multiple antibody-drug conjugates (ADCs) have been approved in solid malignancies. This review explores the use of ADCs in rare GU tumors in the context of biological pathways and ongoing research in solid tumors.

Assessing the Impact of Transition and Peripheral Zone PSA Densities Over Whole-Gland PSA Density for Prostate Cancer Detection on Multiparametric MRI.

Background: Whole-gland (WG) prostate-specific antigen (PSA) density (PSAD) has proven useful in diagnosing to be beneficial in localized prostate cancer (PCa). This study aimed to evaluate the predictive performance of WG and zonal (transition zone [TZ] and peripheral zone [PZ]) PSAD in predicting PCa and clinically significant PCa (csPCa) in prostate MRI.

Methods: A retrospective analysis was conducted on consecutive patients who underwent multiparametric MRI and MRI/US fusion-guided biopsy between March 2019 and July 2024.