Prognostic Factors in Urologic Cancers—Assessment and Integration into Clinical Care

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 7163

Special Issue Editors


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Guest Editor
Department of Urology, St. Josef Medical Center, University of Regensburg, Landshuterstraße 65, 93053 Regensburg, Germany
Interests: prostate cancer; bladder cancer; renal cell cancer; uro-oncology; surgery; robotic; medical therapy; clinical management

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Guest Editor
Department of Urology, Carl Gustav Carus University Dresden, 01307 Dresden, Germany
Interests: prostate cancer; bladder cancer; renal cell cancer; uro-oncology; surgery; robotic; medical therapy; clinical management
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Special Issue Information

Dear Colleagues,

As urological oncology is constantly advancing and offering additional options for cancer care, it is becoming ever more demanding. Which therapy is the most effective for a specific condition and is especially the most effective for a specific patient in such a specific condition? Individual therapy guidance and management is required to obtain the care each patient requires; in short, personalized medicine is required. The key to such personalized medicine is the assessment and interpretation of risk factors defining the outcome of urological cancers and their integration into clinical management. Molecular markers, clinical parameters impacting surgical and medical therapy, histopathology, and socio-economic factors shape the outcome of this, but we need to understand much more. While there will be no such thing as an equation for uranological management, we should try to keep up the pace. We invite you to contribute original data, meta-analyses, and reviews which deal with prognostic factors in urological cancers to this Special Issue.

Prof. Dr. Maximilian Burger
Prof. Dr. Christian Thomas
Guest Editors

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Keywords

  • prognosis
  • prognostic factor
  • clinical management
  • prostate cancer
  • bladder cancer
  • renal cell cancer
  • uro-oncology
  • surgery
  • medical therapy

Published Papers (5 papers)

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Research

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19 pages, 2300 KiB  
Article
Therapeutic and Diagnostic Potential of Folic Acid Receptors and Glycosylphosphatidylinositol (GPI) Transamidase in Prostate Cancer
by Marco Hoffmann, Thomas Frank Ermler, Felix Hoffmann, Radu Alexa, Jennifer Kranz, Nathalie Steinke, Sophie Leypold, Nadine Therese Gaisa and Matthias Saar
Cancers 2024, 16(11), 2008; https://doi.org/10.3390/cancers16112008 - 25 May 2024
Viewed by 387
Abstract
Due to the proliferation-induced high demand of cancer cells for folic acid (FA), significant overexpression of folate receptors 1 (FR1) is detected in most cancers. To our knowledge, a detailed characterization of FR1 expression and regulation regarding therapeutic and diagnostic feasibilities in prostate [...] Read more.
Due to the proliferation-induced high demand of cancer cells for folic acid (FA), significant overexpression of folate receptors 1 (FR1) is detected in most cancers. To our knowledge, a detailed characterization of FR1 expression and regulation regarding therapeutic and diagnostic feasibilities in prostate cancer (PCa) has not been described. In the present study, cell cultures, as well as tissue sections, were analyzed using Western blot, qRT-PCR and immunofluorescence. In addition, we utilized FA-functionalized lipoplexes to characterize the potential of FR1-targeted delivery into PCa cells. Interestingly, we detected a high level of FR1-mRNA in healthy prostate epithelial cells and healthy prostate tissue. However, we were able to show that PCa cells in vitro and PCa tissue showed a massively enhanced FR1 membrane localization where the receptor can finally gain its function. We were able to link these changes to the overexpression of GPI–transamidase (GPI-T) by image analysis. PCa cells in vitro and PCa tissue show the strongest overexpression of GPI-T and thereby induce FR1 membrane localization. Finally, we utilized FA-functionalized lipoplexes to selectively transfer pDNA into PCa cells and demonstrate the therapeutic potential of FR1. Thus, FR1 represents a very promising candidate for targeted therapeutic transfer pathways in PCa and in combination with GPI-T, may provide predictive imaging in addition to established diagnostics. Full article
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15 pages, 3054 KiB  
Article
Assessing the Predictive Accuracy of EORTC, CUETO and EAU Risk Stratification Models for High-Grade Recurrence and Progression after Bacillus Calmette–Guérin Therapy in Non-Muscle-Invasive Bladder Cancer
by Aleksander Ślusarczyk, Karolina Garbas, Patryk Pustuła, Łukasz Zapała and Piotr Radziszewski
Cancers 2024, 16(9), 1684; https://doi.org/10.3390/cancers16091684 - 26 Apr 2024
Viewed by 632
Abstract
The currently available EORTC, CUETO and EAU2021 risk stratifications were originally developed to predict recurrence and progression in non-muscle-invasive bladder cancer (NMIBC). However, they have not been validated to differentiate between high-grade (HG) and low-grade (LG) recurrence-free survival (RFS), which are distinct events [...] Read more.
The currently available EORTC, CUETO and EAU2021 risk stratifications were originally developed to predict recurrence and progression in non-muscle-invasive bladder cancer (NMIBC). However, they have not been validated to differentiate between high-grade (HG) and low-grade (LG) recurrence-free survival (RFS), which are distinct events with specific implications. We aimed to evaluate the accuracy of available risk models and identify additional risk factors for HG RFS and PFS among NMIBC patients treated with Bacillus Calmette–Guérin (BCG). We retrospectively included 171 patients who underwent transurethral resection of the bladder tumor (TURBT), of whom 73 patients (42.7%) experienced recurrence and 29 (17%) developed progression. Initially, there were 21 low-grade and 52 high-grade recurrences. EORTC2006, EORTC2016 and CUETO recurrence scoring systems lacked accuracy in the prediction of HG RFS (C-index 0.63/0.55/0.59, respectively). EAU2021 risk stratification, EORTC2006, EORTC2016, and CUETO progression scoring systems demonstrated low to moderate accuracy (C-index 0.59/0.68/0.65/0.65) in the prediction of PFS. In the multivariable analysis, T1HG at repeat TURBT (HR = 3.17 p < 0.01), tumor multiplicity (HR = 2.07 p < 0.05), previous history of HG NMIBC (HR = 2.37 p = 0.06) and EORTC2006 progression risk score (HR = 1.1 p < 0.01) were independent predictors for HG RFS. To conclude, available risk models lack accuracy in predicting HG RFS and PFS in -NMIBC patients treated with BCG. Full article
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9 pages, 824 KiB  
Article
Feasibility of Monitoring Response to Metastatic Prostate Cancer Treatment with a Methylation-Based Circulating Tumor DNA Approach
by Thomas Büttner, Dimo Dietrich, Romina Zarbl, Niklas Klümper, Jörg Ellinger, Philipp Krausewitz and Manuel Ritter
Cancers 2024, 16(3), 482; https://doi.org/10.3390/cancers16030482 - 23 Jan 2024
Cited by 1 | Viewed by 985
Abstract
Background: Metastatic prostate cancer (mPCA) poses challenges in treatment response assessment, particularly in cases where prostate-specific antigen (PSA) levels do not reliably indicate a response. Liquid biopsy, focusing on circulating cell-free DNA (ccfDNA) methylation analysis as a proxy for circulating tumor DNA, offers [...] Read more.
Background: Metastatic prostate cancer (mPCA) poses challenges in treatment response assessment, particularly in cases where prostate-specific antigen (PSA) levels do not reliably indicate a response. Liquid biopsy, focusing on circulating cell-free DNA (ccfDNA) methylation analysis as a proxy for circulating tumor DNA, offers a non-invasive and cost-effective approach. This study explores the potential of two methylation markers, short stature homeobox 2 (SHOX2) and Septin 9 (SEPT9), as on-mPCA-treatment biomarkers. Methods: Plasma samples were collected from 11 mPCA patients undergoing various treatments. Quantitative assessment of hypermethylated SHOX2 (mSHOX2) and SEPT9 (mSEPT9) levels in ccfDNA was conducted through methylation-specific real-time PCR. Early and overall dynamics of PSA, mSHOX2, and mSEPT9 were analyzed. Statistical evaluation employed Wilcoxon tests. Results: mSHOX2 demonstrated a significant decline post-treatment in patients with a radiographic treatment response as well as in an early treatment setting. mSEPT9 and PSA exhibited non-significant declines. In individual cases, biomarker dynamics revealed unique patterns compared to PSA. Discussion: mSHOX2 and mSEPT9 exhibit dynamics on mPCA treatment. This proof-of-concept study lays the groundwork for further investigation into these markers as valuable additions to treatment response monitoring in mPCA. Further validation in larger cohorts is essential for establishing clinical utility. Full article
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9 pages, 251 KiB  
Article
The BETTY Score to Predict Perioperative Outcomes in Surgical Patients
by Michael Baboudjian, Rawad Abou-Zahr, Bogdan Buhas, Alae Touzani, Jean-Baptiste Beauval and Guillaume Ploussard
Cancers 2023, 15(11), 3050; https://doi.org/10.3390/cancers15113050 - 4 Jun 2023
Cited by 2 | Viewed by 993
Abstract
The aim of this study is to evaluate a new user-friendly scoring system, namely the BETTY score, that aims to predict 30-day patient outcomes after surgery. In this first description, we rely on a population of prostate cancer patients undergoing robot-assisted radical prostatectomy. [...] Read more.
The aim of this study is to evaluate a new user-friendly scoring system, namely the BETTY score, that aims to predict 30-day patient outcomes after surgery. In this first description, we rely on a population of prostate cancer patients undergoing robot-assisted radical prostatectomy. The BETTY score includes the patient’s American Society of Anesthesiologists score, the body mass index, and intraoperative data, including operative time, estimated blood loss, any major intraoperative complications, hemodynamic, and/or respiratory instability. There is an inverse relationship between the score and severity. Three clusters assessing the risk of postoperative events were defined: low, intermediate, and high risk of postoperative events. A total of 297 patients was included. The median length of hospital stay was 1 day (IQR1-2). Unplanned visits, readmissions, any complications, and serious complications occurred in 17.2%, 11.8%, 28.3%, and 5% of cases, respectively. We found a statistically significant correlation between the BETTY score and all endpoints analyzed (all p ≤ 0.01). A total of 275, 20, and 2 patients were classified as low-, intermediate-, and high-risk according to the BETTY scoring system, respectively. Compared with low-risk patients, patients at intermediate-risk were associated with worse outcomes for all endpoints analyzed (all p ≤ 0.04). Future studies, in various surgical subspecialties, are ongoing to confirm the usefulness of this easy-to-use score in routine. Full article

Review

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13 pages, 727 KiB  
Review
Prognostic Factors and Current Treatment Strategies for Renal Cell Carcinoma Metastatic to the Brain: An Overview
by Valeria Internò, Pierluigi De Santis, Luigia Stefania Stucci, Roberta Rudà, Marco Tucci, Riccardo Soffietti and Camillo Porta
Cancers 2021, 13(9), 2114; https://doi.org/10.3390/cancers13092114 - 27 Apr 2021
Cited by 14 | Viewed by 3692
Abstract
Renal cell carcinoma (RCC) is one of primary cancers that frequently metastasize to the brain. Brain metastasis derived from RCC has the propensity of intratumoral hemorrhage and relatively massive surrounding edema. Moreover, it confers a grim prognosis in a great percentage of cases [...] Read more.
Renal cell carcinoma (RCC) is one of primary cancers that frequently metastasize to the brain. Brain metastasis derived from RCC has the propensity of intratumoral hemorrhage and relatively massive surrounding edema. Moreover, it confers a grim prognosis in a great percentage of cases with a median overall survical (mOS) around 10 months. The well-recognized prognostic factors for brain metastatic renal cell carcinoma (BMRCC) are Karnofsky Performance Status (KPS), the number of brain metastasis (BM), the presence of a sarcomatoid component and the presence of extracranial metastasis. Therapeutic strategies are multimodal and include surgical resection, radiotherapy, such as stereotactic radiosurgery due to the radioresistance of RCC and systemic strategies with tyrosin kinase inhibitors (TKI) or Immune checkpoint inhibitors (ICI) whose efficacy is not well-established in this setting of patients due to their exclusion from most clinical trials. To date, in case of positive prognostic factors and after performing local radical therapies, such as complete resection of BM or stereotactic radiosurgery (SRS), the outcome of these patients significantly improves, up to 33 months in some patients. As a consequence, tailored clinical trials designed for BMRCC are needed to define the correct treatment strategy even in this poor prognostic subgroup of patients. Full article
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