Advances and Challenges in the Diagnosis and Treatment of Urological Malignancies (2nd Edition)

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Causes, Screening and Diagnosis".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 4586

Special Issue Editors


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Guest Editor
University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
Interests: uro-oncology; lymph node metastasis-growth and immune evasion; minimally invasive surgery; radio-guided surgery; prostate cancer; bladder cancer
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Guest Editor
Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Professor W. Orlowski, 00-416 Warsaw, Poland
Interests: urologic oncology; molecular diagnostics; endoscopic surgery
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
Interests: uro-oncology; bladder cancer; cancer cell biology; bladder cancer cell cultures; bladder cancer organoids; biomarkers; immunotherapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue is the second edition of the Special Issue Advances and Challenges in the Diagnosis and Treatment of Urological Malignancies, which has 24 papers published.

The incidence of urological tumors has increased significantly over the past 40 years, and prostate cancer is the second most common malignancy among men. Even if in most cases the initial treatment is curative, a certain number of patients experience a poor course of disease with local or distant recurrence, and require further treatment, which significantly worsens their quality of life.

Over the past two decades, great efforts have been made to improve diagnosis and treatment outcomes. Molecular biomarkers have been investigated and introduced into clinical practice, and new pathological and clinical classifications have been proposed to account for tumor behavior and risk of disease recurrence. At the same time, new surgical and pharmacological approaches have been developed to improve treatment outcomes.

Nevertheless, many issues remain a matter of debate regarding accurate diagnosis, targeted therapy, and multidisciplinary management.

This Special Issue of Cancers will cover all aspects of urological cancers, including original research into advanced imaging, molecular characterization, current and experimental treatment options, and quality of life. Expert opinions, systematic reviews, and meta-analyses are also welcome.

Dr. Bartosz Małkiewicz
Prof. Dr. Jakub Dobruch
Dr. Łukasz Nowak
Guest Editors

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Keywords

  • prostate cancer
  • bladder cancer
  • upper urinary tract tumors
  • kidney cancer
  • testicular tumors
  • molecular markers
  • lymph node metastasis
  • diagnosis
  • radical treatment
  • systemic treatment

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Published Papers (3 papers)

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Research

13 pages, 4093 KiB  
Article
Robot-Assisted PSMA-Radioguided Salvage Surgery for Oligorecurrent Prostate Cancer Using the Novel SENSEI® Drop-in Gamma Probe: Correlation of Intraoperative Measurements to Preoperative Imaging and Final Histology
by Giovanni Mazzucato, Fabian Falkenbach, Marie-Lena Schmalhofer, Farzad Shenas, Maria Angela Cerruto, Alessandro Antonelli, Pierre Tennstedt, Markus Graefen, Felix Preisser, Philipp Mandel, Sophie Knipper, Lars Budäus, Daniel Koehler and Tobias Maurer
Cancers 2025, 17(1), 93; https://doi.org/10.3390/cancers17010093 - 31 Dec 2024
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Abstract
Background: To examine the feasibility and safety of the SENSEI® drop-in gamma probe for robot-assisted, prostate-specific membrane antigen (PSMA)-radioguided salvage surgery (RGS) in lymph node or local oligorecurrent prostate cancer (PCa), detected via PSMA positron emission tomography/computed tomography (PET/CT). Methods: The first [...] Read more.
Background: To examine the feasibility and safety of the SENSEI® drop-in gamma probe for robot-assisted, prostate-specific membrane antigen (PSMA)-radioguided salvage surgery (RGS) in lymph node or local oligorecurrent prostate cancer (PCa), detected via PSMA positron emission tomography/computed tomography (PET/CT). Methods: The first thirteen patients with pelvic oligorecurrent PCa who underwent [99mTc]Tc-PSMA-I&S RGS using the SENSEI® drop-in gamma probe at the Martini-Klinik (February–June 2024) were retrospectively analyzed. Radioactivity measurements in counts per second (CPS) as absolute values or ratios (CPS of tumor specimens/mean CPS from the patients’ benign tissues) were correlated with preoperative imaging and pathological findings (benign/malignant, lesion size). Postoperative complete biochemical response (cBR) was defined as prostate-specific antigen (PSA) levels of <0.2 ng/mL. Results: Fifty-four specimens were removed from 13 patients, with nineteen (35%) containing PCa. All patients had one PSMA PET/CT-positive lesion, which were all detected intraoperatively. These lesions showed higher ex vivo CPS, CPS ratios, and larger cancer diameters than PSMA PET/CT-negative lesions (all p < 0.05). Cancer-containing specimens exhibited higher CPS and CPS ratios than benign tissues (median values of 45 vs. 3, and 9.9 vs. 1.0, both p < 0.001). In total, 12/13 (92%) patients achieved cBR. Conclusions: This device yielded excellent detection rates with good correlation to preoperative imaging and histological results without adverse events. Full article
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14 pages, 1621 KiB  
Article
Utility of Machine Learning Models to Predict Lymph Node Metastasis of Japanese Localized Prostate Cancer
by Hideto Ueki, Tomoaki Terakawa, Takuto Hara, Munenori Uemura, Yasuyoshi Okamura, Kotaro Suzuki, Yukari Bando, Jun Teishima, Yuzo Nakano, Raizo Yamaguchi and Hideaki Miyake
Cancers 2024, 16(23), 4073; https://doi.org/10.3390/cancers16234073 - 5 Dec 2024
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Abstract
Background/Objectives: Extended pelvic lymph node dissection is a crucial surgical technique for managing intermediate to high-risk prostate cancer. Accurately predicting lymph node metastasis before surgery can minimize unnecessary lymph node dissections and their associated complications. This study assessed the efficacy of various machine [...] Read more.
Background/Objectives: Extended pelvic lymph node dissection is a crucial surgical technique for managing intermediate to high-risk prostate cancer. Accurately predicting lymph node metastasis before surgery can minimize unnecessary lymph node dissections and their associated complications. This study assessed the efficacy of various machine learning models for predicting lymph node metastasis in a cohort of Japanese patients who underwent robot-assisted laparoscopic radical prostatectomy. Methods: Data from 625 patients who underwent extended pelvic lymph node dissection or standard dissection with lymph node metastasis between October 2010 and February 2023 were analyzed. Four machine learning models—Random Forest, Light Gradient-Boosting Machine, Logistic Regression, and Support Vector Machine—were used to predict lymph node metastasis. Their performance was assessed using receiver operating characteristic curves, a decision curve analysis, and predictive values at different thresholds. Results: Lymph node metastasis was observed in 34 patients (5.4%). The Light Gradient-Boosting Machine had the highest AUC of 0.924, followed by the Random Forest model with an AUC of 0.894. The decision curve analysis indicated substantial net benefits for both models, particularly at low threshold probabilities. The Light Gradient-Boosting Machine demonstrated superior accuracy, achieving 95.6% at the 0.05 threshold and 96.7% at the 0.10 threshold, outperforming other models and conventional nomograms in the validation dataset. Conclusion: Machine learning models, especially Light Gradient-Boosting Machine and Random Forest, show significant potential for predicting lymph node metastasis in prostate cancer, thereby aiding in reducing unnecessary surgical interventions. Full article
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11 pages, 1083 KiB  
Article
“Seeing Is Believing”: Additive Utility of 68Ga-PSMA-11 PET/CT in Prostate Cancer Diagnosis
by Joel Chin, Yu Guang Tan, Alvin Lee, Tze Kiat Ng, Ruoyu Shi, Charlene Yu Lin Tang, Sue Ping Thang, Jeffrey Kit Loong Tuan, Christopher Wai Sam Cheng, Kae Jack Tay, Henry Sun Sien Ho, Hung-Jen Wang, Peter Ka-Fung Chiu, Jeremy Yuen-Chun Teoh, Winnie Wing-Chuen Lam, Yan Mee Law, John Shyi Peng Yuen and Kenneth Chen
Cancers 2024, 16(9), 1777; https://doi.org/10.3390/cancers16091777 - 5 May 2024
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Abstract
Widespread adoption of mpMRI has led to a decrease in the number of patients requiring prostate biopsies. 68Ga-PSMA-11 PET/CT has demonstrated added benefits in identifying csPCa. Integrating the use of these imaging techniques may hold promise for predicting the presence of csPCa [...] Read more.
Widespread adoption of mpMRI has led to a decrease in the number of patients requiring prostate biopsies. 68Ga-PSMA-11 PET/CT has demonstrated added benefits in identifying csPCa. Integrating the use of these imaging techniques may hold promise for predicting the presence of csPCa without invasive biopsy. A retrospective analysis of 42 consecutive patients who underwent mpMRI, 68Ga-PSMA-11 PET/CT, prostatic biopsy, and radical prostatectomy (RP) was carried out. A lesion-based model (n = 122) using prostatectomy histopathology as reference standard was used to analyze the accuracy of 68Ga-PSMA-11 PET/CT, mpMRI alone, and both in combination to identify ISUP-grade group ≥ 2 lesions. 68Ga-PSMA-11 PET/CT demonstrated greater specificity and positive predictive value (PPV), with values of 73.3% (vs. 40.0%) and 90.1% (vs. 82.2%), while the mpMRI Prostate Imaging Reporting and Data System (PI-RADS) 4–5 had better sensitivity and negative predictive value (NPV): 90.2% (vs. 78.5%) and 57.1% (vs. 52.4%), respectively. When used in combination, the sensitivity, specificity, PPV, and NPV were 74.2%, 83.3%, 93.2%, and 51.0%, respectively. Subgroup analysis of PI-RADS 3, 4, and 5 lesions was carried out. For PI-RADS 3 lesions, 68Ga-PSMA-11 PET/CT demonstrated a NPV of 77.8%. For PI-RADS 4–5 lesions, 68Ga-PSMA-11 PET/CT achieved PPV values of 82.1% and 100%, respectively, with an NPV of 100% in PI-RADS 5 lesions. A combination of 68Ga-PSMA-11 PET/CT and mpMRI improved the radiological diagnosis of csPCa. This suggests that avoidance of prostate biopsy prior to RP may represent a valid option in a selected subgroup of high-risk patients with a high suspicion of csPCa on mpMRI and 68Ga-PSMA-11 PET/CT. Full article
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