Prostate cancer (PCa) is a multifaceted disease that envelops 1.41 million new cases globally. It is the second most common cancer reported in men. Its heterogeneity and indolent growth, coupled with incompetent early screening methods such as serum prostate-specific antigen level estimations and digital rectal examinations, contribute to its delayed detection, potentially leading to misdiagnosis or overtreatment. Despite the advancement in surgical methods, better management of PCa requires definitive diagnostics, prognostics, and therapeutics. PCa cells express microRNA (miRNA) on their surface as well as release miRNA into the bloodstream, which enables their noninvasive detection in body fluids like serum, plasma, and urine. miRNA acts as sponge for circulating RNA that regulates gene expression of crucial pathways in PCa progression. In recent years, compelling evidence indicates that the use of miRNAs, individually or in combination, in the form of miRNA panels in both tissue and body fluids, together with clinicopathological parameters, might act as a diagnostic biomarker. This will increase the accuracy of risk stratification and early screening of PCa patients under active surveillance. These findings will help differentiate aggressive PCa from indolent and decipher novel therapeutic findings. We have put together a review of studies that have found and confirmed miRNA panels in PCa tissue and PCa liquid biopsies (serum, plasma, and urine exosomes), with a focus on how they might help patients.
Prostate cancer is the most diagnosed cancer and the leading cause of cancer-related death among men in Sweden. The natural history and risk factors of prostate cancer, particularly within hereditary populations, have been extensively studied in the Swedish context. Despite the absence of national recommendations for prostate-specific antigen (PSA) screening, a large proportion of Swedish men undergo PSA testing. This unstructured testing approach has shown limited effectiveness and imposes a considerable burden on healthcare resources. To address these challenges, many regions in Sweden began implementing organized prostate cancer testing (OPT) in 2020. OPT targets specific age groups, providing them with comprehensive information about PSA testing, including its potential benefits and harms, to support informed individual decision-making. Subsequent PSA testing and follow-up procedures adhere to a standardized algorithm that incorporates individual risk factors, genetic predisposition, and the natural progression of prostate cancer. This review outlines the current recommendations, implementation strategies, and emerging frontiers for prostate cancer diagnosis in Sweden.
Hypospadias is the most prevalent congenital anomaly of the penis, with surgical intervention being its only treatment option. There remains ongoing debate regarding the necessity, the type, and duration of urine diversion following hypospadias repair. Early catheter removal may alleviate discomfort for both the patient and their family, facilitating earlier discharge. Nonetheless, premature removal raises concerns about the potential development of complications. A systematic review was conducted to assess the impact of catheter removal timing on the occurrence of complications. Six observational studies, including 1188 cases, were included. The duration before catheter removal varied among the study groups from less than 24 h up to more than 6 weeks. Prolonged catheterization can potentially lead to better urinary flow rate and better cosmetic results, but without a significant difference in most complications. There is an existing knowledge gap regarding the best urinary diversion and the optimal duration of catheterization in hypospadias repair. The available literature warrants further high-quality research. This includes conducting larger multicenter randomized trials to advance our understanding, aiming at improving the outcomes of hypospadias repair surgery.
Background: Prostate cancer (PCa) patients are at risk of developing second primary malignancies (SPMs), which can significantly shorten their survival. Understanding the risk of SPMs and associated factors is crucial to the optimization of patient follow-up.
Methods: This study focuses on PCa patients who were later diagnosed with SPMs using data from the Surveillance, Epidemiology, and End Results (SEER) database. Variables were carefully selected, and the data were analyzed using machine learning techniques combined with multivariate Cox proportional hazards modeling. Subsequently, a nomogram was generated to predict the 1-, 3-, and 5-year survival rates for SPMs patients. Additionally, a two-sample Mendelian randomization (TSMR) analysis was conducted to investigate the causal relationships between PCa and its top ten SPMs.
Results: Among the variables, age, marital status, SPM site, M stage, American Joint Committee on Cancer (AJCC) stage, PCa surgery, and prostate-specific antigen (PSA) levels were identified as key prognostic factors through least absolute shrinkage and selection operator (LASSO) and backward stepwise regression. Based on these factors, a nomogram was developed to visually represent survival predictions, complemented by a web-based calculator for easy application. This nomogram, which serves as a supplement to traditional AJCC staging, demonstrated strong predictive power for 1-, 3-, and 5-year survival, with area under the curve (AUC) values exceeding 0.85. Additionally, TSMR analysis revealed a causal link between PCa and urothelial carcinoma (UC).
Conclusion: This study developed a nomogram for predicting survival in prostate cancer patients with secondary primary malignancies, enhancing prognosis accuracy. TSMR identified a causal link between PCa and UC.
Background: Liquid biopsy has emerged as a non-invasive method for real-time cancer monitoring especially in genitourinary (GU) oncology. Most current studies utilize a panel-based molecular profiling ranging from 50-600 genes; however, a comprehensive exome-wide profiling of real-world patient samples has been lacking.
Methods: Over 2000 liquid biopsy samples were analyzed in this study, including urine samples from early-stage bladder cancer and plasma samples from prostate, lung, breast, esophageal, head and neck cancers, among others. Cell-free DNA (cfDNA) was extracted from these samples and analyzed using PredicineWES+TM, a boosted comprehensive whole-exome sequencing (WES) assay with an in-depth coverage of 600 cancer-related genes derived from the PredicineATLASTM panel. Data analysis was conducted in-house using Predicine's DeepSea bioinformatics software.
Results: The PredicineWES+TM assay demonstrated high sensitivity for detecting somatic mutations across the exome and showed comparable tumor mutational burden (TMB) estimates with the PredicineATLASTM panel. Interestingly, the highest tumor TMB score was observed in bladder cancer among the analyzed cancers, which is consistent with literature using tissue-based genomic profiling. The most common cancer variants include TP53, ERBB2, KRAS, PIK3CA, FGFR3, APC, among others.
Conclusion: Liquid biopsy-based genomic profiling across various cancer types provides an in-depth analysis of biomarker discovery for personalized cancer care, setting the foundation for improved cancer diagnosis and personalized treatment strategies for urological diseases.
Background: Uro-genital oncology patients often face complex treatment decisions requiring multiple consultations, which can delay treatment initiation and lead to fragmented care. Traditional approaches are particularly challenging for patients with multiple treatment options. Multidisciplinary care models have been shown to improve patient outcomes. This project introduces a multidisciplinary joint counseling clinic (MDJCC) to enhance the quality and efficiency of uro-genital oncology care.
Methods: MDJCC was piloted from May 2019 to January 2020, paused during the COVID-19 pandemic, and re-established in September 2023. Outcome measures include the percentage of patients who make final treatment decisions during or shortly after the clinic. Process measures track the number of clinics conducted monthly, and balance measures assess patient satisfaction. The target population comprises post uro-genital oncology multidisciplinary team (MDT) cases requiring surgical, medical, or radiation therapy.
Results: The clinic reduced delays in traditional counseling pathways, enabling most patients to decide on treatment during the same session or within 7 days, compared to the previous 30-day standard. Consolidating disciplines into a single visit optimized resource utilization, reduced costs, and improved patient understanding and satisfaction.
Conclusion: The MDJCC significantly improved care quality, streamlined decision-making, and enhanced patient satisfaction in uro-genital oncology, highlighting its value as a care model.
Background: Pheochromocytoma is a rare catecholamine-secreting tumor that often presents with symptoms such as hypertension, palpitations, and sweating due to excessive hormone production. In some cases, the catecholamine-induced vasoconstriction and hypercoagulability associated with pheochromocytomas can lead to cerebrovascular accidents and venous thrombosis. We report a rare case of pheochromocytoma in a middle-aged man who initially presented with a stroke and later developed a pulmonary embolism.
Case Presentation: A 44-year-old gentleman presented with sudden right-sided weakness, numbness, and slurred speech, lasting for 6 h. His medical history included hypertension, for which he was on bisoprolol. On examination, he exhibited right-sided facial weakness, asymmetric smile, and motor weakness (0/5 on the right). Brain computed tomography angiography revealed an infarction in the left middle cerebral artery territory, complicated by hemorrhagic transformation. Seven days later, he developed severe left-sided abdominal and chest pain, sweating, and left upper quadrant tenderness. His labs showed leukocytosis, and chest radiography raised suspicion of pulmonary embolism (PE). A computed tomography (CT) pulmonary angiogram confirmed thrombi in the left lower lobe with moderate left pleural effusion. Abdominal ultrasound revealed a non-vascular mass near the left kidney, which was later identified as a 3.6 cm × 4.3 cm adrenal mass on CT. Biochemical tests confirmed pheochromocytoma. An FDG-PET scan suggested an intense FDG-avid left adrenal mass.
Conclusion: This case demonstrates the rare association between pheochromocytoma and thrombotic events. Atypical presentations can complicate diagnosis, highlighting the need for early testing. Surgery remains the primary treatment, with long-term follow-up due to the risk of recurrence.
Background: Urinary problems are common among older men. In a Swedish study of men aged 40-80 years, the prevalence of lower urinary tract symptoms (LUTS) was 24%, but only 4% sought medical care. A Danish survey reported similar prevalence rates, with over 20% of men not discussing their symptoms with anyone. The incidence of LUTS is expected to rise due to an aging population. Artificial intelligence (AI) has been proven valuable in radiology, but its use in primary care remains limited. This study aims to develop an intelligent technique (IT) solution: a user-friendly mobile app that provides individualized support for men with LUTS. The secondary aim is to enhance diagnostic quality in primary care through AI-based decision support.
Methods: A retrospective patient database was created, containing patient-reported symptom scores (IPSS), urinary diaries, and timed micturition assessments. These data were analyzed using machine learning and Bayesian methods to develop algorithms for personalized recommendations. A prospective clinical study, initiated in 2021, collects data from men seeking care for LUTS to expand the database. A randomized study will test the app's efficacy.
Results: The first version of the app showed high concordance between its algorithmic assessments and urologist evaluations. A prospective study enrolled 50 patients from three primary health centers. One third of the patients did not get a recommendation at the first visit. Of the remaining less than half received the same treatment recommendation at this visit as the AI algorithm would have suggested. A web-based study is currently being initiated. Recruitment strategies include public campaigns and targeted invitations. Participants complete a digital questionnaire and are randomized if they meet the inclusion criteria.
Conclusion: LUTS significantly impacts men's health, yet care-seeking remains limited. AI-based solutions, such as mobile apps for diagnosis and personalized recommendations, show promise as tools to improve healthcare for this population.