More harm than good? The UK National Screening Committee's latest review of prostate cancer screening
Professor Sir Mike Richards and colleagues describe the process taken by the UK NSC in developing its recommendations and highlight where additional evidence is still needed
doi.org/10.1111/bju....
![Abstract
Objectives
To evaluate the long-term functional outcomes of robot-assisted partial nephrectomy (RAPN) in patients with and without a solitary kidney.
Materials and Methods
A retrospective review was performed using the prospectively maintained, institutional review board-approved database to identify all consecutive patients who underwent RAPN between 2006 and 2023. A propensity-score-matched analysis was subsequently undertaken to compare patients with and without a solitary kidney. The analysis controlled for various baseline clinicodemographic variables, including age, comorbidities, and baseline tumour characteristics.
Results
Of the 1698 RAPN patients included in our series, 86 were identified to have a pre-existing solitary kidney. Following a 1:1 propensity-score-matched comparison analysis, the solitary kidney cohort was noted to have similarly favourable long-term functional outcomes to the cohort with bilaterally functioning kidneys. This was also indicated by our Kaplan–Meier analysis, which highlighted identical survival from kidney disease progression at a median follow-up duration of 45 months (P = 0.101). Improvements in functional outcomes could be observed as early as 3 months after the respective surgery (median glomerular filtration rate preservation in the solitary vs non-solitary kidney group: 63.7% vs 64.7%; P = 0.815). Of note, the solitary kidney group was more at risk of postoperative acute kidney injury (AKI; solitary vs non-solitary kidney group: 79.7% vs 57.7%; P < 0.001). Lower preoperative renal function (odds ratio [OR] 0.963, 95% confidence interval [CI] 0.922–0.991; P = 0.028), main artery clamping (OR 5.015, 95% CI 1.044–27.462; P = 0.027), and ischaemia time beyond 25 min (OR 4.335, 95% CI 1.381–13.846; P = 0.014) were identified as independent predictors of AKI.](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:lumo4ux3l2ikr2ovf3oqcc3g/bafkreic247jk66v3xmimkjwgarz5dxooa6ukdwyxecm2souqahzoral5se)
![Abstract
Objective
To evaluate the performance of Bladder Epicheck® (BE; Nucleix Ltd., Rehovot, Israel) in predicting tumour recurrence and bacillus Calmette–Guérin (BCG) failure during the first year after induction treatment.
Patients and methods
Prospective study including 65 patients with non-muscle-invasive bladder cancer treated with BCG between 2018 and 2021. Urine samples analysed with BE were collected before and after BCG induction. Logistic binary regression was used to assess the association between clinical and pathological variables and BE results with tumour recurrence and BCG failure during the first year after induction treatment.
Results
During follow-up, 16 (24.6%) patients experienced a bladder cancer event, 11 (68.8%) of which were BCG failure (high-grade recurrence) and five (31.2%) were low-grade recurrences. The median (range) time to overall recurrence was 7.3 (3.8–17.4) months. A significant association was found between the risk of tumour recurrence/BCG failure and post-BCG cystoscopy (odds ratio [OR] 10.0; P < 0.001 and OR 13.1; P < 0.001, respectively), post-BCG BE result (OR 16.9; P < 0.001 and OR 33.1; P < 0.001, respectively) and pre/post-BCG EpiScore value variation (OR 14.4; P = 0.001 and OR 7.1; P = 0.018, respectively). A nomogram including these three variables outperformed the Club Urológico Español de Tratamiento Oncológico (CUETO) risk tables to predict any bladder cancer event after BCG induction (area under the curve 95.1% vs 67.1%). Result validation in a larger and independent series is needed.
Conclusions
The BE post-BCG status and variations in EpiScore values can help us identify patients at higher risk of any bladder cancer event and BCG failure promptly. These data can have an impact on disease management.](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:lumo4ux3l2ikr2ovf3oqcc3g/bafkreicoq27eptxssuy224gine7euotscc43hosjih5k7iwxfxsnxusiiq)
