Katharina Boehm

Background and objective: Multidisciplinary tumour boards (MTBs) play a critical role in prostate cancer management, but their time‐intensive nature limits accessibility. This study evaluates machine learning (ML) algorithms for automating MTB recommendations in prostate cancer patients, focusing on multi‐label classification for diagnostic and therapeutic decisions.Methods: A retrospective dataset of 1929 MTB recommendations from 2020 to 2024 was used for model development and validation at a single academic centre. Three ML algorithms—Decision Tree, Random Forest and K‐Nearest Neighbours (KNN)—were trained to predict recommendations for PSMA‐PET, conventional imaging, active surveillance and local therapy (radical prostatectomy or radiotherapy). Model performance was assessed using accuracy, precision, recall and F1‐score.Key findings and limitations: The Random Forest model achieved the highest overall accuracy (66.3%, 95% CI 61.7–71%) and showed stable performance across most outcome categories. Predictions for local therapy were highly accurate (F1‐score: 0.99), but model performance was lower for less frequent recommendations such as PSMA‐PET and active surveillance, reflecting class imbalance and recent guideline changes. Limitations include moderate overall accuracy, retrospective single‐centre design and the need for extensive manual data preprocessing. In addition, a high proportion of patients were eligible for multiple treatment options, which may limit the discriminatory value of certain outcomes.Conclusions and clinical implications: This study demonstrates the potential of ML to replicate MTB decision patterns in prostate cancer with reasonable accuracy. However, the current model requires further optimization before it can be considered for clinical application. It should be regarded as a proof‐of‐concept that highlights both the opportunities and the challenges of algorithm‐based decision support in oncology. Future work should focus on improving model performance through multi‐institutional data, prospective validation and continuous adaptation to evolving clinical guidelines.

Purpose: Focal therapy (FT) for localized prostate cancer (PCa) is only recommended within the context of clinical trials by international guidelines. We aimed to investigate oncological follow-up and safety data of focal high-intensity focused ultrasound (HIFU) treatment. Methods: We conducted a single-center prospective study of 29 patients with PCa treated with (focal) HIFU between 2016 and 2021. Inclusion criteria were unilateral PCa detected by mpMRI-US-fusion prostate biopsy and maximum prostate specific antigen (PSA) of 15 ng/ml. Follow-up included mpMRI-US fusion-re-biopsies 12 and 24 months after HIFU. No re-treatment of HIFU was allowed. The primary endpoint was failure-free survival (FFS), defined as freedom from intervention due to cancer progression. Results: Median follow-up of all patients was 23 months, median age was 67 years and median preoperative PSA was 6.8 ng/ml. One year after HIFU treatment PCa was still detected in 13/ 29 patients histologically (44.8%). Two years after HIFU another 7/29 patients (24.1%) were diagnosed with PCa. Until now, PCa recurrence was detected in 11/29 patients (37.93%) which represents an FFS rate of 62%.One patient developed local metastatic disease 2 years after focal HIFU. Adverse events (AE) were low with 70% of patients remaining with sufficient erectile function for intercourse and 97% reporting full maintenance of urinary continence. Conclusion: HIFU treatment in carefully selected patients is feasible. However, HIFU was oncologically not as safe as expected because of progression rates of 37.93% and risk of progression towards metastatic disease. Thus, we stopped usage of HIFU in our department.

Hintergrund Publikationen verschiedenster medizinischer Fachgesellschaften und Länder weisen auf einen negativen Einfluss der COVID-19 Pandemie auf die Weiterbildung von Ärzten hin. Fragestellung Ziel dieser Arbeit war es, die Weiterbildungssituation urologischer Assistenzärzte in Deutschland während der 1. Welle der Pandemie zu erfassen. Material und Methoden Vom 20.05.2020 bis 20.06.2020 wurde eine deutschlandweite Onlineumfrage zur Weiterbildungssituation über die Mitglieder der Arbeitsgruppe Versorgungsforschung & Soziale Medien des Forschungsnetzwerkes GeSRU Academics, über soziale Netzwerke (Facebook, Twitter, Instagram) und den monatlichen Newsletter der German Society of Residents in Urology (GeSRU e.V.) an die Zielgruppe der urologischen Assistenzärzte verteilt. Die Umfrage erfasste 3 Teilbereiche: 1) Grundcharakteristika der Teilnehmer, 2) genereller und 3) subjektiver Einfluss der COVID-19 Pandemie auf Klinik und Weiterbildung. Ergebnisse Insgesamt nahmen 50 Assistenzärzte an der Umfrage teil, davon waren 54% Frauen. Das Durchschnittsalter betrug 30,9 Jahre. Die meisten Teilnehmer befanden sich im 2. (22%) sowie im 5. (26%) Ausbildungsjahr und arbeiteten in einer Universitätsklinik (44%) oder in einem Haus der Maximalversorgung (30%) in Baden-Württemberg (18%), Hamburg (16%) oder Bayern (14%). 38% der Befragten gaben an, aufgrund der COVID-19 Pandemie nur noch im Notfallbetrieb zu arbeiten. Für 28% bedeutete dies eine sehr starke Verzögerung (80-100%) der Facharztausbildung, während weitere 28% nur eine geringe Einschränkung angaben. 66% dokumentierten Beeinträchtigungen der Ausbildung aufgrund eines reduzierten OP-Einsatzes, weniger Einsätzen in der Ambulanz (50%) sowie der Absage von Kongressen (50%) und Weiterbildungen (44%). 46% der Befragten gaben direkten Kontakt zu COVID-19 Patienten an. 10% wurden fachfremd auf interdisziplinären Überwachungsstationen eingesetzt. Insgesamt wurden zahlreiche Schritte zum „physical distancing“ und Hygienemaßnahmen von den Kliniken umgesetzt, um Infektionsausbreitungen zu vermeiden. Diskussion Mehr als die Hälfte (56%) der urologischen Assistenzärzte gaben deutliche Einschränkungen in der Weiterbildung durch die COVID-19 Pandemie an. Die Verzögerung der Ausbildung lässt sich aktuell noch nicht in Zeiteinheiten messen, es ist jedoch anzunehmen, dass die Weiterbildung für Ärzte während der Pandemie eine geringere Qualität im Vergleich zu vorausgehenden Generationen haben dürfte. Background Several international medical societies reported a negative impact on urology residency training programs due to the COVID-19 pandemic. Objectives The aim of this study was to investigate the impact of the pandemic on urological residency in Germany. Materials and methods From the 20^th of May 2020 until the 20^th of June 2020, a Germany-wide online survey on the continuing residency training was distributed via the members of the working group, social media (Facebook, Twitter, Instagram) and the German Society of Residents in Urology (GeSRU e.V.) newsletter. The survey covered 3 topics: 1) basic characteristics of the participants, 2) general and 3) subjective influence of the COVID-19 pandemic on clinics and further residency training. Results A total of 50 residents took part in the survey; 54% were women. The median age was 31 years. Most of the participants were in their 2nd (22%) and 5th (26%) year of training and worked in a university hospital (44%) or in a clinic of maximum care (30%). 38% of the respondents stated that they only served urological emergencies during the COVID-19 pandemic. For 28% this meant a very large delay (80-100%) in the specialisation, while 28% stated only a minor impact. 66% documented training impairments caused by fewer operations, low patient numbers in the outpatient department (50%), congress (50%) and workshop (44%) cancellations. 46% of residents reported direct contact with COVID-19 patients while 10% were deployed on interdisciplinary IMC units. Numerous physical distancing and hygiene measures have been implemented by the clinics. Conclusion On average, around 50% of the urology residents indicated significant restrictions in training due to the COVID-19 pandemic in Germany. The delay in training cannot currently be measured in units of time, but it can be assumed that training for residents during the pandemic is likely to be of a lower quality compared to previous generations. Received: 01 January 2022 Accepted after revision: 07 April 2022 Publication Date: 17 May 2022 (online) © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic is disrupting urology health-care worldwide. Reduced emergency room visits resulting in adverse outcomes have most recently been reported in pediatrics and cardiology. We aimed to compare patients with emergency room visits for pyelonephritis in 2019 (pre-COVID-19 era) and within the first wave of pandemic in 2020 (COVID-19 era) with regard to the number of visits and severe adverse disease outcomes. Methods: We performed a retrospective multicentre study comparing characteristics and outcomes of patients with pyelonephritis, excluding patients with hydronephrosis due to stone disease, in 10 urology departments in Germany during a 1-month time frame in March and April in each 2019 and 2020. Results: The number of emergency room visits for pyelonephritis in the COVID-19 era was lower (44 patients, 37.0%) than in the pre-COVID-19 era (76 patients, 63.0%), reduction rate: 42.1% (p = 0.003). Severe adverse disease outcome was more frequent in the COVID-19 era (9/44 patients, 20.5%) than in the pre-COVID-19 era (5/76 patients, 6.6%, p = 0.046). In detail, 7 versus 3 patients needed monitoring (15.9 vs. 3.9%), 2 versus no patients needed intensive-care treatment (4.5 vs. 0%), 2 versus no patients needed drain placement (4.5 vs. 0%), 2 versus no patients had a nephrectomy (4.5 vs. 0%), and 2 versus 1 patient died (4.5 vs. 1.3%). Conclusion: This report of collateral damage during CO­VID-19 showed that emergency room visits were decreased, and severe adverse disease outcomes were increased for patients with pyelonephritis in the COVID-19 era. Health authorities should set up information campaign programs actively encouraging patients to utilize emergency room services in case of severe symptoms specifically during the actual second wave of pandemic.

Objectives: While the coronavirus disease 2019 (COVID-19) pandemic captures healthcare resources worldwide, data on the impact of prioritization strategies in urology during pandemic are absent. We aimed to quantitatively assess the global change in surgical and oncological clinical practice in the early COVID-19 pandemic. Methods: In this cross-sectional observational study, we designed a 12-item online survey on the global effects of the COVID-19 pandemic on clinical practice in urology. Demographic survey data, change of clinical practice, current performance of procedures, and current commencement of treatment for 5 conditions in medical urological oncology were evaluated. Results: 235 urologists from 44 countries responded. Out of them, 93% indicated a change of clinical practice due to COVID-19. In a 4-tiered surgery down-escalation scheme, 44% reported to make first cancellations, 23% secondary cancellations, 20% last cancellations and 13% emergency cases only. Oncological surgeries had low cancellation rates (%): transurethral resection of bladder tumor (27%), radical cystectomy (21–24%), nephroureterectomy (21%), radical nephrectomy (18%), and radical orchiectomy (8%). (Neo)adjuvant/palliative treatment is currently not started by more than half of the urologists. COVID-19 high-risk-countries had higher total cancellation rates for non-oncological procedures (78% vs. 68%, p = 0.01) and were performing oncological treatment for metastatic diseases at a lower rate (35% vs. 48%, p = 0.02). Conclusion: The COVID-19 pandemic has affected clinical practice of 93% of urologists worldwide. The impact of implementing surgical prioritization protocols with moderate cancellation rates for oncological surgeries and delay or reduction in (neo)adjuvant/palliative treatment will have to be evaluated after the pandemic.