Maurício Dener Cordeiro

Purpose: To evaluate the risk factors associated with mortality and recurrence following nephroureterectomy for upper tract urothelial carcinoma (UTUC) in a large Brazilian cohort. Methods: This retrospective study analyzed 126 patients who underwent nephroureterectomy for UTUC between 2009 and 2023 at a single institution in Brazil. Cox regression and Kaplan–Meier analyses were performed to identify factors associated with mortality and recurrence. Results: The median follow-up duration was 38 months. In multivariate analysis, positive surgical margins (HR 3.45, 95% CI 1.52–7.69, p=0.003), presence of carcinoma in situ (HR 2.63, 95% CI 1.27–5.56, p=0.009), and systemic recurrence (HR 3.33, 95% CI 1.32–9.09, p=0.01) were independently associated with increased mortality. The laparoscopic approach was not associated with worse outcomes than open surgery. Conclusion: This large Brazilian cohort study identified several prognostic factors for mortality and recurrence after nephroureterectomy in patients with UTUC. Achieving negative surgical margins and identifying high-risk pathological features are critical for optimizing the outcomes. The laparoscopic approach was not associated with worse oncological outcomes in this cohort. These findings may help guide patient management and follow-up strategies.

Objective: To evaluate the diagnostic performance of multiparametric MRI (mpMRI), mpMRI combined with PSA density (PSAd) and combined biopsy (CBx) in detecting clinically significant prostate cancer (csPCa) in men undergoing active surveillance, using radical prostatectomy (RP) specimens as the reference standard.Patients and Methods: In this prospective single‐centre study, 91 patients with low‐risk prostate cancer under active surveillance underwent mpMRI, PSAd measurement, CBx and ultimately RP. mpMRI was reported using PI‐RADS v2.0, and PSAd was dichotomised at 0.12 ng/ml/cm³. Diagnostic accuracy was compared using ISUP grade ≥2 and ≥3 thresholds. Radical prostatectomy pathology served as the reference standard.Results: For detecting ISUP ≥3 cancer, mpMRI combined with PSAd achieved the highest sensitivity (93.3%) and negative predictive value (94.4%). CBx demonstrated the highest specificity (88.2%) and overall diagnostic balance (Youden index = 0.348). mpMRI alone showed intermediate performance. Differences in classification between strategies were statistically significant (McNemar p < 0.001).Conclusions: mpMRI combined with PSAd provides high sensitivity and negative predictive value for ruling out aggressive prostate cancer, supporting its use as a non‐invasive triage tool in active surveillance. CBx remains the most specific method for histological confirmation. These strategies should be used complementarily to optimise decision‐making in active surveillance protocols.

Objective To prospectively determine the ability of visible lesions on multiparametric MRI (PI-RADS 4–5) and commonly used biomarkers to predict disease upgrading on rebiopsy in men with low-risk prostate cancer (PCa) enrolled in active surveillance (AS). Materials and methods For this prospective study, approved by the Institutional Review Board (IRB), we selected consecutive patients with low-risk, low-grade, and localized prostate cancer (PCa) from our active surveillance (AS) program, who were enrolled between March 2014 and December 2020. Patients who had undergone previous prostate surgery, hormonal treatment, had contraindications for mpMRI, or transrectal ultrasound-guided (TRUS) biopsy were excluded from this study. All eligible patients underwent mpMRI at least 3 months after the initial biopsy, followed by MRI-targeted TRUS-guided re-biopsy within 12 months after enrollment. The mpMRI studies were evaluated by an experienced radiologist using the PI-RADS v2 classification. Statistical significance was determined by comparing the results from the MRI with the pathology data from rebiopsy. Results There were 240 patients included. Overall upgrading rate was 41.2% (99/240), higher among patients classified as PIRADS 4 or 5 (77%). MRI sensitivity was 77.7% and specificity was 83.6% on re-biopsy. Visible lesion on mpMRI, PSA density and 3 + /12 positive cores at the first biopsy were good predictors of disease upgrade on rebiopsy. On our predictive model, patients with PI-RADS 4 or 5, PSA density > 0.15 ng/mL/cm³, and 3 + /12 positive cores at first biopsy had 92.4% chance of having clinically significant PCa. Conclusion Patients in AS with PI-RADS 4 or 5 lesions, PSA density > 0.15 ng/mL/cm³ and 3 + /12 positive cores at first biopsy have a high probability of having significant PCa on re-biopsy.

Objective: In this study, our aim was to search for new genotype-phenotype correlations in patients with Von Hippel-Lindau (VHL) disease. Subjects and methods: We retrospectively studied 53 consecutive patients with VHL disease and confirmed genetic diagnoses from 32 relatives. Results: Most VHL pathogenic or likely pathogenic variants were missense (18 out of 32; 56.25%). The median size of the large carcinoma (RCC) was 3.6 cm (interquartile range, 2.8 to 6.5 cm). Interestingly, the size of the large RCC in [...] ABSTRACT Objective: In this study, our aim was to search for new genotype-phenotype correlations in patients with Von Hippel-Lindau (VHL) disease. Subjects and methods: We retrospectively studied 53 consecutive patients with VHL disease and confirmed genetic diagnoses from 32 relatives. Results: Most VHL pathogenic or likely pathogenic variants were missense (18 out of 32; 56.25%). The median size of the large carcinoma (RCC) was 3.6 cm (interquartile range, 2.8 to 6.5 cm). Interestingly, the size of the large RCC in

Purpose High-risk localized prostate cancer (HRLPC) commonly progresses to metastatic disease after local treatment. Neoadjuvant androgen deprivation therapy (nADT) before radical prostatectomy (RP) has recently been suggested to improve early oncological outcomes in HRLPC. We aimed to perform an exploratory analysis of the pathological outcomes from a prospective trial testing nADT before RP. Methods Prospective, single-centered, phase II, randomized trial performed between October 2018 and July 2021. Random assignment (1:1) for nADT modalities: goserelin (10.8 mg) plus abiraterone acetate (1000 mg/d) plus prednisone (5 mg/d), with or without apalutamide (240 mg/d) for 12 weeks, followed by RP (within 30 days) and extended lymph node dissection. Baseline clinical and pathological variables were assessed in needle biopsies before nADT. Tumor regression was histologically evaluated in surgical specimens using the residual cancer burden index (RCB). Results Sixty-two patients reached the surgical phase. Good response (RCB ≤ 0.25 cm³) was achieved in 14 patients (22.5%). Overall stage migration rate between baseline status (MRI before nADT) and final status (after surgery) was 27.4%. Late stage detection (high tumor burden, perineural invasion) and altered PTEN/ERG immunostatus showed significant association with poor response in univariate analysis. Higher baseline tumor burden was the only independent factor related to poor response in multivariate analysis. Conclusions There are subgroups of patients, such as those with low baseline cancer burden and PTEN/ERG wild-type status, more likely to achieve good response with nADT. In the case of long term oncological benefit to be proven, nADT might be an additional therapeutic resource for these patients.

Benign prostatic hyperplasia (BPH) affects up to 80% of men by age 80, with large-gland BPH often treated by simple prostatectomy (SP). This technique significantly improves symptoms but is associated with high rates of complications such as transfusions and infections. Minimally invasive techniques, including robotic-assisted laparoscopic simple suprapubic prostatectomy (RALSP), have emerged as alternatives. This study reports on 162 patients who underwent RALSP from May 2018 to June 2023. The mean age of the patients was 69 years, mean prostate volume 144.8 cm³, mean robot time 78.7 min, and mean blood loss 183.1 mL. Results demonstrated significant improvements in the results: prostate volume (mean decrease from 144.8 to 26.6 cm³), mean PSA level decreased from 7.8 to 0.8 (p < 0.0001), mean IPSS decreased from 23.0 to 4.4 (p < 0.0001), and mean uroflowmetry increased from 6.3 to 22.6 ml/s (p < 0.0001). No patient experienced worsening erectile function after surgery. All patients showed absence of stress urinary incontinence within 3 months. Catheterization time decreased from 4.2 to 2.6 days over the study period. The postoperative complication rate was 2.29%, with no need for surgical reintervention for complications. While RALSP showed promising results, further prospective studies are needed to compare it with other techniques. This study highlights RALSP as a viable minimally invasive option for treating large-volume BPH, offering reduced recovery times and fewer complications.