Mario Ignacio Fernández

Introduction: Prostate cancer (PCa) varies from indolent to aggressive forms, necessitating the identification of high grade prostate cancer (hgPCa) for effective management. Multiparametric MRI (mpMRI) is standard for prostate evaluation, but PSMA PET has shown promise in enhancing hgPCa detection. The PRIMARY score, combining PSMA uptake patterns and SUVmax, correlates with tumor aggressiveness and may complement mpMRI. This study evaluates the accuracy of the PRIMARY score in identifying ISUP ≥ 3 tumors. Materials and Methods: A retrospective analysis was conducted on prostate cancer patients undergoing robotic radical prostatectomy between 2017 and 2024. Only patients with preoperative PSMA PET were included, with exclusions for missing or external imaging. Data were gathered on demographics, clinical information, and histopathology. Two radiologists reviewed the PSMA PET independently, resolving discrepancies by consensus. PRIMARY scores of 3, 4, and 5 were considered positive for hgPCa. Validity was measured using sensitivity, specificity, PPV, NPV, and AUC. Results: Of 1382 patients, 225 met criteria, with 72% using 18F-PSMA and 23% 68-Gallium. The mean age was 66.2 years; the mean PSA was 8.63 ng/mL. PRIMARY score sensitivity for ISUP ≥ 3 was 94.4%, specificity 22.2%, PPV 75.7%, NPV 60.9%, and AUC 0.697, vs PI-RADS sensitivity of 92.0%, specificity 14.3%, PPV 73.4%, NPV 40.9%, and AUC 0.582. Conclusions: The PRIMARY score shows potential for hgPCa detection (ISUP ≥ 3), possibly complementing mpMRI. Further multicenter studies are needed for validation.

Purpose of review: Management of Bacillus Calmette–Guérin-unresponsive non-muscle-invasive bladder cancer (BCG-unresponsive NMIBC) is rapidly evolving, with an expanding range of bladder-sparing therapies challenging the traditional paradigm of early radical cystectomy. This review is timely given the growing need to balance oncologic safety with quality-of-life considerations in patients who are unfit for or unwilling to undergo cystectomy. Recent findings: Recent studies have demonstrated clinically meaningful response rates with several bladder-sparing strategies, including intravesical chemotherapy combinations, gene therapy, immune-modulating agents, and systemic immunotherapy. Although durability varies and cross-trial comparisons are limited, emerging data suggest that, in carefully selected patients, an initial bladder-sparing approach followed by timely salvage cystectomy – if required – may achieve oncologic outcomes comparable to upfront cystectomy, provided progression to muscle-invasive disease is avoided. Summary: Bladder preservation in BCG-unresponsive NMIBC should be framed as a preference-sensitive decision that integrates individual progression risk, feasibility of delayed cystectomy, and patient-valued functional outcomes. Rather than a fixed threshold, acceptable oncologic risk represents a negotiated balance, with the urologist acting as a navigator who defines safety boundaries while supporting informed, patient-centered decision-making.

Non-muscle invasive bladder cancer (NMIBC) accounts for about 75% of new bladder cancer diagnoses. Early detection improves survival, yet routine white-light cystoscopy is invasive, costly, and can miss up to 45% of flat or small lesions. These shortcomings have prompted development of label-free diagnostic tools that read the intrinsic optical, electrical, or mechanical signatures of urinary biomarkers without added labels. This review examines recent engineering advances in such platforms for NMIBC detection, focusing on analytical performance, readiness for clinical translation, and remaining barriers to adoption. We compare each technology with conventional cytology using key metrics such as limit of detection, diagnostic accuracy, analysis time, cohort size, and stage of clinical development. Surface-enhanced Raman spectroscopy and interferometric flow cytometry offer femtomolar sensitivity and more than 98% accuracy within minutes, while compact electrochemical sensors targeting NMP22, Galectin-1, and microRNAs reach sub-picogram levels on disposable chips. Standardized sample handling, multicenter validation, and robust cost-effectiveness data are now essential for these tools to advance point-of-care NMIBC surveillance.

A poorly studied mechanism suggests that growth is characterized by the expression of TATA-less genes under favorable conditions, while stress induces TATA-containing genes involved in stress responses. The role of this mechanism in cancer remains unclear. This study analyzes the presence of TATA boxes in gene expression data from bladder cancer (BC) cells undergoing ferroptosis (siUSP52 cells), a form of programmed cell death. We hypothesize that growth-related genes (TATA-less) are underrepresented in siUSP52 cells. We found a high prevalence of TATA-less genes in siUSP52 cells (62 of 90 differentially expressed), suggesting that BC promotes growth despite ferroptosis activation.

Introduction and Objectives: Multimorbidity, defined as the coexistence of two or more chronic conditions, poses significant challenges in healthcare by affecting patient outcomes and increasing costs. This study aimed to evaluate multimorbidity’s impact on patients with genitourinary cancer (GUC) in Chile, focusing on prevalent comorbidities, their combinations, and their association with hospitalization severity. Materials and Methods: A retrospective, population-based study was conducted using data from the Fondo Nacional de Salud (FONASA) in Chile, including patients with bladder, prostate, kidney, and testicular cancer between 2019 and 2021. Diagnosis-related group (DRG) data were used to analyze comorbidity prevalence, hospitalization type (elective vs. emergency), severity (moderate/major vs. minor/none), length of stay, and associated costs. Results: Among 4,028,597 hospital events, 11.6% were related to GUC, involving 18,792 patients. Multimorbidity was present in 67.3% of patients, with hypertension and diabetes being the most common comorbidities. These patients accounted for 69.1% of total GUC care costs. Hospital mortality was higher in multimorbid patients (7.5% vs. 3.7%; p < 0.001), who also had longer stays (mean 8 vs. 5 days). Most patients were admitted electively (60.3%), while 39.7% were admitted through the emergency room. Patients with multimorbidity had higher rates of moderate/major severity hospitalizations compared to those without (56.1% vs. 32.5%; p < 0.001). Conclusions: In Chile, multimorbidity among GUC patients is linked to increased costs, longer hospital stays, higher mortality, and greater hospitalization severity. Comprehensive care strategies are needed to improve outcomes and reduce healthcare system burdens.

There are few markers to identify those likely to recur or progress after treatment with intravesical BCG. We developed and validated artificial intelligence-based histologic assays that extract interpretable features from transurethral resection of bladder tumor digitized pathology images to predict risk of recurrence, progression, development of BCG unresponsive disease, and cystectomy. Pre-BCG resection-derived whole-slide images and clinical data were obtained for high-risk non-muscle invasive bladder cancer cases treated with BCG from 12 centers and were analyzed through a segmentation and feature extraction pipeline. Features associated with clinical outcomes were defined and tested on independent development and validation cohorts. Cases were classified into high or low risk for recurrence, progression, BCG unresponsive disease, and cystectomy. 944 cases (development:303, validation:641, median follow-up:36 months) representative of the intended use population were included (high-grade Ta:34.1%, high-grade T1:54.8%; carcinoma-in-situ only:11.1%, any carcinoma-in-situ:31.4%). In the validation cohort, "High recurrence risk" cases had inferior high-grade recurrence-free survival versus "Low recurrence risk" cases (HR 2.08, p<0.0001). "High progression risk" patients had poorer progression-free survival (HR 3.87, p<0.001) and higher risk of cystectomy (HR 3.35, p<0.001) than "Low progression risk". Cases harboring the BCG unresponsive disease signature had a shorter time to development of BCG unresponsive disease than cases without the signature (HR 2.31, p<0.0001). AI assays provided predictive information beyond clinicopathologic factors. We developed and validated AI-based histologic assays that identify high-risk non-muscle invasive bladder cancer cases at higher risk of recurrence, progression, BCG unresponsive disease, and cystectomy, potentially aiding clinical decision-making.

Introduction and Objectives: Multimorbidity, defined as the coexistence of two or more chronic conditions, poses significant challenges in healthcare by affecting patient outcomes and increasing costs. This study aimed to evaluate multimorbidity's impact on patients with genitourinary cancer (GUC) in Chile, focusing on prevalent comorbidities, their combinations, and their association with hospitalization severity. Materials and Methods: A retrospective, population-based study was conducted using data from the Fondo Nacional de Salud (FONASA) in Chile, including patients with bladder, prostate, kidney, and testicular cancer between 2019 and 2021. Diagnosis-related group (DRG) data were used to analyze comorbidity prevalence, hospitalization type (elective vs. emergency), severity (moderate/major vs. minor/none), length of stay, and associated costs. Results: Among 4,028,597 hospital events, 11.6% were related to GUC, involving 18,792 patients. Multimorbidity was present in 67.3% of patients, with hypertension and diabetes being the most common comorbidities. These patients accounted for 69.1% of total GUC care costs. Hospital mortality was higher in multimorbid patients (7.5% vs. 3.7%; P<0.001), who also had longer stays (mean 8 vs. 5 days). Most patients were admitted electively (60.3%), while 39.7% were admitted through the emergency room. Patients with multimorbidity had higher rates of moderate/major severity hospitalizations compared to those without (56.1% vs. 32.5%; P<0.001). Conclusions: In Chile, multimorbidity in GUC patients is linked to increased costs, longer hospital stays, higher mortality, and greater hospitalization severity. Comprehensive care strategies are needed to improve outcomes and reduce healthcare system burdens.