Seung-Hwan Jeong

Purpose: This study used the Seoul National University Hospital FIRST-Cancer Panel (v3.2.2) to identify potentially druggable targets in prostate cancer. We compared genetic alterations between primary, treatmentnaive, hormone-sensitive prostate cancer (HSPC) tissue obtained at initial diagnosis and metastatic, castrationresistant prostate cancer (CRPC) tissue obtained after disease recurrence to identify candidate genes associated with the metastatic, castration-resistant phenotype. Because this was a cross-sectional comparison, the findings represent associations only and do not establish a causal role in metastasis.Materials and Methods: We analyzed samples from 93 patients with prostate cancer using the FIRST-Cancer Panel, which included 192 genes, 25 fusion genes, 8 microsatellite instability markers, and 45 druggable genomic targets. The cohort comprised 80 primary, treatment-naive HSPC tumor samples obtained at diagnosis and 13 distant metastatic CRPC samples obtained after recurrence. DNA was extracted from formalin-fixed paraffin-embedded tissue, sequenced using the NextSeq 550Dx platform, and analyzed with the Seoul National University Hospital CPM Solid v3.7 pipeline. Oncoprint analysis using cBioPortal and survival analyses were performed to assess clinical implications, and GraphPad Prism was used for correlation analysis.Results: Patient age, microsatellite instability status, and tumor mutational burden were comparable between the groups, but oncoprint analysis showed distinct alteration patterns. Primary tumors most frequently showed alterations in FOXA1, RB1, BRCA2, TP53, and SPOP, whereas metastatic samples most frequently showed alterations in FANCA, TMPRSS2, ERG, PTEN, and TP53, consistent with previous reports implicating these genes in advanced prostate cancer. In this exploratory comparison, UGT1A1, NOTCH3, and MAP3K4 were altered more frequently in metastatic samples than in primary samples. In external, aggregated cBioPortal cohorts, UGT1A1 and NOTCH3 alterations were associated with poorer 5-year overall survival rates (<60%).Conclusion: Targeted sequencing showed distinct genetic profiles between primary and metastatic prostate cancers. FANCA, TMPRSS2, ERG, PTEN, and TP53 alterations were more common in metastatic samples, consistent with established roles in advanced disease. UGT1A1 and NOTCH3 emerged as candidate genes that were more frequently altered in metastatic disease and were associated with worse survival in external cohorts. Given the cross-sectional design and small number of metastatic samples, these findings should be interpreted as associations rather than causal evidence. Further studies are warranted to evaluate these genes as potential therapeutic targets.

Background/Objectives: While robot-assisted radical cystectomy (RARC) is widely adopted, its long-term survival impact relative to open radical cystectomy (ORC) remains uncertain. We compared survival outcomes between ORC and RARC using a propensity score-matched multicenter cohort. Methods: We retrospectively analyzed 3972 radical cystectomy patients from 11 Korean tertiary centers between 2003 and 2024. After stratifying by surgical approach (ORC vs. RARC), 1:1 propensity score matching (PSM) mitigated baseline imbalances. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were evaluated using Kaplan–Meier and multivariable Cox analyses. Results: PSM yielded 473 well-balanced patients per group. Compared to ORC, RARC was associated with a longer operative time but demonstrated a superior perioperative profile, including reduced estimated blood loss, lower intraoperative transfusion rates, shorter hospital stays, higher lymph node yields, and lower positive margin rates. RARC significantly improved OS (5-year: 75.4% vs. 56.1%; 10-year: 68.3% vs. 44.5%; p < 0.001) and CSS (5-year: 88.1% vs. 71.6%; 10-year: 82.7% vs. 67.7%; p < 0.001), with comparable RFS (5-year: 59.6% vs. 54.8%; 10-year: 51.1% vs. 47.4%; p = 0.155). Multivariable analyses confirmed RARC as an independent predictor of improved OS (hazard ratio [HR] 0.564, p < 0.001) and CSS (HR 0.474, p < 0.001). Conclusions: RARC demonstrated superior perioperative outcomes and favorable survival trends compared to ORC, with no difference in RFS. Although RARC appears to be an oncologically safe alternative, these exploratory survival benefits require cautious interpretation due to potential residual confounding. Further prospective validation is warranted.

Purpose: Radical cystectomy (RC) is associated with substantial postoperative morbidity, and unplanned readmission remains common despite advances in perioperative management. However, the association between postoperative readmission due to complications and oncologic outcomes after RC for bladder cancer has not been clearly defined. We evaluated the impact of postoperative readmission on overall survival (OS) and cancer-specific survival (CSS) after RC for bladder cancer.Materials and Methods: We retrospectively analyzed 3,972 patients who underwent RC for bladder cancer in a multicenter cohort. Postoperative readmission was defined as unplanned hospitalization within 90 days postsurgery due to surgery-related complications. Survival outcomes were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify independent predictors of OS and CSS.Results: Among the study population, 916 patients (23.1%) experienced postoperative readmission. Baseline and perioperative characteristics were generally comparable between patients with and without readmission. Kaplan-Meier analyses demonstrated significantly worse OS and CSS among patients who experienced postoperative readmission (both log-rank p<0.001). In multivariable analyses adjusting for clinicopathological factors, postoperative readmission remained independently associated with worse OS (hazard ratio [HR], 1.654; 95% confidence interval [CI], 1.464–1.868; p<0.001) and CSS (HR, 1.761; 95% CI, 1.509–2.055; p<0.001).Conclusion: Postoperative readmission within 90 days after RC was independently associated with inferior long-term oncologic outcomes. These findings suggest the importance of strategies aimed at preventing postoperative complications and subsequent readmission.

Robot-assisted radical prostatectomy (RARP) has evolved from a novel minimally invasive option to the standard of care for localized prostate cancer. As metrics for success expand to the pentafecta of outcomes, surgical techniques have diversified. This review provides a comprehensive overview of the contemporary RARP landscape, comparing technical modifications aimed at minimizing morbidity and optimizing functional preservation. We systematically reviewed the literature on various RARP approaches, including standard transperitoneal (TP), extraperitoneal (EP), single-port (SP), and transvesical (TV) techniques, and evaluated functional preservation strategies-specifically Retzius-sparing (RS) and intrafascial nerve-sparing approaches-focusing on trade-offs between functional recovery and oncological safety. While TP-RARP remains the standard, EP-RARP offers advantages in patients with prior abdominal surgery by avoiding the peritoneal cavity. The SP platform demonstrates superior pain control and cosmetic results versus multi-port (MP) systems. The novel TV-RARP approach allows exceptionally rapid continence recovery and same-day discharge but is limited by prostate size and lymph node dissection capability. RS-RARP provides significantly higher early continence rates, though this benefit is associated with increased positive surgical margins. Similarly, aggressive nerve-sparing techniques improve potency but require careful risk stratification to ensure oncological control. Surgical experience significantly impacts operative efficiency and margins, though less so for continence. The optimal RARP technique is no longer a single standard but a personalized, evidence-based decision: surgeons should individualize the platform and approach-whether MP, SP, TV, or RS-to the patient's anatomy, cancer risk, and functional priorities to achieve optimal outcomes.

Choi J, et al. Investig Clin Urol. 2026 ;67:e25. https://doi.org/10.4111/icu.20250573

Heo JE, et al. Investig Clin Urol. 2026 ;67:e24. https://doi.org/10.4111/icu.20250455

Lee HY, et al. Investig Clin Urol. 2026 Jan;67(1):15-23. https://doi.org/10.4111/icu.20250385

Jeong CW, et al. World J Mens Health. 2026 Jan;44(1):150-160. https://doi.org/10.5534/wjmh.240090

Purpose: This study aimed to evaluate the prognostic value of a trifecta, defined as negative soft tissue surgical margin (STSM), removal of ≥16 lymph nodes, and absence of major complications (Clavien-Dindo classification grade >III) within 90 days, after radical cystectomy (RC), using a large multicenter cohort.Materials and Methods: We retrospectively analyzed data from 3,972 patients with bladder cancer who underwent RC at 11 tertiary centers in South Korea between 2003 and 2024. Survival outcomes, including overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS), were compared according to trifecta status using Kaplan-Meier and Cox regression analyses. Propensity score matching was performed to adjust for baseline differences.Results: A total of 2,014 eligible patients were included in the final analysis, and the trifecta was achieved in 47.8%. Kaplan-Meier analysis demonstrated significantly improved 5- and 10-year OS (66.7% vs. 62.0%; 62.9% vs. 57.2%; p=0.002), CSS (79.3% vs. 75.4%; 77.8% vs. 73.8%; p=0.008), and RFS (62.7% vs. 57.6%; 60.8% vs. 55.2%; p=0.001) in the trifecta group. In multivariable analysis, trifecta achievement was significantly associated with better OS (HR, 0.813; p=0.008), CSS (HR, 0.787; p=0.017), and RFS (HR, 0.844; p=0.036). Among individual components, negative STSM showed the strongest prognostic effect across all endpoints.Conclusions: In this large multicenter study, patients who achieved the RC trifecta exhibited significantly superior survival outcomes compared with those who did not. The trifecta may serve as a practical and standardized metric for assessing surgical quality and performance in RC. Future prospective studies are warranted to validate its prognostic and quality-assurance utility.