Editorial for JUO 2024 Vol. 22 No. 3 - Rethinking Urologic Oncology Surgery

Prostate Cancer

In the 20 years since its introduction in the 2000s, robotic-assisted radical prostatectomy (RARP) has introduced a steady stream of new approaches and suturing methods. The most recent achievement is the transvesical approach, a procedure beyond Retzius sparing and specialized for single-port robots. Professor Jae Hoon Chung [1] from Hallym University reports the outcomes of the first transvesical approach in Korea, particularly the early recovery of urinary incontinence, which was replicated in this series. The paper was selected as the best paper in the 2024 Best Paper Award competition by The Korean Urological Oncology Society.

At present, most prostate cancers can be diagnosed and risk predicted to some extent using prostate-specific antigen (PSA) and magnetic resonance imaging (MRI) before biopsy, so it would be possible to shorten the time to surgery and minimize the patient’s discomfort due to biopsy by omitting biopsy in cases of obviously elevated PSA observed on murtiparametic MRI. Based on this innovative idea, Dr. Tae Young Park and Professor Sung Gu Kang [2] of Korea University report the first report of RARP in a single session after performing a targeted biopsy after anesthesia in the operating room and confirming cancer through frozen.

The introduction of artificial intelligence (AI) could lead to more precise prediction of disease morbidity. Based on a retrospective data set of 928 patients, Professor Sukjung Choi and Professor Jeong Hyun Kim [3] from Kangwon National University summarized 5 clinical indicators that help predict the presence of prostate cancer by applying AI methodology.

As drug development has become increasingly intense, from hormone therapy to the current generation of androgen receptor-targeted agents, the gap between results in clinical trials and actual clinical outcomes is well known. While the development of a new drug can be extremely costly and time-consuming, delays result in societal losses as patients who could benefit from the drug are unable to receive it. Dr. Matthew Rashid and colleagues [4] at Oklahoma State University have taken a new approach to abiraterone, one of the leading drugs for metastatic prostate cancer, using a risk-to-benefit portfolio analysis to show that the results of various clinical trials published over the past decade have been effective.

Kidney Cancer

While the long-term efficacy of immunotherapy and targeted therapies or a combination of immunotherapeutic agents have been presented at major oncology meetings and form the backbone of current treatment for metastatic kidney cancer, metastatic-directed therapy (MDT), including metastatectomy, remains an important treatment strategy in kidney cancer. Advances in stereotactic body radiation therapy have also made it an important modality for MDT. In this issue of JUO, we have prepared 2 reviews on this topic: the first is by Professor Hyung Joon Kim [5] from Seoul National University Bundang Hospital, who summarizes the current data on MDT in a brief report. The second is a very detailed narrative review of metastatectomy by Professor Jongkyou Kwon and Professor Kang Su Cho [6] from Gangnam Severance Hospital. In this paper, the authors comprehensively reviewed the principles of metastatectomy for kidney cancer, factors affecting outcomes, and outcomes according to metastatic sites through the literature from the 2010s. The recent resurgence of adjuvant therapy and neoadjuvant options in these surgeries is also summarized, which will be valuable information for use in real-world clinical practice.

Characteristic changes in cancer patients, such as sarcopenia, have received attention as important prognostic indicators. Myosteatosis, an increase in fatty infiltration in muscle tissue, indicates a decrease in muscle mass and a decrease in muscle quality. Not much has been known about the clinical value of this change, but Professor Byeong Kin Kang and Professor Hong Koo Ha [7] from Pusan National University analyzed retrospective imaging data of 170 kidney cancer patients using AI techniques to show that myosteatosis can be an important prognostic factor even in the presence of localized disease, providing a promising new indicator for the future.

Bladder Cancer

The development of new therapies to replace radical cystectomy in non–muscle-invasive bladder cancer that continues to recur or progress unresponsive to conventional therapy has become a significant trend in bladder cancer treatment. Meanwhile, even in muscle-invasive bladder cancer, where radical cystectomy has been the standard of care, tri-modality therapy (TMT) is being taken seriously in several updated guidelines. In addition to developing new targeted therapies such as antibody drug conjugates and FGFR3, several clinical studies utilizing TMT are underway. In this issue of JUO, we invited renowned bladder cancer researchers representing Korea to provide narrative reviews on 2 topics. On the first topic, Professor Jong Ho Park and Professor Jong Jin Oh [8] from Seoul National University summarize recent research achievements. On the second topic, Professor Yongsoo Jo and Professor Hyeong Dong Yuk [9] from Seoul National University summarize which patients, in particular, can be recommended for TMT in a very well-organized table.

As with other cancers, advances in AI can be utilized in the diagnosis of bladder cancer. A relatively new field for clinical researchers, Dr. Satyendra Singh [10] from Shri pd Siddhivinayak Hospital, India, provides a narrative review that takes us from concepts to the latest trends in the field with rich illustrations and tables. This issue includes original AI research in every cancer field, making it particularly valuable for readers interested in future methodologies.

We hope you enjoy this issue of JUO and will take advantage of our efforts to translate new intuitions and discoveries in urologic oncology into clinical practice.