This month’s prostate cancer review is a comprehensive look at precision medicine for prostate cancer by Professors Gabriela M. Diaz and Michael S. Leapman [1] of Yale University in the United States. It provides a compelling forecast that artificial intelligence technology, biomarkers, and new imaging diagnostic technologies will enable more precise predictions and treatment choices in the complex field of prostate cancer with heterogeneity.

It is common in clinical practice that many patients diagnosed with prostate cancer develop anxiety and depression, but the extent to which this affects the prognosis of treatment has not been well understood. Professors Elliott J. Druten and Jonathan Heinlen [2] of the University of Oklahoma in the United States conducted a survey of 489 patients at a single institution, Of these, 92% reported minimal or mild depression, and 8% of patients reported moderate to severe depression. The degree of post-alcohol complications, especially incontinence, had a statistical association with the degree of depression in all periods of this study, which was observed up to 12 months after alcohol consumption, suggesting that consideration of psychological status should be provided in the management of patients after surgery.

As radiation therapy tends to deliver higher-energy radiation over a shorter treatment period, installing a barrier that can provide effective protection for adjacent organs, especially the rectum, can be an important means of increasing the efficiency of treatment and reducing complications. Professor Hyunho Han [3] of Yonsei University has shown through a retrospective analysis of 104 SpaceOAR hydrogel insertions and 2 gold fiducial marker placements that the procedure can be performed safely and efficiently without major complications. In particular, the time required for the initial 50 cases and the late 54 cases was 12.70±3.40 minutes and 12.50±5.35 minutes, respectively, with almost no difference, suggesting that the learning curve experienced in the early stages is almost invisible and that the technique can be acquired quickly.

In general, the discovery of a pT3b lesion, defined as a seminal vesicle invasion in the histopathological findings after radical prostatectomy, is associated with a poor prognosis. However, considering the structural characteristics of the seminal vesicles, it is possible to distinguish between the prognostic value of pT3b lesions. Professor Hyun Jung Lee of the Department of Pathology at Pusan National University and Professor Sung Woo Park [4] of the Department of Urology reanalyzed the tissue findings of 252 patients and divided them into muscle layer invasion (SVI-muscle) and mucosal layer invasion (SVI-mucosa). There was no difference in biochemical recurrence or metastatic-free survival, but they showed a statistical association with the size and grade of the cancer, suggesting the possibility of a promising pathological indicator in the future.

The era of tyrosine kinase inhibitors (TKIs) has passed, and the era of immune-oncology (IO) has arrived. As a result, combination therapy between these two, i.e., IO+IO or IO+TKI, has become the standard treatment for metastatic renal cancer, and it has been reported that it is effective even in long-term follow-up of more than 5 years. Indeed, the question of which of these treatment methods to choose remains an important clinical challenge without a clear biomarker. In contrast to the cytoreductive nephrectomy that was commonly performed in the cytokine era, Professor Renpei Kato [5] of Iwate University in Japan has attempted a 3-dimensional analysis that takes into account the characteristics of the primary tumor, the location and characteristics of metastatic lesions, the type of histopathological findings, and the host’s tolerance, and has summarized it in a wellorganized table. From an editor’s point of view, this is the most interesting paper in this issue of JUO, and I recommend that you closely look at Table 2.

Although the role of partial nephrectomy in T1 renal cancer is gradually expanding, a comparison with radical nephrectomy is still needed from a long-term perspective. Regarding the choice between partial nephrectomy and radical nephrectomy, Professor Dongrul Shin and Professor Jungyo Suh [6] of the University of Ulsan, who analyzed 823 patients in an interesting paper that predicts which of the 2 methods is better in terms of recurrence and renal function 5 years later, are currently using the 5 artificial intelligence models available to analyze which model is the best. We expect that this will become more clinically valuable information through external validation in the future.

Professor Mónica Sanz del Pozo [7] and her team at Miguel Servet University in Spain have published an interesting paper that focuses on the prognostic value of carbonic anhydrase IX (CAIX), a factor commonly found in clear cell type renal cell carcinoma, and analyzes the degree of CAIX in tissue and serum samples and changes before and after surgery. The degree of CAIX in the tissue had no prognostic value. Still, the degree of progression of the kidney cancer was clearly different based on the preoperative level of 169.95 pg/mL. The fact that the possibility of death increased fivefold is an interesting finding that suggests that this test will be a helpful indicator in future preoperative investigations.

The standard treatment for muscle-invasive bladder cancer is radical cystectomy after neoadjuvant chemotherapy, but chemotherapy is not administered to about half of the patients because of the presence of other diseases or the high proportion of elderly patients. Many studies have used single IO agents as an alternative neoadjuvant therapy for these patients, but they have faced a common limitation in that they have only shown a response in less than 40% of patients. In this context, Professors Hye Won Lee and Hyun Hwan Sung [8] of the Department of Urology at Samsung Medical Center have been timely summarizing the mechanisms and recent achievements of TAR-200, a bladder-intravenous drug therapy that has recently been gaining attention as a new alternative and CG0070, which uses oncolytic adenovirus.

Although extended lymph node dissection is currently the standard procedure for bladder cancer, its clinical efficacy, especially its effect on improving survival, has not been demonstrated in the most recent phase III studies, the LEA AUO study or the SWOG S1011 study. To investigate which patients would benefit from extended lymph node dissection, Prof. Jiwoong Yu and Prof. Hyun Hwan Sung [9] of Samsung Medical Center analyzed data from 2,202 radical cystectomy cases collected from 11 tertiary medical institutions through the bladder cancer research group. They achieved meaningful results showing that recurrence-free survival can be increased in the group with upper tract urothelial carcinoma who had prior or concurrent radical nephroureterectomy (p/cRNU).

It is a known fact that bladder cancer occurs 3 to 4 times more frequently in men than in women, but the prognosis for female bladder cancer patients is relatively poor. Noting the prognostic value of these gender differences, Professors Jee Soo Park and Won Sik Ham [10] of Yonsei University used data from a study of 3,913 bladder cancer patients who underwent radical cystectomy and found that hormone status, i.e., premenopausal women had a reduced recurrence rate and bladder cancer-specific mortality rate, suggesting future clinical applications related to hormones.

As such, we have summarized the overall overview and key information of the papers published this month. In particular, Professor Kato’s review paper was selected as an editor’s choice as it is expected to broaden readers’ perspectives in this field. We ask for the interest and support of urologic oncology experts looking for fresh and helpful information in the field of urologic oncology, as JUO is gaining international recognition day by day.