The following is a comprehensive list of Yale Urology faculty contributions to the field, as represented in their published work / research for the 3rd quarter of this year. The listing is in ascending published date order and includes cite details and at least portions of each abstract/summary.
Franco I. Long-term safety and tolerability of repeated treatments with OnabotulinumtoxinA in children with neurogenic detrusor overactivity. Toxicon (Oxford). 07/2022;214:S18-S19. doi: 10.1016/j.toxicon.2021.11.049.
Conclusions: OnabotulinumtoxinA continued to be well tolerated in up to four repeated treatments in pediatric patients with NDO with similar safety profiles across dose groups. TEAEs were primarily urological with no new safety concerns.
Marks VA, Hsiang WR, Nie J, Demkowicz P, Umer W, Haleem A, Galal B, Pak I, Kim D, Salazar MC, Berger ER, Boffa DJ, Leapman MS. Acceptance of Simulated Adult Patients With Medicaid Insurance Seeking Care in a Cancer Hospital for a New Cancer Diagnosis. JAMA Netw Open. 2022 Jul 1;5(7):e2222214. doi: 10.1001/jamanetworkopen.2022.22214. PMID: 35838668; PMCID: PMC9287756.
Conclusions and relevance: This study identified access disparities for patients with Medicaid insurance at centers designated for high-quality care. These findings highlight gaps in cancer care for the expanding population of patients receiving Medicaid.
Lokeshwar SD, Nguyen J, Rahman SN, Khajir G, Ho R, Ghabili K, Leapman MS, Weinreb JC, Sprenkle PC. Clinical utility of MR/ultrasound fusion-guided biopsy in patients with lower suspicion lesions on active surveillance for low-risk prostate cancer. Urol Oncol. 2022 Sep;40(9):407.e21-407.e27. doi: 10.1016/j.urolonc.2022.06.005. Epub 2022 Jul 8. PMID: 35811206.
Conclusion: In men with clinical low-risk prostate cancer on active surveillance with PI-RADS 2 and 3 lesions, there is an almost 18% risk of upgrade to csCaP. Integration of PSAD may be a useful adjunctive tool in identifying patients at highest risk for upgrade despite favorable imaging findings.
Williams BR, Burgio KL, Hebert-Beirne J, James A, Kenton K, LaCoursiere DY, Rickey L, Brady SS, Kane Low L, Newman DK; Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. A multisite focus group study of US adult women's beliefs and assumptions about bladder health and function. Neurourol Urodyn. 2022 Sep;41(7):1590-1600. doi: 10.1002/nau.25006. Epub 2022 Jul 12. PMID: 35819129.
This analysis explored and characterized the ideas adult women have about how the bladder works, the assumptions guiding their bladder-related behaviors, and the beliefs they hold about how their behaviors affect bladder health.
Fang AM, Shumaker LA, Martin KD, Jackson JC, Fan RE, Khajir G, Patel HD, Soodana-Prakash N, Vourganti S, Filson CP, Sonn GA, Sprenkle PC, Gupta GN, Punnen S, Rais-Bahrami S. Multi-institutional analysis of clinical and imaging risk factors for detecting clinically significant prostate cancer in men with PI-RADS 3 lesions. Cancer. 2022 Sep 15;128(18):3287-3296. doi: 10.1002/cncr.34355. Epub 2022 Jul 12. PMID: 35819253.
Conclusions: For PI-RADS 3 lesions, an elevated PSA density, older age, and a biopsy-naive status were associated with CSPCa, whereas a prior negative biopsy was negatively associated. A predictive model could prevent PI-RADS 3 biopsies while missing few CSPCas.
Dong S, Hangel G, Chen EZ, Sun S, Bogner W, Widhalm G, You C, Onofrey JA, de Graaf R, Dunca JS. Flow-based Visual Quality Enhancer for Super-resolution Magnetic Resonance Spectroscopic Imaging. arXiv. 2022. https://doi.org/10.48550/arxiv.2207.10181.
Conclusion: … Results show that our method outperforms the adversarial networks and the baseline flow-based methods. Our method also allows visual quality adjustment and uncertainty estimation. The method can be extended in the future to other modalities.
Dinan MA, Wilson LE, Greiner MA, Spees LP, Pritchard JE, Zhang T, Kaye D, George D, Scales CD, Baggett CD, Gross CP, Leapman MS, Wheeler SB. Oral Anticancer Agent (OAA) Adherence and Survival in Elderly Patients With Metastatic Renal Cell Carcinoma (mRCC). Urology. 2022 Jul 22:S0090-4295(22)00604-5. doi: 10.1016/j.urology.2022.07.012. Epub ahead of print. PMID: 35878815.
Conclusion: Local poverty levels and high out-of-pocket costs are associated with poor initial adherence to OAA therapy in Medicare beneficiaries with mRCC, which in turn, suggests a trend toward poor overall and disease-specific survival. Efforts to improve outcomes in the broader mRCC population should incorporate OAA adherence and economic factors.
Shaw NM, Hakam N, Lui J, Abbasi B, Sudhakar A, Leapman MS, Breyer BN. COVID-19 Misinformation and Social Network Crowdfunding: Cross-sectional Study of Alternative Treatments and Antivaccine Mandates. J Med Internet Res. 2022 Jul 27;24(7):e38395. doi: 10.2196/38395. PMID: 35820053; PMCID: PMC9337619.
Conclusions: A small minority of web-based crowdfunding campaigns for COVID-19 were directed at unproven COVID-19 treatments and support for campaigns aimed against masking or vaccine mandates. Approximately half (71/133, 53%) of these campaigns contained verifiably false or misleading information and had limited fundraising success.
Shore ND, Renzulli J, Fleshner NE, Hollowell CMP, Vourganti S, Silberstein J, Siddiqui R, Hairston J, Elsouda D, Russell D, Cooperberg MR, Tomlins SA. Enzalutamide Monotherapy vs Active Surveillance in Patients With Low-risk or Intermediate-risk Localized Prostate Cancer: The ENACT Randomized Clinical Trial. JAMA Oncol. 2022 Aug 1;8(8):1128-1136. doi: 10.1001/jamaoncol.2022.1641. Erratum in: JAMA Oncol. 2022 Aug 1;8(8):1225. PMID: 35708696; PMCID: PMC9204619.
Conclusions and Relevance: The results of this randomized clinical trial suggest that enzalutamide monotherapy was well-tolerated and demonstrated a significant treatment response in patients with low-risk or intermediate-risk localized prostate cancer. Enzalutamide may provide an alternative treatment option for patients undergoing AS.
Alter KH, [Sterling J]. Robotic partial nephrectomy in the treatment of a posterior excluded caliceal diverticulum with a renal calculus. Videourology (New Rochelle, N.Y.). 08/2022;36(6). doi: 10.1089/vid.2022.0037.
Follow-up/Outcomes: … Postoperative noncontrast CT of abdomen/pelvis showed complete treatment of the stone burden and CD. Patient was symptom free at 1-, 3-, 6-, and 12-month follow-up visits and no stones were seen on imaging. Our series of patients includes the aforementioned patient who underwent a retroperitoneal PN and another patient who underwent transperitoneal PN for large upper pole CD. The second patient reported history of recurrent urinary tract infections, which have since resolved. Her 3-month CT was unremarkable and she is symptom free. Both patients were refractory to extracorporeal shockwave lithotripsy treatment done previously.
Petrylak DP, Watkins SP, Loehr A. What Plasma Can Tell Us When Tissue Cannot: A Case Report of Genomic Testing in mCRPC and Clinical Response to Treatment With the PARP Inhibitor Rucaparib. Front Oncol. 2022 Aug 1;12:951348. doi: 10.3389/fonc.2022.951348. PMID: 35978838; PMCID: PMC9377337.
Background: … Although genomic screening is recommended as part of a comprehensive assessment of prostate cancer prognosis and treatment options, the best way to select patients with mCRPC for treatment with a PARP inhibitor depends on individual clinical circumstances. For example, assessment of tumor tissue may not always be feasible. Genomic testing of DNA from plasma has become more readily available, providing a minimally invasive option to evaluate DNA from primary and metastatic lesions simultaneously.
Baboudjian M, Breda A, Rajwa P, Gallioli A, Gondran-Tellier B, Sanguedolce F, Verri P, Diana P, Territo A, Bastide C, Spratt DE, Loeb S, Tosoian JJ, Leapman MS, Palou J, Ploussard G. Active Surveillance for Intermediate-risk Prostate Cancer: A Systematic Review, Meta-analysis, and Metaregression. Eur Urol Oncol. 2022 Aug 4:S2588-9311(22)00135-3. doi: 10.1016/j.euo.2022.07.004. Epub ahead of print. PMID: 35934625.
Objective: To evaluate treatment-free survival and oncologic outcomes in patients with IR PCa managed with AS and to compare with AS outcomes in low-risk (LR) PCa patients.
Rajwa P, Hopen P, Wojnarowicz J, Kaletka J, Paszkiewicz I, Lach-Wojnarowicz O, Mostafaei H, Krajewski W, D'Andrea D, Małkiewicz B, Paradysz A, Ploussard G, Moschini M, Breyer BN, Pradere B, Shariat SF, Leapman MS. Online Crowdfunding for Urologic Cancer Care. Cancers (Basel). 2022 Aug 25;14(17):4104. doi: 10.3390/cancers14174104. PMID: 36077641; PMCID: PMC9454944.
Conclusions: using an automated web-based approach, we identified and characterized online crowdfunding for urologic cancer care. These findings indicated a diverse range of patient needs related to urologic care and factors related to campaigns' success.
Hoimes CJ, Flaig TW, Milowsky MI, Friedlander TW, Bilen MA, Gupta S, Srinivas S, Merchan JR, McKay RR, Petrylak DP, Sasse C, Moreno BH, Yu Y, Carret AS, Rosenberg JE. Enfortumab Vedotin Plus Pembrolizumab in Previously Untreated Advanced Urothelial Cancer. J Clin Oncol. 2022 Aug 30:JCO2201643. doi: 10.1200/JCO.22.01643. Epub ahead of print. PMID: 36041086.
Conclusion: Enfortumab vedotin plus pembrolizumab showed a manageable safety profile. Most patients experienced tumor shrinkage. The median DOR and median OS exceeding 2 years in a cisplatin-ineligible patient population make this a promising combination currently under investigation in a phase III study (ClinicalTrials.gov identifier: NCT04223856).
Petrylak DP. 1398P overall survival (OS) in patients (pts) with metastatic hormone-sensitive prostate cancer (mHSPC) who received prior androgen deprivation therapy (ADT) and reached low prostate-specific antigen (PSA) levels treated further with enzalutamide (ENZA): Post hoc analyses of ARCHES. Annals of oncology. 09/2022;33:S1183-S1184. doi: 10.1016/j.annonc.2022.07.1884.
Background: In the phase 3 ARCHES trial, >90% of men with mHSPC received prior ADT and achieved a range of PSA values (≤0.2, >0.2−4, and >4 μg/L) before randomization. This post hoc analysis examined the effect of treatment intensification with ENZA + ADT versus continuing ADT alone on OS and other efficacy outcomes by baseline PSA categories.
Rosenberg JE, [Petrylak DP]. LBA73 study EV-103 cohort K: Antitumor activity of enfortumab vedotin (EV) monotherapy or in combination with pembrolizumab (P) in previously untreated cisplatin-ineligible patients (pts) with locally advanced or metastatic urothelial cancer (la/mUC). Annals of oncology. 09/2022;33:S1441. doi: 10.1016/j.annonc.2022.08.079.
Conclusions: EV+P showed high ORR with rapid responses and median DOR not reached in a 1L cisplatin-ineligible population. The safety profile was tolerable and generally consistent with the known profile for EV+P. EV monotherapy was consistent with prior experience. These data support ongoing investigations of 1L EV+P in patients with la/mUC who have a high unmet need.
De Wit R, [Petrylak DP]. 1747P impact of prior chemotherapy (chemo) on pembrolizumab (pembro) response in urothelial cancer (UC): Exploratory analysis of the phase III KEYNOTE-045 study. Annals of oncology. 09/2022;33:S1336-S1337. doi: 10.1016/j.annonc.2022.07.1825.
Background: KEYNOTE-045 (NCT02256436) demonstrated a survival benefit with pembro monotherapy vs chemo in pts with advanced UC whose disease progressed on platinum chemo. This post hoc exploratory analysis evaluated the impact of prior chemo on response to pembro monotherapy in KEYNOTE-045.
Arlen, Angela M. "Transurethral Resection of Posterior Urethral Valves." Urology Video Journal, vol. 15, 09/2022, pp. 100165, doi:10.1016/j.urolvj.2022.100165.
Posterior urethral valves (PUV) are the most common cause of lower urinary tract obstruction in boys with an incidence of 1.6-2.1 per 10,000 births. Most valves appear as leaflets arising from the verumontanum that fuse anteriorly. PUV during fetal development results in detrusor hypertrophy with high storage and voiding pressures. PUV may lead to dilation of the posterior urethra, bladder neck hypertrophy, bladder wall thickening, vesicoureteral reflux (VUR), upper tract dilation, and – in one third of affected patients – end-stage renal disease.
Nie J, Leapman MS. AUTHOR REPLY. Urology (Ridgewood, N.J.). 09/2022;167:127. doi: 10.1016/j.urology.2022.03.047.
… These findings suggest that future analyses should not only examine the phenomenon of practice consolidation but also consider the specific circumstances of the ventures, including the history and priorities of investment partners. Such information may provide a higher level of detail about characteristics of successful partnerships that may be valuable to urologists and healthcare systems.
Matsubara N, Yonese J, Kojima T, Azuma H, Matsumoto H, Powles T, Rosenberg JE, Petrylak DP, Matsangou M, Wu C, Campbell M, Yamashiro M. Japanese subgroup analysis of EV-301: An open-label, randomized phase 3 study to evaluate enfortumab vedotin versus chemotherapy in subjects with previously treated locally advanced or metastatic urothelial carcinoma. Cancer Med. 2022 Sep 2. doi: 10.1002/cam4.5165. Epub ahead of print. PMID: 36052536.
Background: Enfortumab vedotin (EV) is an antibody-drug conjugate showing significant overall survival (OS) benefit versus chemotherapy for patients with previously treated locally advanced or metastatic urothelial carcinoma (la/mUC) in EV-301. This subgroup analysis was conducted to further analyze the efficacy and safety in a Japanese population.
Zeng T, [Onofrey JA]. et al. (2022). Supervised Deep Learning for Head Motion Correction in PET. In: Wang, L., Dou, Q., Fletcher, P.T., Speidel, S., Li, S. (eds) Medical Image Computing and Computer Assisted Intervention – MICCAI 2022. MICCAI 2022. Lecture Notes in Computer Science, vol 13434. Springer, Cham. https://doi.org/10.1007/978-3-031-16440-8_19.
… An algorithm ablation study was performed to determine the contributions of each of our DL-HMC design choices to network performance. Our results demonstrate accurate motion prediction performance for brain PET using a data-driven registration approach without external motion tracking hardware. All code is publicly available on GitHub: https://github.com/OnofreyLab/dl-hmc_miccai2022.
Zhang, J., Venkataraman, R., Staib, L.H., Onofrey, J.A. (2022). Atlas-Based Semantic Segmentation of Prostate Zones. In: Wang, L., Dou, Q., Fletcher, P.T., Speidel, S., Li, S. (eds) Medical Image Computing and Computer Assisted Intervention – MICCAI 2022. MICCAI 2022. Lecture Notes in Computer Science, vol 13435. Springer, Cham. https://doi.org/10.1007/978-3-031-16443-9_55.
Discussion and Conclusion: … Our results demonstrate that the use of this atlas improves segmentation performance compared to baseline results without the atlas. Furthermore, our method provides users with the ability to dynamically control the atlas weighting parameter (λλ) in real-time during inference. This feature can be integrated into GUI software to perform real-time inspection by clinicians for robust and accurate segmentation results.
Dong S, [Onofrey JA]. et al. (2022). Multi-scale Super-Resolution Magnetic Resonance Spectroscopic Imaging with Adjustable Sharpness. In: Wang, L., Dou, Q., Fletcher, P.T., Speidel, S., Li, S. (eds) Medical Image Computing and Computer Assisted Intervention – MICCAI 2022. MICCAI 2022. Lecture Notes in Computer Science, vol 13436. Springer, Cham. https://doi.org/10.1007/978-3-031-16446-0_39.
Magnetic Resonance Spectroscopic Imaging (MRSI) is a valuable tool for studying metabolic activities in the human body, but the current applications are limited to low spatial resolutions. The existing deep learning-based MRSI super-resolution methods require training a separate network for each upscaling factor, which is time-consuming and memory inefficient. We tackle this multi-scale super-resolution problem using a Filter Scaling strategy that modulates the convolution filters based on the upscaling factor, such that a single network can be used for various upscaling factors.
Chen X, [Onofrey JA]. et al. (2022). Dual-Branch Squeeze-Fusion-Excitation Module for Cross-Modality Registration of Cardiac SPECT and CT. In: Wang, L., Dou, Q., Fletcher, P.T., Speidel, S., Li, S. (eds) Medical Image Computing and Computer Assisted Intervention – MICCAI 2022. MICCAI 2022. Lecture Notes in Computer Science, vol 13436. Springer, Cham. https://doi.org/10.1007/978-3-031-16446-0_5.
Conclusion: … In our experiments, a network embedded with DuSFE modules generated more consistent registration parameters with ground truth compared to other traditional and deep learning methods, which then enabled more accurate attenuation correction for cardiac SPECT.