Benign Conditions

Benign Prostatic Hyperplasia

Bladder Cancer

Female Urology

Genitourinary Cancers

Genomic Testing

Hormone Therapy

Kidney Cancer

Challenging Anatomy

Innovative Techniques

Laser Lithotripsy

PCNL Tech & Devices

Ureteroscopy Tech & Devices

Kidney Stones

Men's Health

Next-Generation Imaging

Voiding Dysfunction

OAB and Incontinence

Pediatrics

Controveries in Urologic Cancer

Drug Therapy

Prostate Cancer

Sexual Dysfunction

UTUC

Cosmetic Surgery

Urologic Surgery

Business

Practice Management

Malpractice Consult

Health Law & Policy

Media

Case-Based Peer Perspectives

Investigator Perspectives 

Medical World News

Podcasts

Urology Medical Perspectives

UTv Videos

Peer Exchange

Special Report

Virtual Tumor Board

Insights

Medcast

Peers & Perspectives

Conferences

Conference Listing

Conference Previews 

Conference Recaps

Publications

Urology Times Journal

Editorial Advisory Board

Urologists in Cancer Care

Supplements and Featured Publications

Clinical Forums Recaps

CME/CE

Resources

Begin Your Journey: Tackling Burnout

Live Events

Interactive Tools

Job Board

Partners

Treatment Landscape Evolutions

Subscribe

Articles

“The technology in the field of stone management is exciting, and I think it offers patients a lot more options than what they've had in the past,” says Brian Stork, MD. 

“Go big or go small”: Current and emerging tools in kidney stone management

An approach to WVTT involving 1 treatment per prostate lobe was associated with decreased post-operative complications.

Minimal approach to WVTT linked to favorable post-operative outcomes

This approval marks the first clearance of a stapler designed for single-port robotic surgery in the US. 

FDA clears stapler for use with da Vinci SP surgical system 

"Building on decades of research into the genetic markers of prostate cancer, our study shows that the theory does work in practice – we can identify men at risk of aggressive cancers who need further tests and spare the men who are at lower risk from unnecessary treatments," says Professor Ros Eeles. 

Polygenic risk score may identify more clinically significant PCa than PSA, MRI

Urology Times is the leading resource for urologists & allied health professionals offering clinical analysis, policy perspectives, & practical advice.

About Us

Advertise

Editorial

Contact Us

Terms and Conditions

Privacy

Do not sell my Personnal Information

Urology Times | News & Insights for Urologists & Health Professionals

Facebook

LinkedIn

Spotlight

Peers and Perspectives

Clinical

1rem

Authors

Dr. Kaplan, a member of the Urology Times Editorial Council, is E. Darracott Vaughan Jr. Professor of Urology at Weill Cornell Medical College and and director of the Iris Cantor Men’s Health Center, New York Presbyterian Hospital, New York.

"LUTS is an important health care burden, and health care professionals should be screening for its presence in men at risk," writes Steven A. Kaplan, MD.

LUTS’ burden may extend to cardiac events

The management of BPH has had an interesting roller coaster ride over the past 25 years with new medicines, minimally invasive surgical therapies, and a host of novel surgical technologies, including lasers and bipolar electrosurgery.

New tech may bring exciting era in BPH

Dr. De La Cerda provides an overview of a patient case involving a 68 year-old male presenting with severe back pain, with an analysis of the clinical presentation, workup, and medical history.

Bone Predominant mCRPC Patient Case

Video content above is prompted by the following:

What are your initial impressions of the case?

Video Series

The FDA has accepted a Biologics License Application (BLA) seeking approval of nivolumab (Opdivo) co-formulated with Halozyme’s proprietary recombinant human hyaluronidase (rHuPH20), or subcutaneous nivolumab, for the treatment of patients with all previously approved solid tumor indications for nivolumab as a monotherapy, monotherapy maintenance following completion of combination therapy with nivolumab plus ipilimumab (Yervoy), or in combination with chemotherapy or cabozantinib (Cabometyx).

Nivolumab is currently approved under several indications, including in combination with ipilimumab for the first-line treatment of patients with intermediate- or poor-risk advanced renal cell carcinoma (RCC), in combination with cabozantinib for the first-line treatment of patients with advanced RCC, for the treatment of patients with advanced RCC who have received prior anti-angiogenic therapy, and in combination with cisplatin and gemcitabine for the first-line treatment of patients with unresectable or metastatic urothelial carcinoma.

The FDA is set to have a decision regarding the subcutaneous nivolumab formulation on or by December 29, 2024.

 According to a news release from Bristol Myers Squibb,

 approval of the formulation would make it the first and only subcutaneously administered PD-1 inhibitor.

“We believe subcutaneous nivolumab has the potential to make a significant difference in the lives of patients, which is reinforced by the FDA’s acceptance of our application,” said Gina Fusaro, PhD, vice president, global program lead, Bristol Myers Squibb, in the news release.

 “Opdivo is a foundational PD-1 inhibitor approved for many different types of cancer, and our continued investment in research that puts patients first remains a priority. If approved by the FDA, the subcutaneous administration of nivolumab would provide patients and their physicians with a new option that delivers the same well-known benefits as IV Opdivo but with the improved convenience of an injection administered in 3 to 5 minutes rather than a 30-to-60-minute infusion.”

The BLA submission is supported by findings from the phase 3 CheckMate-67T trial (NCT04810078), in which subcutaneous nivolumab met the study’s co-primary end points by demonstrating noninferiority to intravenous (IV) nivolumab regarding time average nivolumab serum concentration over 28 days (C

; geometric mean ratio [GMR}, 2.098; 90% CI, 2.001-2.200) and minimum serum concentration at a steady state (C

Data from the study, which were presented at the 2024 American Society of Clinical Oncology Genitourinary Cancers Symposium in San Francisco, California,

 also showed that subcutaneous nivolumab demonstrated noninferiority to IV nivolumab in the key powered secondary end point of objective response rate (ORR). Specifically, the subcutaneous arm demonstrated an ORR of 24.2% (95% CI, 19.0-30.0) per blinded independent central review (BICR), compared with 18.2% (95% CI, 13.6-23.6) in the IV arm.

The safety profile for subcutaneous nivolumab was consistent with that of the IV formulation. Among patients who received the subcutaneous formulation, 8.1% experienced injection-site reactions, with all being low-grade and transient. Deaths due to study drug toxicity occurred in 3 patients in the subcutaneous arm and 1 patient in the IV arm. Most deaths that occurred during the study were due to disease progression.

In total, the phase 3, open-label CheckMate-67T trial enrolled 495 patients with advanced or metastatic ccRCC who had received prior systemic therapy. Patients were randomly assigned 1:1 to receive 1200 mg subcutaneous nivolumab plus rHuPH20 every 4 weeks (n = 248) or to 3 mg/kg IV nivolumab every 2 weeks (n = 247) for up to 2 years of treatment or until disease progression, unacceptable toxicity, withdrawal, or death.

The co-primary pharmacokinetic end points for noninferiority testing were C

 of subcutaneous nivolumab vs IV nivolumab. The key secondary end point was ORR per BICR.

Final completion of the CheckMate-67T study is expected in January 2026.

1. U.S. Food and Drug Administration accepts Bristol Myers Squibb’s application for subcutaneous nivolumab (nivolumab and hyaluronidase). News release. Bristol Myers Squibb. May 6, 2024. Accessed May 7, 2024. https://news.bms.com/news/corporate-financial/2024/U.S.-Food-and-Drug-Administration-Accepts-Bristol-Myers-Squibbs-Application-for-Subcutaneous-Nivolumab-nivolumab-and-hyaluronidase/default.aspx

2. Bristol Myers Squibb announces updated action date by the U.S. Food and Drug Administration for subcutaneous nivolumab (nivolumab and hyaluronidase). News release. Published online and accessed May 21, 2024. https://investors.bms.com/iframes/press-releases/press-release-details/2024/Bristol-Myers-Squibb-Announces-Updated-Action-Date-by-the-U.S.-Food-and-Drug-Administration-for-Subcutaneous-Nivolumab-nivolumab-and-hyaluronidase/default.aspx

3. George S, Bourlon TB, Chacon MR, et al. Subcutaneous nivolumab (NIVO SC) vs intravenous nivolumab (NIVO IV) in patients with previously treated advanced or metastatic clear cell renal cell carcinoma (ccRCC): Pharmacokinetics (PK), efficacy, and safety results from CheckMate 67T. 

4. A study of subcutaneous nivolumab versus intravenous nivolumab in participants with previously treated clear cell renal cell carcinoma that is advanced or has spread (CheckMate-67T). ClinicalTrials.gov. Last updated March 1, 2024. Accessed May 7, 2024. https://clinicaltrials.gov/study/NCT04810078

The FDA is set to have a decision regarding the subcutaneous nivolumab formulation on or by December 29, 2024. 

News

FDA accepts BLA for subcutaneous nivolumab in solid tumors

In February 2025, the labeling requirements for testosterone caught up with what urologists and other prescribers have known for years: testosterone does not increase the risk of adverse cardiovascular outcomes.

The journey to this conclusion began in 2014, when the FDA first convened a Joint Meeting of the Bone, Reproductive and Urologic Drugs and the Drug Safety and Risk Management Advisory Committee to discuss increased reports of stroke, heart attack, and death in men who were taking testosterone. The result of these discussions was to initiate a trial to assess the safety of testosterone in men with hypogonadism—a trial we now know as the TRAVERSE trial (NCT03518034).

The results from TRAVERSE were reassuring. Published in 2023 in the 

, the data showed that the incidence of major adverse cardiac events (MACE) for men on testosterone was non-inferior to that of those on placebo. Specifically, a MACE event occurred in 7.0% of patients taking testosterone vs 7.3% of patients taking placebo (HR, 0.96; 95% CI, 0.78 to 1.17; 

It's important to take into consideration the design of the TRAVERSE trial. TRAVERSE was a randomized controlled study that enrolled 5246 men aged 45 to 80 years who had a preexisting or a high risk of cardiovascular disease at study entry. Patients received either transdermal 1.62% testosterone gel (with the dose adjusted to maintain testosterone levels between 350 and 750 ng/dL) or placebo gel.

Although these results confirmed what many urologists already knew, the data may alleviate concerns for other prescribers of testosterone, such as those in primary care.

“There was a lot of fear and caution on a provider standpoint, even if you knew the data and knew that the risks were not significant or not dramatic,” said Landon Trost, MD, founder and director of the Male Fertility and Peyronie’s Clinic in Orem, Utah, in an interview with 

More importantly, these findings may alleviate concerns for patients.

“Men have been deprived of testosterone therapy because of fears of MACE, and it now opens up testosterone therapy to very large groups of men who will benefit from it,” John P. Mulhall, MD, a urologic surgeon at Memorial Sloan Kettering Cancer Center in New York, New York, told 

These findings push back against previous studies that raised concerns about the safety of testosterone. The original studies, though, had design flaws that called into question the accuracy of their findings.

According to Trost, “The original studies that reported these risks had numerous major flaws, and those involved in the testosterone side of things even called for retractions of some of these papers.”

This is important to discuss with patients when counseling them on the risks and benefits for testosterone, especially for those who may have concerns based on the original studies.

Helen L. Bernie, DO, MPH, an assistant professor of urology at Indiana University School of Medicine in Indianapolis, Indiana, explained her approach, saying, “When I'm talking to my patients, I explain the studies with them. I explain to them why we had that data. I talk to them about the newer studies and the safety. I specifically mention the TRAVERSE trial, because I think that helps give patients a lot of reassurance, because they recognize that it's a large, randomized controlled trial that showed safety in men who already were at high risk for cardiovascular disease.”

However, testosterone should be used wisely in clinical practice, considering that TRAVERSE assessed MACE risk in a controlled environment, according to Steven E. Nissen, MD, a cardiologist at Cleveland Clinic in Cleveland, Ohio. Patients should be carefully counseled on the risks and benefits, and initiation of therapy should be done with a careful titration of dosage.

He cautioned, “I want to say that while we agree with the FDA taking away the black box warning, this is not a license to give testosterone to every aging man who doesn't feel like they felt when they were 18 years old.”

Importantly, the FDA's labeling changes also recommended retaining the “Limitation of Use” language for age-related hypogonadism and required the addition of information on increased blood pressure for testosterone products.

There are also still unanswered questions following TRAVERSE. A comprehensive understanding of the true risks and benefits of testosterone are not fully elucidated. Specifically, there may be a need to specifically assess for the risk of venous thromboembolic events, according to Mulhall, who also chaired the guidelines committee for the AUA’s “Evaluation and Management of Testosterone Deficiency” guideline.

In the TRAVERSE trial, patients in the testosterone cohort experienced a higher incidence of pulmonary embolism, a component of venous thromboembolic events. Specifically, the incidence of pulmonary embolism was 0.9% in the testosterone cohort vs 0.5% in the placebo cohort. According to the authors, testosterone should be used cautiously in men with a previous history of venous thromboembolic events.

“I would say that the outstanding concern that I have would be the concept of venous thromboembolic events,” Mulhall said. “I think what we really need is a TRAVERSE study that is focused primarily on venous thromboembolic events in the testosterone therapy group.”

That being said, the labeling change for testosterone products reflects a key step forward in understanding the safety profile of this life-improving therapy. This change has significant implications for urologists and the patients that they treat.

“I'm excited about [the FDA] finally removing this box warning,” said Bernie. “I think it's something that many of us who prescribe testosterone therapy often have known for a long time, so it's nice to finally see this down in paper.”

The hope, according to experts, is that this suggested removal of the black box warning leads to other changes that reflect TRAVERSE findings.

“This is massively important,” said Mulhall. “It is my hope that the AUA will go back and change [the guideline] statement so that we now have guideline-based instructions to physicians that will say, ‘You are now allowed to say to patients that testosterone therapy is not associated with major adverse cardiovascular events.’”

1. FDA issues class-wide labeling changes for testosterone products. News release. US Food & Drug Administration. February 28, 2025. Accessed April 9, 2025. https://www.fda.gov/drugs/drug-safety-and-availability/fda-issues-class-wide-labeling-changes-testosterone-products

2. Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy. 

. 2023;389(2):107-117. doi:10.1056/NEJMoa2215025

In 2025, labeling for testosterone was updated to reflect that it does not increase cardiovascular risk, aligning with findings from the TRAVERSE trial. This trial, involving 5,246 men, demonstrated that testosterone therapy's risk of major adverse cardiac events (MACE) is non-inferior to placebo. Despite these findings, caution is advised due to potential venous thromboembolic events. The updated labeling is expected to alleviate prescriber and patient concerns, potentially expanding testosterone therapy access. Experts hope for further guideline updates to reflect these findings.

In February 2025, the FDA recommended a removal of the black box warning related to an increased risk of adverse cardiovascular outcomes for all testosterone products. This recommendation has important implications for urologists and the patients they treat.

Label change for testosterone: Implications for urologists, prescribers, and patients

The PROSTOX ultra test, which consists primarily of microRNA single-nucleotide polymorphisms (mirSNPs), demonstrated the ability to predict which patients may experience late-grade genitourinary (GU) toxicity following radiation treatment for prostate cancer.

"These findings represent a very important moment in the treatment of prostate cancer and for the field of oncology treatment as a whole," said senior author Joanne B. Weidhaas, MD, PhD, a professor at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA); head of translation research in the Department of Radiation Oncology; and co-founder of MiraDx and founder of MiraKind, in a news release on the findings.

 "While tumor-based molecular profiling tests that inform treatment selection have contributed to improved patient outcomes, no tests based on germline genetics currently exist to identify toxicity risks to treatment. PROSTOX ultra is the first test that predicts radiation toxicity, giving patients and their physicians important information to make decisions that balance effectiveness with long-term quality of life.”

For the study, the investigators assessed data from the phase 3 MIRAGE trial (NCT04384770), which assessed the use of aggressive margin reduction with MRI-guided stereotactic body radiotherapy (SBRT) to standard CT-guided SBRT. The current study included data from 148 patients.

Overall, the PROSTOX ultra test accurately predicted which patients in that trial would experience late grade 2 or greater GU toxicity, with an area under the curve (AUC) of 0.762. In the MRI- and CT-guided arms, the AUC was 0.762 and 0.761, respectively.

The test also demonstrated a sensitivity of 0.576 and a specificity of 0.948 in this cohort. Compared with data from the original training set, the sensitivity was lower (original set, 0.714) and the specificity was similar (original set, 0.924) in the MIRAGE cohort.

The authors noted, “While it should be acknowledged that the sensitivity of PROSTOX was lower in this study than in the original cohort, this could be explained by the use of a different toxicity scoring systems (CTCAE [Common Terminology Criteria for Adverse Events] vs RTOG [Radiation Therapy Oncology Group]), as well as [the] inclusion of pelvic lymph nodes and ADT in this validation study.”

When the investigators used numeric outputs for PROSTOX (as opposed to binary cutoff values), the AUC of PROSTOX was 0.83 in the MRI group and 0.71 in the CT group. A higher PROSTOX score was also correlated with a higher GU toxicity grade overall (lin reg 

 = 1.2E-9) as well as in the MRI group (lin reg 

The authors then used Gene Ontology (GO) analyses to identify unique pathways associated with acute, chronic, and late toxicity.

“Here we found that acute only and chronic GU toxicity have unique mirSNP-based genetic signatures, and that all 3 forms of toxicity have gene pathway alterations based on GO analyses that differentiate them from each other,” the authors wrote.

According to the authors, these findings support the potential of mirSNPs to predict toxicity and “to act as a path for the continued personalization of RT with improved patient outcomes.”

“Advancements in radiation technology, treatment planning, patient care, and follow-up make it challenging to directly compare toxicity between older and more modern treatment approaches,” explained lead author Amar U. Kishan, MD, a radiation oncologist at UCLA, in the news release.

 “Despite these challenges, this study validated PROSTOX ultra as a predictive biomarker, and that a genetic predisposition to increased toxicity persists with modern, high-precision SBRT, including MRI-guided SBRT. This finding reinforces PROSTOX ultra as a true measure of the biological response to radiation, independent of treatment era or technique that can identify the safest course of treatment to avoid toxicity.”

1. Kishan AU, McGreevy K, Valle L, et al. Validation and derivation of microRNA-based germline signatures predicting radiation toxicity in prostate cancer. 

. Published online April 7, 2025. doi:10.1158/1078-0432.CCR-24-3951

2. MiraDx announces new study published in Clinical Cancer Research validating PROSTOX ultra diagnostic test for predicting radiation-induced late toxicity in prostate cancer. News release. MiraDx. April 7, 2025. Accessed April 7, 2025. https://www.businesswire.com/news/home/20250404130675/en/MiraDx-Announces-New-Study-Published-in-Clinical-Cancer-Research-Validating-PROSTOX-ultra-Diagnostic-Test-for-Predicting-Radiation-Induced-Late-Toxicity-in-Prostate-Cancer

The PROSTOX ultra test, utilizing microRNA single-nucleotide polymorphisms (mirSNPs), effectively predicts late-grade genitourinary toxicity in prostate cancer patients post-radiation therapy. This test marks a significant advancement in oncology, being the first to predict radiation toxicity based on germline genetics, aiding in treatment decisions that balance efficacy and quality of life. The study, part of the phase 3 MIRAGE trial, demonstrated the test's predictive accuracy with an AUC of 0.762. Gene Ontology analyses revealed distinct genetic signatures for different toxicity forms, supporting personalized radiation therapy.

"This finding reinforces PROSTOX ultra as a true measure of the biological response to radiation, independent of treatment era or technique that can identify the safest course of treatment to avoid toxicity," says Amar U. Kishan, MD. 

Genetic test can predict risk of toxicity following radiation for prostate cancer

, shares in-depth insights into the study, “Perioperative outcomes of neoadjuvant (neoadj) TAR-200 plus cetrelimab (CET) or CET alone in patients (pts) with muscle-invasive bladder cancer (MIBC) ineligible for or refusing neoadj cisplatin-based chemotherapy (NAC),” which was recently presented at the 40

 Annual European Association of Urology (EAU) Congress in Madrid, Spain.

Necchi is a professor of medical oncology at Vita-Salute San Raffaele University and the director of GU oncology at San Raffaele Hospital in Milan, Italy.

Could you describe the background/rationale for this study? What previous data have been reported?

SunRISe-4 is part of the platform of SunRISe studies that are targeting early bladder cancer, including non–muscle invasive disease and muscle-invasive disease. In particular, SunRISe-4 is targeted to patients diagnosed with the muscle-invasive tumor, so T clinical—T2-T4a N0M0 muscle-invasive bladder cancer with pure or predominant urothelial cancer histology.

SunRISe-4 is a randomized phase 2 study evaluating TAR-200, which is a gemcitabine-releasing system into the bladder, plus cetrelimab, a checkpoint inhibitor and anti-PD-1 agent, in patients scheduled for radical cystectomy and who are also ineligible for or refuse cisplatin-based chemotherapy. [There are] 2 parallel arms: TAR-200 and cetrelimab in arm A and cetrelimab monotherapy in arm B. It's not actually a comparative study. These 2 arms are not intended to provide a formal, statistical comparison of the efficacy outcomes but are parallel arms. The design is aimed to provide a descriptive analysis of the outcomes in both arms.

In [the] interim analysis that I presented at ESMO [the European Society for Medical Oncology Congress] a few months ago, neoadjuvant TAR-200 and cetrelimab showed a higher pathological complete response (pCR) rate, as high as 42%, and pathological objective response (pOR), meaning downstaging to non–muscle invasive disease, of 62% in the ITT population. In the cetrelimab arm, these proportions were 23% and 36%. There was an enrichment in particular in pCR and pOR in patient presenting with the clinical t2 stage. Based on various secondary assessments, like, for example, the exposure to TAR-200 [of] those patients. The majority [of patients who] were able to receive the 4 doses of neoadjuvant TAR-200 benefited the most in terms of pCR from the neoadjuvant therapy.

Most of the adverse events provided at the interim analysis were grade 1 and 2 and were mostly confined to urinary events. So, nothing really major and nothing very concerning with regard to systemic [adverse events].

What were the key findings presented at EAU?

The analysis that was presented very nicely by Sarah Psutka, MD, at the EAU meeting [was] focused on the surgical safety and surgical outcomes. We are still dealing with an interim analysis subset and not the full study accrual. The patients who were evaluated were 50 patients in the combination therapy arm and 26 radical cystectomies in the cetrelimab monotherapy arm. In general, the patient characteristics were pretty much in line with those already presented with the interim analysis at the ESMO meeting.

Importantly, the main safety parameters that were represented—changes in body mass index, changes in albumin level, changes in creatinine, changes in hemoglobin level—were not significant pre- and post-therapy. Other very important safety parameters, such as the median time to radical cystectomy, were [generally] in line with the safety boundaries, being 13.6 weeks in the TAR-200/cetrelimab arm and 12.4 weeks in the cetrelimab monotherapy arm. So, the treatment was pretty much safe in both arms.

With regard to the overall grade 3 and 4 [adverse] effects, they were reported in 42% of the combination therapy arm patients and 41% in the cetrelimab monotherapy [arm patients]. Again, most of these [adverse events] were not preventing the continuation of therapy, preventing cystectomy, or exposing the patient to an extra toxicity, but were primarily confined to local [adverse events]. With regard to the distribution between robotic and open cystectomy, there was nothing major to say. The data were pretty much in line with what is happening in standard practice.

The only missing point is to look at the entire dataset [to] confirm these findings with regard to efficacy and safety in the interim analysis. The study is accrued, and we are still waiting for the finalized subset, so we'll see if there will be any change. Very small changes are expected, with regard to both efficacy and safety, in my opinion.

Based on these initial findings, what is the overall take-home message for urologists?

We can target the MIBC treatment with a different modality as compared with what we were used to in the recent past. Looking at the combination of intravesical therapy and systemic therapy may provide us and may provide the patient with an opportunity of achieving sustained responses, while preserving most of the [adverse] effects that are usually provided by aggressive systemic therapy, meaning chemotherapy or maybe in the near future, an [antibody-drug conjugate] and [immunotherapy] combination.

We have a snapshot of the safety data from different approaches, such as the NIAGARA approach—the immune therapy and chemotherapy combination. The safety data from NIAGARA is in line with the chemotherapy data. So, nothing exceedingly higher than the literature. But the quality of the 40% to 45% of grade 3/4 [adverse] effects that have been reported in NIAGARA is different from the quality of [adverse events] reported in SunRISe-4, mainly being represented by systemic [adverse events]. We are shifting the landscape toward something that is maybe more manageable for the patient. Provided that we will confirm the efficacy data long-term, there is an opportunity to spare, de-escalate a bit, the treatment in select patients, and to expose the patient with inferior risk of developing severe [adverse] effects.

Is there anything else that you’d like to add?

The natural evolution for SunRISe-4, provided that there would be a validation of pathological response findings, is to fine-tune the selection of the patients, trying to select the patients for whom the pCR rate rises to above 50%, such as clinical T2 patients, or maybe [using] biomarkers. We are still waiting for biomarkers from SunRISe-4. If we're able to get this point, to overcome the 50% pCR bar in select patients from SunRISe-4, there would be an opportunity to think about bladder-sparing approaches as the next step. [We could] provide maybe an IO and then reintravesical therapy with the aim to spare the bladder in patients who respond completely at the clinical evaluation after treatment as compared to the baseline situation.

SunRISe-4 is a phase 2 study evaluating TAR-200 and cetrelimab in muscle-invasive bladder cancer patients ineligible for cisplatin-based chemotherapy. The study showed promising pathological complete response rates, particularly in clinical T2 stage patients. Adverse events were mostly mild and localized. Surgical safety outcomes were favorable, with no significant changes in key safety parameters. The study suggests a potential shift towards more manageable treatment modalities, combining intravesical and systemic therapies. Future directions include refining patient selection and exploring bladder-sparing approaches based on biomarker validation.

"Provided that we will confirm the efficacy data long-term, there is an opportunity to spare, de-escalate a bit, the treatment in select patients, and to expose the patient with inferior risk of developing severe [adverse] effects," says Andrea Necchi, MD.

Perioperative outcomes support benefit of TAR-200 plus cetrelimab in MIBC

The FDA has granted 510(k) clearance to the Glean Urodynamics System for adult patients with lower urinary tract dysfunction (LUTD), Bright Uro announced in a news release.

According to the company, the system is a “urodynamic analyzer system that is intended to quantify the pressure and flow characteristics of the lower urinary tract.” The device enables wireless, catheter-free ambulatory urodynamics monitoring that can aid decision-making for LUTD.

“I consider Glean to be the kind of diagnostic technology advance that the urology community has awaited for decades,” said Alan J. Wein, MD, of the University of Miami, Florida, in the news release.

 “The system produces information that is closer to a real-life situation than that generated in a urodynamics laboratory. New norms may have to be worked out, but ultimately, I think this has great potential for deciphering lower urinary tract symptomatology and thereby improving patient care.”

Bright Uro shared that the Glean System was found to be easier for clinicians to use, delivered more accurate data, and was more comfortable for patients.

 the company explained, “The Glean system consists of an insertion tool, a Bluetooth-enabled pressure sensor in a flexible silicone tube, a software app for use by clinicians and patients, and a uroflowmeter to sense volume and flow.”

Bright Uro also explained that the catheter-free design of the system may enable clinicians to collect more ambulatory data with greater physiologic accuracy compared with current standard-of-care options.

“The majority of urologists, including myself, believe that current urodynamics testing is lacking," said Bilal I. Chughtai, MD, of Northwell Health in Syosset, New York.

 “With artificial filling and voiding with catheters in place, patients are often unable to replicate symptoms during the test. Urodynamics is uncomfortable for patients, sometimes even traumatic. Glean will enable patients to void naturally, without catheters in place. I believe this advance will yield a better test that mimics actual symptoms.”

The Glean Urodynamics System, developed by Bright Uro, has received FDA 510(k) clearance for use in adult patients with lower urinary tract dysfunction (LUTD). This innovative system offers wireless, catheter-free ambulatory urodynamics monitoring, providing more accurate and comfortable testing compared to traditional methods. The system's design allows for natural voiding, potentially improving diagnostic accuracy and patient care. Developed in collaboration with the Cleveland Clinic and other institutions, the Glean System aims to enhance access to urodynamics testing by simplifying the process and reducing the need for specialized equipment and personnel.

"Glean will enable patients to void naturally, without catheters in place. I believe this advance will yield a better test that mimics actual symptoms," says Bilal I. Chughtai, MD. 

Steven A. Kaplan, MD

Articles

Latest Updated Articles