Highlights include:
- 3D modeling for robotic prostatectomy
- Cost comparison of checkpoint inhibitors in high-risk bladder cancer
- AI-generated prostate cancer mapping
- A wearable optical system for bladder monitoring after spinal cord injury
- A shared decision-making intervention for kidney stone treatment
Investigators from the and the UCLA Health Jonsson Comprehensive Cancer Center will be involved in more than four dozen sessions at the annual meeting of the American Urological Association, where they will present new research findings and advances in patient care. AUA 2025 will be in Las Vegas from April 26 to 29.
“The AUA annual meeting is an essential forum for sharing new science, improving patient care and advancing the field of urology,” said Christopher Saigal, MD, professor and vice chair of Urology at the David Geffen School of Medicine at UCLA. “It’s a chance for UCLA’s clinician-scientists to contribute to the national conversation on emerging technologies and treatment approaches, while learning from colleagues from around the world.
Highlights of noteworthy presentations led by UCLA researchers include:
3D modeling improves planning and outcomes in robotic prostate cancer surgery
Abstract: IP11-37: 3D digital models for robotic prostatectomy: Surgeon survey and outcomes correlation from a randomized clinical trial
Surgeons who used 3D digital models for planning robotic-assisted prostatectomy often changed their surgical plans after viewing the models and better understanding key anatomic considerations, according to research led by Joseph Shirk, MD, assistant professor of Urology at the David Geffen School of Medicine at UCLA, and Asha Ayub, MD, a resident in the Department of Urology. Clinical trial results suggest 3D modeling led to greater nerve sparing and better outcomes.
The study follows the researchers’ earlier findings showing an association between 3D digital models and better oncologic and functional outcomes at 3 and 18 months. Here, they report surgeon survey data and correlation to patient outcomes after conducting a randomized, single-blind clinical trial from January 2019 to December 2022 at six academic institutions. Sixty-six percent of the 41 patients analyzed were white, and mean age was 62. According to results, surgeons modified their operative plan in 33% of cases based on the 3D digital model. Compared with multiparametric MRI, the 3D modeling significantly improved cancer visualization and the ability to see and understand the relationship between the mass and surrounding anatomic structures. In 74% of cases, surgeons reported enhanced clarity of anatomic details. Analyses showed that the model’s ability to aid in performing nerve sparing was associated with negative margin status, early continence and erectile function, and durable erectile function.
Ayub will present the new findings during a session Sunday, April 27, from 9:30 to 11:30 a.m. in Marco Polo 701.
Pembrolizumab may be more cost-effective than nivolumab in high-risk bladder cancer
Abstract PD37-11: Cost-effectiveness of nivolumab versus pembrolizumab versus surveillance for the adjuvant treatment of patients with high-risk muscle-invasive bladder cancer
A UCLA study using an analytical model found that the checkpoint inhibitor pembrolizumab may be more cost-effective than nivolumab as an adjuvant therapy for patients with muscle-invasive bladder cancer at high risk for recurrence. The model used data from the CheckMate 274 trial, which compared nivolumab versus placebo, and the AMBASSADOR trial, which compared pembrolizumab with observation. The new analysis also included published literature to inform transitions among health states, and inputs on cost, utility, adverse events, and disease management.
The research team, led by Alexandra Drakaki, MD, PhD, associate professor of Hematology/Oncology and Urology at UCLA Health, and , a fellow and clinical instructor in Urologic Oncology at the David Geffen School of Medicine at UCLA, developed an analytical model to investigate the cost-effectiveness of the drugs compared with surveillance over a 20-year time horizon for a 65-year-old patient with high-risk muscle-invasive bladder cancer after cystectomy. Primary outcomes were life years, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios. The willingness-to-pay threshold – a tool used in cost-benefit analyses – was $100,000/quality-adjusted life year. Total costs were higher with pembrolizumab ($190,160) and nivolumab ($218,091) compared with surveillance ($93,846) but associated with improved disease-free survival and quality-adjusted life years. Pembrolizumab had the lowest incremental cost effectiveness ratio (ICER) at $50,476/QALY. In probabilistic sensitivity analysis, pembrolizumab had the highest probability of being the most cost-effective strategy across a wide range of commonly accepted willingness-to-pay thresholds. Researchers concluded that both drugs are shown to be disease-free-extending and cost-effective options, with pembrolizumab demonstrating improved cost-effectiveness compared with nivolumab.
Kanabur will present the results on Tuesday, April 29, from 10:50 to 10:58 a.m. in Marco Polo 805.
AI more accurately predicts prostate cancer spread to seminal vesicles than MRI
Abstract MP13-20: Prediction of seminal vesicle invasion using artificial intelligence prostate cancer risk mapping
Seminal vesicle invasion (SVI) – the spread of cancer cells from the prostate gland into the seminal vesicles – is a critical factor in disease staging and prognosis, and preoperative prediction of SVI is essential for treatment planning, particularly when determining resection or radiation margins. But due to limitations in resolution, contrast, and inter-reader variability, SVI is often missed on MRI. A UCLA-led study determined that artificial intelligence-generated cancer mapping accurately predicted SVI, despite never being specifically trained for this task. AI dramatically improved upon the SVI predictions of MRI, with the potential to support early diagnosis and treatment of invasive prostate cancer.
Two patient cohorts were evaluated. The first consisted of 147 prostatectomy patients at a single institution. A second cohort of 20 patients, enriched to 50% SVI prevalence, was accrued from a second independent institution. All patients had Gleason Grade group ≥2 prostate cancer diagnosed via MRI-targeted biopsy and were treatment-naïve prior to radical prostatectomy. SVI suspicion on preoperative multiparametric MRI was assessed by a radiologist. A pathologist examined prostatectomy specimens to establish ground-truth SVI.
The research team used multimodal preoperative imaging and clinical data to generate 3D cancer estimation maps (CEMs); the average cancer risk of spaces adjacent to the seminal vesicles and ejaculatory ducts was used to predict seminal vesicle invasion. The researchers employed common analytical and statistical methods to calculate and compare AI and MRI predictions. AI scored significantly higher in accuracy in both cohorts. In the first, MRI missed 12 of 25 cases (48%) with SVI, whereas AI missed only 2 of 25 cases (8%). In the second cohort, MRI missed 4 of 10 cases (40%), whereas AI missed only 2 of 10 (20%) cases with SVI.
Wayne Brisbane, MD, assistant professor of Urology at UCLA Health, will present this study during a session Sunday, April 27, from 9:30 to 11:30 a.m. in Casanova 503.
Wearable optical device shows promise for monitoring bladder health after spinal cord injury
Abstract PD15-04: A wearable optical system for monitoring neurogenic bladder: tracking volume and pressure as a means of lessening the risks of incontinence and autonomic dysreflexia following spinal cord injury
UCLA researchers have demonstrated the feasibility of a wearable optical system able to transcutaneously track changes in bladder volume in real time for patients with neurogenic lower urinary tract dysfunction (NLUTD) from spinal cord injury (SCI). It is engineered to monitor bladder fullness to facilitate optimal intermittent catheterization frequency, providing a practical, personalized method of reducing incontinence and lowering the risk of autonomic dysreflexia (AD), a potentially life-threatening syndrome of the nervous system that can be triggered by an unpleasant or painful stimulus such as an overly full bladder.
The system is a self-contained, wireless optical interface based on near-infrared spectroscopy secured above the pubic area. With three wavelengths of LEDs, it is designed to detect water and to monitor changes in the oxygenation status of blood in the detrusor muscle – the muscle layer of the bladder wall that is responsible for contracting to expel urine. The device is composed of a soft silicone sheet with paired emitter detector arrays configured 4 centimeters (about 1.57 inches) apart for monitoring at two levels. The UCLA study included 66 patients with spinal cord injury and 15 controls. Changes in light attenuation were first detected by the lower sensor as urine accumulated. As bladder volume increased, attenuation by the higher sensor became progressively greater. Autonomic dysreflexia occurred in 20% of spinal cord injury patients with NLUTD. Three algorithms were identified based on near-infrared spectroscopy-derived data that correlated with detrusor pressure. The researchers say future studies will establish how home monitoring for bladder fullness and pressure can positively impact quality of life and the frequency of events triggering AD.
Lynn Stothers, MD, MHS, professor in residence of Urology and Obstetrics and Gynecology will present this study Sunday, April 27, from 9:54 to 10:02 a.m. in Galileo 1001.
Strategies to boost shared decision-making for kidney stone care
MP33-09: Optimizing implementation of an online shared decision-making intervention in management of nephrolithiasis
Shared decision-making (SDM) – a process in which patients and clinicians collaborate to make treatment decisions – has been helpful in improving decisional quality and patient satisfaction in care settings, but implementation has been challenging. Researchers led by Christopher Saigal, MD, professor and vice chair of Urology at the David Geffen School of Medicine at UCLA, and Saam Kazemi, a research assistant in the UCLA Department of Urology, hypothesized that use of tactics from implementation science and quality improvement would lead to successful implementation of a decision aid (DA) to facilitate shared decision-making in nephrolithiasis (kidney stone) management. They enrolled 240 English-speaking patients 18 years old and older who came to UCLA Urology for new evaluation of nephrolithiasis between August 2024 to October 2024. Their software-based decision aid measured preferences and used decision analysis to generate a ranking of treatments for each patient.
At launch, “reach” – the proportion of eligible patients who were identified and invited to use the DA – was 40%, and “fidelity” – the proportion of eligible patients who used the DA as intended to completion – was 13%. Goals were 80% and 60%, respectively. The study documents the challenges the researchers faced and the solutions they devised to overcome them, using Plan Do Study Act (PDSA) cycles to improve reach and fidelity. They concluded that successful DA implementation efforts should include a focus on technical ease of access in addition to human or electronic physician endorsement of the process at its introduction. Using a mixed quality improvement and science-based approach to implementation is feasible and can rationally guide actions to improve patient engagement in shared decision-making programs. Kazemi will present this study during a session Monday, April 28, from 3:30 to 5:30 p.m. in Marco Polo 703.
All dates and times displayed for are Pacific time. The meeting will be at The Venetian Convention & Expo Center in Las Vegas.
