Editor’s Choice

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You have accessJournal of UrologyEditor's Choice1 Apr 2024Editor's Choice D. Robert Siemens D. Robert SiemensD. Robert Siemens https://orcid.org/0000-0002-3203-6468 View All Author Informationhttps://doi.org/10.1097/JU.0000000000003897AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Practical Applications of Artificial Intelligence in Surgical Education and Quality Careful readers of The Journal of Urology® will have noticed a refreshed section entitled New Technology, Digital Health, and Artificial Intelligence. The section's purpose, led by editorial board members Drs Gill and Cacciamani, is to bring a spotlight onto the quickly evolving areas of intersection between these innovative tools and our current clinical practice. In this issue of the journal, Khanna et al publish a perfect example of the near-future role of such artificial intelligence (AI) tools.1 The study addresses a practical and untapped opportunity by developing an AI computer vision algorithm for automated identification and annotation of the surgical steps in robotic-assisted radical prostatectomy videos. So many of these cases are recorded worldwide, yet these data are underutilized due to the labor-intensive process of manual annotation. The authors present a novel AI algorithm trained on manually annotated robotic-assisted radical prostatectomy videos to identify surgical steps automatically, achieving a 92.8% concordance with human annotation. The ability of the AI to recognize surgical steps, irrespective of their order and across different surgical techniques, should allow surgeons to better capitalize on video review to improve surgical training and education, offer quality and safety benchmarking, and even enhance operating room logistics. The paper is also an excellent example of the importance of adhering to high reporting standards in medical AI research, such as the STREAM-URO AI framework, and demonstrates a pragmatic effort to harness AI to supplement other innovations in surgical practice and education.2,3 A Randomized Trial of Weight Management for Patients With Prostate Cancer "What can I do?" is a common question from our patients with a new prostate cancer diagnosis. In this issue of The Journal Bechtel et al help solidify some much-needed advice.4 The authors describe a novel phase II study focusing on the effect of weight management on obesity-driven prostate cancer biomarkers. The study randomized 40 men who were scheduled for prostatectomy into 2 groups: one following a weight management program and the other receiving standard educational materials. The intervention led to significant weight loss and improvements in various metabolic parameters such as insulin, cholesterol levels, and the leptin-adiponectin ratio, alongside a reduction in visceral fat. Although no significant changes were observed in prostate tissue markers, quality-of-life measures, specifically general and emotional health, showed improvement. These results align with the growing recognition of exercise and diet in cancer care and supports the hypothesis that weight reduction may counteract some obesity-driven cancer progression mechanisms, alongside a more holistic optimization of quality-of-life.5 Role of Neoadjuvant Chemotherapy for Bladder Cancer Variant Histology Despite the well-recognized role of neoadjuvant chemotherapy (NAC) for patients with muscle-invasive bladder cancer, the benefits for those presenting with variant histology (VH) or divergent differentiation (DD) remain a significant gap in our knowledge. The VESPER trial, investigating 2 different NAC regimens, represents an excellent opportunity to address this gap. Allory et al present a post hoc analysis of the phase III randomized trial, assessing the pathological response and progression-free survival (PFS) in relation to VH/DD presence.6 The analysis, adjusted for treatment arms, indicated that while VH/DD was common, it did not significantly affect the proportion of complete pathological response or PFS when compared to pure urothelial carcinoma. However, the study found that specific subtypes of VH/DD, particularly the nested subtype, were associated with a lower likelihood of a complete pathological response and downstaging, while patients with significant squamous or micropapillary differentiation faced a higher risk of progression. These findings suggest that while VH/DD does not generally impact NAC outcomes, certain VH subtypes could predict worse prognosis and significantly adds to our increasingly nuanced understanding of the complexity of urothelial cancer.7,8 The study also highlights that there was no evidence that VH/DD impacted dose-dense methotrexate-vinblastine-doxorubicin-cisplatin superiority over gemcitabine/cisplatin in local control and PFS. The observations, from a sizable sample of prospectively collected data alongside central pathological review, could help inform treatment planning for those with more uncommon and aggressive variants of muscle-invasive bladder cancer after further independent confirmation. REFERENCES 1. Automated identification of key steps in robotic-assisted radical prostatectomy using artificial intelligence. J Urol. 2024; 211(4):575-584. Link, Google Scholar 2. Effect of 3-dimensional, virtual reality models for surgical planning of robotic prostatectomy on trifecta outcomes: a randomized clinical trial. J Urol. 2022; 208(3):618-625. Link, Google Scholar 3. Tailored feedback based on clinically relevant performance metrics expedites the acquisition of robotic suturing skills-an unblinded pilot randomized controlled trial. J Urol. 2022; 208(2):414-424. Link, Google Scholar 4. Impact of weight management on obesity-driven biomarkers of prostate cancer progression. J Urol. 2024; 211(4):552-562. Link, Google Scholar 5. . A randomized trial of the effects of exercise on anxiety, fear of cancer progression and quality of life in prostate cancer patients on active surveillance. J Urol. 2022; 207(4):814-822. Link, Google Scholar 6. . Impact of divergent differentiation and/or histological subtype of urothelial carcinoma on patient outcomes in the GETUG-AFU V05 VESPER trial. J Urol. 2024; 211(4):564-574. Link, Google Scholar 7. Survival impact of variant histology diagnosis in upper tract urothelial carcinoma. J Urol. 2022; 208(4):813-820. Link, Google Scholar 8. Pathological and survival outcomes associated with variant histology bladder cancers managed by cystectomy with or without neoadjuvant chemotherapy. J Urol. 2021; 205(1):100-108. Link, Google Scholar © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 4April 2024Page: 507-508 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information D. Robert Siemens More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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