Handelsman DJ, Idan A, Sleiman S, et al. Testicular function after non-cytotoxic and immunotherapy drug treatment. Andrology. 2024;12(4):891-898. doi:10.1111/andr.13546

Special thanks to Drs Emma Waddell and Martin Kathrins at the Brigham and Women’s Hospital.

As the landscape of cancer therapeutics evolves to include more noncytotoxic agents, such as small molecule enzyme inhibitors and monoclonal antibodies, there is hope that many patients will be spared the side effects of traditional cytotoxic regimens. Infertility is one such effect that occurs due to the poor specificity of older drugs. This study is the first to examine the impact of novel immunotherapies on male fertility outside of preclinical development.

These researchers considered 2 groups of men either planning to undergo or having already started a noncytotoxic treatment for a wide range of diagnoses. No participants had previously received radiation or chemotherapy. Data were analyzed within individuals and demonstrated that noncytotoxic drugs reduced total sperm counts and concentration by 50%. They did not appear to be antiandrogenic, as they had no effect on serum testosterone, luteinizing hormone, and sex hormone–binding globulin. Notably, the median sperm concentration in study participants on treatment was 28 million/mL, which was within normal limits excluding other factors.

The implication of these findings is that young men on noncytotoxic therapy may be able to avoid the physical, psychological, and financial strain associated with fertility preservation interventions. However, an important caveat is that the efficacy and duration of these newer agents are unpredictable, so patients should be counseled that their final treatment plan may change.

Scott M, Muncey W, Seranio N, et al. Assessing artificial intelligence-generated responses to urology patient in-basket messages. Urol Pract. 2024;11(5):793-798. doi:10.1097/UPJ.0000000000000637

Special thanks to Drs Luca Morgantini and Mahmoud Mima at the University of Illinois at Chicago.

Are artificial intelligence (AI)language models ready to help doctors manage the flood of patient messages in health care? Doctors are now so accessible with just a click away that the time and effort involved in responding to endless inbox queries is a great challenge. Could AI help lift that burden? This study explored whether ChatGPT, a popular AI language tool, could step in and handle urology patient messages. So, how did it perform?

These researchers tested ChatGPT’s ability to respond to 100 real patient messages, evaluating whether its replies were accurate, complete, and suitable for patient communication. While the AI showed potential, with nearly half of its responses being acceptable, this simply isn’t good enough in health care where real lives are at stake.

The key takeaway is that AI language models aren’t quite ready for this task today. A 50% success rate might be impressive in other contexts, but in health care, where precision and patient safety are critical, it falls short. While the study highlights AI’s potential, it also makes clear that significant improvements are needed before these models can be used reliably in clinical settings. Until language models achieve consistent and far greater accuracy, particularly for more complex inquiries, they remain a promising tool under development and are not the reliable support doctors need today with directly answering patient queries.

Canfield SE, George AK, Jue JS, et al. A multi-institutional study of magnetic resonance/ultrasound fusion-guided nanoparticle-directed focal therapy for prostate ablation. JUrol. Published online September 3, 2024. doi:10.1097/JU.0000000000004222

Special thanks to Drs John Smith and Juan Ramon Torres-Anguiano at the University of Illinois at Chicago.

As nanomedicine matures, we race to identify its applications in urology. Photothermal therapy emerged as a groundbreaking technique that selectively targets and destroys prostate cancer cells while preserving healthy tissue. Initial studies demonstrated that gold nanoshell-localized photothermal ablation was a safe and effective treatment for men with low- to intermediate-risk prostate cancer. These investigators studied the oncologic effectiveness and quality of life outcomes for patients who have undergone this promising therapy.

This prospective multicenter study examined the effectiveness of gold nanoparticles (AuroShells) combined with magnetic resonance/ultrasound fusion-guided laser excitation in men with localized prostate cancer of Gleason Grade Groups 1 to 3. PSA levels decreased by about 50% over time, a statistically significant finding. At 12 months, approximately three-fourths of patients achieved oncologic success, confirmed by negative magnetic resonance/ultrasound-guided biopsies in the ablation zone. It is worth noting that larger lesions were linked to treatment failure, indicating that they might pose more challenges. No significant adverse events were reported.

This study clearly underscores the potential of gold nanoshell-localized photothermal ablation as an exciting new treatment for localized prostate cancer. The significant PSA reductions and oncologic success rates suggest a bright future for this therapy. Importantly, the absence of serious adverse events reinforces its safety. However, addressing the challenges posed by larger lesions is crucial for maximizing effectiveness and expanding its use in clinical practice.