Urological Cancers and ChatGPT: Assessing the Quality of Information and Possible Risks for Patients

INTRODUCTION

OpenAI has created ChatGPT, an artificial intelligence language model that has gained considerable recognition for its capacity to produce text responses resembling human language. Consequently, this study seeks to evaluate the effectiveness of ChatGPT's responses in addressing publicly accessible queries related to prostate, kidney, bladder, and testicular cancers.

MATERIAL AND METHODS

A comprehensive compilation of frequently asked questions (FAQs) pertaining to prostate, bladder, kidney, and testicular cancers was gathered from diverse sources. Additionally, the recommendations outlined in the European Association of Urology (EAU) 2023 Guideline Oncology were consulted. The chosen questions for evaluation were presented to the ChatGPT 4.0 premium version. The quality of ChatGPT responses was appraised using the global quality score (GQS). Each ChatGPT response was independently reviewed by a panel of physicians, who assigned a GQS score to assess its overall quality.

RESULTS

For prostate cancer, 64.6% of the questions had a GQS score of 5, compared to 62.9 % for bladder, 68.1% for kidney, and 63.9% for testicular cancers, whereas none of the responses had a GQS score of 1. Meanwhile, the category with the lowest proportion of responses, with a GQS score of 5 for each disease, was prognosis and follow-up. The mean GQS score of the answers given to EAU guideline questions was statistically significantly lower than the average score of the answers given to FAQs.

CONCLUSION

ChatGPT is a valuable tool for addressing general inquiries regarding urological cancers, boasting commendable accuracy rates. Nonetheless, its performance in responding to questions aligned with the EAU guideline was deemed unsatisfactory.

Effects of the lesion size on clinically significant prostate cancer detection rates in PI-RADS category 3-5 lesions

INTRODUCTION

Prostate cancer (PCa) ranks second among prevalent cancers in men, necessitating effective screening tools such as multiparametric magnetic resonance imaging (mpMRI) with the prostate imaging reporting and data system (PI-RADS) classification. This study explores the impact of lesion volume on clinically significant prostate cancer (csPCa) detection rates in PI-RADS 3-5 lesions, aiming to contribute insights into the underexplored relationship between lesion size and csPCa detection.

MATERIALS AND METHODS

A retrospective analysis was conducted on data from 754 patients undergoing mpMRI-guided transrectal ultrasound (TRUS) prostate biopsy between January 2016 and 2023. Patients with PI-RADS 3, 4, and 5 lesions were included. Lesion size and PI-RADS categories were assessed through mpMRI, followed by MR fusion biopsy.

RESULTS

Of the patients, 33.7%, 52.3%, and 14.1% had PI-RADS 3, 4, and 5 lesions, respectively. Lesion sizes correlated significantly with csPCa detection in PI-RADS 4 and 5 categories. For PI-RADS 3 lesions, no significant differences in csPCa rates were observed based on lesion size. However, in PI-RADS 4 and 5 groups, larger lesions showed higher csPCa rates.

CONCLUSION

This study suggests that subgroup categorizations based on lesion volume could predict clinically significant PCa with high accuracy, potentially reducing unnecessary biopsies and associated overtreatment. Future research should further explore the relationship between lesion size and csPCa, clarifying discussions regarding the inclusion of systematic biopsies in diagnostic protocols.

Failed insertion of ureteral access sheath during flexible ureterorenoscopy: a randomized controlled trial comparing second session flexible ureterorenoscopy or same session mini percutaneous nephrolithotomy

PURPOSE

To compare different treatment approaches in patients with failed ureteral access sheath placement during first flexible ureterorenoscopy (f-URS) session.

METHODS

Patients with kidney stones measuring 1-2 cm, presented to our urology clinic between September 2020 and September 2021, were included in the study for evaluation. The study was designed prospectively (Clinical-Trials number NCT05911945). Patients were randomized into two groups, in case of a failed ureteral access sheath placement during the first f-URS session. In group 1, JJ stent was placed for dilation and second session of f-URS was planned. In group 2, mini percutaneous nephrolithotomy (mPNL) was performed in the same session.

RESULTS

Twenty-four patients were included in each group. Pre-operative demographic data and stone characteristics of the patients in each group were comparable. Operation time, fluoroscopy time, and hospital stay were significantly higher in the mini-PNL group. When SF-36 values were compared, physical function, pain, role limitation, and general health value scores were improved in both groups after treatment. The improvement in physical function and pain parameters was statistically significant in the mPNL group. In patients with failed ureteral access sheath placement, placing a JJ stent for dilation and postponing f-URS for 4-6 weeks provides the advantages of low hospitalization time for each admission, shorter fluoroscopy and operation time.

CONCLUSIONS

Performing mPNL in the same session, results in better improvements in SF-36 parameters such as pain and physical function compared to f-URS. The success and complication rates of the two procedures were comparable.

Evaluating the performance of ChatGPT in answering questions related to pediatric urology

INTRODUCTION

Artificial intelligence is advancing in various domains, including medicine, and its progress is expected to continue in the future.

OBJECTIVE

This research aimed to assess the precision and consistency of ChatGPT's responses to commonly asked inquiries related to pediatric urology.

MATERIALS AND METHODS

We examined commonly posed inquiries regarding pediatric urology found on urology association websites, hospitals, and social media platforms. Additionally, we referenced the recommendations tables in the European Urology Association's (EAU) 2022 Guidelines on Pediatric Urology, which contained robust data at the strong recommendation level. All questions were systematically presented to ChatGPT's May 23 Version, and two expert urologists independently assessed and assigned scores ranging from 1 to 4 to each response.

RESULTS

A hundred thirty seven questions about pediatric urology were included in the study. The answers to questions resulted in 92.0% completely correct. The completely correct rate in the questions prepared according to the strong recommendations of the EAU guideline was 93.6%. No question was answered completely wrong. The similarity rates of the answers to the repeated questions were between 93.8% and 100%.

CONCLUSION

ChatGPT has provided satisfactory responses to inquiries related to pediatric urology. Despite its limitations, it is foreseeable that this continuously evolving platform will occupy a crucial position in the healthcare industry.

Evaluating the performance of ChatGPT in answering questions related to urolithiasis

PURPOSE

ChatGPT is an artificial intelligence (AI) program with natural language processing. We analyzed ChatGPT's knowledge about urolithiasis whether it can be used to inform patients about urolithiasis.

METHODS

Frequently asked questions (FAQs) about urolithiasis on the websites of urological associations and hospitals were analyzed. Also, strong recommendation-level information was gathered from the urolithiasis section of the European Association of Urology (EAU) 2022 Guidelines. All questions were asked in order in ChatGPT August 3rd version. All answers were evaluated separately by two specialist urologists and scored between 1 and 4, where 1: completely correct, 2: correct but inadequate, 3: a mix of correct and misleading information, and 4: completely incorrect.

RESULTS

Of the FAQs, 94.6% were answered completely correctly. No question was answered completely incorrectly. All questions about general, diagnosis, and ureteral stones were graded as 1. Of the 60 questions prepared according to the EAU guideline recommendations, 50 (83.3%) were evaluated as grade 1, and 8 (13.3%) and 2 (3.3%) as grade 3. All questions related to general, diagnostic, renal calculi, ureteral calculi, and metabolic evaluation received the same answer the second time they were asked.

CONCLUSION

Our findings demonstrated that ChatGPT accurately and satisfactorily answered more than 95% of the questions about urolithiasis. We conclude that applying ChatGPT in urology clinics under the supervision of urologists can help patients and their families to have better understanding on urolithiasis diagnosis and treatment.

Evaluating the performance of ChatGPT in answering questions related to benign prostate hyperplasia and prostate cancer

BACKGROUND

The aim of this study was to evaluate the accuracy and reproducibility of ChatGPT's answers to frequently asked questions about benign prostate hyperplasia (BPH) and prostate cancer.

METHODS

Frequently asked questions on the websites of urology associations, hospitals, and social media about prostate cancer and BPH were evaluated. Also, strong recommendation-level data were noted in the recommendations tables of the European Urology Association (EAU) 2022 Guidelines on Prostate Cancer and Management of Non-neurogenic Male Lower Urinary Tract Symptoms sections. All questions were asked in order in ChatGPT Mar 23 Version. All answers were evaluated separately by two specialist urologists and scored between 1-4.

RESULTS

Forty questions about BPH and 86 questions about prostate cancer were included in the study. The answers to all BPH-related questions resulted in 90.0% completely correct. This rate for questions about prostate cancer was 94.2%. The completely correct rate in the questions prepared according to the strong recommendations of the EAU guideline was 77.8% for BPH and 76.2% for prostate cancer. The similarity rates of the answers to the repeated questions were 90.0% and 93% for questions related to BPH and prostate cancer, respectively.

CONCLUSIONS

ChatGPT has given satisfactory answers to questions about BPH and prostate cancer. Although it has limitations, it can be predicted that it will take an important place in the health sector in the future, as it is a constantly evolving platform. ChatGPT was able to provide helpful information about BPH and prostate cancer, although it is not perfect. It is constantly getting better, and may become an important resource in the healthcare field in the future.

Comparison of Flexible Ureterorenoscopy and Mini Percutaneous Nephrolithotomy in the Management of Multiple Renal Calculi in 10-30 mm Size

PURPOSE

To evaluate the efficacy and safety of flexible ureterorenoscopy (f-URS) and mini percutaneous nephrolithotomy (mini-perc) in the management of 10-30 millimeter multiple renal stones.

MATERIALS AND METHODS

The charts of patients who underwent f-URS or mini-perc for multiple kidney stones between January 2011 and July 2015 were retrospectively analyzed. Patients with multiple 10-30-mm-sized renal stones were enrolled in the study. A total of 374 patients underwent mini-perc and 85 patients met the study inclusion criteria. In the same period, f-URS was performed in 562 patients, and 163 had 10-30-mm multiple renal stones. We selected 85 patients to serve as the control group from this cohort using propensity score matching with respect to the patient's age, ASA score, number, size, and location of stones to avoid potential bias between groups.

RESULTS

The mean operation time and fluoroscopy screening time (FST) was significantly longer in the mini-perc group (P = .001 and P = .001, respectively). The mean hospitalization time was 76.9±38.7 hours in the mini-perc group and 25.0±27.7 hours in the f-URS group (P = .001). Post-operative complications, according to the Clavien classification system, were significantly more frequent in the mini-perc group (P = .003). The stone-free rate was 87% in the f-URS group and 83.5% in the mini-perc group (P = .66).

CONCLUSION

Our study demonstrated that f-URS and mini-perc were effective treatment options for multiple renal stones 10-30 mm in size. However, f-URS was associated with a significantly lower complication rate, shorter operation time, shorter FST, and shorter hospitalization time.

Prediction of recurrence in non-muscle invasive bladder cancer patients. Do patient characteristics matter?

PURPOSE

To evaluate patients, diagnosed with non-muscle invasive bladder cancer, according to patient specific parameters including hemoglobin level, estimated glomerular filtration rate (eGFR), body mass index (BMI) and cigarette smoking and to identify if any of these parameters matters in terms of recurrence prediction.

METHODS

231 patients who have undergone transurethral resection of the bladder (TURB) between January 2015 and January 2018 and diagnosed with non-muscle invasive bladder cancer (NMIBC) were included. Patient demographic characteristics including age, sex, BMI and cigarette smoking were assessed. Hemoglobin, creatinine and eGFR values were recorded. Follow-up was performed according to the European Association of Urology (EAU) guidelines' recommendations. Recurrence and progression during follow-up were recorded.

RESULTS

231 patients were included in the study. Median patient BMI, Hb levels, and eGFR values were 26.51 kg/m2 (IQR 5.48), 14,2 g/dL (IQR 2.50), and 83.25 ml/min/1.73m2 (IQR 27.83), respectively. Among all patients, 105 (45%) were ex-smokers and 78 (33%) were current smokers, 41 had anemia (17.7%), 37 (16%) patients were obese; 104 (45%) had mildly impaired renal function and 34 (14.7%) had impaired renal function. During follow-up, 67 (29%) patients had disease recurrence and 21 (9.1%) had disease progression (9.1%). Univariate and multivariate analyses revealed significant relationship between recurrence and obesity, impaired renal function and cigarette smoking.

CONCLUSIONS

Recurrence is a commonly encountered unfortunate consequence of NMIBC, and obesity, renal failure, history of smoking and anemia seem to increase the rate of recurrence among bladder cancer patients.

Primary lung cancer coexisting with active pulmonary tuberculosis

SETTING

Lung cancer and pulmonary tuberculosis (TB) comorbidity is a clinical problem that presents a challenge for the diagnosis and treatment of both diseases.

OBJECTIVE

To clarify the clinical and survival characteristics of cases with both lung cancer and active pulmonary TB.

DESIGN

From 2008 to 2013, 3350 TB patients admitted to the TB Department of the Chest Diseases Hospital of Izmir, Turkey, were evaluated.

RESULTS

In 38 (1.1%) male patients, lung cancer and TB were found to coexist. Almost all of the patients were diagnosed at Stage III (n = 14, 36.8%) or IV (n = 17, 44.7%) lung cancer, whereas four (10.6%) had Stage II and three (7.9%) had Stage I disease. Squamous cell lung cancer was the predominant histology (n = 23, 60.7%). The median overall survival among patients was 13.4 months (95%CI 8.09-18.8). One-year survival rates for patients with Stages I, II, III and IV were respectively 100%, 75%, 57% and 40%.

CONCLUSION

The present study demonstrates that lung cancer combined with active pulmonary TB most frequently presents as squamous cell carcinoma, with a male predominance. The overall survival of lung cancer patients did not change even with concomitant active TB.