About

Shilajit D Kundu is a Professor of Urology and the Chief of Urologic Oncology in the Department of Urology at Northwestern University Feinberg School of Medicine. His professional role involves leadership in urologic oncology, contributing to the academic and clinical excellence of the department. He is associated with several institutes including the Center for Reproductive Science, the Institute for Augmented Intelligence in Medicine, and the Robert H. Lurie Comprehensive Cancer Center, indicating a broad engagement in research and clinical initiatives related to urology and oncology.

Research topics

• Internal medicine
• Medicine
• Family medicine
• Psychiatry
• Clinical psychology
• Psychology
• Social psychology
• Oncology
• Radiology
• Urology
• Surgery

Selected publications

• Urologic malignancy risk with chronic tumor necrosis factor-alpha inhibitor (TNF-I) exposure: a multicenter, retrospective cohort study

  World Journal of Urology · 2026-02-26

  articleOpen accessSenior author

  Chronic inflammation has been linked to oncogenesis, including in prostate cancer (PCa). Tumor Necrosis Factor (TNF) has been implicated in many of these chronic inflammatory pathways. We assessed urologic malignancy risk in patients with long-term exposure to TNF inhibitors (TNF-I). Retrospective non-matched cohort study of patients with chronic inflammatory conditions from 1996 to 2023. TNF-I exposure was identified using medications. The unmatched control cohort consisted of TNF-I-unexposed patients with the same chronic inflammatory conditions. Urologic malignancies identified using ICD-10 codes and manual chart review. Inverse Probability of Treatment Weighting was used to balance distributions across exposure groups. Hazard ratios (HR) were estimated using multivariable regression followed by logistic regression for relative risk (RR) on sub-analysis. There were 13,377 patients with TNF-I exposure and 42,832 patients without TNF-I exposure. TNF-I exposure was negatively associated with PCa (HR 0.50, 95% CI 0.28–0.90, P = 0.02), but with higher Gleason grade group (RR 1.11, 95% CI 1.01–1.22, P = 0.04). TNF-I exposure was not associated with bladder cancer diagnosis (HR 0.71, 95% CI 0.26–1.95, P = 0.51) but had increased risk of multifocal tumor development (P = 0.001) and high-grade tumor (P = 0.004). TNF-I exposure was not associated with kidney cancer risk (HR 1.47, 95% CI 0.85–2.54, P = 0.17) but with increased risk of higher clinical stage (RR 2.01, 95% CI 1.21–3.33, P = 0.01). TNF-I exposure was associated with lower risk of PCa but higher-grade group PCa. TNF-I exposure was associated with higher risk of multifocal and high-grade bladder cancer and of higher stage kidney cancer. TNF-I exposed patients may need modified urologic cancer screening. In this report, we looked at exposure to TNF inhibitor medications and their risk of prostate, bladder, and kidney cancer. We found that, compared to patients who did not take these medications, there was a lower risk of prostate cancer but with higher grade disease. There was no change in the overall risk of bladder or kidney cancer diagnosis, but they did have worse features. Further studies of patients on TNF inhibitors should be performed to confirm these findings.

  PublisherOA PDFDOI

• Tumor necrosis alpha inhibitor therapy is associated with increased long-term risk of nonmelanoma skin cancer and melanoma: A retrospective cohort study

  Journal of the American Academy of Dermatology · 2026-02-16

  articleSenior author
  PublisherDOI

• Tumor Necrosis Factor-Alpha Inhibitor Use and Malignancy Risk: A Systematic Review and Patient Level Meta-Analysis

  Cancers · 2025-01-24 · 10 citations

  reviewOpen accessSenior author

  Over the last two decades, tumor necrosis factor-alpha inhibitors (TNF-Is) have become standard therapies for chronic inflammatory disorders, with an ongoing expansion of indications and off-label applications [...].

  PublisherOA PDFDOI

• Long-term risk of de novo malignancy with tumor necrosis factor alpha (TNF) inhibitor immunosuppression: a multicenter, retrospective cohort study

  Journal of Inflammation · 2025-08-14 · 6 citations

  articleOpen accessSenior author

  BACKGROUND: Tumor necrosis factor-alpha (TNF) is an inflammatory cytokine implicated in the development of many chronic inflammatory diseases and TNF-α inhibitors (TNF-I) are frequently prescribed as treatment. Their malignancy risk is debated, with pro-oncogenic effects of decreased immune surveillance and anti-oncogenic effects of decreasing chronic inflammation. As such, the literature is inconclusive in the malignancy risk of these medications. Here we investigate the malignancy risk in patients with chronic TNF-I exposure. METHODS: This is a single health system, retrospective non-matched cohort study of patients with chronic inflammatory conditions between 1996 and 2023. Patients exposed to TNF-I were identified using the generic medication names and the chronic inflammatory disease indication. The unmatched control cohort consisted of patients with the same chronic inflammatory conditions but without TNF-I exposure. Malignancies in this population were identified using ICD-9 and ICD-10 codes. TNF-I exposure was analyzed as a time-varying covariate prior to model fitting. Hazard ratios (HR) for TNF-I exposure on overall and individual cancer risk were estimated using two-sided Cox proportional hazards regression. RESULTS: There were 12,941 patients exposed to TNF-I and 37,402 patients unexposed to TNF-I. TNF-I exposure was not associated with overall cancer risk (HR 1.05, 95% CI 0.92-1.19). TNF-I exposure was positively associated with melanoma (HR 1.45, 95% CI 1.01-2.08), basal cell carcinoma (BCC) (HR 1.6, 95% CI 1.18-2.15) and squamous cell carcinoma (SCC) (HR 1.8, 95% CI 1.15-2.83), and negatively associated with prostate cancer (PCa) (HR = 0.51, 95% CI 0.29-0.91), leukemia (HR 0.12, 95% CI 0.02-0.83), and non-Hodgkin lymphoma (NHL) (HR 0.36, 95% CI 0.13-0.98). There was an increased risk of overall malignancy in TNF-I exposed patients with Psoriasis (HR 1.53, 95% CI 1.15-2.03, p = 0.003) but not in other inflammatory conditions. CONCLUSIONS: Patients with TNF-I exposure had higher risk of melanoma, skin SCC and BCC along with lower risk of leukemia, NHL, and PCa. This is consistent with previous melanoma, skin SCC and BCC data and demonstrates novel findings for leukemia, NHL, and PCa. There may need to be differential cancer screening algorithms for patients with different inflammatory conditions and TNF-I exposure.

  PublisherOA PDFDOI

• Tumor necrosis factor alpha signaling activity and NCCN risk, adverse pathology, and progression during active surveillance in prostate cancer.

  Journal of Clinical Oncology · 2025-02-10 · 2 citations

  articleSenior author

  415 Background: Elevated serum levels of tumor necrosis factor alpha (TNF-α) are characteristic of chronic inflammatory conditions and advanced prostate cancer (PCa). Local and systemic inflammation associated with TNF-α may enhance oncogenicity in the prostate. This study investigates the association between intra-tumoral TNF-α levels, NCCN risk, adverse pathology (AP) at radical prostatectomy (RP), and progression on active surveillance (AS). Methods: Intra-tumoral TNF-α pathway expression levels were assessed through TNF-α signaling via the NF-kB pathway. Transcriptomic profiles from 82,470 prospectively collected biopsy samples with the Decipher prostate genomic classifier (Veracyte, San Diego, CA) retrieved from the Decipher GRID registry (NCT02609269) were used to compare TNF-α levels by quartile across NCCN risk groups, Decipher score, and basal-luminal prostate subtype classifier (PSC). Transcriptomic data from a retrospective study of 647 patients with low or favorable intermediate risk (FIR) disease treated with RP were used in logistic regression to examine TNF-α levels with AP (any of Gleason grade group ≥3, SVI or LNI). A cohort of 28 favorable disease patients prospectively tested (2019-2024) with Decipher and managed with AS compared TNF-α levels with Wilcoxon for the binary endpoint of progression on AS. For progression, data from a retrospective study at a single academic center (2019-2024) were classified based on progression status (n=17 progressed, n=11 did not) following Decipher analysis of their initial biopsy specimens. Results: Among 82,470 PCa patients, the proportion of highest quartile TNF-α signature increased across NCCN low to very high risk prostate cancer and the lowest quartile decreased with increased NCCN risk group (Fisher’s exact test p < 2.2e-16). Median Decipher score was 0.57 (IQR 0.38-0.78) in the highest quartile TNF-α compared to 0.38 (IQR 0.24-0.58) for the lowest. The majority of samples with the highest TNF-α were PSC basal (73%) whereas the lowest were PSC luminal (76%) subtypes. Among 647 FIR disease patients treated with RP, higher TNF-α levels were significantly associated with AP (univariable OR 3.41, p=0.02; multivariate OR 2.93, p=0.05). In the AS cohort, elevated TNF-α signature correlated with a higher likelihood of progression. Conclusions: Increased TNF-α signaling levels are associated with increasingNCCN and Decipher risk groups and basal subtype. Elevated TNF-α levels in patients with FIR disease tumors had higher risk of AP at RP. In AS, higher TNF-α signaling was associated with progression and it may serve as a tool to guide treatment counseling. Uni- and multivariable analysis for pT3b+, GG 3-5, or LNI+. Univariable OR (95% CI) P-value Multivariable OR (95% CI) P-value TNF-α 3.41 (1.21 – 9.12) 0.02* 2.93 (1.01 – 8.02) 0.05* CAPRA - - 1.43 (1.08 – 1.91) 0.01* *p < 0.05 denotes significance.

  PublisherDOI

• IP05-14 TUMOR NECROSIS FACTOR ALPHA SIGNALING IN DECIPHER TESTING CORRESPONDS TO ADVERSE PATHOLOGY AT TIME OF RADICAL PROSTATECTOMY AND BASAL-LUMINAL SUBTYPE

  The Journal of Urology · 2025-04-08

  articleSenior author
  PublisherDOI

• PD18-12 RACIAL AND ETHNIC DISPARITIES IN URINARY SYMPTOMS AND CONTINENCE RECOVERY FOLLOWING PROSTATECTOMY SURGERY

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

• Negative Predictive Value of a Prostate MRI in Black Men: Implications for Biopsy Decision-Making

  The Journal of Urology · 2025-03-17 · 3 citations

  articleOpen access

  PURPOSE: has been shown to enhance mpMRI's NPV in non-Black men. Populations with higher disease prevalence are known to have lower NPVs. Given that Black men have higher prostate cancer prevalence, we evaluate sensitivity and NPV of mpMRI in Black vs non-Black men to assess possible mpMRI performance differences. As an exploratory objective, we investigate PSAD thresholds providing ≥ 90% sensitivity in Black men. MATERIALS AND METHODS: We prospectively recruited Black and non-Black men referred to outpatient urology clinics for abnormal PSA or prostate examination in 3 similar biomarker validation studies from 2017 to 2023 before MRI-informed diagnostic prostate biopsy. We combined the research cohorts with a retrospective clinical cohort of clinically similar Black and non-Black men from 1 academic institution who also underwent mpMRIs and MRI-informed biopsies. MRIs were scored using PIRADS version 2.0 or 2.1. RESULTS: < .05). Using PSAD ≥ 0.09 for Black men with PIRADS 1 to 2 lesions increased sensitivity to 92.9%. CONCLUSIONS: PIRADS < 3 has a lower NPV and sensitivity in Black men. For negative prostate MRIs, PSAD ≥ 0.09 may be a better threshold for safe biopsy deferral in Black men to maintain a ≥ 90% sensitivity.

  PublisherDOI

• Racial and ethnic disparities in urinary continence recovery post-prostatectomy.

  Journal of Clinical Oncology · 2025-02-10

  article

  376 Background: Urinary incontinence is a common complication following prostatectomy, with continence recovery rates varying widely across the literature. While 12-month continence rates are consistently above 90%, disparities in short- and intermediate-term recovery rates exist. This study investigates the differences in overall urinary continence outcomes among Black, non-Black Hispanic, and non-Black non-Hispanic men within 12 months post-surgery. Methods: Data were collected from two sources: (1) men recruited in clinic from the Northwestern University Department of Urology as part of the URO-QOL study, an observational study of Quality Of Life (QOL), and (2) cross-sectional, retrospective data from an online health panel maintained by OP4G (Opinions 4 Good, http://op4g.com/). Eligible participants had clinically localized prostate cancer, were 18 years or older, and were able to read and speak English. Urinary continence outcomes were assessed within 12 months post-surgery using the American Urological Association Symptom Score (AUASS), Expanded Prostate Cancer Index Composite-26 (EPIC-26), and Functional Assessment of Cancer Therapy-Bladder (FACT-Bl). One-way ANOVA, as well as Chi-squared tests, were performed to assess differences in functional outcomes across racial and ethnic groups. Results: There were 417 patients total, with 57 (14%) Black men, 87 (21%) non-Black Hispanic men, and 273 (65%) non-Black non-Hispanic men.One-way ANOVA demonstrated significant differences in overall AUA Symptom Score (p=0.0166) and EPIC-26 Urinary Symptom Score (p=0.00276), but not FACT-Bl Scores (p=0.253), between Black, non-Black Hispanic, and non-Black non-Hispanic men, with Black men demonstrating highest symptom burden across all three surveys (Table). Conclusions: Racial and ethnic disparities in urinary continence recovery following radical prostatectomy are evident, with Black men in particular experiencing worse outcomes compared to Hispanic and non-Black non-Hispanic men. While overall functional recovery improves within 12 months post-surgery, these disparities suggest a need for further investigation into underlying factors influencing these outcomes. Ultimately, targeted pre- and post-operative interventions such as pelvic floor muscle training may help mitigate the racial and ethnic disparities highlighted in this study. Univariate ANOVA analysis of summed scores of post-treatment urinary symptoms surveys. Overall Black Non-Black Hispanic Non-Black Non-Hispanic P-value AUASS Sum (mean) 21.40 23.32 22.95 20.48 0.0166* Category (mean) 2.556 2.737 2.628 2.494 0.0137* EPIC-26 Sum Urinary Symptom Responses (mean) 19.96 22.78 20.92 19.07 0.00179* Overall Urinary Symptom Score^ (mean) 50.584 42.644 48.109 53.053 0.00276* FACT- Bl Sum (mean) 8.856 9.302 9.076 8.678 0.253 *p&lt;0.05 denotes statistical significance. ^Lower EPIC-26 score represents higher symptom burden.

  PublisherDOI

• Urologic malignancy risk with chronic Tumor Necrosis Factor-Alpha Inhibitor (TNF-I) exposure: a multicenter, retrospective cohort study

  Research Square · 2025-12-08

  preprintOpen accessSenior author
  PublisherOA PDFDOI

Frequent coauthors

• Rick Bangs

  SWOG Cancer Research Network

  226 shared

• Subodh M. Lele

  Fred and Pamela Buffett Cancer Center

  214 shared

• Sam S. Chang

  New York University

  214 shared

• Jonathan D. Tward

  214 shared

• Michael Abern

  Cancer Institute (WIA)

  214 shared

• Matthew K. Tollefson

  214 shared

• Harry W. Herr

  Memorial Sloan Kettering Cancer Center

  214 shared

• Thomas W. Flaig

  University of Colorado Cancer Center

  214 shared

Education

• M.D.

  Northwestern University Feinberg School of Medicine

• B.S.

  University of Calcutta