Urology

PSMA-PET preoperative staging improves short-term oncologic outcomes in high-risk cN0M0 prostate cancer

This multi-institutional cohort included 1475 high-risk cN0M0 patients undergoing radical prostatectomy with extended pelvic lymph node dissection. After propensity matching (463 vs 463), PSA persistence was lower with PSMA-PET staging than with conventional imaging (3.2% vs 14%; p < 0.001). Three-year biochemical recurrence–free survival was higher with PSMA-PET than with conventional imaging (90.9% vs 82.2%). On multivariable Cox analysis, PSMA-PET independently predicted lower biochemical recurrence risk (HR 0.48, 95% CI 0.29–0.77; p = 0.003). 1

Percutaneous nephrostomy is noninferior to ureteral stent for decompression of obstructing stones

This nationwide randomized noninferiority trial assigned 204 patients with obstructing urolithiasis to percutaneous nephrostomy (PCN) or internal ureteral stent. Time to clinical recovery was similar: 1.7 days after PCN versus 1.5 days after stent, meeting the 1-day noninferiority margin. Adverse event rates and serious complications did not differ significantly between groups. Crossover for technical failure was more frequent from PCN to stent, highlighting the need to consider anatomy and operator expertise. 2

Darolutamide-based regimens rank highest for efficacy; darolutamide + ADT has best safety among mCSPC combinations

This network meta-analysis compared androgen deprivation therapy (ADT) alone with multiple androgen receptor pathway inhibitor combinations in metastatic castration-sensitive prostate cancer. Darolutamide + docetaxel + ADT had the best progression-free survival (HR 0.27, 95% CrI 0.18–0.39; SUCRA 0.97). For overall survival, darolutamide + docetaxel + ADT also ranked highest (HR 0.52, 95% CrI 0.43–0.64; SUCRA 0.95). Grade 3–5 adverse events were more frequent with docetaxel combinations, with abiraterone + docetaxel + ADT having the highest risk. 3

Concomitant H1 antihistamines during BCG are associated with better outcomes in NMIBC

This territory-wide retrospective study included 2028 patients with NMIBC receiving intravesical BCG in Hong Kong between 2001 and 2020. Concomitant H1 antihistamine use during BCG was associated with better overall survival (HR 0.69, 95% CI 0.58–0.82). Cancer-specific, recurrence-free, and progression-free survival also improved with concomitant antihistamines (CSS HR 0.44; RFS HR 0.81; PFS HR 0.64). Benefits appeared strongest when antihistamines were taken during, rather than only before, BCG therapy. 4