30-Second Takeaway
- Darolutamide-based regimens offer leading survival in mHSPC with comparatively favorable toxicity versus other ARPIs.
- Gemcitabine/docetaxel is a viable first-line intravesical option in BCG-naïve NMIBC, improving 1-year RFS, QoL, and cost-effectiveness.
- utDNA assays after TURBT may triage NMIBC patients for repeat resection and flag early recurrence, outperforming cytology.
- Risk calculators can safely reduce ePLND rates, complications, and OR time without compromising nodal staging or recurrence outcomes.
- Midurethral slings show low long-term removal and reoperation rates, supporting their continued use for SUI.
Week ending December 27, 2025
Practice-shaping updates in prostate, bladder, stone disease, and female incontinence care
Darolutamide combinations deliver leading survival with favorable tolerability in mHSPC
This network meta-analysis pooled 11 mHSPC trials with 11,389 patients to compare systemic strategies without head-to-head data. Darolutamide triplet therapy achieved the best progression-free survival (HR 0.24) and overall survival (HR 0.54) among evaluated regimens. In low-volume disease, darolutamide and enzalutamide provided the highest progression-free survival estimates. Darolutamide had toxicity comparable to ADT alone, while enzalutamide and abiraterone increased hypertension risk and enzalutamide increased fatigue. These data support darolutamide for low-volume or comorbidity-limited mHSPC where tolerability is critical.
Gemcitabine/docetaxel improves short-term outcomes and cost-effectiveness versus BCG in BCG-naïve NMIBC
This prospective per-protocol comparison enrolled 39 Gem/Doce and 44 BCG-treated intermediate/high-risk BCG-naïve NMIBC patients. Gem/Doce improved 1-year recurrence-free survival (94.74% vs 75%, HR 0.44) and numerically improved progression-free survival versus BCG. Adverse events were fewer with Gem/Doce (12.82% vs 34.10%), and only BCG patients experienced grade 3 toxicity. Gem/Doce patients reported better global health, multiple functioning domains, and urinary symptom scores at 6–12 months. Gem/Doce yielded higher QALYs with an ICER well within national willingness-to-pay thresholds, supporting it as a clinically and economically attractive alternative.
Post-TURBT urinary tumor DNA robustly identifies residual NMIBC and predicts recurrence
This retrospective study evaluated a multidimensional utDNA assay (utLIFE) in 161 NMIBC patients undergoing repeat TURBT. Residual tumor was present in 35% of patients, and utLIFE showed 80.7% sensitivity, 96.2% specificity, and 90.7% overall accuracy. utLIFE markedly outperformed urine cytology and was the strongest independent predictor of residual disease (OR 77.5). utLIFE positivity also predicted shorter recurrence-free survival (HR 16.4) over a median 32.5-month follow-up. Longitudinal testing showed utDNA positivity often preceded cystoscopic recurrence by several months, suggesting a role in surveillance and re-TURBT triage.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.