Urology

Intensified SBRT provides durable control in high-risk localized prostate cancer with acceptable toxicity

Among 440 men with high-risk localized prostate cancer treated with SBRT, 5-year biochemical recurrence and distant metastasis rates were 22% and 9.2%, respectively. An intensified regimen (≥12 months ADT plus ≥8 Gy/fraction SBRT) in 21% of patients lowered 5-year biochemical recurrence to 7.4% and distant metastasis to 3.7%. Intensification independently reduced risks of biochemical recurrence (HR 0.38) and distant metastasis (HR 0.43) versus less intensive approaches. Five-year rates of late grade ≥2 GU and GI toxicity were 23% and 10%, indicating a manageable long-term toxicity profile. 1

Micro-ultrasound–targeted biopsy matches MRI-targeted biopsy for clinically significant prostate cancer

This meta-analysis of 22 studies compared micro-ultrasound–targeted biopsy with MRI-targeted biopsy in over 11,000 procedures for suspected or surveilled prostate cancer. Micro-ultrasound and MRI-targeted biopsy detected nearly identical numbers of clinically significant cancers (2037 vs 2043 cases). The pooled detection ratio for micro-ultrasound versus MRI-targeted biopsy was 1.04, supporting comparable clinically significant cancer yield. Pooled sensitivity/specificity were 0.88/0.25 for micro-ultrasound and 0.81/0.17 for MRI, with overlapping ROC curves and no modality effect on accuracy. 2

Early PSMA SUV increase on enzalutamide predicts poor PSA-PFS but improves with added 177Lu-PSMA-617

In this ENZA-p substudy, 154 treated mCRPC patients starting enzalutamide ± 177Lu-PSMA-617 had baseline and day-15 PSMA PET scans. PSMA SUVmean increased by day 15 in 68% of patients, indicating frequent early PSMA upregulation under androgen receptor blockade. Among patients with increasing SUVmean, median PSA-PFS was 5.8 months with enzalutamide alone versus 13.1 months with added 177Lu-PSMA-617 (HR 0.38). When SUVmean decreased, PSA-PFS was similar between treatment arms, and the SUV change–treatment interaction approached significance. 3

Inadequate maintenance drives poor outcomes in BCG-exposed NMIBC patients

This US cohort included 26,876 NMIBC patients who received at least one full BCG induction course, with a median initiation age of 73 years. Adequate BCG maintenance was uncommon; only about one-quarter of eligible patients received maintenance across risk groups. Among 5271 patients with carcinoma in situ and sufficient follow-up, 59.3% recurred within 24 months, predominantly in the BCG-exposed group. BCG-exposed patients accounted for 83% of progressions and nearly 88% of cystectomies after recurrence. 4