Urology

Dose-escalated salvage prostate-bed RT adds GI toxicity without oncologic gain

Men with biochemical recurrence after radical prostatectomy were randomized to 64 Gy versus 70 Gy prostate-bed salvage radiotherapy without ADT (n=350). After 8.6 years’ median follow-up, freedom from biochemical progression was identical at 8.7 years in both arms (HR 1.03; p=0.87). Clinical progression-free survival, time to hormonal therapy, and overall survival did not differ between doses. Late grade ≥2 gastrointestinal toxicity was significantly more frequent with 70 Gy, while late genitourinary toxicity was similar. 1

Adjuvant leuprorelin after radical prostatectomy with undetectable PSA offers no survival benefit

AFU-GETUG-20 randomized 325 high-risk, nonmetastatic prostate cancer patients with undetectable postoperative PSA to observation or 24 months of leuprorelin. Ten-year metastasis-free survival was similar between groups (HR 0.63; 95% CI 0.30-1.30; p=0.204). There were no differences in PSA rise-free survival, overall survival, or prostate cancer–specific survival. Leuprorelin significantly worsened quality of life, with more fatigue, pain, hot flashes, psychiatric symptoms, and earlier global health deterioration. 2

Preoperative 5α-reductase inhibitors reduce TURP bleeding and transfusion risk

This meta-analysis pooled 30 randomized trials including 2974 men undergoing TURP for BPH, comparing preoperative 5α-reductase inhibitors with placebo or no therapy. 5α-reductase inhibitor use reduced intraoperative blood loss by about 80 mL and postoperative hemoglobin drop by 0.9 g/dL. Transfusion risk decreased substantially (odds ratio 0.31), with modest reductions in operative time and irrigation volume. Resected specimens showed lower microvessel density and VEGF expression, supporting an antiangiogenic mechanism. 3