Urology

Margin length ≥3 mm after radical prostatectomy doubles recurrence and metastasis risk

In this nationwide cohort of 998 post–radical prostatectomy patients, 31% had positive surgical margins with median length 5 mm. At 5 years, 36% developed biochemical recurrence and 11% developed metastases. Margins ≥3 mm independently doubled risks of biochemical recurrence (HR 2.04) and metastases (HR 2.12) versus negative margins. Margins <3 mm and margin location were not significantly associated with recurrence or metastases. 1

After radiotherapy, PSA relapse timing and Gleason grade drive mortality risk

Among 26 634 Swedish men treated with primary radical radiotherapy, 10-year PSA relapse risk was 25%. Following relapse, 10-year prostate cancer–specific mortality was 35% overall but varied widely by Gleason score and relapse timing. Late relapse (>3 years) conferred relatively low death risk for Gleason 6 and 3+4 disease, around one in five men. Very early relapse (≤18 months) in Gleason 4+3 or 9–10 disease carried death risks exceeding half of men. 2

Post-PSA test model estimates long-term prostate cancer–specific mortality

Investigators developed a prognostic model for prostate cancer–specific mortality after PSA testing using 33 339 PLCO participants and validated it in 174 787 VA patients. The model uses PSA, family history, and race for cancer risk, plus age, BMI, smoking, and vascular comorbidities for other-cause mortality. In PLCO, discrimination for cancer-specific mortality at 29.5 years showed an AUC of 0.666, outperforming the PBCG biopsy model. In VA validation at 20 years, the AUC was 0.776 versus 0.749 for PBCG. 3

On-clamp partial nephrectomy in solitary kidneys preserves eGFR and reduces transfusions

This multicenter series included 426 solitary-kidney patients undergoing on- or off-clamp partial nephrectomy for cT1–3 renal masses. Median preoperative eGFR was 58 mL/min and median ischemia time was 19 minutes. On multivariable analysis, ischemia duration was not associated with postoperative or 1-year eGFR change. On-clamp versus off-clamp strategy also showed no significant difference in short- or 1-year renal function. 4