Urology

Active surveillance matches induction BCG for rigorously restaged HG T1 NMIBC with less toxicity

This phase 3 noninferiority RCT randomized HG T1 bladder cancer patients with T0 at second TURBT to active surveillance (AS) or eight-dose BCG induction without maintenance. AS was noninferior for invasive relapse-free survival (hazard ratio 0.69, 90% CI 0.44–1.08; p = 0.001). Any-grade adverse events were far fewer with AS than BCG (50% vs 90%), while grade ≥3 events were similarly uncommon (3.1% vs 3.8%). Because the control omitted modern BCG maintenance, direct extrapolation to current regimens is limited. 1

Transperineal biopsy lowers infection risk and improves non-MRI csPC detection versus transrectal biopsy

This meta-analysis of 12 RCTs (4244 men) compared transperineal (TP) and transrectal (TR) prostate biopsy in MRI-targeted and non-MRI pathways. Overall clinically significant prostate cancer detection was similar (odds ratio 1.15, 95% CI 0.95–1.39). In non-MRI settings, TP biopsy improved csPC detection (odds ratio 1.41, 95% CI 1.02–1.95), likely via better anterior sampling. TP biopsy significantly reduced infections (odds ratio 0.70 for any infection; 0.35 for grade ≥3 infection) but increased procedural pain (odds ratio 2.05). 2

Real-world data show superior 5-year durability for anatomical BPH procedures versus MISTs

This retrospective fixed-cohort analysis used Epic Cosmos data on 6.45 million patients and 420 611 BPH procedures from 2014 to 2024. Five-year retreatment rates were higher after MISTs (PUL 16%, TUNA 15%, TUMT 17%, Rezūm 14%) compared with TURP (7.1%). Holmium or thulium laser enucleation (HoLEP/ThuLEP 4.4%) and simple prostatectomy (1.2%) had the lowest retreatment, outperforming TURP and MISTs. Medication restarts at 5 years were more common after PUL and Rezūm and lower after HoLEP/ThuLEP and simple prostatectomy than after TURP. 3

Prospective urine tumor DNA assay enables accurate NMIBC detection and early recurrence prediction

In 108 consecutive NMIBC patients, the utLIFE-UC urine tumor DNA assay showed 90.5% sensitivity for NMIBC detection, including de novo and recurrent cases. Among patients undergoing repeat TURBT, utLIFE-UC correctly identified all residual tumors, yielding a 100% negative predictive value for residual disease. Positive postoperative utLIFE-UC before first cystoscopy predicted higher relapse risk, whereas persistently negative tests aligned with recurrence-free status. The assay anticipated recurrences with a median lead time of 73.5 days before clinical confirmation. 4