Urology

Risk score predicts recurrence and progression after endoscopic kidney-sparing surgery for UTUC

Among 223 patients undergoing endoscopic kidney-sparing surgery for UTUC, 48% recurred and 17% progressed at a median 39 months of follow-up. Recurrence risk was stratified using synchronous bladder cancer, high-grade biopsy, multifocal disease, and prior UTUC history. Progression risk used synchronous bladder cancer, high-grade biopsy, tumor size ≥2 cm, and positive cytology as predictors. Five-year recurrence incidence was 37%, 58%, and 70% for low-, intermediate-, and high-risk groups, respectively. 1

Imaging misses most nodal disease in intermediate-risk prostate cancer at RP+PLND

In 8043 intermediate-risk prostate cancer patients undergoing radical prostatectomy with pelvic lymph node dissection, 7.8% had pathologic lymph node invasion. PSMA-PET, CT, and MRI all showed poor sensitivity for nodal metastases: 13%, 0.9%, and 8.3%, respectively. Negative predictive values were similar, around 89–93%, reflecting low prevalence but not reliable exclusion of nodal disease. Patients with positive PSMA-PET had worse biochemical recurrence-free and metastasis-free survival than those with negative scans. 2

Active surveillance in men ≥75 years preserves 10-year metastasis-free and cancer-specific survival

The PRIAS-JAPAN prospective cohort included 231 men ≥75 and 1043 younger men with localized prostate cancer managed on active surveillance. Older men presented with larger prostates, more Gleason 3+4, and more T2 disease than younger counterparts. Despite this, 10-year metastasis-free and cancer-specific survival were both 100% in the ≥75 group. Protocol biopsy adherence declined over time but did not differ between age groups, indicating similar real-world intensity of monitoring. 3

IRRADIaTE registry shows severe late GU toxicity after prostate radiotherapy is common and resource-intensive

The IRRADIaTE registry prospectively enrolled 321 men who presented with late (≥6 months) genitourinary complications after curative, adjuvant, or salvage prostate radiotherapy. At admission, 43% already had grade 3–5 genitourinary toxicity by CTCAE criteria, often requiring urgent care. Among these affected men, hospitalization-free survival declined from 86% to 42% over five years after radiotherapy. The proportion avoiding major surgery for radiotherapy-related complications fell from 81% at 12 months to 66% at 60 months. 4