Urology

BCG plus mitomycin equals BCG alone for DFS while conserving BCG in high-risk NMIBC

In this phase 3 trial, 501 BCG-naïve high-grade pTa/pT1 NMIBC patients were randomized to BCG plus mitomycin or BCG alone post-TURBT. Two-year disease-free survival was similar (75% vs 71%; HR 0.87, 95% CI 0.65-1.16; p = 0.3), showing no superiority of combination therapy. The combination arm used 39% fewer BCG doses (median nine vs 16) yet had more patients completing ≥75% of planned instillations (78% vs 68%; p = 0.02). Recurrence, progression, deaths, and grade 3-5 adverse events were numerically similar between arms, indicating no major efficacy or safety trade-off. 1

Aquablation noninferior to laser enucleation with better sexual and continence outcomes in large-gland BPH

WATER III enrolled men with 80–180 ml prostates and moderate to severe LUTS to Aquablation or laser enucleation of the prostate. At 3 months, IPSS improvement was similar (−12.9 with Aquablation vs −13.1 with LEP), meeting noninferiority with Bayesian probability >0.999. Clavien-Dindo grade ≥2 or persistent grade 1 complications occurred at comparable rates, supporting similar short-term safety. Retrograde ejaculation was far less frequent with Aquablation than LEP (14.8% vs 77.1%; p < 0.001). 2

PURE-01 5-year results show durable outcomes with neoadjuvant pembrolizumab before cystectomy in MIBC

PURE-01 treated 155 cisplatin-ineligible or refusing cT2-3bN0M0 MIBC patients with three cycles of pembrolizumab before radical cystectomy. After >60 months median follow-up, 5-year event-free and overall survival rates were 68% and 77% in the intention-to-treat population. Among cystectomy patients, 5-year recurrence-free survival was 77%, with a 19% cumulative recurrence risk and a few late relapses beyond 5 years. Patients achieving complete or major pathologic response had approximately 90% 5-year overall survival, highlighting response as strongly prognostic. 3

PSA persistence after prostatectomy defines a distinct high-risk state with worse survival than standard BCR

This MUSIC registry study analyzed 15,390 men undergoing radical prostatectomy with median follow-up of 4.0 years. Postoperative status was categorized as no evidence of disease, PSA persistence (detectable first PSA), or biochemical recurrence after an initially undetectable PSA. One in eight men experienced PSA persistence and had significantly higher-risk preoperative and pathologic features than those with NED or BCR. PSA before secondary treatment was higher in PSA persistence than BCR (median 0.73 vs 0.28 ng/mL; p < .001). 4