Urology

Salvage focal ablation competes oncologically with salvage prostatectomy for radiorecurrent localized prostate cancer

This international matched cohort included 923 men with biopsy-proven, localized radiorecurrent prostate cancer treated with salvage focal therapy (HIFU/cryotherapy) or salvage radical prostatectomy. Ten-year cancer-specific survival was 92% after salvage focal therapy versus 99% after salvage prostatectomy, without a statistically significant difference. Overall survival was also similar, suggesting durable cancer control with both strategies in appropriately selected men. Perioperative complications, including major Clavien-Dindo grade 3–5 events, were less frequent with salvage focal therapy than with salvage prostatectomy. 1

Transperineal biopsy lowers infection risk versus transrectal with similar clinically significant cancer detection

This systematic review and Bayesian meta-analysis pooled five contemporary RCTs including 3072 predominantly biopsy-naïve men undergoing mpMRI-based transperineal or transrectal biopsy. Transperineal biopsy significantly reduced infectious complications compared with transrectal biopsy (pooled odds ratio 0.38, 95% credible interval 0.11–0.90), despite no antibiotic prophylaxis in transperineal arms. Detection of clinically significant and insignificant prostate cancer was similar between approaches, as were rates of urinary retention. Transperineal biopsy showed a trend toward fewer bleeding events requiring intervention but slightly higher post-biopsy pain and procedure times of uncertain clinical relevance. 2

Response-guided strategy safely omits second TURBT in most T1 NMIBC over 2 years

The prospective multicenter HuNIRe trial enrolled 90 patients with T1 non–muscle-invasive bladder cancer after complete initial TURBT. Patients had urine cytology at 3–4 weeks and cystoscopy at 4–6 weeks; only those with positive findings underwent second TURBT. This protocol avoided second TURBT in 71% of patients, and no patient was upstaged to muscle-invasive disease at resection. At median 26 months, 2-year recurrence-free and progression-free survival were 69% and 91%, with no significant differences by second TURBT status. Outcomes were comparable to a retrospective routine second TURBT cohort, though limited by small sample size and relatively short follow-up. 3

Fixed-dose dutasteride–tadalafil improves LUTS more than either monotherapy in BPH

This phase III trial randomized 667 men with BPH to fixed-dose dutasteride 0.5 mg/tadalafil 5 mg, dutasteride 0.5 mg, or tadalafil 5 mg for 48 weeks. Among 619 efficacy-evaluable patients, fixed-dose combination therapy produced substantially greater IPSS reductions than either dutasteride or tadalafil alone at week 48. Quality-of-life improvements were most pronounced with combination therapy, while maximum flow and postvoid residual improved similarly across groups. Erectile function scores improved more with combination versus dutasteride monotherapy, suggesting tadalafil may offset 5-alpha-reductase–related sexual effects. Treatment-emergent adverse events were somewhat more frequent with combination therapy but serious events were uncommon, supporting an acceptable safety profile. 4