30-Second Takeaway
- bpMRI is noninferior to mpMRI for csPCa detection at the patient level, supporting wider adoption without contrast.
- Targeted PSA screening in BRCA2 carriers, and potentially BRCA1 carriers, detects more clinically significant prostate cancer.
- Strict adherence to EAU NMIBC guidelines for EI, re-TURBT, and intravesical therapy substantially improves recurrence and progression outcomes.
- ctDNA and utDNA refine selection and surveillance for bladder-sparing approaches in MIBC.
- Mirabegron maintains efficacy and cardiac safety in OAB patients with cardiovascular comorbidities.
Week ending February 21, 2026
Grand Rounds in Urology: Imaging, Risk-Adapted Screening, and Evolving Bladder Cancer Paradigms
bpMRI matches mpMRI for csPCa detection and may safely omit contrast in many men
This meta-analysis of 40 head-to-head studies (9403 patients) found bpMRI noninferior to mpMRI for clinically significant prostate cancer detection at the patient level. Compared with mpMRI, bpMRI sensitivity was only 2.3% lower and specificity 1.8% higher for csPCa, within a predefined noninferiority margin. Per-lesion analyses showed noninferiority for specificity but not sensitivity, likely reflecting fewer studies and higher heterogeneity. Findings support bpMRI as a contrast-free alternative in settings that can assure high image quality and robust quality control.
Targeted PSA screening in BRCA2, and selected BRCA1 carriers, yields more clinically significant prostate cancer
The IMPACT study followed 3063 men (40–69 years) with or without BRCA1/2 pathogenic variants through five annual PSA screening rounds. Overall prostate cancer incidence did not differ significantly by BRCA1/2 status, but clinically significant cancer was more frequent in BRCA2 carriers than noncarriers. BRCA1 and BRCA2 carriers had higher proportions of NCCN intermediate-unfavorable or high-risk tumors than noncarriers, yet no T4 or metastatic cases occurred. Systematic PSA screening is recommended for BRCA2 carriers and should be considered for BRCA1 carriers to enable earlier, clinically relevant detection.
Low adherence to EAU NMIBC guideline elements worsens recurrence and progression outcomes
In a multicenter cohort of 2194 NMIBC patients, adherence to early instillation, re-TURBT, and risk-adapted intravesical therapy was markedly low. Only 22% received early instillation, 44% underwent indicated re-TURBT, and 29% initiated recommended intravesical instillations. Adherence to each component significantly improved recurrence-free survival, with hazard ratios around 0.5 compared to nonadherence. Re-TURBT and intravesical instillations also improved progression-free survival, highlighting substantial real-world underuse of effective guideline-based care.
ctDNA and utDNA help select candidates for bladder-sparing management in MIBC
In a bladder-sparing trial for MIBC, three-year bladder-intact survival after complete clinical response to systemic therapy was 69%. Baseline detectable plasma ctDNA was associated with markedly higher metastatic risk, while undetectable ctDNA identified patients with extremely low risk. Only one of 22 patients with undetectable baseline ctDNA developed metastatic disease over follow-up. Urine tumor DNA was more sensitive than plasma ctDNA for intravesical residual disease and predicted shorter bladder-intact survival when detectable. These biomarkers may refine decisions about omitting cystectomy and guide intensity of post-treatment surveillance.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.