Urology

SBRT beats HDR brachytherapy for long-term biochemical control in intermediate-risk prostate cancer

This pooled individual patient analysis compared SBRT with HDR brachytherapy monotherapy in 247 men with intermediate-risk prostate cancer without ADT. After 10 years, biochemical failure was 38.0% for HDR-BT versus 10.4% for SBRT, indicating substantially better biochemical control with SBRT. HDR-BT produced more acute grade ≥2 GU adverse events than SBRT (74.6% vs 51.7%), with no significant differences in other acute or late events. Late patient-reported quality of life did not differ significantly between modalities. These data support SBRT as a preferred monotherapy option when feasible in intermediate-risk patients not receiving ADT. 1

Nonadherence to EAU NMIBC guidelines carries a clear recurrence and progression penalty

This multicenter retrospective cohort included 2194 NMIBC patients treated with TURBT at six European tertiary centers. Early instillation, re-TURBT, and intravesical instillations were frequently omitted despite guideline indications, with adherence rates of 22%, 44%, and 29%, respectively. Adherence to early instillation, re-TURBT, and intravesical therapy significantly improved recurrence-free survival, with hazard ratios around 0.60, 0.53, and 0.49. Re-TURBT and intravesical instillations also improved progression-free survival, with hazard ratios 0.41 and 0.47, respectively. Nonadherence reasons were not captured, but findings argue strongly for standardized pathways to deliver guideline-concordant NMIBC care. 2

RAPN and open partial nephrectomy show similar 2-year cancer and renal outcomes, but RAPN reduces chronic morbidity

The ROBOCOP II phase 2 randomized trial assigned 50 patients with localized RCC to robot-assisted or open partial nephrectomy. At 2 years, overall survival was 100% in both groups, with only one lymph-node recurrence in the RAPN arm. Estimated GFR at 2 years was similar between RAPN and open surgery, with no significant difference in renal function. Health-related quality of life remained high and comparable, but chronic operative-site pain and flank bulge were much more common after open surgery. These results support RAPN as oncologically and functionally equivalent to open surgery while offering lower long-term morbidity. 3

Urine tumor DNA liquid biopsy may refine NMIBC response assessment beyond cystoscopy alone

This Cell study commentary describes a urine-based liquid biopsy using tumor DNA to assess treatment response in NMIBC. The approach detects minimal residual disease and helps distinguish the respective contributions of surgery and immunotherapy to disease control. Such assays could ultimately refine surveillance intensity and timing in BCG-era NMIBC management. They may also identify patients needing earlier treatment adaptation, though clinical utility still requires prospective validation in practice. 4