Urology

Nationwide shift to transperineal biopsy sharply lowers early postbiopsy hospitalizations

This Danish registry included 19,456 men with prostate cancer diagnosed between 2020 and 2024. Transperineal biopsy use increased from under 1% to 87% over the study period. Seven-day postbiopsy hospitalizations fell in parallel from 6.5% to 1.1%. Compared with transrectal biopsy, transperineal biopsy had a much lower adjusted hospitalization risk (odds ratio 0.17; 95% CI 0.12–0.22). Hospitalizations declined despite discontinuation of routine antibiotic prophylaxis for transperineal procedures. Only men with cancer and hospital-treated events were captured, so minor or outpatient complications were not assessed. 1

Mitomycin chemoresection reduces TURBT burden in recurrent Ta NMIBC without harming 5-year outcomes

This randomized trial enrolled 120 patients with recurrent Ta low- or high-grade NMIBC and multiple papillary tumors <2 cm. Short, intensive intravesical mitomycin chemoresection reduced the proportion undergoing TURBT versus standard care (64% vs 89%; p = 0.003). More chemoresection patients avoided any procedures entirely during follow-up (17% vs 0%; p = 0.002). Five-year recurrence-free survival did not differ significantly between groups (hazard ratio 1.32; 95% CI 0.86–2.01). Nonresponders were shifted from TURBT toward office procedures, reducing operative burden, but baseline high-grade numbers were small. 2

Urinary EV gene-based AI score improves csPCa detection and avoids biopsies

This multicentre study assessed the Extracellular Vesicles Gene-based Prostate Score (EGPS) in 645 biopsy-naïve men with PSA 0–15 ng/mL. EGPS, using AMACR, HOXB13, and PSGR expression, achieved AUCs of 0.838, 0.825, and 0.811 in training, internal validation, and external cohorts. Performance exceeded PSA and did not require digital rectal examination or invasive sampling. At a cut-off of 0.22, sensitivity exceeded 95%, with very low missed clinically significant cancer rates in validation cohorts. Using this threshold, the model could avoid approximately 15–23% of biopsies across cohorts while maintaining high csPCa detection. 3

Metformin addition to enzalutamide fails to improve outcomes in mCRPC

This phase 2 trial randomized men with metastatic castration-resistant prostate cancer to enzalutamide plus metformin or enzalutamide alone. Disease-control rates at 15 months were similar (52% vs 56%; p = 0.64), with no improvements in secondary endpoints. Post hoc, metformin improved time to PSA progression only in patients with PTEN-expressing tumors (p = 0.0074), not PTEN-negative tumors. Overweight and obese men (BMI ≥25 kg/m²) had better disease control and survival than normal-weight patients, independent of treatment arm. These data do not support empiric metformin use with enzalutamide outside biomarker-driven clinical trials. 4