Urology

Pretreatment prostate MRI adds independent prognostic value after radical prostatectomy

This meta-analysis of 40 studies included 24 941 men undergoing radical prostatectomy with pretreatment prostate MRI. MRI-detected extraprostatic extension (mrT3a) was independently associated with higher biochemical recurrence, metastatic failure, and markedly increased prostate cancer–specific mortality. Seminal vesicle invasion (mrT3b) on MRI further increased risks of biochemical recurrence and metastatic failure. Higher PI-RADS scores, larger tumor diameter, and lower apparent diffusion coefficient values predicted greater biochemical recurrence risk. These MRI features provided prognostic information beyond standard clinicopathologic factors, supporting incorporation into preoperative counseling and adjuvant therapy discussions. 1

64Cu-SAR-bisPSMA PET/CT improves detection in low-PSA biochemical recurrence post-prostatectomy

This prospective trial enrolled 50 men with biochemical recurrence after radical prostatectomy and PSA 0.2–0.75 ng/ml. Mean per-patient lesion count was higher with 64Cu-SAR-bisPSMA than 68Ga-PSMA-11, with a lesion ratio of 2.63. At 24 hours, 78% of patients were positive on 64Cu-bisPSMA versus 36% on 68Ga-PSMA-11. Scan results changed management in 44% of patients, reflecting improved localization of recurrent disease. Reference-standard analysis showed more true positives and fewer false negatives with 64Cu-bisPSMA, supporting its use in early biochemical recurrence. 2

Intravesical gemcitabine offers BCG-like control with less toxicity in NMIBC

This systematic review and meta-analysis pooled seven comparative studies including about 774 patients with NMIBC post-TURBT. Recurrence-free and progression-free survival did not differ significantly between gemcitabine and BCG. Gemcitabine was associated with a substantially lower incidence of adverse events, with about half the odds of toxicity versus BCG. Randomized trials had some risk-of-bias concerns, and non-randomized studies showed moderate to serious bias. Nonetheless, the data support gemcitabine as a reasonable alternative when BCG toxicity, intolerance, or shortage is an issue. 3

Late NMIBC recurrence and progression remain possible after 5 disease-free years

This nationwide Danish cohort included 21 037 patients with NMIBC diagnosed between 2009 and 2022. The 5-year cumulative incidence after diagnosis was 44% for recurrence and 10% for progression. Among 6583 patients recurrence-free for 5 years, the next 5-year recurrence risk was 9.8% and progression risk 1.5%. About one-third of these late progressions developed muscle-invasive disease, indicating clinically meaningful residual risk. Results suggest most events occur early, but selected patients may warrant individualized surveillance beyond a 5-year recurrence-free interval. 4