Urology

Real-world adjuvant nivolumab linked to better survival than observation after radical surgery

This multicenter retrospective cohort of 366 high-risk bladder or upper tract urothelial carcinoma patients compared adjuvant nivolumab (n=126) with observation or adjuvant chemotherapy. In the primary propensity-score–matched analysis (97 pairs), nivolumab was associated with improved DFS (HR 0.56) and OS (HR 0.40) versus observation. Secondary analyses found similar DFS and OS between nivolumab and adjuvant chemotherapy. Residual confounding remains possible, so findings require confirmation in prospective studies. 1

Baseline testosterone status predicts docetaxel benefit in nonmetastatic high-risk prostate cancer

Pooled predictive analysis from two randomized trials examined docetaxel added to RT+ADT in nonmetastatic high-risk prostate cancer. Patients with normal baseline testosterone experienced a significant reduction in all-cause mortality with docetaxel; those with low testosterone did not. Treatment-by-testosterone interactions were significant in both discovery and validation cohorts (p=.048 and p=.042). Patients with PSA>20, T3/4, or Gleason 9–10 and normal testosterone derived the clearest benefit. 2

EAU BCG-failure definitions validated for prognostic stratification in NMIBC

International retrospective study of 776 NMIBC patients with recurrence after adequate BCG evaluated EAU failure categories. Refractory subgroups had the highest progression rates; HG recurrence at 6 months had 46% progression at 5 years. Early recurrences classified as BCG-unresponsive showed progression outcomes similar to refractory disease. These validated categories can inform risk-based counselling and consideration of early radical cystectomy. 3