Urology

Large US cohort shows persistent sociodemographic disparities in radical prostatectomy use

In 917,194 men with localized or regional prostate cancer, 33.5% underwent radical prostatectomy between 2004 and 2022. Increasing age lowered surgical odds (OR per year 0.904), while being married (OR 1.601) and higher income increased odds. Black patients had substantially lower odds of surgery than White patients (OR 0.547), highlighting racial inequities in access. These associations persisted after multivariable adjustment and varied by year of diagnosis, implying systemic drivers of disparity. 1

pCR after cystectomy is prognostic but fails formal surrogacy for overall survival

Across 12 neoadjuvant trials (n=3119), the association between trial-arm pCR and 3-year OS was weak (R2 = 0.30). Excluding high-risk-of-bias trials improved the association to moderate (R2 = 0.50), but trial-level surrogacy remained inadequate. In eight RCTs, treatment effects on pCR poorly predicted OS (R2 = 0.06), improving only after excluding biased trials. Conclusion: pCR informs prognosis but should not substitute for OS when designing registrational neoadjuvant MIBC trials. 2

Swiss registry: radical prostatectomy shifted to more MIS and better early outcomes (2020–2025)

Among 7687 radical prostatectomies, minimally invasive approaches rose from 81% to 95% and MRI-targeted biopsy from 46% to 84%. Positive surgical margins fell from 27% to 22% and PSA persistence from 18.5% to 11.3%, with fewer severe complications. Operative time and blood loss decreased while pelvic lymph node dissection rates declined, reflecting evolving practice patterns. Improvements likely reflect diagnostic changes and surgical experience but apply to Swiss registry patients and may not generalize universally. 3