A urine test beat MRI at deciding who needs a surveillance biopsy, and two of three checkpoint inhibitors added to BCG worked

The edition in brief

A network meta-analysis of 23 trials and 18,689 patients compared first-line combinations in metastatic hormone-sensitive prostate cancer. No triplet showed a statistically significant overall survival benefit over an androgen receptor pathway inhibitor with androgen deprivation in the all-comer analysis; docetaxel added to that combination did improve survival in high-volume disease (HR 0.76, 95% CI 0.61-0.95, high certainty). Safety estimates were too imprecise to exclude meaningful extra toxicity. A network meta-analysis of three phase 3 trials of checkpoint inhibitors added to BCG in BCG-naive high-risk non-muscle-invasive bladder cancer found durvalumab (HR 0.68, 0.50-0.93) and sasanlimab (0.68, 0.49-0.94) improved event-based disease control, while atezolizumab did not (0.98, 0.71-1.36). Grade 3 or worse treatment-related events rose from 3.8-8.8% with BCG alone to 21-29% with combinations. In 52 patients with high-risk non-muscle-invasive bladder cancer, tumour-informed circulating tumour DNA was detectable in 33%. Clinical upstaging occurred in 59% of ctDNA-positive against 14% of ctDNA-negative patients (p=0.002), and pathological upstaging in 78% versus 8% of those undergoing cystectomy. The FDA acted on a generic tadalafil application from Sun Pharma. Across 11 practices and 330 patients with grade group 1 cancer due for a surveillance biopsy, the MyProstateScore 2.0 urine test outperformed multiparametric MRI for predicting upgrading (area under the curve 0.82 vs 0.73 for grade group 3 or above). Using it would have avoided 64% of unnecessary biopsies while missing 3.2% of grade group 3 upgrades, against MRI missing 18%.