The edition · Urology
A recall on the raw material, and a urine test that sees recurrence four months early
The EAU has rewritten its relapsing and metastatic prostate cancer guidance; the first randomised comparison of robotic and open kidney transplantation misses its endpoint but points somewhere; and urine tumour DNA finds BCG failures before cystoscopy does.
The edition in brief
The 2026 update of the EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on relapsing and metastatic prostate cancer covers evidence from 2023 to 2025 and carries strength ratings for each recommendation. The treatment landscape it describes has widened to androgen receptor pathway inhibitors, metastasis-directed therapy, PARP inhibitors and their combinations, and PSMA-based therapy - and the panel states plainly that the recommendations take no account of cost, reimbursement or resource availability. ORAKTx, the first randomised trial of robot-assisted against open kidney transplantation, randomised 107 adults at a single Danish centre: major surgical complications occurred in 25% of the open arm and 13% of the robotic arm (risk difference -11%, 95% CI -26 to 3.4, P=0.2) and vascular complications in 19% against 9.4% (-9.4%, -23 to 3.7, P=0.3), so the primary endpoint was not met. A multicentre validation of urine tumour DNA testing in 57 patients receiving BCG for high-risk non-muscle-invasive bladder cancer found 40% positive before treatment, with 12-month recurrence-free survival of 61% against 85% (hazard ratio 3.2, P=0.04); after BCG, 19% of clinically negative patients were urine tumour DNA positive, and their 12-month recurrence-free survival was 25% against 91% (hazard ratio 10.0, P<0.001), with a median lead time of 4.1 months over clinical surveillance. The FDA has posted Class II recalls of sildenafil citrate and tadalafil active pharmaceutical ingredient made by an Indian manufacturer for compounding use, for current good manufacturing practice deviations found at inspection. And in 199 men on active surveillance, a Stockholm3 threshold of 15 spared 19% of biopsies while missing 7% of upgrades, none of them grade group 3 or above.
The EAU's relapsing and metastatic prostate cancer guidance has been rewritten for 2026
Read the 2026 Part II update with its own caveat in mind - it states what the evidence supports and explicitly not what is affordable or available, and in Indian practice that gap is where most of the decision sits.
Robotic kidney transplantation halved complications and still missed its endpoint
Robotic kidney transplantation is feasible and safe in trained hands, but this trial did not show it reduces complications - open surgery remains the standard.
FDA Class II recall of sildenafil and tadalafil raw material from an Indian manufacturer
This is a manufacturing quality recall of bulk active ingredient for compounding, not a safety problem with sildenafil or tadalafil - patients on licensed tablets need no action.
Urine tumour DNA found BCG failures a median four months before cystoscopy did
Urine tumour DNA after BCG identifies a group in which three-quarters recur within a year - but no trial has yet shown that acting on it earlier helps, so keep cystoscopy as the standard.
Ask what else he is taking before you blame the prostate
Review the whole drug list, packets in hand, before investigating male lower urinary tract symptoms - moving an evening diuretic or stopping an over-the-counter antihistamine resolves a real share of referrals.
A blood test spared one in five surveillance biopsies without missing a significant upgrade
A blood-based risk score can defer about one surveillance biopsy in five at the cost of missing 7% of upgrades, all grade group 2 - useful as a complement where MRI is scarce, not as a replacement for it.
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