The edition · Urology
80 Gy with long-term ADT cut 10-year progression by 44% in high-risk prostate cancer
GETUG AFU 18 finally shows a durable benefit from dose escalation alongside hormones; a blinded Indian trial favours thinner stents after ureteroscopy; and testosterone therapy did not speed progression on active surveillance.
The edition in brief
Five findings for urologists and the physicians who refer to them. The French GETUG AFU 18 phase 3 trial randomised 505 men with high-risk prostate cancer on long-term androgen deprivation to 80 Gy or 70 Gy; 10-year progression-free survival was 83.6% versus 72.2% (HR 0.56, 95% CI 0.40-0.78), with similar severe late toxicity, though the 10-year analysis was post hoc and survival benefit is unproven. A patient- and assessor-blinded trial in India randomised 124 patients after ureteroscopic lithotripsy to 4.7Fr or 6Fr stents; the thinner stent gave better Ureteral Stent Symptom Questionnaire scores (difference 7 points) but more dislodgement (8.8% vs 3.2%). Among 3,324 men on active surveillance for grade group 1-2 prostate cancer, the 79 on testosterone therapy did not progress faster (HR 0.99, 0.67-1.48). A meta-analysis of 16 randomised trials found prehabilitation before radical prostatectomy reduced incontinence at 1 month (OR 0.58) and 6 months (OR 0.52) but not at 12 months, with no effect on erectile function. The 2026 EAU urological infections guideline restructures around a new UTI classification, adds chapters on fungal UTI and herpes simplex, and updates prostate biopsy prophylaxis.
A 4.7Fr stent was better tolerated than 6Fr after ureteroscopy, at the cost of more dislodgement
After uncomplicated ureteroscopy, a 4.7Fr stent reduces stent symptoms; use 6Fr where dislodgement would be risky.
Testosterone therapy was not associated with faster progression on active surveillance
Symptomatic hypogonadism in men on active surveillance can be treated with testosterone under close PSA and imaging monitoring.
Prehabilitation before prostatectomy reduced early incontinence but not at 12 months
Start pelvic floor prehabilitation before radical prostatectomy to shorten early incontinence, without promising better continence at a year.
EAU 2026 infections guideline: new UTI classification, fungal UTI and herpes chapters, revised biopsy prophylaxis
Check your prostate biopsy prophylaxis and fungal UTI protocols against the 2026 EAU urological infections guideline.
FDA: an administrative supplement to a generic carvedilol licence, with no change for urology
No change to urological practice from this FDA record; do check for carvedilol and other antihypertensives before starting an alpha-blocker.
Every stent needs a removal date before the patient leaves
Enter every ureteric stent into a register with a removal date, and give the patient that date in writing before discharge.
Dose-escalated 80 Gy radiotherapy with long-term ADT improved 10-year progression-free survival
For high-risk prostate cancer on long-term ADT, give dose-escalated radiotherapy rather than 70 Gy; it reduces progression with similar toxicity.
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