Bladder cancer followed microhaematuria in 1.5% of 267,133 patients, and the AUA risk tiers barely discriminated

The edition in brief

A Veterans Health Administration and Medicare-linked cohort followed 267,133 adults with new microhaematuria from 2015 to 2024. Within two years, 11.9% had completed cystoscopy and 1.5% (95% CI 1.4 to 1.5) had a new bladder cancer diagnosis. Older age, male sex, smoking history and 25 or more red cells per high-power field were each associated with cancer after accounting for the competing risk of death. A model built from these ordinary clinical variables discriminated better than the American Urological Association risk categories - AUC 0.63 against 0.52 (P < 0.001) - which means the current tiers performed close to chance and gave no gradation within the large 'high risk' group. The 2026 EAU and partner-society guideline on localised prostate cancer recommends risk-adapted detection from about age 50 based on individual life expectancy, multiparametric MRI before biopsy, combined targeted and regional cores when biopsy is done, and introduces a five-tier EAU classification; active surveillance now extends to selected favourable intermediate-risk ISUP grade group 2 disease, hypofractionated radiotherapy is to be considered in intermediate risk, and cN1 disease should get radiotherapy to the primary with long-term intensified hormonal treatment. In a randomised salvage radiotherapy trial, African American men had higher failure-free survival than men of other races (72.8% vs 58.7%, P = 0.002) despite lower socioeconomic and higher allostatic load scores. The FDA has posted an ongoing Class II recall of sildenafil citrate active ingredient for compounding, for good manufacturing practice deviations found on inspection.