PSA density after a negative MRI could cut repeat scans by 60% and biopsies by 46%

The edition in brief

A pre-specified sub-analysis of the population-based Göteborg-2 screening trial followed 1,685 men with a negative initial MRI (PI-RADS 2 or below) for a median 5.5 years. Cumulative incidence of clinically significant prostate cancer at seven years was 7.1 per cent overall, and 5.5, 13.8 and 11.9 per cent across PSA density bands below 0.10, 0.10 to under 0.15, and 0.15 ng/mL² or above. Eighty-seven per cent of repeat MRIs stayed negative. A modelled strategy of biennial PSA with repeat MRI triggered only at density 0.10 or above would cut MRI use by 60 per cent and biopsies by 46 per cent, halve detection of insignificant cancer, and delay significant cancer diagnosis in 17 per cent of cases — including one man with Gleason 4+3 or higher. A Cochrane review of 52 trials and 6,242 participants found that against TURP at up to 12 months, holmium laser enucleation gave little to no difference in symptom score (mean difference −0.67, I² 93 per cent, low certainty), quality of life, major adverse events, re-treatment or erectile function, and reduced blood transfusion (RR 0.19, 95% CI 0.09 to 0.42, moderate certainty) — which the authors call the only clinically important advantage the randomised evidence supports. In 212 men with radiation-induced bulbomembranous stenosis, buccal mucosa graft onlay carried more than three times the recurrence hazard of anastomotic urethroplasty (HR 3.43, 1.03 to 11.47), with ten-year recurrence 20 versus 6.8 per cent and no difference in complications, satisfaction, erectile dysfunction or incontinence.