The edition · Urology
With two decades of follow-up, PSA screening does reduce prostate cancer deaths
Five trials and 721,607 men, at high certainty — and the authors still stop short of endorsing population screening; plus the 2026 EAU update on metastatic disease, a urine test that beat MRI on active surveillance, and frailty as the missed variable before an artificial sphincter.
The edition in brief
Today's urology desk opens with a systematic review of five randomised trials covering 721,607 men aged 45 to 80 with 11 to 23 years of follow-up. PSA-based screening reduced prostate cancer-specific mortality at longest follow-up with high certainty of evidence (p<0.001), a conclusion that reverses earlier syntheses, and the relative reduction grew with longer follow-up. The authors are explicit that this does not by itself justify population screening. The 2026 EAU and partner-society update on relapsing and metastatic prostate cancer covers a widened treatment landscape — androgen receptor pathway inhibitors, metastasis-directed therapy, PARP inhibitors and combinations, and prostate-specific membrane antigen-based therapy — with strength ratings and an explicit statement that cost and availability are not accounted for. A single-centre, single-surgeon randomised non-inferiority trial in 248 patients found sutureless purely off-clamp robotic partial nephrectomy non-inferior to renorrhaphy on Trifecta achievement, 93% against 95% (difference −2.4%, 90% CI −7.4 to 2.6), with nine urinary fistulae overall and a non-significant excess in the sutureless arm. Among 7,252 Medicare men having an artificial urinary sphincter or male sling, frailty independently predicted 30-day complications (adjusted relative risk 2.5 in the frailest) and one-year device revision or removal, while comorbidity did not predict revision. A pearl covers post-obstructive diuresis. The edition closes with a 330-patient multisite validation in which a urine test outperformed multiparametric MRI for detecting grade group upgrading on active surveillance.
The screening question, reopened by longer follow-up
Treat the mortality benefit of PSA screening as established, and spend the consultation on overdiagnosis, life expectancy and what happens after an abnormal result.
The 2026 metastatic prostate cancer guidance, and the line it does not cross
Take the relapse risk stratification and the sequencing logic into practice; check each named therapy against what your patients can actually access.
Leaving out the renorrhaphy held up, with a caveat about fistulae
Sutureless off-clamp partial nephrectomy met its non-inferiority bar for surgical quality, but the urinary fistula question is open and the evidence is one surgeon's.
Frailty, not comorbidity, predicted device revision after continence surgery
Score function before continence device surgery — frailty predicted revision and removal where comorbidity did not.
After you relieve chronic retention, watch the output and the sodium
After draining chronic retention, chart hourly output for 24 hours and recheck electrolytes — the risk starts when the catheter goes in, not before.
A urine test beat MRI at deciding who needs the surveillance biopsy
Magnetic resonance imaging alone is not a safe gate for the surveillance biopsy — it missed nearly one in five significant upgrades in this cohort.
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