Ejaculation-sparing prostate surgery raised the odds of keeping antegrade ejaculation nearly sevenfold, with no loss of urinary benefit

The edition in brief

Today's urology edition closes on a meta-analysis (Journal of Sexual Medicine, 14 September) of 16 studies and 1493 men having surgery for benign prostatic obstruction: ejaculation-sparing techniques preserved antegrade ejaculation far more often than standard technique (OR 6.76, 3.86 to 11.84), with no difference in IPSS, flow rate or erectile function at 6–12 months. For a sexually active man, that makes it a standard part of consent. The lead is NRG-GU005 (JAMA, 22 September), a phase 3 trial of 698 men with intermediate-risk prostate cancer: five-fraction SBRT gave fewer bowel quality-of-life declines (34.9% vs 43.8%), better continence and early sexual function, and fewer grade 3–4 urinary events than moderately hypofractionated IMRT, but was not superior on disease-free survival (88.6% vs 92.1% at three years). A pooled analysis of 17 retrospective studies and 18,626 men (BJUI, 1 September) found apalutamide doublets associated with better outcomes than abiraterone in metastatic hormone-sensitive disease, with abiraterone stopped less often for side effects; it is real-world data, not randomised comparison. A 38-man study of intermittent enzalutamide without ADT (BJUI, 13 September) found testosterone rose a median 63% and 42% developed gynaecomastia, unrelated to testosterone level. The pearl is on asking about ejaculation before BPH surgery.