Abiraterone intensification did not raise fracture admissions in STAMPEDE, and lowered them in metastatic disease

The edition in brief

Four studies for urologists and referring physicians. In 3,102 men from two STAMPEDE trials with linked English hospital data, adding abiraterone with prednisolone to standard care did not increase fracture-related hospitalisation; in metastatic disease the 5-year incidence was lower (22% vs 30%, SDHR 0.77), and lower again with abiraterone plus enzalutamide (28% vs 38%, SDHR 0.69). A reanalysis of six registrational trials in BCG-unresponsive carcinoma in situ showed trial design changes reported complete response rates: counting re-induction as failure or adjusting for missed biopsies lowered several agents' 12-month CR rates, so published figures cannot be compared directly. In the DEPROMP trial of 230 biopsy-naive men, combined systematic, MRI- and PSMA-targeted transrectal biopsy caused mostly low-grade adverse events, and quality-of-life change at 6 months was attributed far more to the cancer diagnosis than to the biopsy. A 109-man RCT found device biofeedback and physiotherapist-guided pelvic floor training gave similar continence gains after prostatectomy, with about half reaching a 50% leakage reduction. The pearl covers bone health on ADT.