The edition · Urology
After a negative prostate MRI, PSA density sorted who needed another look
In Göteborg-2, men with PSA density below 0.10 had less than half the seven-year risk of significant cancer after a clear MRI; a membranous urethral length model predicted near-continence but not pad-free continence; and a local-anaesthetic device handled small bladder recurrences in clinic.
The edition in brief
A pre-specified analysis of the Göteborg-2 screening trial followed 1685 men with a negative initial prostate MRI for a median 5.5 years. Seven-year cumulative incidence of clinically significant cancer was 5.5% with PSA density below 0.10 ng/mL², against 13.8% and 11.9% at higher densities; a follow-up strategy triggering repeat MRI only at density 0.10 or above was modelled to cut MRI use by 60% and biopsies by 46%, at the cost of delaying 17% of significant diagnoses. An external validation in 500 men found a continence model using MRI membranous urethral length was useful for predicting 0–1 pad a day after prostatectomy (C-statistic 0.69) but not pad-free continence (0.64, poor calibration). A French retrospective study of 442 patients found clinical variables predicted stone composition with a macro-AUC of 0.81, rising to 0.98 once stone morphology was added. A first-in-human study of 18 patients with small recurrent bladder tumours found an all-in-one outpatient device under local anaesthesia gave evaluable biopsies in 92% with no complications. Today's pearl covers the obstructed, infected kidney.
Membranous urethral length helped predict near-continence after prostatectomy, not full dryness
Report membranous urethral length on pre-prostatectomy MRI and use it to counsel about near-continence, not full dryness.
Clinical data predicted stone composition moderately well; stone morphology made it excellent
Send every stone for analysis including morphology, and use CT density as an early clue to uric acid stones.
An all-in-one device managed small recurrent bladder tumours in clinic under local anaesthesia
Office-based management of small bladder recurrences looks feasible, but this device is at first-in-human stage.
An obstructed, infected kidney needs draining before anything else
Fever with an obstructing stone means emergency drainage by stent or nephrostomy, not definitive stone surgery.
PSA density below 0.10 after a negative MRI marked a lower long-term cancer risk
After a negative prostate MRI, use PSA density to set follow-up intensity: closer at 0.10 or above, continued PSA checks below it.
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