Five fractions gave better quality of life and worse disease-free survival

The edition in brief

NRG-GU005 randomised 698 men with localised intermediate-risk prostate cancer at 136 centres to stereotactic body radiotherapy (36.25 Gy in 5 fractions) or moderately hypofractionated intensity-modulated radiotherapy. At two years the urinary irritative domain did not differ (35.4% vs 33.7% with a clinically important decline, P = .68), but fewer men had a bowel domain decline with stereotactic treatment (34.9% vs 43.8%, P = .03), and grade 3 or 4 genitourinary events were fewer (0.6% vs 2.5%, P = .04). Continence at one and two years and sexual function at one year favoured stereotactic treatment. Three-year disease-free survival was 88.6% (95% CI 85.2-92.1) with stereotactic radiotherapy against 92.1% (88.9-95.2). A post-hoc analysis of 8,614 participants in two canagliflozin trials found abnormal urinary leukocyte esterase in 10.7% and nitrite in 3.5%. Both predicted urinary tract infection (hazard ratios up to 2.81 for 3+ leukocyte esterase). Canagliflozin itself did not raise infection risk overall (HR 1.07, 95% CI 0.93-1.22), and dipstick findings did not modify that. A meta-analysis of 16 studies and 1,999 patients found pooled sensitivity for histologically confirmed pelvic nodal metastasis of 54.6% for PSMA PET-CT and 33.0% for multiparametric MRI, with specificity above 92% for both. In 38 men given intermittent enzalutamide without androgen deprivation, testosterone rose by a median 63% and gynaecomastia occurred in 42%, with no correlation to peak testosterone or its duration. A meta-analysis of nine studies found lower erectile function scores and testosterone in obstructive sleep apnoea than in shift work sleep disorder, with very high heterogeneity.