The edition · Urology
PSMA-guided radiotherapy helps selected prostate cancer, and bladder patients refuse surgery
A phase 2 trial of PSMA-PET-guided radiotherapy missed its overall endpoint but favoured high-risk and post-prostatectomy patients; ctDNA androgen-receptor alterations mark worse mCRPC prognosis; most patients offered radical cystectomy refuse it; and prostate cancer's heavy toll on sexual and relational wellbeing.
The edition in brief
Today's urology edition is weighted towards genitourinary cancer. A phase 2 randomised trial of PSMA-PET-guided radiotherapy intensification (253 patients) did not meet its overall failure-free survival endpoint at five years (66% vs 62%), but freedom from biochemical progression favoured the intensified arm overall and more clearly in high-risk and post-prostatectomy patients, supporting the populations now in the phase 3 PATRON trial. A meta-analysis of 25 studies found that androgen-receptor gene alterations detectable in circulating tumour DNA mark worse survival in metastatic castration-resistant prostate cancer (overall survival hazard ratio 1.99, progression-free 2.37), but as a prognostic, not treatment-predictive, biomarker. A multinational survey showed radical cystectomy is used in only about 7 to 8% of recurrent high-risk non-muscle-invasive bladder cancer, and most patients offered it refuse, mainly over quality of life and stoma concerns, underscoring the need for bladder-preserving options. A clinic pearl restates visible-haematuria workup. The practice-changer: a nationally representative study quantifies the large sexual and relational burden of prostate cancer on patients and their partners, arguing survivorship care must include both.
PSMA-guided radiotherapy: no overall win, but a signal in high-risk disease
PSMA-guided radiotherapy did not improve overall failure-free survival but favoured biochemical control in high-risk and post-prostatectomy patients, the groups the phase 3 trial now targets.
ctDNA androgen-receptor changes mark worse prognosis in advanced prostate cancer
Androgen-receptor alterations in circulating tumour DNA mark worse prognosis in advanced prostate cancer, but should not yet be used to select between hormonal therapies.
Most bladder cancer patients offered radical cystectomy refuse it
Radical cystectomy is recommended but frequently refused in high-risk bladder cancer, so counsel honestly about its impact and consider bladder-preserving options where it is declined.
Work up visible haematuria, do not explain it away
Investigate visible haematuria in any adult with cystoscopy and upper-tract imaging to exclude urothelial cancer, even on anticoagulation or alongside a urinary infection.
Prostate cancer's sexual toll reaches the partner too
Build sexual and relational wellbeing, and the partner, into routine prostate cancer survivorship care rather than treating sexual recovery as the patient's problem alone.
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