Prostate SBRT and conventional radiotherapy match on 5-year continence, and augmentation cystoplasty needs lifelong surveillance

The edition in brief

At five years in the phase 3 PACE-B trial, patient-reported urinary outcomes were comparable after stereotactic body radiotherapy and conventional radiotherapy for localised prostate cancer: pad-free rates 91% versus 90%, and moderate or big leakage problems in 6% versus 4%. Erections adequate for intercourse fell from 35% to 17% with stereotactic and from 40% to 20% with conventional treatment. A retrospective cohort of 1,385 robotic prostatectomies found nerve-sparing was done in 57.3% of men with two or more STAMPEDE high-risk features with similar margin rates (21.3% versus 23.2%) and biochemical recurrence at 12 months (6.7% versus 5.4%) to non-nerve-sparing, and fewer pads at 12 months. A meta-analysis of 15 studies (5,671 patients, two randomised) found extended lymphadenectomy at cystectomy added 26 minutes of operating time with no clear survival benefit and very low certainty. A retrospective series of 70 spinal cord injury patients found augmentation cystoplasty gave durable bladder capacity and pressure gains over a mean 19 years, with late stones in 10% and malignancy in 4%. The American Academy of Pediatrics updated its guideline on urinary tract infection in children aged 8 days to 5 years.