The edition · Urology
Lutetium-PSMA before SBRT roughly doubled progression-free survival in oligorecurrent prostate cancer
Extended follow-up of a randomised phase 2 trial, a pooled look at transurethral ultrasound ablation, whether Gleason pattern 4 length could widen active surveillance, and how often men with prostate cancer have low bone density.
The edition in brief
In the randomised phase 2 LUNAR trial (92 patients with PSMA PET-detected oligorecurrent hormone-sensitive prostate cancer), two cycles of neoadjuvant lutetium-177 PNT2002 before stereotactic body radiotherapy improved progression-free survival over radiotherapy alone (median 17.6 vs 7.4 months; HR 0.38, 95% CI 0.23 to 0.61) at a median follow-up of 31.9 months, with no new safety signals; the further endpoints were exploratory. A meta-analysis of 12 studies (630 patients) of MRI-guided transurethral ultrasound ablation found pooled 12-month recurrence-free survival of 70% for primary treatment, pad-free continence of 90% and erectile function preserved in 81%, with long-term oncological control unproven. In 2,499 men with grade group 2 to 4 cancer, less than 2 mm of Gleason pattern 4 predicted adverse pathology (5.2%) and 5-year biochemical recurrence (20%) like favourable intermediate-risk disease, but the authors say the cut-point needs defining before use. A meta-analysis of 52 studies found osteoporosis in 22.0% and low bone mass in 41.7% of men with prostate cancer, with very high heterogeneity.
Lutetium-PSMA before stereotactic radiotherapy: longer progression-free survival in oligorecurrent disease
Neoadjuvant lutetium-PSMA before SBRT delayed progression in a randomised phase 2 trial; consider trial referral rather than routine use.
Transurethral ultrasound ablation: low functional morbidity, uncertain long-term cancer control
TULSA looks to have low functional morbidity, but its long-term cancer control is unknown, so offer it with clear follow-up and caution.
Could Gleason pattern 4 length widen active surveillance? A prostatectomy cohort suggests so
Pattern 4 length may refine surveillance eligibility, but it is not a replacement for current criteria yet.
Ask about bone health before starting androgen deprivation
Think about bone health at the start of androgen deprivation, not after a fracture.
About one in five men with prostate cancer had osteoporosis in pooled studies
Consider bone density assessment in men with prostate cancer, since low bone density was frequent in pooled data.
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