The edition · Urology
No clear cardiovascular signal from intensified hormone therapy in STAMPEDE, most patients decline cystectomy for BCG-treated bladder cancer, and robotic prostatectomy shows better 12-month function in a registry
A STAMPEDE post hoc analysis finds no statistically significant rise in cardiovascular events with abiraterone and other intensification, a global survey shows two in three offered cystectomy after BCG say no, and a New Zealand registry favours robotic over open prostatectomy for continence and sexual function.
The edition in brief
A post hoc analysis of 6,292 men in the STAMPEDE trial with linked English health records found no statistically significant increase in major adverse cardiovascular events (MACE) with abiraterone plus prednisolone (non-metastatic SDHR 1.15, 95% CI 0.80-1.67; metastatic 1.36, 0.87-2.10), abiraterone plus enzalutamide, docetaxel, zoledronic acid or prostate radiotherapy compared with androgen deprivation alone, with 5-year MACE of 9% (M0) and 7% (M1) with androgen receptor pathway inhibitor intensification; the confidence intervals do not exclude a moderate rise, and SCORE2 underestimated cardiovascular risk (AUC 0.61-0.63). A multinational physician survey covering 2,583 patients with high-risk non-muscle-invasive bladder cancer found radical cystectomy was offered to 20% of BCG-treated patients and refused by 68% of those, mainly for quality-of-life concerns, stoma reluctance and safety. In a randomised single-centre trial of 149 men having robotic radical prostatectomy, opioid-free anaesthesia reduced 24-hour oxycodone use (median 12.0 vs 19.0 mg, p = 0.001) with similar pain scores. A New Zealand registry of 4,889 men found robotic prostatectomy associated with higher 12-month EPIC-26 continence (6.9 points) and sexual (11.4 points) scores than open surgery, though it is observational with incomplete questionnaire completion.
STAMPEDE: no statistically significant rise in cardiovascular events with intensified hormone therapy, but wide intervals
Keep assessing and managing cardiovascular risk in men starting intensified hormone therapy, and do not take a low SCORE2 as reassurance.
Most patients offered cystectomy after BCG refuse it, mainly over quality of life and stoma fears
Plan the cystectomy discussion with stoma and quality-of-life information, since most patients who are offered it decline.
Opioid-free anaesthesia cut postoperative oxycodone use in robotic prostatectomy
Consider discussing opioid-free anaesthesia with your anaesthetists for robotic prostatectomy, recognising this is single-centre evidence with a modest difference.
Painless visible haematuria in an adult needs urological assessment
Refer adults with visible haematuria for urological assessment even if it settles.
Robotic prostatectomy was associated with better 12-month continence and sexual function than open surgery in a national registry
Consider presenting these registry differences in counselling while stressing that surgeon experience, patient selection and non-response may explain part of them.
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