The edition · Urology
PSMA PET found more significant cancer in equivocal PI-RADS 3 lesions
In 66 men with a PI-RADS 3 lesion, PSMA PET-targeted biopsy detected significant cancer more often than MRI targeting, and no negative scan missed one. Also: fracture risk after cystectomy, a coated ureteric stent, and 5-ARIs on active surveillance.
The edition in brief
A single-centre prospective paired study of 66 biopsy-eligible men with an equivocal PI-RADS 3 lesion and at least one high-risk feature found PSMA PET/MRI-targeted biopsy detected clinically significant prostate cancer in 15%, against 6% for MRI-targeted biopsy. PSMA PET had 100% sensitivity and negative predictive value in this small cohort, and 68% of men had a negative scan; the authors call for multicentre evaluation before biopsy is deferred on a negative result. A Swedish national cohort of 2,908 cystectomy patients found fracture risk about doubled in women and raised by half in men compared with matched referents, without a rise in bone-protective treatment. A two-centre German randomised trial of 100 stone patients found a sulfonic acid-coated stent halved encrustation and reduced stent symptoms and antibiotic use over 30 days. A retrospective cohort of 1,938 men on active surveillance for grade group 1 cancer found 5-alpha reductase inhibitor use associated with less grade progression and less progression to treatment.
After cystectomy, fracture risk doubles in women
Include bone health and fracture prevention in follow-up after radical cystectomy, especially for women.
A sulfonic acid-coated stent halved encrustation in a randomised trial
A sulfonic acid-coated stent may reduce encrustation and stent symptoms over 30 days, pending larger trials.
5-alpha reductase inhibitors on active surveillance linked to less grade progression
5-alpha reductase inhibitors appear compatible with active surveillance, provided PSA is re-baselined after starting.
Write down the PSA before the 5-alpha reductase inhibitor starts
Record a baseline PSA before starting a 5-alpha reductase inhibitor and interpret later values against it.
PI-RADS 3: PSMA PET-targeted biopsy detected more significant cancer
For PI-RADS 3 lesions with high-risk features, consider PSMA PET-targeted biopsy, but do not yet skip biopsy on a negative scan.
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