Dropping systematic cores at transperineal biopsy would miss up to one in six significant cancers, and PSMA-guided radiotherapy misses its primary endpoint

The edition in brief

Across five institutions, 1,587 men had both MRI-targeted and systematic transperineal prostate biopsy. Targeted cores found a higher grade than systematic cores alone in 27.4%, and systematic sampling could have been omitted in 83.3%, but omitting it would have missed up to 17% of clinically significant cancers; PI-RADS 5 lesions were more often upgraded by systematic cores. In the phase 2 PSMAgRT trial of 253 men, radiotherapy intensified to all PSMA-PET-detected sites did not significantly improve five-year failure-free survival (66% vs 62%, HR 0.80), though freedom from biochemical progression favoured it, particularly in high-risk and post-prostatectomy strata; the phase 3 PATRON trial is testing those groups. In England, the share of patients with high-risk renal cell carcinoma treated within 31 days of the decision fell from 83.7% in 2019 to 64.8% in 2023, and once the standard was breached the daily chance of surgery fell sharply. Augmentation cystoplasty in 70 people with spinal cord injury, followed for a mean 19 years, raised capacity from 155 to 490 mL and lowered pressures, with 67% continent, but 10% developed stones and 4% adenocarcinoma. The European Association of Urology's 2026 infections guideline restructures around a new UTI classification and updates biopsy prophylaxis. The pearl: abdominal pain and sepsis in an augmented bladder is a perforation until proven otherwise.