In STAMPEDE, adding abiraterone or enzalutamide to hormone therapy did not significantly raise cardiovascular events — but SCORE2 underestimated risk

The edition in brief

Today's urology edition leads on cardiovascular safety in advanced prostate cancer. A European Urology post hoc analysis of 6292 men in STAMPEDE with linked English health records found five-year major adverse cardiovascular event incidence with androgen receptor pathway inhibitor intensification of 9% in non-metastatic and 7% in metastatic disease, comparable to androgen deprivation alone; subdistribution hazard ratios ranged from 1.15 to 1.36 with intervals crossing 1. Prior cardiovascular disease was the strongest predictor, and the SCORE2 risk tool discriminated modestly (AUC 0.61 to 0.63) and underestimated absolute risk. A single-arm phase 2 trial of intravesical gemcitabine–docetaxel in 25 BCG-naive patients with high-risk non-muscle-invasive bladder cancer reported high-grade recurrence-free survival of 84% at 24 months and 80% at 36 months, with no progression on treatment. A randomised trial of 149 men having robotic prostatectomy found opioid-free anaesthesia with dexmedetomidine and ketamine reduced 24-hour oxycodone use by a median 6 mg versus remifentanil, with no difference in pain. A proteomic case-cohort study within EPIC identified plasma proteins associated with prostate cancer diagnosed more than 15 years later, a research-stage finding. The pearl covers investigation of visible haematuria.