The edition · Urology
Abiraterone added no clear cardiac risk in STAMPEDE, but the usual risk score missed many events
A STAMPEDE analysis found no significant rise in major cardiovascular events with treatment intensification, though SCORE2 underestimated risk; urethroplasty fixed most post-BPH strictures; and TULSA showed good function but uncertain cancer control.
The edition in brief
Today's urology edition. In 6,292 men in STAMPEDE with linked English health records, adding abiraterone, abiraterone with enzalutamide, docetaxel, zoledronic acid or prostate radiotherapy to androgen deprivation was not associated with a statistically significant increase in major adverse cardiovascular events, with five-year incidence of 7–9% on androgen receptor pathway inhibitors; prior cardiovascular disease was the strongest predictor and the SCORE2 tool underestimated risk. A meta-analysis of 11 observational studies found urethroplasty for bulbomembranous strictures after BPH surgery achieved about 90% freedom from re-intervention with about 5% new incontinence. A review of 630 men treated with MRI-guided transurethral ultrasound ablation reported 90% pad-free continence and 81% preserved erections, but only 70% free of significant cancer at 12 months after primary treatment. A combined MRI and ultrasound AI model localised significant prostate cancer with higher specificity than radiologists in a 110-man prostatectomy cohort. The pearl covers cardiovascular review when starting hormone therapy.
Urethroplasty fixed most bulbomembranous strictures after BPH surgery
For post-BPH bulbomembranous strictures, urethroplasty in experienced hands succeeded in about 9 in 10 men with low new incontinence; consider referral over repeated endoscopic treatment.
TULSA preserved function well, but a quarter or more still had significant cancer at a year
TULSA preserved continence and erections in most men, but short-term cancer control was modest; it is not yet an alternative to radical treatment.
An AI model combining MRI and ultrasound localised prostate cancer more specifically than radiologists
Combining MRI and ultrasound in an AI model improved cancer localisation on ultrasound in this study, but it needs external validation before clinical use.
Start hormone therapy with a cardiovascular check
Every man starting long-term hormone therapy should have a baseline cardiovascular review.
STAMPEDE: intensified hormone therapy was not linked to more cardiac events, but SCORE2 underestimated risk
Intensified hormone therapy was not linked to significantly more cardiovascular events in STAMPEDE; assess cardiac history directly, as SCORE2 underestimates risk.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for urology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free