The edition · Urology
Perioperative apalutamide extends event-free time around prostatectomy, and pelvic nodal radiotherapy shows no survival gain
A PROTEUS substudy compares a year of apalutamide plus ADT around prostatectomy with surgery alone, a meta-analysis of five trials questions routine whole-pelvic radiotherapy, and claims data put numbers on overactive bladder drugs after BPH surgery.
The edition in brief
In an open-label PROTEUS substudy of 408 men with high-risk localised or locally advanced prostate cancer, a year of perioperative apalutamide plus androgen-deprivation therapy around radical prostatectomy improved event-free survival over surgery alone (3-year rates 63% vs 41%; HR 0.38), adding about 11 months of event-free time in the first three years. Metastasis-free survival on conventional imaging did not differ, and grade 3 to 4 adverse events were more common (31% vs 22%). A meta-analysis of five randomised trials in 5,172 men found elective whole-pelvic radiotherapy did not improve overall survival over prostate-only treatment (HR 1.07), and the progression benefit rested on one PSMA-staged trial. Michigan claims data on 11,519 men found 5.7% to 11% started an anticholinergic or beta-3 agonist within a year of BPH surgery, highest after photoselective vaporisation. A small trial found empiric and test-guided stone prevention gave similar urine risk profiles at eight weeks. The pearl covers fluid targets for stone formers.
Whole-pelvic radiotherapy does not improve survival in node-negative high-risk prostate cancer
Discuss with radiation oncology before adding elective pelvic fields for node-negative high-risk prostate cancer; pooled trials show no survival benefit.
Overactive bladder drugs after BPH surgery: how often, and after which procedure
Counsel men before BPH surgery that about 6% to 11% start an overactive bladder drug within a year, depending on the procedure.
Empiric versus test-guided stone prevention gave similar urine risk at eight weeks
Where 24-hour urine testing is impractical, consider empiric prevention for recurrent calcium stones; this small trial found similar urine risk profiles.
Give stone formers a urine volume target, not a glass count
Ask stone formers to aim for a urine output of at least 2 to 2.5 litres a day, adjusting intake for heat and work.
A year of apalutamide plus ADT around prostatectomy delays events in high-risk disease
Consider perioperative apalutamide plus ADT for fit men having prostatectomy for high-risk prostate cancer; it delays events but survival benefit is not yet shown.
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