IgorCaetano.Uro

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[محمدالقرني أبو فيصل @abofisal56]

سبحان الله العظيم

[Kiyon Tavakolian @KiyonTavakolian]

Reintervention Through Five Years After Prostatic Artery Embolization … https://t.co/WCjaadfjBD

Another paper out of @ColumbiaVIR comparing reintervention rates after PAE. Great work by our colleague Dr. Tarub Mabud! @DrSteveReis @AbinSajanMD

[JAMA @JAMA_current]

Among patients with nonmetastatic #ProstateCancer, 51% of focal therapy procedures occurred in low-, high-, or very–high-risk disease, settings in which routine use is not supported by current guidelines. https://t.co/P3QOjQ41uT

[Dra. María Natalia Gandur Quiroga @nataliagandur]

The future of #ProstateCancer care is not simply more treatment — it is smarter integration.

🎯 Right radiotherapy.
🎯 Right systemic therapy.
🎯 Right patient.
🎯 Right timing.

Excellent #IUCS26 talk by @alison_tree on how risk-adapted combinations of local and systemic therapy are reshaping high-risk prostate cancer care.

Precision is not just about what we give — but to whom, when, and for how long.

@neerajaiims @gbanna74 @Sebastiano_Buti @CinziaConted @dralishadamani @amg120395 @PGrivasMDPhD @ravikanesvaran @koshkin85 @MicheleMaffezz @ManiamAkash @ParamMariappan @dmukherji @VanitaNoronha @montypal @DanieleRaggi83 @PasRescigno @jteoh_hk @yekeduz_emre @ONCOassist

#IUCS26 #GUOncology #Radiotherapy #ADT #PrecisionOncology

[European Urology @EUplatinum]

Spotlight: Epidemiology of Renal Cancer: Incidence, Mortality, Survival, Genetic Predisposition, and Risk Factors by Alessandro Larcher et al

#Spotlight #Medtwitter #UroSoMe #RenalCancer

[Dra. María Natalia Gandur Quiroga @nataliagandur]

✨ In high-risk localized #ProstateCancer, the question is no longer simply whether to use ADT — but who needs it, for how long, and who should receive more.

Excellent #IUCS26 discussion by @alison_tree on integrating loco-regional and systemic approaches.

🔵 STAMPEDE / abiraterone and ENZARAD / enzalutamide reinforce the role of systemic intensification in selected higher-risk patients, including cN1 disease.

🔵 In PROTEUS, perioperative apalutamide + ADT improved pathological response:
• pCR/MRD: 8.9% vs 1.0%
• Fewer positive surgical margins
• 5-year MFS: 78.2% vs 73.5% in the data presented

But the message is not “more treatment for everyone.”

The real questions are:
➡️ Who can avoid ADT?
➡️ Who needs standard or longer-course ADT?
➡️ Who derives enough absolute benefit to justify AR-pathway intensification?

🎯 Clinical takeaway: localized high-risk prostate cancer is moving toward risk-adapted selective intensification, balancing disease control against the long-term burden of systemic therapy.

@neerajaiims @gbanna74 @Sebastiano_Buti @CinziaConted @dralishadamani @amg120395 @PGrivasMDPhD @ravikanesvaran @koshkin85 @MicheleMaffezz @ManiamAkash @ParamMariappan @dmukherji @VanitaNoronha @montypal @DanieleRaggi83 @PasRescigno @jteoh_hk @DrYukselUrun @yekeduz_emre

#pcsm #Radiotherapy #ADT #GUOncology #UroOnc

[Journal of Urology @JUrology]

🔍 Are We Changing Bladder Cancer Detection?

Urine Tumor DNA (utDNA) testing predicts recurrence and tracks therapy in high-risk bladder cancer patients on BCG treatment.

🔬 Early Detection - utDNA finds recurrence months ahead of clinical diagnosis
🔗 Personalized Care - Identifies need for intensified or reduced therapies
📈 High Sensitivity - Detects 67% recurrences with 94% specificity

#BladderCancer #utDNA #BCG https://t.co/X8PK8ji55i

[IgorCaetano.Uro @igor_jclima]

@PellegrinoMD @DrAndrewLoblaw @DongNguyeb What is this trial? Could you send me?

[IgorCaetano.Uro @igor_jclima]

@DrAndrewLoblaw The difference it’s a systemic treatment.
RP isolate couldn’t do miracles, like SBRT isolate.

[Carlos Gonzalez Gonzalez @DrCarlosGlezX2]

🔬 Can we preserve the kidney in UTUC without compromising long term cancer control?

Important new data from @Pietro9609 , @FZorzi , @candela_luigi , @OTRAXER and our Tenon team in European Urology Oncology. @EurUrolOncol

📊 254 patients treated with endoscopic kidney sparing surgery
⏱️ Median follow up: 67 months
At 7 years:

🔹 UTUC recurrence: 55%
🔹 Only 22% ultimately required radical nephroureterectomy
🔹 High risk disease had higher RNU risk: 35% vs 13%
🔹 Metastatic progression: 17% vs 5%
🔹 Cancer specific mortality: 23% vs 11%
🔹 Median eGFR decline: 9 mL/min/1.73 m²

Importantly, recurrence did not differ significantly between low and high risk disease, and patients classified as high risk based only on weaker risk factors showed outcomes comparable to low risk patients.

Take home message: recurrence after eKSS is common, but recurrence does not necessarily equal treatment failure. With careful patient selection, rigorous second look ureteroscopy and prolonged surveillance, many patients can achieve durable cancer control while preserving renal function.

Link🔗: https://t.co/TcBJeJkB2k

#UTUC #Urology #Endourology #UroOncology #KidneySparing

[Tyler Seibert MD PhD @TylerSbrt]

🚨IMPACT trial 5y results

3063 participants in 20 countries. Median age 54y

2 cohorts: BRCA1/2+ vs age-matched BRCA1/2-

Annual PSA. Biopsy if >3 ng/ml

⬆️ csPC (GG>=2) in BRCA2+

⬆️ % of cancers NCCN unfav/high if BRCA2+ or BRCA1+

@OncoAlert @urotoday @PCF_Science

[Adam B. Weiner, MD @Adam_Weiner535]

🚨 Start ADT + ARPI & metabolic dysfunction follows, often in just a few months🚨

@JAMAOnc

👥 16,924 men w/ #ProstateCancer starting ADT + ARPI, no prior metabolic dx

📊 12-mo cumulative incidence:
🔺 New HTN 83%
🔺 Dyslipidemia 52%
🔺 Metabolic syndrome 39%
⏱️ Median time to 1st abnormality: 1 mo. MetS: 2.6 mo

🔗 https://t.co/i5GLEJlUsP

@AmerUrological @PCFnews @PCF_Science @UroOnc @UrologyTimes @urotoday @renalandurology

[Jim Hu @jimhumd]

1/10 🧵 Posterior Approach to Endopelvic Neurovascular Total Sparing (PATENTS) was associated with >2-fold faster recovery of erections sufficient for intercourse after nerve-sparing RP. Our new Nature Reviews Urology @NatRevUrol COMMENTasks whether preserving more anterolateral tissue may explain why. https://t.co/pz3wz80H5A

[IgorCaetano.Uro @igor_jclima]

@netojdsneto -lambe lambe e folhetos anônimos espalhandos pela cidade denegrindo a governadora

[Quoc-Dien Trinh, MD, MBA @qdtrinh]

Our new paper is out in JAMA, led by our fellow Andrea Cosenza: focal therapy for prostate cancer remains uncommon nationally, but half of the procedures performed were in patients whose disease was either too low-risk to need treatment, or too high-risk for focal therapy to be the appropriate choice.

Focal therapy has real promise. My partners and I at @UPMC @UPMCUrology believe in it. But promise isn't the same as "right for every patient." That distinction matters more as our treatment options keep growing. @DavidDan_Ngn @JasonZhiyuQian @ruimmbernardino @Putnam_Cole @daviesbj @GGandaglia

[Adam B. Weiner, MD @Adam_Weiner535]

🚨 93% active surveillance for low-risk #prostatecancer in the VA system 🚨

@JAMA_current

👥 73,042 pts w/ NCCN low or favorable intermediate risk PCa, VA system 2005 to 2024

📊 38,130 managed initially w/ surveillance or watchful waiting

✅ Low risk: AS use 27% to 93%
✅ Favorable intermediate: 14% to 61%
✅ GG1 w/ PSA 10 to 20: 27% to 88%. GG2 in <50% of cores: 11% to 55%
✅ For GG1 dx 2015 to 2024, nearly every VA facility sat between 60% and 100%

⚠️ For context: ~60% national AS rate for low risk in AQUA those same year
⚠️ Gaps remain: lower AS odds for Black (OR 0.95) and Hispanic (OR 0.85) pts and higher area deprivation, independent of risk

🎯 Bottom line: an integrated system w/ guideline monitoring, no financial reward for intervening, and nowhere to opinion-shop got AS to 93%.
👉The barrier to surveillance was never the evidence. It was the incentives.

🔗https://t.co/DpLvnPiIyO

@dr_coops @AmerUrological @UroOnc @SUO_YUO @PCFne @UrologyTimes @renalandurology @urotoday @GabeCanales

[Adam B. Weiner, MD @Adam_Weiner535]

🚨 Half of focal therapy for #ProstateCancer in the US is happening where no guideline supports it 🚨

@JAMA_current research letter

👥 1,179,384 pts w/ nonmetastatic PCa, NCDB 2010 to 2023

📊 15,672 (1.3%) got focal therapy

⚠️ 51% was in low, high, or very high risk disease.
-No guideline supports routine use in ANY risk group outside trials or registries
⚠️ Low risk held flat (1.8% to 2.2%) and favorable intermediate is rising (2.1% to 2.9%) while marketing and&reimbursement expand
⚠️ Focal therapy more likely w/ age ≥75 (adjusted probability 22.9%), community centers (7.6% vs 2.5% academic), nonprivate insurance

✒️From the accompanying editorial
"Volume of this kind shows diffusion, not benefit."

🎯 Key points
1⃣In low risk this converts surveillance candidates into procedure pts
2⃣In high risk it is undertreatment.
3⃣Repeated use is building "an aura of legitimacy the data have not earned." We owe pts trials, not marketing.

🔗 Study: https://t.co/xbxCAXPfWE
🔗 Editorial: https://t.co/Nb0yjFHhSx

@QDTrinh @DrSpratticus @AmerUrological @UroOnc @SUO_YUO @urotoday @UrologyTimes @PCF_Science @PCFnews

[IgorCaetano.Uro @igor_jclima]

@cec_cabeludo Craque

[Adam B. Weiner, MD @Adam_Weiner535]

🚨 MRI-first screening w/o contrast finds more ≥GG2 #ProstateCancer 🚨

@EurUrol

👥 759 pts randomized

📊 Biparametric MRI first vs MRI only if PSA ≥3
⏱️ 15 min scan, no contrast

✅ csPCa detected: 4.6% vs 1.8% (RR 2.6, 95% CI 1.1-6.1)
✅ Several csPCa found in pts w/ normal PSA

⚠️ More biopsies in MRI-first arm (10.8% vs 5.2%)

🎯 A FAST⚡️ contrast-free MRI up front catches significant PCa a PSA screen might miss

@PCF_Science @PCFnews @urotoday @UrologyTimes @UroOnc

🔗https://t.co/E8rXTQL1nW

[NEJM @NEJM]

Original Article: Perioperative Apalutamide in High-Risk Localized Prostate Cancer (phase 3 PROTEUS trial) https://t.co/dJMlGVWc04

Editorial: A Watershed Moment in the Perioperative Treatment of Prostate Cancer https://t.co/YEfC0j9pC6

#Oncology #Urology