European Urology[JOURNAL]

Khan S, Papa N, Kneebone A … +21 more , Eade T, Ayati N, Nguyen A, Wong K, Chen J, Ho B, Idiare J, Sidhom G, Roberts MJ, Thompson J, Sharma S, Weir S, Devitt K, Kooner R, Lieng H, Rasiah K, Olphert J, de Leon J, Hruby G, Stricker P, Emmett L

Eur Urol · 2026 Jun · PMID 41904043 · Publisher ↗

BACKGROUND AND OBJECTIVE: Prostate-specific membrane-antigen positron emission tomography (PSMA-PET) has transformed management of prostate cancer biochemical recurrence (BCR) with higher diagnostic accuracy than previou... BACKGROUND AND OBJECTIVE: Prostate-specific membrane-antigen positron emission tomography (PSMA-PET) has transformed management of prostate cancer biochemical recurrence (BCR) with higher diagnostic accuracy than previous imaging modalities. Cu-SAR-bisPSMA PET/computed tomography (CT) (Cu-bisPSMA) is a bivalent-PSMA-peptide with 12.7-hr half-life. The study objective was detection rate (per-patient) comparison between Cu-bisPSMA and GaPSMA-11 PET/CT (Ga-PSMA) in BCR post radical prostatectomy (RP) (NCT06907641). METHODS: This prospective imaging trial enrolled 50 participants with BCR (PSA 0.2-0.75 ng/ml). Cu-bisPSMA (1 and 24 hr) and Ga-PSMA were acquired within 3-wk. Images were prospectively reported, and triple read for concordance. Management impact was evaluated after Ga-PSMA and Cu-bisPSMA. A reference standard (RS) for accuracy included biopsy, targeted treatment response (no androgen deprivation therapy), PSA increase/decrease on observation or repeat imaging (Cu-bisPSMA). The primary endpoint was mean per-participant lesional difference. Paired t tests and mixed-effects Poisson regression assessed lesion number differences between scans. KEY FINDINGS AND LIMITATIONS: Median prostate specific antigen (PSA) was 0.43 (interquartile range: 0.31-0.63). Mean per-participant lesions were higher in Cu-bisPSMA (1.26) versus GaPSMA (0.48), difference 0.78 (95% CI: 0.52-1.04), ratio 2.63 (95% CI: 1.64-4.20) (p < 0.0001). At a per-participant level 78% (39/50) were positive on 24-hr Cu-bisPSMA compared to 36% (18/50) on GaPSMA. Management changed between scans in 22/50 (44%). Cu-bisPSMA were triple concordant in 84% (42/50) and Ga-PSMA reads in 80% (40/50). RS-true positive was 71% (24/34) versus 29% (10/34) and RS-false negative rate was 21% (7/34) versus 65% (22/34) for Cu-bisPSMA versus Ga-PSMA, respectively. CONCLUSION AND CLINICAL IMPLICATIONS: Cu-bisPSMA-PET/CT identifies a higher number of disease recurrences than Ga PSMA-PET/CT with substantial management impact and a high RS true positive rate in men with BCR post RP.

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Re: Hiroshi Kitamura, Taiji Tsukamoto, Yoshiyuki Kakehi, et al. Active Surveillance Versus Intravesical Bacillus Calmette-Guérin for High-grade T1 Bladder Cancer with Negative Second Transurethral Resection: The Randomized Noninferiority Phase 3 JCOG1019 Trial. Eur Urol. 2026;89:437-445.

Contieri R, Lazzeri M, Perdonà S … +1 more , Hurle R

Eur Urol · 2026 Jul · PMID 41864760 · Publisher ↗

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Reply to Roberto Contieri, Massimo Lazzeri, Sisto Perdonà, and Rodolfo Hurle's Letter to the Editor re: Kitamura, Tsukamoto T, Kakehi Y, et al. Active Surveillance Versus Intravesical Bacillus Calmette-Guérin for High-grade T1 Bladder Cancer with Negative Second Transurethral Resection: The Randomized Noninferiority Phase 3 JCOG1019 Trial. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2026.01.008.

Kitamura H, Nishiyama H

Eur Urol · 2026 Mar · PMID 41864759 · Publisher ↗

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Re: Surgical Outcomes of Robotic Surgery for Kidney Stones: A Systematic Review and Meta-analysis from Section of YAU and EAU Endourology.

Chew BH

Eur Urol · 2026 Jun · PMID 41862386 · Publisher ↗

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A Phase 2, Randomized, Controlled Trial of Best Systemic Therapy Versus Best Systemic Therapy with Definitive Treatment of the Primary Tumor in Metastatic Prostate Cancer.

Chapin BF, Smaldone M, Zurita AJ … +35 more , Wang J, Cooperberg MR, Gleave M, Delacroix SE, Davis J, Pettaway C, Pisters L, Adibi M, Chery L, Papadopoulos J, Ward J, Gregg J, Navai N, Corn P, Subudhi SK, Logothetis C, Kuban D, Nguyen Q, Tang C, Choi S, Hoffman K, Lozano M, Elsheftawi M, Achim M, Zhao Y, Ramesh N, Sei E, Navin N, Nogueras Gonzalez GM, Wang X, Zhu K, Troncoso P, Zhang M, McGuire S, Aparicio AM

Eur Urol · 2026 Mar · PMID 41833492 · Publisher ↗

BACKGROUND AND OBJECTIVE: Studies reported to date indicate that local therapy may improve outcomes in men with de novo metastatic (M1) prostate cancer (PCa). The aim of this study was to evaluate the effect of local the... BACKGROUND AND OBJECTIVE: Studies reported to date indicate that local therapy may improve outcomes in men with de novo metastatic (M1) prostate cancer (PCa). The aim of this study was to evaluate the effect of local therapy to the primary tumor on progression-free survival (PFS) in men with M1 PCa. METHODS: In a multicenter, randomized phase 2 trial, men with de novo M1 PCa, after receiving 6 mo of best systemic therapy (BST), were randomly assigned (1:1) to continue BST alone (arm 1) or BST with the addition of either radiotherapy or surgery to their primary tumor (arm 2). The primary endpoint was PFS, defined as the time from randomization to progression (Prostate Cancer Working Group 2) by prostate-specific antigen, radiographic or symptomatic progression, or the time to change systemic therapy as per physician discretion and/or clinical decision, or death, whichever occurred first. Immunohistochemistry for the tumor suppressors p53, RB1, and PTEN was performed on available prostate biopsies at baseline and 6 mo. The aggressive variant PCa molecular signature (AVPC-MS) was assigned if two or more of these tumor suppressors were abnormal. In the current intent-to-treat analysis, the Kaplan-Meier product-limit method was used to estimate the median PFS. KEY FINDINGS AND LIMITATIONS: Between March 2013 and April 2018, 119 patients were randomized (arm 1: 59 and arm 2: 60). The median follow-up for patients who survived was 66 mo (64 mo for BST alone and 67 mo for BST plus local therapy groups). BST included androgen deprivation therapy (n = 119), with docetaxel (n = 37) or with androgen receptor pathway inhibitor agents (n = 9). Local therapy included surgery (n = 45), radiation (n = 13), or none (n = 2). At data analysis, 88 patients met Prostate Cancer Working Group 2 progression, and 53 patients had died. The median PFS was 17.9 mo (95% confidence interval [CI] 11.7-36.4) in arm 1 and 14.8 mo (95% CI 11.4-42.9) in arm 2 (hazard ratio [HR] 0.89, 95% CI 0.59-1.34, p = 0.6). Toxicity was limited in both arms, with grade 3 toxicities in four patients (6.7%) in arm 2 and zero patients in arm 1. Three patients required palliative intervention for symptomatic local progression in arm 1, while an additional six patients crossed over to receive local therapy after meeting castration-resistant PCa progression criteria. Predictors of worse overall survival (OS) for all comers included CHAARTED high-volume (HR 1.84, 95% CI 1.06-3.19) and clinical cT3b/T4 (HR 1.97, 95% CI 0.88-4.41) disease. Having the AVPC molecular profile (AVPC-MS) at baseline or 6 mo was significantly associated with worse PFS (HR 1.74, 95% CI 1.02-2.98, p = 0.04). However, there was no statistically significant association with OS (HR 1.83, 95% CI 0.94-3.56, p = 0.08). CONCLUSIONS AND CLINICAL IMPLICATIONS: This phase 2 randomized study failed to demonstrate improved PFS in men with de novo M1 PCa treated with BST with the addition of local therapy to their primary tumor. Its effect on OS is being tested in an ongoing phase 3 trial (SWOG 1802). We identified biomarkers of potential prognostic value (CHAARTED volume status, cT3b/cT4 disease, and the AVPC-MS) that may serve to optimize therapy selection and stratification in this population, but these require further evaluation.

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KIM-1 and Circulating Tumor DNA Are Prognostic Markers for Oligometastatic Clear-cell Renal Cell Carcinoma: Development of a Multivariable Prognostic Model.

Tang C, Seo A, Sherry AD … +24 more , Yang P, Hara K, Sircar K, Genovese G, Jonasch E, Shah AY, Zurita AJ, Kovitz CA, Campbell M, Su S, Yang J, Ratzel S, Acevedo A, LaBella M, Battey CJ, Steiner C, Ascione L, Liu X, Hannan R, Shapiro DD, Choueiri TK, Tannir NM, Msaouel P, Xu W

Eur Urol · 2026 Apr · PMID 41765697 · Publisher ↗

Better tools are needed for clinical decision-making in oligometastatic clear-cell renal cell carcinoma (ccRCC). Plasma KIM-1 concentrations and circulating tumor DNA (ctDNA) were measured in a clinical trial evaluating... Better tools are needed for clinical decision-making in oligometastatic clear-cell renal cell carcinoma (ccRCC). Plasma KIM-1 concentrations and circulating tumor DNA (ctDNA) were measured in a clinical trial evaluating metastasis-directed therapy (MDT) for oligometastatic ccRCC (NCT03575611). Shorter systemic therapy-free survival (STFS) was associated with high KIM-1 at baseline (hazard ratio per log pg/ml [HR]: 2.45, 95% confidence interval [CI] 1.48-4.08; p < 0.001), the end of radiation therapy (HR 2.56, 95% CI 1.56-4.21; p < 0.001), and 3-mo follow-up (HR 3.22, 95% CI 1.91-5.43; p < 0.001). KIM-1 was also associated with progression-free survival and overall survival. In multivariable analysis, both KIM-1 and ctDNA molecular residual disease status were independently associated with STFS when measured at baseline (KIM-1: HR 1.91, 95% CI 1.03-3.55; p = 0.041; ctDNA: HR 2.47, 95% CI 1.08-5.64; p = 0.03) and 3-mo follow-up (KIM-1: HR 2.22, 95% CI 1.09-4.51; p = 0.03; ctDNA: HR 2.70, 95%CI 1.09-6.67; p = 0.03). After elastic net-informed selection, Weibull regression fitted with four clinical variables plus baseline KIM-1 and ctDNA yielded a prognostic model (K-COMPASS) for STFS that demonstrated favorable discrimination (C index 0.76) and calibration. In conclusion, plasma KIM-1 and ctDNA were independently associated with patient outcomes across time points, and their prognostic value further improved with the addition of clinical variables.

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Re: Soluble MAdCAM-1 as a Biomarker in Metastatic Renal Cell Carcinoma.

Li Y, Liu Y, Lu B … +5 more , Yao Y, Lyu D, Zhang H, Cui X, Pan X

Eur Urol · 2026 Jun · PMID 41748389 · Publisher ↗

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Re: Presence of Intracellular Bacterial Communities in Uroepithelial Cells, a Potential Reservoir in Symptomatic and Non-symptomatic People.

Chai TC

Eur Urol · 2026 Jul · PMID 41748388 · Publisher ↗

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Re: Durvalumab in combination with BCG for BCG-naive, high risk, non-muscle-invasive bladder cancer (POTOMAC): final analysis of a randomised, open-label, phase 3 trial.

Clark PE

Eur Urol · 2026 Jul · PMID 41748387 · Publisher ↗

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Re: Maxime Pattou, Elliot Tokarski, Chris Bangma, et al. Introducing the Sustainable Urology Recommendations Score: Weighing Environmental Impact Within Urological Guidelines. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2025.10.019.

Seizilles de Mazancourt E, Kassir J, Kaulanjan K

Eur Urol · 2026 Feb · PMID 41741296 · Publisher ↗

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Less Is More? How Much Bacillus Calmette-Guérin (BCG) Is Enough for BCG-naïve High-risk Non-muscle invasive Bladder Cancer?

Nusbaum DJ, Li R, Peyton CC … +1 more , Spiess PE

Eur Urol · 2026 May · PMID 41741295 · Publisher ↗

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Re: Faisal S. BinHumaid, Anshita Goel, Naheema S. Gordon, et al. Circulating Tumour DNA Positivity Predicts Shorter Survival for Patients with High-grade pT1 Urothelial Bladder Carcinoma. Eur Urol. 2026;89:381-383.

Gabriel PE, Sfakianos JP, Xylinas E

Eur Urol · 2026 Jun · PMID 41741294 · Publisher ↗

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Re: Twelve-month Results from the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-grade Non-muscle-invasive Bladder Cancer.

Liu P, Chen J, Zhou J

Eur Urol · 2026 Jul · PMID 41741293 · Publisher ↗

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Re: Active Monitoring, Surgery, and Radiotherapy for Cribriform-positive and Cribriform-negative Prostate Cancer: A Secondary Analysis of the PROTECT Randomized Clinical Trial.

Bratt O, Egevad L

Eur Urol · 2026 Jun · PMID 41735149 · Publisher ↗

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Optimal Management of Muscle-invasive Bladder Cancer: Recommendations from the International Bladder Cancer Group.

Gupta S, Li R, Hensley PJ … +18 more , Daneshmand S, Faltas BM, Grivas P, Lobo N, Mir MC, Meeks JJ, Mouw KW, Moschini M, Necchi A, Oualla K, Pohar KS, Rosenberg JE, Schmidt B, Siefker-Radtke AO, Steinberg GD, Stenzl A, Buckley RJ, Kamat AM

Eur Urol · 2026 Jun · PMID 41724648 · Publisher ↗

BACKGROUND AND OBJECTIVE: The management of muscle-invasive bladder cancer (MIBC) is evolving rapidly with the emergence of new perioperative treatments and approaches for bladder preservation. We provide guidance on cli... BACKGROUND AND OBJECTIVE: The management of muscle-invasive bladder cancer (MIBC) is evolving rapidly with the emergence of new perioperative treatments and approaches for bladder preservation. We provide guidance on clinical staging and optimal therapeutic sequencing for patients with MIBC in clinical practice and within the context of clinical trial design. METHODS: The International Bladder Cancer Group (IBCG) convened global experts in bladder cancer to develop recommendations for the management of MIBC and to guide clinical trial design. Working groups reviewed the literature and developed draft recommendations. This was followed by voting by the IBCG members during a live meeting in August 2024 using a modified Delphi process. Recommendations achieving ≥75% agreement during the meeting were further refined and presented. KEY FINDINGS AND LIMITATIONS: The IBCG recommends thorough clinical staging and multidisciplinary care for patients with MIBC. Contemporary retrospective comparisons suggest that radical cystectomy (RC) and trimodal therapy have similar oncologic efficacy. Patients with pure squamous-cell carcinoma or adenocarcinoma are best managed with upfront RC, while cisplatin-based neoadjuvant therapy before RC is recommended for other histologic subtypes. Risk-stratified adjuvant therapy approaches should be used after RC. There are no currently validated predictive biomarkers to guide clinical decision-making in MIBC outside the context of a clinical trial. The IBCG recommends the use of time-to-event endpoints for perioperative therapy trials, and bladder-intact event-free survival for bladder preservation trials, with an emphasis on incorporating patient-reported quality-of-life endpoints. CONCLUSIONS AND CLINICAL IMPLICATIONS: The IBCG consensus recommendations provide practical guidance on optimal treatment sequencing strategies in the management of MIBC.

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Targeted Prostate Cancer Screening in Carriers of BRCA1 or BRCA2 Pathogenic Germline Variants Detects Clinically Relevant Disease: 5-year Results from the IMPACT Study.

Bancroft EK, Page EC, McHugh J … +117 more , Thomas S, Taylor N, Pope J, Evans DG, Rothwell J, Grindedal EM, Maehle L, James P, McKinley J, Mascarenhas L, Side L, Thomas T, van Leerdam ME, van Asperen CJ, Kiemeney LALM, Ringelberg J, Vlaming M, Rønlund K, Osther PJS, Helfand BT, Hutten CG, Oldenburg RA, Cybulski C, Wokolorczyk D, Ong KR, Huber C, Salinas M, Feliubadaló L, Oosterwijk JC, van Zelst-Stams WAG, Cook J, Rosario DJ, Maxwell K, Powers J, Buys S, Lyman J, Ausems MGEM, Schmutzler RK, Rhiem K, Izatt L, Tripathi V, Teixeira MR, Cardoso M, Foulkes WD, Aprikian A, Davidson R, Longmuir M, Ruijs MWG, Blom EW, van Engelen K, Williams R, Andrews L, Murphy DG, Saya S, Halliday D, Walker L, Liljegren A, Carlsson S, Azzabi A, Jobson I, Snape K, Gowie M, Harris M, Tischkowitz M, Taylor A, Kirk J, Susman R, Chen-Shtoyerman R, Spigelman A, Pachter N, Ahmed M, Cajal TRY, Krajc M, Cleaver R, Cruellas M, Perez-Ballestero E, Brady AF, Gallagher D, Donaldson A, Barwell J, Nicolai N, Friedman E, Hall MJ, Greenhalgh L, Murthy V, Copakova L, McGrath JS, Cooke P, Arun B, Myhill K, Hogben M, Hussain S, Aaronson NK, Ardern-Jones A, Bangma CH, Castro E, Dearnaley D, Eccles DM, Tricker K, Falconer A, Gronberg H, Hamdy FC, Khoo V, Lilja H, Lindeman GJ, Lubinski J, Axcrona K, Mikropoulos C, Mitra A, Offman J, Rennert G, Suri M, Dudderidge T, IMPACT Study Collaborators, Brook MN, Kote-Jarai Z, Eeles RA

Eur Urol · 2026 May · PMID 41714267 · Publisher ↗

BACKGROUND AND OBJECTIVE: BRCA1 and BRCA2 pathogenic germline variants (PGVs) are associated with higher risk of prostate cancer (PC). The IMPACT study evaluated the utility of targeted prostate-specific antigen (PSA) sc... BACKGROUND AND OBJECTIVE: BRCA1 and BRCA2 pathogenic germline variants (PGVs) are associated with higher risk of prostate cancer (PC). The IMPACT study evaluated the utility of targeted prostate-specific antigen (PSA) screening in BRCA1/BRCA2 PGV carriers. Here we report outcomes after five rounds of PSA screening in IMPACT. METHODS: Between 2005 and 2015, 3063 participants aged 40-69 yr (median 54 yr) were recruited from 65 centres in 20 countries in two cohorts: (1) BRCA1/BRCA2 PGV carriers (915 BRCA1, 901 BRCA2); and (2) age-matched noncarriers for a familial PGV (727 BRCA1 and 520 BRCA2 noncarriers). Annual PSA screening was performed, with PSA >3.0 ng/ml used as the indication for prostate biopsy. Our aim was to identify differences by PGV status in (1) the incidence of PC and of clinically significant PC (csPC; grade group ≥2) and (2) tumour stage and characteristics after five screening rounds. KEY FINDINGS AND LIMITATIONS: There was no statistically significant difference in PC incidence between BRCA1/BRCA2 PGV carriers and noncarriers. csPC incidence was significantly higher for BRCA2 PGV carriers than for noncarriers (3.1% vs 1.3%; p = 0.04). Among men with PC, the proportion of tumours with National Comprehensive Cancer Network intermediate unfavourable/high risk was higher in the BRCA1/BRCA2 PGV groups versus the corresponding group without PGVs (BRCA2: 65% vs 32%, p = 0.029; BRCA1: 56% vs 18%, p = 0.0017). There were no T4 or metastatic PC cases. Pathology after radical prostatectomy revealed tumour upgrading for 7/23 (26%) BRCA1 PGV carriers and 10/34 (26%) BRCA2 PGV carriers, with no tumour upgrading for men without PGVs. Study limitations include the biopsy compliance rate and changes in PC diagnostic pathways since 2005. CONCLUSIONS AND CLINICAL IMPLICATIONS: Annual PSA screening in BRCA2 PGV carriers confirmed a higher incidence of csPC and detection of clinically relevant tumours in comparison to noncarriers. For the first time, we confirm that PSA screening in BRCA1 PGV carriers results in early detection of NCCN IR-U/HR PC. Systematic PSA screening is recommended for BRCA2 PGV carriers and should be considered for BRCA1 PGV carriers.

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European Urology[JOURNAL]

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