Flores JM, Vertosick E, Jenkins LC, et al. Do phosphodiesterase type 5 inhibitors increase the risk of biochemical recurrence after radical prostatectomy?. J Urol. 2024;211(3):400-406. doi:10.1097/JU.0000000000003823

Special thanks to Drs Halsie Donaldson and Mahmoud Mima at the University of Illinois at Chicago.

Let’s face it, regaining sexual function after prostate cancer surgery can feel like a whole new battle, and many patients turn to phosphodiesterase type 5 inhibitors for help. But do these pills have a hidden impact on fueling the cancer’s return? This very question has left both patients and urologists looking for answers. To clear the air, researchers took a deep dive into the records of about 4600 men who had undergone radical prostatectomy. Survey responses revealed that 9 out of every 10 of these patients used phosphodiesterase type 5 inhibitors at some point during the first 12 months after surgery. The big question was whether those who took the pills were more likely to see their cancer return. After looking closely at around 770 men who did experience a recurrence, the researchers found a reassuring answer. There was no association found between medication use and biochemical cancer recurrence at 12 months or 24 months. There was also no association between quantity of medication used and biochemical recurrence. In addition, there was no association between length of exposure to the medication during the first year and biochemical recurrence. This study provides reassurance that the desire to improve erectile function does not have to come at the cost of increased cancer risk.

Sterling J, Simhan J, Flynn BJ, et al. Multi-institutional outcomes of dorsal onlay buccal mucosal graft urethroplasty in patients with postpros tatectomy, postradiation anastomotic stenosis. J Urol. 2024;211(4):596-604. doi:10.1097/JU.0000000000003848

Special thanks to Drs Jose Quesada Olarte and Omer Acar at the University of Illinois at Chicago.

Urologists know well that prostate cancer is the second-most frequent cause of cancer-related death in men and that radical prostatectomy and radiation therapy, either alone or in combination, are the most widely used treatment options. They serve well in survival rates but do often lead to urinary complications with functional implications. Postprostatectomy incontinence and vesicourethral anastomotic stenosis are difficult to treat, especially in patients with a history of radiotherapy. Attempts to repair postradiation anastomotic stenosis with endoscopic approaches are nearly always ineffective with a high rate of recurrence, and excisional urethroplasty techniques have high rates of incontinence. This multi-institutional retrospective case series included 45 irradiated men after prostatectomy who underwent dorsal onlay buccal mucosal graft urethroplasty for nonobliterative anastomotic or bulbous-membranous urethral stenosis. Results were impressive with an 84% luminal patency rate and no incidents of de novo stress urinary incontinence at a median follow-up of 21 months. The authors attributed the high success rate to a dorsal approach to nontransecting urethroplasty with buccal graft onlay and highlighted the benefits of avoiding ventral dissection and transection of the bulbar vessels as well as sparing functionally critical structures such as the striated muscle of the rhabdosphincter and cavernous nerves. This approach also eliminates the need for morbid ancillary procedures such as pubectomy or crural splitting and rerouting. The technical nuances described in this study show great potential to achieve durable outcomes with urethroplasty in postradiotherapy and postprostatectomy nonobliterative posterior urethral stenosis.

Mannas MP, Deng FM, Ion-Margineanu A, et al. Stimulated Raman histology interpretation by artificial intelligence provides near-real-time pathologic feedback for unprocessed prostate biopsies. J Urol. 2024;211(3):384-391. doi:10.1097/JU.0000000000003811

Special thanks to Drs Gabriel van de Walle and Daniel Garvey at the University of Illinois at Chicago.

Your patient has a highly suspicious prostate lesion on MRI, but the targeted prostate biopsy samples you obtained are negative or indeterminate. You enter a Sisyphean contemplation: “Did I miss the lesion or is this a true negative?” This is a situation most urologists have experienced. But what if there were an innovation that could prevent this?

This study investigates a technique called stimulated Raman histology, which generates detailed microscopic images of prostate tissue without needing to section or dye it, meaning the tissue is preserved. The authors trained an artificial intelligence system to read and interpret these images and identify cancer in about 1 minute. That’s faster than brewing your morning coffee! Additionally, they showed that the system was more than 95% accurate and mirrored the consensus of their genitourinary pathologists reviewing traditional pathology slides.

Imagine performing that targeted biopsy on your patient and knowing in as little as 1 minute whether cancer was identified. As a result, this may reduce the risk of false-negative targeted biopsies and could guide biopsy intensity. But the possibilities don’t end in the office: this could help optimize oncologic outcomes by enabling real-time tissue evaluation to identify margins during both focal ablative procedures and radical prostatectomy. While the authors do note that the current iteration of the system does not accurately assess tumor grade, this is something it could likely eventually be trained to do.

This combination of a new imaging technique and artificial intelligence trained to spot cancer isn’t just a cool gimmick. It could change the game when it comes to how we diagnose and treat prostate cancer, making the process quicker, more efficient, and less stressful for everyone involved. Exciting stuff, if you ask me!