Bhojani N, Wollin DA, El Tayeb MM, et al. Prospective multicenter evaluation of pain before and after removal of nonobstructing renal calculi: a CoRE initiative. J Urol. 2024;211(3):436-444.

Special thanks to Drs Grace Chen and Mahmoud Mima at the University of Illinois at Chicago.

How many of us have counseled patients presenting with flank pain in the setting of nonobstructing small renal stones that their pain may not improve with treatment because obstruction is the usual culprit for stone pain? This multicenter study involving 11 urology departments across the US and Canada presents compelling evidence that for such patients, surgical treatment may not be such a far-fetched idea after all. The prospective observational trial included 43 individuals with moderate to severe flank pain and nonobstructing small renal stones under 10 mm, all of whom were treated surgically and had their pain and quality of life measured with 3 validated questionnaires over the next 12 weeks. Astoundingly, the vast majority of patients reported at least some tangible alleviation of their pain, with nearly 70% of patients having their pain cut in half. Here at last is empirical evidence that renal colic symptoms in the setting of nonobstructing small stones can be significantly mitigated with surgery. It may be time to change the way we counsel and treat such patients: rather than reluctantly booking these patients with the mindset that their pain is either unrelated to their stones or unlikely to resolve with surgical removal, we now have data to support providing patients with a more optimistic outlook on treatment outcomes.

Mistry NA, Sun Z, Sweis J, et al. Development and validation of a prostate biopsy risk calculator in Black men. J Urol. 2024;211(2):223-233.

Special thanks to Drs Juan Ramon Torres and Simone Crivellaro at the University of Illinois at Chicago.

These researchers focused on improving prostate cancer diagnosis in developing a risk calculator designed specifically for Black men, a population that is typically underrepresented in these types of instruments. The current general-use calculators likely do not adequately reflect the risks for this demographic, leading to inaccuracies in screening and treatment options.

Their research drew from the heart of Chicago with volunteers in 2 cohorts undergoing prostate biopsies. A cohort served for building and training 3 models and the other for external validation. The first model included serum PSA and prior negative biopsy. The second added abnormal digital rectal exam, and the third added prostate volume and age. They assessed their models with C-statistics, also known as concordance statistics or C-indices, and represent the receiver operating characteristic curve area under the curve for logistic regression–type models. For a C-statistic, the worst outcome is 0.5 and a perfect one is 1.0. The investigators reported C-statistics of 0.74, 0.74, and 0.78 for these models, which were similar to or higher than existing calculators. And in the lower-risk thresholds, their models had the fewest unnecessary biopsies.

This is a step forward, a piece of a larger puzzle. With each iteration, the potential grows to sharpen precision in prostate cancer detection for Black men and ultimately revolutionize how we approach diagnosis across the board. It’s research like this that paves the way for a new era of inclusive, personalized medicine.

Mian BM, Feustel PJ, Aziz A, et al. Complications following transrectal and transperineal prostate biopsy: results of the ProBE-PC randomized clinical trial. J Urol. 2024;211(2):205-213.

Special thanks to Drs Graham Hale and Ikenna Madueke at the University of Illinois at Chicago.

Recently, transperineal prostate biopsy has been promoted as reducing infectious complications while also avoiding prophylactic antibiotics when compared to the transrectal approach. However, high-quality comparative studies have been lacking until now.

These investigators reported results from the first prospective, randomized, single-center trial directly comparing 30-day composite complication rates between transperineal and transrectal prostate biopsy in over 700 men from 2019 to 2022. Composite infectious complication rates were 2.6% and 2.7% for the transperineal and transrectal biopsy approaches, respectively, and noninfectious complication rates were 2.2% and 1.7%. Fever and additional antibiotics were the 2 most frequent infectious complications, while phone calls and doctor visits were the 2 most frequent noninfectious complications in both groups. No cases of sepsis or surgical interventions were reported in either group. Baseline patient characteristics were comparable between both groups considering age, race, PSA, prostate volume, family history, clinical stage, and prebiopsy MRI PI-RADS (Prostate Imaging Reporting and Data System) scores.

The reported infection rates between the 2 approaches are similar, but transperineal biopsy avoided prebiopsy antibiotics in all but 2 patients, suggesting that transperineal biopsy is superior in this respect. Given the challenging trends of increasing antibiotic resistance and the frequency of prostate biopsies, transitioning to a transperineal approach to avoid antibiotics warrants real consideration.