Kaplan-Marans E, Zhang TR, Hu JC. Oncologic outcomes of testosterone therapy for men on active surveillance for prostate cancer: a population-based analysis. Eur Urol Open Sci. 2024;60:36-43. doi:10.1016/j.euros.2024.01.005

Special thanks to Drs Mary Rostom and Rodrigo Pagani at the University of Miami.

We urologists have long held the belief that the use of testosterone replacement therapy in patients with prostate cancer is dangerous. Patients with prostate cancer and hypoandrogenism suffer symptoms from the latter, but most clinicians avoid prescribing testosterone for fear of compromising cancer control. These investigators retrospectively compared oncological outcomes of about 170 prostate cancer patients in the Surveillance, Epidemiology, and End Results database under active surveillance who opted to proceed with testosterone therapy to over 6600 men who didn’t have it. The results? There was no significant difference between progression to active treatment between those treated with testosterone and those who were not. There were also no prostate cancer–specific deaths in the men prescribed testosterone compared to a bit under 1% in those without, the caveat, of course, being that there were over 2 magnitudes more subjects in the latter group. The strongest predictor of the switch to active treatment was a higher PSA at diagnosis.

These results are promising and support the concept that testosterone receptors in the prostate are already saturated at physiological levels. As the population of patients under active surveillance continues to increase, these findings are important, as the mainstay of active surveillance is the preservation of quality of life.

Mian BM, Feustel PJ, Aziz A, Kaufman RP Jr, Bernstein A, Fisher HAG. Clinically significant prostate cancer detection following transrectal and transperineal biopsy: results of the prostate biopsy efficacy and complications randomized clinical trial. J Urol. 2024;212(1):21-31. doi:10.1097/JU.0000000000003979

Special thanks to Drs John Smith and Daniel Garvey at the University of Illinois at Chicago.

With the increasing number of transperineal prostate biopsies performed, questions about the effectiveness of detecting clinically significant prostate cancer compared to traditional transrectal prostate biopsies have arisen. Are transperineal prostate biopsies superior or at least as effective at detecting prostate cancer as transrectal prostate biopsies? This is the question the authors sought to answer.

They investigated this question with a randomized clinical trial of 840 men undergoing either a transrectal or a transperineal prostate biopsy. Clinically significant prostate cancer detection rates were equivalent between the 2 groups. Similarly, the detection rates between transperineal and transrectal prostate biopsies were similar when performed in an MRI-targeted fashion. A big question was whether anterior prostate lesions seen on MRI affected detection rates differently between the 2 groups, but this was found to be similar for both biopsy approaches.

Expert recommendations recently have favored the transperineal approach based on several observational studies pointing toward a potentially higher detection rate of clinically significant prostate cancer, especially in anterior lesions, despite little level 1 evidence being available. This randomized trial indicates that both transrectal and transperineal prostate biopsy methods are equally effective in detecting clinically significant prostate cancer. Given these findings, we can be comfortable as urologists in choosing the procedure based on the patient’s needs outweighing which method of prostate biopsy is used.

Chen Q, Sun X, Guo L, Lin H. Noncystoscopic removal of double-J stent in women: feasibility and safety. Urology. 2024;184:40-44. doi:10.1016/j.urology.2023.11.022

Special thanks to Drs Luca Morgantini and Mahmoud Mima at the University of Illinois at Chicago.

Medical device companies are in an arms race to develop the best cystoscope. What if the best option for a simple procedure were an inexpensive feeding tube and suture instead? Traditionally, the removal of double-J stents has required the use of cystoscopy. This is an invasive procedure that, while effective, is often associated with patient discomfort and requires sterile instruments. A new technique, previously tested in pediatric patients, offers an alternative that could significantly improve patient experience and reduce health care costs.

The study involved women who were randomly assigned to undergo either cystoscopic or noncystoscopic stent removal. The noncystoscopic method employed a simple snare device made from a feeding tube and a monofilament suture lasso. What makes this study noteworthy is the significant advantages of the noncystoscopic method: patients underwent this procedure in one-third the time and for a fraction of the cost. The success rate was impressively high, with minimal complications reported.

This approach is more than just a technical triviality. It represents a significant shift in how we approach patient care in urology. By minimizing the invasiveness of a common procedure, we can lessen patient discomfort and psychological stress. Valuable medical resources are conserved, and waste is reduced, aligning with broader health care sustainability goals.

We often assume routine procedures are set in stone. This study proves otherwise. The introduction of a noncystoscopic double-J stent removal marks a promising step forward. It demonstrates how simple yet innovative solutions can lead to better patient care and more efficient use of medical resources.