Editor’s Note: The following is from the May 2025 issue of The Journal of Urology^®. Visit The Journal of Urology Current Issue page to access these articles. Reprinted with permission from Siemens DR. Editor’s Choice. J Urol. 2025;213(5):545-546. doi:10.1097/JU.0000000000004470

Improving Adherence to Guideline Concordant Evaluation of Microscopic Hematuria: A Randomized Trial

The management of asymptomatic microscopic hematuria (MH) presents a conundrum given its high prevalence yet relatively low association with urological cancers. The result has been low-value interventions for many, while at the same time, delays in timely evaluation for those at higher risk. Matulewicz et al,¹ in this issue of The Journal of Urology®, evaluated whether an electronic health record–integrated clinical decision support (CDS) tool improved adherence to AUA guideline–concordant evaluations for high-risk MH. In a cluster-randomized trial across multiple sites, an automated CDS alert recommending imaging and cystoscopy was triggered for those in the intervention arm. While the alert correctly triggered in 83% of cases, there was no significant improvement in the completion of full evaluations between intervention and control groups (which were remarkably low). However, the intervention group had a higher likelihood of having a CT urogram ordered. The authors conclude that while the CDS tool was feasible and effectively deployed, further investigation is needed to address barriers to improving adherence to MH guidelines. 

A Randomized Trial of 3D-Printed Models for Surgical Planning  

3D imaging is essential for planning of complex surgical procedures,² and 3D printing can transform these digital images into a hands-on experience to aid in tactile and spatial understanding of the anatomy. For the first time, Rivero-Belenchón et al³ from Spain test its potential perioperative benefits for radical nephrectomy with caval thrombus in a randomized trial. The authors found that while surgical time and hospital stay were similar between groups, patients in the 3D group had significantly fewer complications and required ICU care less frequently. Notably, severe complications were much more common in the conventional imaging group. This would seem to be a scalable solution, at least for those centers that routinely tackle these procedures, to help preoperative simulation and team communication with the aim of decreasing major complications of this complex surgery. 

Validation of Prostate Cancer Biomarkers in Contemporary Practice 

To attain our goals of optimal prostate cancer early detection, finding life-threatening cancer while avoiding unnecessary biopsies, or a diagnosis of low-risk disease, contemporary practice seems to have dramatically shifted to the use of novel imaging such as multiparametric MRI and microultrasound.⁴ However, in many jurisdictions, such enhanced imaging remains a limited resource so the use of other blood-based and urine-based biomarkers, beyond PSA and other clinical variables, remains an important adjunctive tool. In this issue of The Journal, 2 studies present important validation of such biomarkers in the present-day practice. 

First, Tosoian et al⁵ validate the 18-gene MyProstateScore 2.0 (MPS2) test using first-catch, non–digital rectal examination urine for detecting clinically significant prostate cancer (Grade Group ≥2). Compared with PSA and the Prostate Cancer Prevention Trial risk calculator, MPS2 demonstrated superior predictive performance. Using MPS2, a significant number of biopsies could be avoided while maintaining high sensitivity for detecting significant cancer compared with the clinical data only in the risk calculators. The authors conclude that non–digital rectal examination MPS2 testing offers a convenient and accurate alternative to reduce imaging and biopsy needs in men with elevated PSA. 

Second, a multicenter study by Lazarovich et al⁶ externally validated the Stockholm 3 test for detecting clinically significant prostate cancer (Grade Group ≥2) in a diverse population and compared its performance with PSA derivatives and risk calculators. Among 2115 men undergoing biopsy, Stockholm 3 demonstrated superior discrimination compared with free/total PSA, PSA density, and multiple risk calculators. Decision curve analysis confirmed its higher net benefit, with the potential to reduce unnecessary biopsies by 44% while maintaining 95% sensitivity. The authors conclude that Stockholm 3 outperforms many existing tools for prostate cancer risk assessment in a diverse population of men. 

1. Matulewicz RS, Tsuruo S, King WC, et al. Efficacy of a clinical decision support tool to promote guideline-concordant evaluations in patients with high-risk microscopic hematuria: a cluster randomized quality improvement project. J Urol. 2025;213(5):558-567. doi:10.1097/JU.0000000000004436
2. Shirk JD, Reiter R, Wallen EM, et al. Effect of 3-dimensional, virtual reality models for surgical planning of robotic prostatectomy on trifecta outcomes: a randomized clinical trial. J Urol. 2022;208(3):618-625. doi:10.1097/JU. 0000000000002719
3. Rivero-Belenchón I, Congregado Ruíz C, Gomez CG, Gomez Dos Santos V, Burgos RF, Medina LR. Impact of 3D-printed models for surgical planning in renal cell carcinoma with venous tumor thrombus: a randomized multicenter clinical trial. J Urol. 2025;213(5):568-580. doi:10.1097/JU.0000000000004425
4. Nandalur KR, Shen C, Zhao L, et al. Association of baseline magnetic resonance imaging Prostate Imaging Reporting and Data System score with prostate cancer active surveillance early biopsy reclassification: data from the Michigan Urological Surgery Improvement Collaborative (MUSIC). J Urol. 2024;212(4):571-579. doi:10.1097/JU.0000000000004117
5. Tosoian JJ, Zhang Y, Meyers JI, et al. Clinical validation of MyProstateScore 2.0 testing using first-catch, non–digital rectal examination urine. J Urol. 2025;213(5):581-589. doi:10.1097/JU.0000000000004421
6. Lazarovich A, Vigneswaran H, Palsdottir T. A comparison of Stockholm3, serum biomarkers, and risk calculators to predict prostate cancer in a racially and ethnically diverse cohort: evaluation of the Stockholm3 multiethnic SEPTA trial. J Urol. 2025;213(5):590-599. doi:10.1097/JU.0000000000004437