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Articles

Overall, 71% of patients had no fragment greater than 2 mm following treatment.

BWL plus ultrasonic propulsion shows safety, efficacy for small renal stones

“We are witnessing the dawn of teletreatment,” says Jihad Kaouk, MD, FACS. 

Urologists perform first remote robot-assisted HIFU for prostate cancer

Two recent Clinical Forum discussions sought to examine how emerging therapeutic options and evolving treatment standards in non–muscle invasive bladder cancer affect clinical practices and patient outcomes.

NMIBC Clinical Forums highlight novel therapies and treatment strategies

Three recent expert-led Clinical Forums explored current challenges and advancements in the management of non–muscle invasive bladder cancer.

Exploring new avenues in non–muscle invasive bladder cancer treatment

The prostate cancer section is a comprehensive resource for urology news and expert insights. Read more at Urology Times.

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Clinical Focus

Leonard G. Gomella, MD, FACS; Maha Hussain, MD, FACP, FASCO; Daniel P. Petrylak, MD

18th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies

, discusses the need to increase diversity in clinical trials, specifically focusing on studies in prostate cancer. He also highlights the recent Northwestern-led course, “Enhancing Recruitment of Ethnic Minorities in Cancer Clinical Trials,” which took place on February 16, 2024. Murphy is a urologist at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

During the discussion, Murphy provides some advice for researchers looking to increase diversity in their trials. He also references a study in which 64% of Black patients indicated that they would be willing to discuss clinical trials in prostate cancer, compared with 82% of White patients.

 While there is a difference, Murphy notes that the percentage of more than half of Black patients being willing to discuss clinical trials is not insignificant, and the data supports the idea of clinicians continuing to make the ask to their patients in order to help increase diversity in prostate cancer trials.

Murphy ends the discussion by sharing some of his thoughts on future work building on the Northwestern-led course, such as a session focused on mock recruitments with patients who have previously enrolled in clinical trials.

Don’t forget to subscribe to Speaking of Urology® on 

, or anywhere that podcasts are available.

1. Senft N, Hamel LM, Manning MA, et al. Willingness to discuss clinical trials among Black vs White men with prostate cancer. 

. 2020;6(11):1773-1777. doi:10.1001/jamaoncol.2020.3697

In this podcast episode, Adam B. Murphy, MD, MBA, MSCI, discusses the need to increase diversity in clinical trials, specifically focusing on studies in prostate cancer.

Dr. Murphy on increasing diversity in cancer clinical trials 

On an episode of Cleveland Clinic’s Cancer Advances podcast, host Dale Shepard, MD, PhD, talked with Zeyad Schwen, MD, about the use of focal therapy to treat patients with localized prostate cancer.

Schwen, who is a urologic oncologist at Cleveland Clinic, covers these topics:

The difference between traditional treatments and focal therapies

Factors that make a patient a good candidate for focal therapy

Focal procedures, including Nanoknife, high-intensity focused ultrasound and cryotherapy

Clinical trials devoted to focal therapies

Zeyad Schwen, MD, a urologic oncologist at Cleveland Clinic, discusses how patient factors and cancer characteristics are key to deciding between focal therapies and whole gland treatment for prostate cancer. 

Dr. Schwen on focal therapies for prostate cancer

In this episode of Speaking of Urology®, 

, discuss precision medicine and the use of biomarker tests in prostate cancer screening and detection. Albala is the chief of urology at Crouse Hospital in Syracuse, New York, and Punnen is an associate professor of urologic oncology and an associate professor and vice chair of research at the Desai Sethi Urology Institute at the University of Miami in Florida.

This discussion originally took place during a live X (formerly Twitter) Spaces event held by Urology Times. In this exclusive interview, Albala and Punnen discussed the significance of advances such as liquid biopsies in prostate cancer, reviewed the current liquid biopsy tests available, and shared their own clinical experiences with the tests in their practice. They also highlighted data on the ExoDx prostate test from studies of clinical utility and validation studies.

Albala and Punnen ended their discussion by highlighting current education gaps surrounding the use of biomarker tests in practice and their predictions for the future of precision medicine.

In this episode, David M. Albala, MD, and Sanoj Punnen, MD, discuss precision medicine and the use of biomarker tests in prostate cancer screening and detection.

Speaking of Urology: Liquid biopsy in prostate cancer 

 (NCT04384770), which compared Magnetic Resonance Imaging-guided stereotactic body radiotherapy with Computed Tomography-guided stereotactic body radiotherapy in localized prostate cancer. Kishan is an associate professor of radiation oncology and urology and the chief of genitourinary oncology for radiation oncology at University of California, Los Angeles. 

Don’t forget to subscribe to Speaking of Urology

Amar Kishan, MD, highlights findings showing that MRI-guided SBRT is superior to CT-guided SBRT in localized prostate cancer.

Dr. Kishan highlights findings from the MIRAGE trial in prostate cancer

® spoke with Dr. Aaron Laviana, who discusses decisional regret in patients with prostate cancer. Laviana is an assistant professor of surgery and perioperative care and a courtesy faculty member of the department of oncology at The University of Texas at Austin Dell Medical School.

“Localized prostate cancer is a very complicated disease space,” says Aaron A. Laviana, MD, MBA.

Dr. Laviana on decisional regret after prostate cancer treatment

®Assistant Editor Janelle Hart spoke with 

. She discusses the findings of a recent 

 study, “Representation in Online Prostate Cancer Content Lacks Racial and Ethnic Diversity: Implications for Black and Latinx Men.” More specifically, she explains how these findings emphasize the need for content creators to focus more on equity, diversity, and inclusion when it comes to online medical literature. Loeb is a professor in the departments of urology and population health at the NYU Grossman School of Medicine in New York City, New York.

“The current landscape of online materials about prostate cancer is generally pretty bleak,” says Stacy Loeb, MD, PhD, MSc.

Study finds lack of Black and Latinx representation in online prostate cancer literature

® Assistant Editor Janelle Hart spoke with 

 She discusses the role that high-intensity focused ultrasound (HIFU) has played among other minimally invasive and robotic technologies to mitigate the side effects and complications of treatment for prostate cancer, compared toe other treatment options. Linehan is an associate professor of urology and urologic oncology at the John Wayne Cancer Institute in Santa Monica, California.

“It's really become the epicenter of all the surgeries that we do in urology,” says Jennifer Linehan, MD.

Emerging HIFU technology shows promise in men with prostate cancer

 He discusses how even though there are stigmas surrounding active surveillance, a lot of research actually suggests that this form of care is preferred in patients with prostate cancer. Therefore, he emphasizes that this treatment method should be counseled accordingly by clinicians. Ehdaie is a urologic surgeon at the Memorial Sloan Kettering Cancer Center, New York City, New York.

“It doesn't need to be surgery or radiation. Setting that stage, really focusing on those conversations, using the appropriate tools that we've grasped from behavioral psychologists that are being used by negotiation specialists, are critical in medicine,” says Behfar Ehdaie, MD, MPH.

Destigmatizing Urology: Dr. Ehdaie discusses active surveillance

. She discusses the benefits of plant-based diets given the promising findings of the prospective study, “Association of plant-based diet index with prostate cancer risk,” published recently in the 

. Loeb is a professor in the departments of urology and population health at the NYU Grossman School of Medicine, New York City, New York.

“We find that consuming more healthy, plant-based foods is associated with a lower risk of aggressive and lethal prostate cancer, and has many other health benefits, too,” says Stacy Loeb, MD, PhD, MSc.

Dr. Loeb on the association between plant-based diets and prostate cancer risk

 He discusses how his new technology, The PrecisionPoint Transperineal Access System, is used for detecting prostate cancer in patients. Matthew J. Allaway, MD, is the founder and president of Perinealogic and a urologist and managing partner at Urology Associates, Cumberland, Maryland.

“We need to do a better job sampling the prostate,” says Matthew J. Allaway, MD.

Dr. Allaway on the increased efficiency of transperineal biopsies

The first patient in the trial will be receiving 67Cu-SAR-bisPSMA in combination with enzalutamide.

Dose expansion begins in phase 1/2 trial of 67Cu-SAR-bisPSMA in mCRPC

"The goal of the PRECISION study is to ensure that treatment with 3 radiation doses does not lead to greater side effects than those observed in the PACE-B study," says Professor Duncan B. McLaren, MBBS. 

Study underway to assess 3-fraction SBRT regimen in prostate cancer

"Building on decades of research into the genetic markers of prostate cancer, our study shows that the theory does work in practice—we can identify men at risk of aggressive cancers who need further tests and spare the men who are at lower risk from unnecessary treatments," says professor Ros Eeles. 

Polygenic risk score may identify more clinically significant PCa than PSA, MRI

"This finding reinforces PROSTOX ultra as a true measure of the biological response to radiation, independent of treatment era or technique that can identify the safest course of treatment to avoid toxicity," says Amar U. Kishan, MD. 

Genetic test can predict risk of toxicity following radiation for prostate cancer

Data from the phase 3 TALAPRO-2 trial (NCT03395197) showed that the combination of enzalutamide (Xtandi) plus talazoparib (Talzenna) led to a statistically significant and clinically meaningful improvement in overall survival (OS) vs enzalutamide alone in patients with metastatic castration-resistant prostate cancer (mCRPC).

2025 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium

, shared the key take-home messages for urologists based on data from this trial.

“TALAPRO-2 is the first PARP inhibitor plus ARPI combination study to show a statistically significant and a clinically meaningful improvement in overall survival vs an active control of enzalutamide in our patients with metastatic CRPC,” he stated. “The benefit was present [in the] all-comer patient population, as well as [in] patients who were selected for [the] presence of HRR gene mutations.”

Agarwal is professor of medicine and the director of the genitourinary oncology program at the Huntsman Cancer Institute of the University of Utah in Salt Lake City.

Neeraj Agarwal, MD, FASCO, shared the key take-home messages for urologists based on data from TALAPRO-2.

Neeraj Agarwal, MD, shares key takeaways from TALAPRO-2

Specifically, data from the trial showed a median OS of 45.8 months (95% CI, 39.4 to 50.8) in the combination arm vs 37.0 months (95% CI, 34.1 to 40.4) in the enzalutamide monotherapy arm (HR, 0.796; 95% CI, 0.661 to 0.958; 2-sided

= .0155). OS favored the combination among patients who were HRR-deficient (n = 169; HR, 0.549; 95% CI, 0.364 to 0.826; 

= .0035) and among those who were HRR–non-deficient/unknown (n = 636; HR, 0.878; 95% CI, 0.713 to 1.080; 

Additionally, the median radiographic progression-free survival among all patients was 33.1 months in the combination arm vs 19.5 months in the enzalutamide monotherapy arm (HR, 0.667; 95% CI, 0.551 to 0.807; 

Based on these findings, Agarwal concluded, “These data support the use of talazoparib plus enzalutamide as a standard of care initial treatment option for our patients with mCRPC. I really hope this option is brought up during the discussion we have with our patients when they are starting treatment with enzalutamide.”

1. Agarwal N, Azad A, Carles J, et al. Final overall survival (OS) with talazoparib (TALA) + enzalutamide (ENZA) as first-line treatment in unselected patients with metastatic castration-resistant prostate cancer (mCRPC) in the phase 3 TALAPRO-2 trial. Presented at: 2025 American Society of Clinical Oncology Genitourinary Cancers Symposium. San Francisco, California. February 13-15, 2025. Abstract LBA18

Videos

Enzalutamide plus talazoparib significantly extended overall survival vs enzalutamide alone in mCRPC.

The 40th Annual European Association of Urology Congress in Madrid, Spain, featured an extensive scientific program. In a recent video for 

, Betty Wang, MD, provided insight on 3 presentations that she believes “may be game changing” in urology.

The first study Wang highlighted was “Micro-ultrasound-guided versus MRI-guided biopsy for prostate cancer diagnosis: The OPTIMUM randomized clinical trial.”

“OPTIMUM was an international randomized study that compared micro-ultrasound guided vs MRI-guided biopsy for prostate cancer diagnosis,” explained Wang, a Society of Urologic Oncology fellow at Cleveland Clinic in Cleveland, Ohio.

“The authors noted that OPTIMUM demonstrated [that] micro ultrasound is non inferior to MRI fusion biopsy for detecting clinically significant prostate cancer and established itself as an appealing alternative to MRI for image guided biopsy. This would mean having a single procedure for both imaging and biopsy, and that could potentially be less expensive without using IV contrast, which is currently needed for multi-parametric MRIs,” Wang said.

The second study she highlighted was “Surgical outcomes and neoadjuvant safety with perioperative durvalumab for muscle-invasive bladder cancer (NIAGARA).”

 Previously reported data from the NIAGARA trial showed that perioperative durvalumab (Imfinzi) plus neoadjuvant chemotherapy extended event-free survival and overall survival vs neoadjuvant chemotherapy alone in muscle-invasive bladder cancer (MIBC).

 The FDA recently approved this treatment regimen for adult patients with MIBC.

At EAU, Wang said, investigators presented data on “the perioperative safety of durvalumab.”

“One of the main takeaways from this presentation was that durvalumab had no significant impact on the patient's ability to undergo surgery. In fact, if you look at the divide between the 2 arms, the addition of durvalumab actually increased the percentage of patients who underwent radical cystectomy from 83% (the chemo arm), compared to 88% (the chemo plus durvalumab arm). So if anything, it did not reduce the number of patients that could get their surgery in terms of cystectomy timing,” Wang said.

Betty Wang, MD, provided insight on 3 presentations that she believes “may be game changing” in urology.

Betty Wang, MD, recaps 3 key urologic cancer studies from EAU 2025

The final study Wang discussed was “AURORAX-0087A: Urine Glycosaminoglycan Scores for Surveillance of Recurrence in Intermediate and High-risk Non-metastatic Clear Cell Renal Cell Carcinoma - An Observational Prospective Multicenter Diagnostic Test Cohort Study.”

“This study demonstrates that urine GAGome scores can be a promising biomarker for clear cell RCC [renal cell carcinoma] recurrence. It has a 97% negative predictive value, meaning a negative test can almost definitely rule out a recurrence. In terms of clinical impact, this could potentially reduce unnecessary imaging costs and radiation exposure to the patient,” Wang said.

1. Kinnaird A, Luger F, Cash H, et al. Micro-ultrasound-guided versus MRI-guided biopsy for prostate cancer diagnosis: The OPTIMUM randomized clinical trial. Presented at: 40th Annual European Association of Urology Congress. March 21-24, 2025. Madrid, Spain

2. Catto JWF, Al-Ahmadie H, van der Heijden MS, et al. Surgical outcomes and neoadjuvant safety with perioperative durvalumab for muscle-invasive bladder cancer (NIAGARA) Presented at: 40th Annual European Association of Urology Congress. March 21-24, 2025. Madrid, Spain

3. Powles T, Catto JWF, Galsky MD. Perioperative durvalumab with neoadjuvant chemotherapy in operable bladder cancer. 

. 2024;391:1773-1786. doi:10.1056/NEJMoa2408154

4. FDA approves durvalumab for muscle invasive bladder cancer. News release. US Food & Drug Administration. Published online and accessed March 28, 2025. 

https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-durvalumab-muscle-invasive-bladder-cancer

5. Dabestani S. AURORAX-0087A: Urine Glycosaminoglycan Scores for Surveillance of Recurrence in Intermediate and High-risk Non-metastatic Clear Cell Renal Cell Carcinoma - An Observational Prospective Multicenter Diagnostic Test Cohort Study. Presented at: 40th Annual European Association of Urology Congress. March 21-24, 2025. Madrid, Spain

Betty Wang, MD, provides insight on 3 presentations that she believes “may be game changing” in urology.

These data were recently presented at the 

, shared key safety data from the trial. Agarwal is professor of medicine and the director of the genitourinary oncology program at the Huntsman Cancer Institute of the University of Utah in Salt Lake City.

Neeraj Agarwal, MD, FACS, shares key safety data from the TALAPRO-2 trial. 

Neeraj Agarwal, MD, on the safety profile of talazoparib/enzalutamide in mCRPC

Agarwal began his discussion by highlight adverse events of special interest, namely myelodysplastic syndrome (MDS) and acute myeloid leukemia.

He explained, “We reported previously in 2023 1 case of MDS and 1 case of acute leukemia. I'm happy to report that we didn't find any more cases at the time of data cutoff for this presentation. So, after 4 years of follow up, we are not seeing any more cases of MDS and leukemia.”

Overall, treatment-emergent adverse events (TEAEs) were generally manageable. In total, 22% of patients discontinued the study due to TEAEs.

The most common grade 3 or higher TEAEs were anemia (49%) and neutropenia (19%). According to Agarwal, the median time to onset of grade 3/4 anemia was 3.3 months, and 8.5% of patients discontinued talazoparib due to anemia.

Agarwal added, “That tells me that we should not be preemptively reducing the dose for all our patients, because half of the patients will never develop grade 3/4 anemia.”

1. Agarwal N, Azad A, Carles J, et al. Final overall survival (OS) with talazoparib (TALA) + enzalutamide (ENZA) as first-line treatment in unselected patients with metastatic castration-resistant prostate cancer (mCRPC) in the phase 3 TALAPRO-2 trial. J Clin Oncol 43, 2025 (suppl 5; abstr LBA18). doi:10.1200/JCO.2025.43.5_suppl.LBA18

"We should not be preemptively reducing the dose for all our patients, because half of the patients will never develop grade 3/4 anemia," says Neeraj Agarwal, MD, FASCO. 

, shares the background and key findings from the study, “Real-world persistence and adherence to relugolix (REL) in US patients with nonmetastatic (nm) vs metastatic (m) prostate cancer (PC).”

Overall, data from the real-world study showed that adherence to treatment was high among patients who persisted on relugolix.

"We demonstrate that patients with metastatic disease stayed on therapy longer—a median of 9 months vs 7 months for the non-metastatic patients," says Rana R. McKay, MD, FASCO. 

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