Benjamin J Croll, Hafiz A Yahya, Jordan Fredette, Abigail Keller, Rainjade Chung, Shuanzeng Wei, Douglas Flieder, Fern Anari, Pooja Ghatalia, Elizabeth R Plimack, Matthew R Zibelman, Andres Correa, Alexander Kutikov, Randall Lee, Marc Smaldone, Robert Uzzo, Rosalia Viterbo, David Y T Chen, Daniel M Geynisman
{"title":"Feasibility and Characterization of Immune-related Pathologic Response Criteria in Renal Cell Carcinoma.","authors":"Benjamin J Croll, Hafiz A Yahya, Jordan Fredette, Abigail Keller, Rainjade Chung, Shuanzeng Wei, Douglas Flieder, Fern Anari, Pooja Ghatalia, Elizabeth R Plimack, Matthew R Zibelman, Andres Correa, Alexander Kutikov, Randall Lee, Marc Smaldone, Robert Uzzo, Rosalia Viterbo, David Y T Chen, Daniel M Geynisman","doi":"10.1016/j.euo.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.euo.2026.08.007","url":null,"abstract":"<p><p>Pathologic assessment of treatment response in renal cell carcinoma (RCC) after systemic combination therapy is increasingly relevant, yet traditional reporting methods fail to capture unique immune-mediated changes, and a lack of standardized reporting recommendations has led to discordant clinical trial definitions. We evaluated the feasibility and implementation of immune-related pathologic response criteria (irPRC), recently endorsed by the International Neoadjuvant Kidney Cancer Consortium, in a retrospective cohort of 35 patients (37 tumors). Application of irPRC was feasible in all cases and identified major pathologic response in 35% of the tumors. Tumor bed evaluation based on irPRC components revealed substantial heterogeneity, highlighting the limitations of relying on tumor fraction alone. All patients (N = 11) experiencing recurrence within 6 mo of surgery exhibited necrosis-predominant tumor beds and a complete absence of tissue repair features, suggesting an area for additional research. In addition, radiographic response correlated poorly with pathologic findings; nearly one-third of major pathologic responders lacked significant radiographic improvement. These findings support the feasibility of irPRC in RCC and underscore the limitations of current radiographic and traditional pathologic response assessments. Broader adoption of standardized immune-related pathologic response frameworks may improve consistency in reporting and better reflect underlying tumor biology in clinical research.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christoph Nössing, Isabella Prantl, Reinhard Grausenburger, Iris E Ertl, Ursula Lemberger, Paula Herek, Luis Rupp, Agata Suleja, Oliver Baumfried, Jule Schrimpf, Christine Pirker, Anna Koren, Stefan Kubicek, Eva Compérat, Markus Eckstein, Walter Berger, Shahrokh F Shariat, Bernhard Englinger
{"title":"Gemcitabine-Cisplatin Chemotherapy Induces Nectin-4 Downregulation and Enfortumab Vedotin Resistance in Bladder Cancer.","authors":"Christoph Nössing, Isabella Prantl, Reinhard Grausenburger, Iris E Ertl, Ursula Lemberger, Paula Herek, Luis Rupp, Agata Suleja, Oliver Baumfried, Jule Schrimpf, Christine Pirker, Anna Koren, Stefan Kubicek, Eva Compérat, Markus Eckstein, Walter Berger, Shahrokh F Shariat, Bernhard Englinger","doi":"10.1016/j.euo.2026.08.003","DOIUrl":"https://doi.org/10.1016/j.euo.2026.08.003","url":null,"abstract":"<p><p>Antibody-drug conjugates (ADCs), particularly enfortumab vedotin (EV) in combination with pembrolizumab, have emerged as transformative treatments for advanced bladder cancer (BC). However, platinum-based chemotherapy, especially gemcitabine-cisplatin (GC), remains a widely used, first-line standard globally. This study investigated the impact of GC-therapy on subsequent ADC responsiveness. Using novel, patient-derived BC models, in vitro selection for acquired GC-resistance consistently resulted in downregulation of the EV target, Nectin-4, and corresponding EV cross-resistance in GC-resistant (GC/R) cells. This decrease in membranous Nectin-4 expression was validated in two independent human BC cohorts: (1) matched transurethral resections and radical cystectomy/lymph node specimens during neoadjuvant therapy and (2) primary tumors and distant metastases during adjuvant GC chemotherapy. Transcriptomic profiling indicated that GC-resistance and Nectin-4 downregulation were linked to a transcriptional shift toward an epithelial-to-mesenchymal transition (EMT)-like phenotype. Large-scale drug screening and transcriptomic data highlighted potential vulnerabilities in GC/R cells, notably associated with the transforming growth factor beta (TGF-beta) signaling pathway. These findings suggest that platinum-based chemotherapy may promote EMT-like transcriptional reprogramming in BC, associated with Nectin-4 loss and EV resistance. As such, assessing membranous Nectin-4 expression prior to EV therapy might be particularly relevant in postplatinum settings. Additionally, identifying alternative, chemotherapy-induced druggable vulnerabilities can inform more effective treatment strategies.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Transdermal Estradiol for Treating Prostate Cancer: Revisiting Huggins and Hodges' Revolutionary Breakthrough.","authors":"David J Benjamin, Arash Rezazadeh Kalebasty","doi":"10.1016/j.euo.2026.08.011","DOIUrl":"https://doi.org/10.1016/j.euo.2026.08.011","url":null,"abstract":"<p><p>Androgen deprivation therapy remains the cornerstone of treating prostate cancer and is now available in multiple formulations based on several randomized phase 3 trials. The estradiol patch offers numerous potential advantages, including fewer hot flashes, less adverse impact on bone health, and less financial toxicity.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reply to Francesco Di Bello, Andrea Gallioli, Joan Palou, and Alberto Breda's Letter to the Editor re: Roberto Contieri, Marco Paciotti, Alessandro Uleri et al. Second Transurethral Resection of Bladder Tumor Can Be Safely Omitted in Selected Patients with T1 Non-muscle-invasive Bladder Cancer: Results from the Prospective HuNIRe Trial. Eur Urol Oncol 2026;9:404-12.","authors":"Roberto Contieri, Rodolfo Hurle","doi":"10.1016/j.euo.2026.08.010","DOIUrl":"10.1016/j.euo.2026.08.010","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alfonso Santangelo, Wooju Jeong, Carlo Silvani, Alex Stephens, Emanuele Montanari, Nicola Nicolai, Alberto Briganti, Francesco Montorsi, Craig Rogers, Mani Menon, Firas Abdollah
{"title":"Long-term Oncological Outcomes of Retzius-sparing Versus Anterior Robot-assisted Radical Prostatectomy: Post Hoc Analysis of a Randomized Cohort.","authors":"Alfonso Santangelo, Wooju Jeong, Carlo Silvani, Alex Stephens, Emanuele Montanari, Nicola Nicolai, Alberto Briganti, Francesco Montorsi, Craig Rogers, Mani Menon, Firas Abdollah","doi":"10.1016/j.euo.2026.07.012","DOIUrl":"10.1016/j.euo.2026.07.012","url":null,"abstract":"<p><strong>Background and objective: </strong>The Retzius-sparing (RS) robot-assisted radical prostatectomy (RARP) was proposed in 2010 to enhance early postoperative continence recovery. However, long-term oncological outcomes following this approach remain insufficiently characterized. This study reports the long-term oncological outcomes of a randomized controlled trial originally designed to compare early continence recovery in patients treated using the RS versus standard (anterior) approach.</p><p><strong>Design, setting, participatns and intervention: </strong>A total of 120 men aged 40-75 yr with low- to intermediate-risk prostate cancer underwent RARP at a tertiary referral center. Patients were randomized 1:1 to the anterior or RS approach (n = 60 per arm).</p><p><strong>Outcome measurements and statistical analysis: </strong>The primary end point was progression-free survival (PFS), defined as biochemical recurrence and/or the need for any additional treatment. Kaplan-Meier plots were used to depict and compare PFS between the approaches. Cox regression was used to examine the impact of the approach on PFS after adjusting for the Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) scores.</p><p><strong>Results and limitations: </strong>Median follow-up was 77 mo (interquartile range 30-110). At 5 yr, PFS was 80.2% in the RS group versus 91.1% in the anterior group (p = 0.01). After adjusting for CAPRA-S score, patients undergoing the RS approach were 2.64-fold more likely to experience progression (p = 0.049). The main limitations of this study stem from its original design, which did not consider long-term oncological outcomes as a primary end point, and from surgeons' limited prior experience with the RS approach.</p><p><strong>Conclusions: </strong>Although RS RARP provides superior early continence outcomes, patients randomized to this approach experienced less favorable long-term oncological control, potentially because of the increased technical demands of the procedure.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luc Delobel, Arnauld Villers, Denis Seguier, Philippe Puech, Xavier Leroy, Emeline Cailliau, Jonathan Olivier
{"title":"Long-term Prediction of Metastatic Recurrence in Patients Candidate to Radical Prostatectomy Using MRI and Targeted Biopsy: Insights into Tumor Zonal Origin.","authors":"Luc Delobel, Arnauld Villers, Denis Seguier, Philippe Puech, Xavier Leroy, Emeline Cailliau, Jonathan Olivier","doi":"10.1016/j.euo.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.euo.2026.08.009","url":null,"abstract":"<p><p>Prostate cancer recurrence after radical prostatectomy (RP) is primarily driven by tumor aggressiveness, but accurate long-term prediction remains challenging. We evaluated long-term oncological outcomes using magnetic resonance imaging (MRI) and targeted biopsy data in 646 patients treated with RP between 2009 and 2018, and the median follow-up for survivors was 8.3 yr. The primary end point was metastatic recurrence and the secondary end point was biochemical recurrence (BCR). Preoperative variables included MRI-derived tumor volume and quantification of Gleason pattern 4/5 (GP4/5). Tumors were classified according to zonal origin as peripheral zone (PZ) or transition zone/anterior fibromuscular stroma (TZ/AFMS). At 10 yr, metastatic recurrence occurred in 11% (95% confidence interval [CI] = 9-15), including distant metastases in 7.3% (95% CI = 5.1-10). BCR occurred in 28% (95% CI = 24-32). MRI- and biopsy-derived GP4/5 burden strongly predicted metastatic recurrence (c-index 0.82, 95% CI = 0.76-0.88) and BCR (c-index 0.73, 95% CI = 0.69-0.78). Outcomes were consistently worse for PZ compared with TZ tumors, with higher 10-yr BCR rates (32% vs 14%, p = 0.004) and numerically higher metastatic recurrence (8.2% vs 3.7%), with overlapping CIs. These findings provide long-term validation of MRI-based quantification of tumor aggressiveness to predict metastatic recurrence after RP. Although PZ tumors showed consistently worse outcomes in unadjusted analyses, zonal origin was not an independent predictor after multivariable adjustment, suggesting mediation through higher GP4/5 burden.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lee Silcock, Robert K Hastings, Samuel Clokie, Rebecca Sadler, Michael Parks, Matthew Smith, Victoria Hewitt, Jayne Louise Douglas-Moore, Helena Wignall, Hugo Escabelado, John Piedad, Sagar Kanabar, Chris Blick, Amar Mohee, Niall Pumfrey, Nadine Coull, Andy Goffe, Richard Tippett, Alexander Laird, Chandrarajan Premal Shah, Murray MacKay, Catherine Owen, Uwais Mufti, Douglas G Ward, Richard T Bryan
{"title":"Real-World Multicentre Evaluation of GALEAS Bladder for Detecting Bladder Cancer in UK NHS Haematuria Clinics.","authors":"Lee Silcock, Robert K Hastings, Samuel Clokie, Rebecca Sadler, Michael Parks, Matthew Smith, Victoria Hewitt, Jayne Louise Douglas-Moore, Helena Wignall, Hugo Escabelado, John Piedad, Sagar Kanabar, Chris Blick, Amar Mohee, Niall Pumfrey, Nadine Coull, Andy Goffe, Richard Tippett, Alexander Laird, Chandrarajan Premal Shah, Murray MacKay, Catherine Owen, Uwais Mufti, Douglas G Ward, Richard T Bryan","doi":"10.1016/j.euo.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.euo.2026.08.005","url":null,"abstract":"<p><strong>Background and objective: </strong>Cystoscopy is a core component of haematuria investigations; however, it is invasive and resource intensive. GALEAS Bladder is a DNA-based diagnostic urine test that measures mutations in 23 bladder cancer (BC)-associated genes.</p><p><strong>Objective: </strong>We aimed to assess the diagnostic performance of GALEAS Bladder in real-world patients with haematuria and its utility as a molecular triage tool in this setting.</p><p><strong>Methods: </strong>Patients referred for urgent investigation of haematuria were prospectively enrolled across seven UK National Health Service urology departments between October 2024 and June 2025. Urine samples were collected prior to cystoscopy and analysed by GALEAS Bladder. Assay results were compared with cystoscopy and biopsy/transurethral resection of bladder tumour findings.</p><p><strong>Key findings and limitations: </strong>Cystoscopic findings and GALEAS Bladder results were available for 964 participants (575 visible and 294 non-visible haematuria, 95 unknown), including 77 (8.0%) newly diagnosed with pathology-confirmed BC. The assay detected 71 of the 77 BCs, including all 17 muscle-invasive BCs and 35 of the 36 high-grade BCs, with negative predictive value >99% (95% confidence interval [CI] 98-100), positive predictive value 50% (95% CI 42-58), positive likelihood ratio (LR) 11.5, and negative LR 0.09. Decision curve analysis showed net benefit over cystoscopy for all referrals. Limitations include observational study design over a limited timeframe and absence of subsequent diagnoses for participants with positive GALEAS Bladder test results without cystoscopically visible tumour.</p><p><strong>Conclusions and clinical implications: </strong>GALEAS Bladder is a clinically implementable molecular urine test that detects new cases of BC with high negative predictive value and favourable LRs in patients undergoing urgent investigation of haematuria. These data show that GALEAS Bladder can be used now to triage patients with haematuria to immediate or deferred cystoscopy.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Giulia Carta, Lars Tögel, Miriam Angeloni, Marie Sieger, Christian Fiebig, Sven Wach, Helge Taubert, Andreas Manseck, Patrick Adam, Norbert Meidenbauer, Silvia Spoerl, Arndt Hartmann, Bernd Wullich, Florian Haller, Markus Eckstein, Fulvia Ferrazzi
{"title":"Landscape of Actionable Genetic Alterations in Advanced Urothelial Carcinoma: High Prevalence but Limited Clinical Use.","authors":"Maria Giulia Carta, Lars Tögel, Miriam Angeloni, Marie Sieger, Christian Fiebig, Sven Wach, Helge Taubert, Andreas Manseck, Patrick Adam, Norbert Meidenbauer, Silvia Spoerl, Arndt Hartmann, Bernd Wullich, Florian Haller, Markus Eckstein, Fulvia Ferrazzi","doi":"10.1016/j.euo.2026.07.001","DOIUrl":"https://doi.org/10.1016/j.euo.2026.07.001","url":null,"abstract":"<p><strong>Background and objective: </strong>The Food and Drug Administration and the European Medicine Agency approved erdafitinib for patients with FGFR3-altered metastatic urothelial carcinoma (mUC), highlighting the central role of tumor molecular profiling for patients with mUC. Although different studies described the molecular landscape of muscle-invasive bladder cancer (MIBC) using publicly-available data, a dedicated evaluation of real-world actionable alterations, with evidence-based therapeutic recommendations according to current Molecular Tumor Board (MTB) guidelines, is still lacking.</p><p><strong>Design, setting, and participants: </strong>We characterized actionable genetic alterations in a retrospective cohort of 233 patients with MIBC/mUC (Muscle-Invasive Erlangen [MIER] cohort) using targeted sequencing.</p><p><strong>Outcome measurements and statistical analysis: </strong>Clinically relevant variants were assessed through a custom bioinformatics workflow and expert medical review. To validate their clinical relevance in a real-world setting, we examined actionable alterations and associated therapy recommendations in a cohort of 40 patients with MIBC/mUC undergoing routine diagnostics (MTB cohort).</p><p><strong>Results and limitations: </strong>In the MIER cohort, 95% of patients (n = 226/233; 95% confidence interval [CI], 94-99) harbored at least one pathogenic/likely pathogenic variant. Therapeutically relevant FGFR3 alterations were identified in 11% of patients (n = 26/233; 95% CI, 7.4-16). Additionally, 40% of patients (95% CI, 34-47) showed alterations in 24 biomarkers for FDA-approved therapies. In the MTB cohort, 55% of patients received either on-label (5.0%) or off-label (50%) therapy recommendations. Notably, the recommendation was implemented in only one patient, who achieved stable disease for 4 mo with off-label alpelisib. Retrospectively, similar on-label and off-label indications could have applied to 10% and 70% of patients in the MIER cohort, respectively.</p><p><strong>Conclusions: </strong>Overall, evidence-based indications for on-label and off-label therapies were observed for the majority of patients with MIBC/mUC. However, our results also revealed a significant gap between the high prevalence of actionable findings and the actual implementation of MTB-guided treatments in clinical practice, suggesting a need for enhanced therapy access and physician adherence to MTB recommendations.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrey Soares, Silke Gillessen, Ananya Choudhury, Fred Saad, Enrique Gallardo, Yohann Loriot, Raymond S McDermott, Alejo Rodriguez-Vida, Pedro Isaacsson Velho, Franco Nolè, Felipe Melo Cruz, Thierry André Roumeguère, Gedske Daugaard, Rosely Yamamura, Coralie Poncet, Corneel Coens, Béatrice Fournier, Bertrand F Tombal
{"title":"Alkaline Phosphatase and Prostate-specific Antigen Response in Metastatic Castration-resistant Prostate Cancer Treated with Enzalutamide Alone or in Combination with Radium-223: Ad Hoc Analysis of the PEACE-3 Consortium Trial.","authors":"Andrey Soares, Silke Gillessen, Ananya Choudhury, Fred Saad, Enrique Gallardo, Yohann Loriot, Raymond S McDermott, Alejo Rodriguez-Vida, Pedro Isaacsson Velho, Franco Nolè, Felipe Melo Cruz, Thierry André Roumeguère, Gedske Daugaard, Rosely Yamamura, Coralie Poncet, Corneel Coens, Béatrice Fournier, Bertrand F Tombal","doi":"10.1016/j.euo.2026.08.001","DOIUrl":"https://doi.org/10.1016/j.euo.2026.08.001","url":null,"abstract":"<p><strong>Design, setting, and participants: </strong>Exploratory post hoc analysis of the international, randomised, open-label phase 3 PEACE-3 trial including 446 patients with asymptomatic or mildly symptomatic mCRPC and bone metastases. Overall, 441 and 436 patients were evaluable for ALP and PSA, respectively.</p><p><strong>Intervention: </strong>Enzalutamide 160 mg daily alone or combined with six-monthly injections of radium-223 (55 kBq/kg).</p><p><strong>Outcome measurements and statistical analysis: </strong>ALP response was defined as a ≥30% decline from baseline (ALP-30), and PSA response as a≥50% decline (PSA-50) or ≥90% decline (PSA-90). Confirmed responses required consecutive measurements ≥21 d apart. Time-to-event endpoints were analysed using Kaplan-Meier and Cox models.</p><p><strong>Results and limitations: </strong>At 6 months, confirmed ALP-30 response was 56.5% with the combination versus 50.8% with enzalutamide alone. Median time to confirmed ALP-30 response was 2.4 versus 3.7 months (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.12-1.78; p = 0.003), and time to ALP normalisation was 2.0 versus 4.5 months (HR 2.05, 95% CI 1.46-2.88; p < 0.001). Confirmed PSA-90 response at 6 months was 50.5% versus 34.1% (p = 0.001), with median time to confirmed PSA-90 response of 5.6 versus 22.1 months (HR 1.48, 95% CI 1.13-1.93; p = 0.004). Limitations include the exploratory post hoc design, the absence of multiplicity adjustment, and the lack of an analysis linking biomarker responses to clinical outcomes.</p><p><strong>Conclusions: </strong>Adding radium-223 to enzalutamide was associated with faster and more frequent ALP and deep PSA responses. These findings support additional antitumour activity of radium-223 when combined with enzalutamide.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Re: Paolo Gontero, Richard Perry, Daisy Bridge, et al. Unmet Treatment Need and Challenges Associated with Comparative Evidence Generation in BCG-unresponsive Non-muscle-invasive Bladder Cancer: An Expert Consensus. Eur Urol Oncol 2026;9:652-9.","authors":"Roberto Mario Scarpa","doi":"10.1016/j.euo.2026.07.022","DOIUrl":"https://doi.org/10.1016/j.euo.2026.07.022","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}