Therapeutic Advances in Urology最新文献

{"title":"Micro-ultrasound versus mpMRI for targeted prostate biopsy: A systematic review, meta-analysis, and clinical integration.","authors":"Huseyin Besiroglu, Mustafa Erkoc, Suleyman Sami Cakir, Yasar Pazir, Mustafa Kadihasanoglu","doi":"10.1177/17562872261476755","DOIUrl":"10.1177/17562872261476755","url":null,"abstract":"<p><strong>Background: </strong>In the era of precision prostate cancer diagnostics, the role of emerging imaging modalities requires redefinition within integrated diagnostic pathways. Micro-ultrasound (mUS) has emerged as a potential alternative to multiparametric magnetic resonance imaging (mpMRI) for targeted prostate biopsy; however, comparative evidence remains methodologically heterogeneous.</p><p><strong>Objectives: </strong>We aimed to re-evaluate the comparative detection performance of mUS versus mpMRI-targeted biopsy for clinically significant prostate cancer (csPCa), with particular attention to contemporary evidence and study design considerations.</p><p><strong>Design: </strong>Systematic review with meta-analysis.</p><p><strong>Data sources and methods: </strong>A systematic review of PubMed/MEDLINE, Web of Science, ScienceDirect, and the Cochrane databases was conducted up to February 28, 2026, in accordance with the PRISMA guidelines to identify studies comparing mUS- and mpMRI-targeted prostate biopsies. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The primary outcome was the pooled detection ratio (DR) for csPCa, defined as the ratio of detection rates between mUS- and mpMRI-targeted biopsy.</p><p><strong>Results: </strong>Fifteen studies comprising 2,512 patients were included. mUS-targeted biopsy detected csPCa in 654/2181 participants, compared to 691/2391 with mpMRI-targeted biopsy. The pooled DR for csPCa detection was 1.06 (95% CI 0.97-1.15; p=0.20), indicating no significant difference between modalities. Similarly, detection of clinically insignificant prostate cancer did not differ significantly (DR 0.89, 95% CI 0.72-1.10; p=0.28). Across studies, heterogeneity in design and potential within-patient correlations were identified as important contextual factors influencing interpretation. The inclusion of the OPTIMUM randomized trial provided complementary evidence from independently assigned diagnostic pathways, supporting the overall consistency of findings.</p><p><strong>Conclusion: </strong>No statistically significant difference was observed between mUS-targeted and mpMRI-targeted biopsies in the detection of clinically significant prostate cancer. Beyond a binary comparison, these findings support a shift toward integrated diagnostic pathways in which mUS may serve as a complementary or alternative tool depending on the clinical context. Further prospective and methodologically robust studies are needed to refine its role in precision prostate cancer diagnostics.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261476755"},"PeriodicalIF":3.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted third kidney transplantation in a patient with exhausted iliac fossae: A case report.","authors":"Jianxin Cui, Jiantao Wang, Jitao Wu, Chengjun Zhang, Haijian Wei, Xiaohua Fu, Chen Zhang, Zhengfei Shan, Shengqiang Yu","doi":"10.1177/17562872261476756","DOIUrl":"10.1177/17562872261476756","url":null,"abstract":"<p><p>Third kidney transplantation is rare and technically challenging because of exhausted iliac fossae, dense adhesions, and increased vascular risks. Robot-assisted kidney transplantation (RAKT) has emerged as a minimally invasive alternative, although its role in complex retransplantation remains uncertain. We report a 41-year-old man with two failed deceased-donor kidney transplants who underwent robot-assisted third kidney transplantation using the da Vinci Xi system. Vascular anastomoses were performed under continuous intra-abdominal hypothermic perfusion, and uretero-ureterostomy was selected because severe pelvic adhesions precluded bladder reconstruction. Immediate graft function was achieved, with serum creatinine decreasing to 62 μmol/L on postoperative day 2 and remaining stable thereafter. This case demonstrates that robot-assisted third kidney transplantation is feasible in carefully selected patients and suggests that robotic techniques may expand surgical options for complex kidney retransplantation.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261476756"},"PeriodicalIF":3.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal bladder cuff management in radical nephroureterectomy: A multicenter retrospective cohort study comparing one-position excision versus ureteral pluck technique.","authors":"Jia Li, Yajun Song, Yiqiang Huang, Dong Xu, Jinhui Lu, Yixin Tang, Chao Ma, Zhou Yang, Junpu Mo, Yu Guo, Hengxin Yan, Yonghao Jiang, Weihua Lan, Ji Zheng, Zhenqiang Fang","doi":"10.1177/17562872261474954","DOIUrl":"10.1177/17562872261474954","url":null,"abstract":"<p><strong>Background: </strong>Given the complexity of radical nephroureterectomy (RNU), simplifying the procedure is particularly important.</p><p><strong>Objective: </strong>To compare perioperative and oncological outcomes, this study evaluated a novel one-position bladder cuff resection (nRNU) against the conventional ureteral pluck technique (UPT) for distal ureter excision in RNU, a procedure traditionally requiring patient repositioning.</p><p><strong>Design: </strong>A multicenter retrospective cohort study comparing two approaches to bladder cuff management.</p><p><strong>Methods: </strong>This study evaluated patients with upper urinary tract urothelial carcinoma (UTUC) who underwent laparoscopic RNU between January 2015 and November 2024. Participants were stratified into two groups: a nRNU group and a UPT group. Data on baseline characteristics, perioperative outcomes, and oncological results were collected.</p><p><strong>Results: </strong>In this study, 169 patients were enrolled according to predefined inclusion and exclusion criteria, of whom 135 underwent nRNU and 34 underwent UPT. Baseline demographic and clinicopathological characteristics were well balanced between the two groups. Perioperative outcomes indicated significantly shorter operative time and reduced postoperative hospital stay in the nRNU group compared with the UPT group (operative time: 207.74 ± 50.29 min vs 256.91 ± 60.17 min, p < 0.001; postoperative hospital stay: 6 [5, 7] days vs 13.5 [12, 16] days, p < 0.001). Regarding oncological outcomes, the nRNU group exhibited a lower rate of bladder tumour recurrence than the UPT group (p = 0.006). No significant between-group difference was observed in the incidence of distant metastasis.</p><p><strong>Conclusion and registration: </strong>Our findings suggest that the novel one-position approach to RNU is associated with an accelerated postoperative recovery process, as evidenced by reduced duration of hospitalisation and a lower incidence of subsequent bladder tumour recurrence.This study, as part of the novel one-position RNU series, have been registered with the Chinese Clinical Trial Registry (registration No. ChiCTR2400090932).</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261474954"},"PeriodicalIF":3.5,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor re: Predictors of poor kidney function in patients with emphysematous pyelonephritis: A retrospective observational study: Choudhary et al.","authors":"Meral Çeker, Gökhan Çeker","doi":"10.1177/17562872261476771","DOIUrl":"10.1177/17562872261476771","url":null,"abstract":"","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261476771"},"PeriodicalIF":3.5,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging MRI to reduce overtreatment in low‑grade prostate cancer: a retrospective single‑centre cohort study.","authors":"Katarzyna Skrobisz, Kevin Miszewski, Bartłomiej Marczak, Laura Miszewska, Jakub Kulski, Marcin Matuszewski","doi":"10.1177/17562872261463095","DOIUrl":"10.1177/17562872261463095","url":null,"abstract":"<p><strong>Background: </strong>Prostate cancer is one of the most common malignancies in men worldwide. Radical prostatectomy is an effective curative treatment, but a noticeable number of men are ultimately found to have clinically insignificant disease, such as a Gleason score of 3 plus 3, on final histopathology. This suggests that some patients may undergo unnecessary surgery. The widespread adoption of multiparametric MRI has improved tumour detection and targeted biopsy accuracy, yet its potential role in preventing overtreatment is not fully understood. Because some low-risk tumours demonstrate low conspicuity on MRI, we hypothesised that specific MRI features, particularly low lesion conspicuity and PI-RADS 3 or lower, may be associated with final Grade Group 1 pathology in men undergoing radical prostatectomy.</p><p><strong>Objectives: </strong>The purpose of this study was to assess whether pre-operative multiparametric MRI can help identify men with potentially indolent prostate cancer and reduce unnecessary radical prostatectomies. We focused on MRI features such as PI-RADS 3 or lower, low lesion conspicuity and overall imaging quality to see how strongly they relate to final Grade Group 1 in men who were selected for surgery.</p><p><strong>Design: </strong>Retrospective single-centre cohort study.</p><p><strong>Methods: </strong>We reviewed 400 consecutive men who underwent robot-assisted radical prostatectomy for presumed clinically significant prostate cancer. Final pathology identified 13 men with Grade Group 1 disease. Pre-operative mpMRI examinations were reassessed for PI-RADS category, lesion location, lesion conspicuity and overall image quality to determine whether imaging features were associated with low-risk pathology.</p><p><strong>Results: </strong>Analyses showed that certain MRI characteristics were frequently associated with Gleason 3 plus 3 pathology. Several patients who proceeded to surgery had inconspicuous, equivocal or low probability MRI lesions such as PI-RADS 2 or 3 that lacked features typically associated with clinically significant cancer. Recognising these signatures may refine patient selection and support broader use of active surveillance.</p><p><strong>Conclusion: </strong>Assessment of MRI appearance, lesion conspicuity and PI-RADS category may improve selection for surgery and reduce overtreatment. MRI-based identification of low-grade prostate cancer could help avoid unnecessary prostatectomies and the associated morbidity while preserving oncologic safety.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261463095"},"PeriodicalIF":3.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urology for older adults: a blind spot in international guidelines?","authors":"Patrick Juliebø-Jones, Bhaskar K Somani, Stephen Baug, Sanjeev Madaan, Carlotta Palumbo, Chang Wook Jeong, Maarten Albersen, Christian Beisland","doi":"10.1177/17562872261468904","DOIUrl":"10.1177/17562872261468904","url":null,"abstract":"","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261468904"},"PeriodicalIF":3.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"YouTube as a source of patient information on robot-assisted radical prostatectomy: a cross-sectional study of quality, reliability, transparency, and content gaps.","authors":"Cem Tuğrul Gezmiş, Basri Çakıroğlu","doi":"10.1177/17562872261469665","DOIUrl":"10.1177/17562872261469665","url":null,"abstract":"<p><strong>Background: </strong>YouTube is widely used by patients seeking information about robot-assisted radical prostatectomy (RARP), but the reliability, transparency, and counseling coverage of RARP-related videos remain variable, particularly in a fragmented and search-driven digital environment.</p><p><strong>Objectives: </strong>To evaluate the quality, reliability, transparency, and patient-oriented counseling coverage of YouTube videos on RARP and identify underrepresented topics relevant to shared decision-making.</p><p><strong>Design: </strong>Cross-sectional observational study.</p><p><strong>Methods: </strong>YouTube was searched on February 16, 2026, using \"robotic radical prostatectomy,\" \"RARP prostate,\" and \"da Vinci prostatectomy\" in incognito mode. After duplicate removal and eligibility assessment, 174 videos were included. Video characteristics, uploader type, target audience, and format were recorded. Educational quality, reliability, and transparency were assessed using the Global Quality Scale (GQS), modified DISCERN, and <i>Journal of the American Medical Association</i> (JAMA) benchmark criteria. Counseling-related coverage was assessed using a 15-item RARP-specific checklist designed to evaluate key patient-centered domains rather than stand-alone adequacy. Non-parametric tests and Spearman correlations were used.</p><p><strong>Results: </strong>Among 174 videos, 93.7% targeted patients. Median duration was 3.09 min (interquartile range (IQR), 1.92-5.91), and median view count was 1658 (IQR, 371-9747). Educational quality and reliability were low to moderate (median GQS 2 (IQR, 2-3); modified DISCERN 2 (IQR, 2-3)). Transparency was limited (median JAMA 2 (IQR, 1-2)), with only 10.9% achieving JAMA ⩾3. Clinically important counseling topics were frequently underrepresented, including postoperative prostate-specific antigen follow-up (84.5%), complications/complication rates (55.2%), erectile dysfunction (40.8%), urinary continence outcomes (39.7%), and recovery timeline (31.6%). Transparency differed by uploader type (<i>p</i> < 0.001), whereas quality and counseling coverage did not differ by uploader source. Popularity metrics showed no meaningful correlation with GQS.</p><p><strong>Conclusion: </strong>YouTube provides accessible and highly searchable information on RARP; however, the reliability, transparency, and coverage of key counseling-related topics vary considerably across videos. While short-form or highly specialized content may help address specific patient questions, important topics related to complications, functional outcomes, and postoperative follow-up are frequently underrepresented. Development of patient-centered and platform-adapted educational frameworks may improve the balance, transparency, and practical value of YouTube-based patient education in RARP.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261469665"},"PeriodicalIF":3.5,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An innovative predictive scoring system for assessing stone-free rate of lower caliceal stones after flexible ureteroscopic lithotripsy: a retrospective cohort study.","authors":"Deheng Cui, Guoqiang Chen, Qinghong Ma, Liefu Ye, Zesong Yang","doi":"10.1177/17562872261468894","DOIUrl":"10.1177/17562872261468894","url":null,"abstract":"<p><strong>Background: </strong>Lower caliceal stones (LCS) account for 25%-36% of all renal stones. Flexible ureteroscopic lithotripsy (FURL) is first-line treatment for LCS, but its stone-free rate (SFR) is significantly affected by renal anatomy and stone characteristics. Currently, there is a lack of specific, convenient scoring systems for predicting SFR of LCS after FURL.</p><p><strong>Objectives: </strong>To assess the factors influencing the SFR of LCS after FURL, and establish a practical, convenient, and accurate scoring system.</p><p><strong>Design: </strong>A single-center retrospective cohort study.</p><p><strong>Methods: </strong>A total of 149 patients who underwent FURL between September 2020 and December 2022 were divided into two groups based on the results of NCCT of the kidney performed 1 month after surgery: Group A (stone clearance group) with 112 patients and Group B (residual stone group) with 37 patients. Variables with <i>p</i> values less than 0.1 from univariate analysis were incorporated into binary unconditional multivariate logistic regression analysis. The degree of correlation was assessed based on the odds ratio of independent risk factors. The optimal cutoff value for the early warning scoring system was determined using the Youden index.</p><p><strong>Results: </strong>According to binary unconditional multivariate logistic regression analysis, stone length (<i>p</i> = 0.003), stone CT value (<i>p</i> = 0.043), infundibulopelvic angle (IPA; <i>p</i> = 0.031), infundibular width (IW; <i>p</i> = 0.043), calyceal pelvic height (CPH; <i>p</i> = 0.006), and renal pelvis morphology (<i>p</i> = 0.036) were identified as independent risk factors. Each factor was assigned one point based on OR values, resulting in a total score of six points. The area under the ROC curve was 0.859, and the cutoff value was 1.5. Internal validation was performed via bootstrap resampling (1000 iterations). The optimism-corrected AUC was 0.842 (95% CI: 0.797-0.913). When the total score was less than 2, the overall SFR was 96.20%; however, when the total score was ⩾2, this rate significantly decreased to 49.32%.</p><p><strong>Conclusion: </strong>Stone length, stone CT value, renal pelvis shape, IPA, IW, and CPH were identified as independent factors influencing the SFR of LCS after FURL. Each factor was assigned a score of 1, resulting in a prediction scoring system with a total score of six points. A total score exceeding two was associated with a significantly reduced SFR. FURL was strongly recommended for scores of 0-1, used with caution for scores of 2-3, and not routinely recommended for scores 4-6.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261468894"},"PeriodicalIF":3.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacral neurostimulation of penile erection: advancing intraoperative neurophysiological monitoring during pelvic surgeries-a narrative review.","authors":"Arthur L Burnett","doi":"10.1177/17562872261468106","DOIUrl":"10.1177/17562872261468106","url":null,"abstract":"<p><p>Demand has increased in recent years to develop and implement strategic approaches for improving functional outcomes following pelvic surgery. Intraoperative neurophysiological monitoring represents one such possible approach for this field. It involves generating neuronal activity within the nerve supply of pelvic organs and structures, conventionally using an external electrical current, and conjunctively recording neuronally mediated functional responses, which then, in real time, guides the surgical dissection in a manner that maximizes nerve preservation. A central aspect of this methodology is the creation of a neuronal stimulus. As such, sacral neurostimulation is proposed, strategically exploiting the neuroregulatory influence of the sacral spinal cord in pelvic physiology. While resembling sacral neuromodulation, a distinct methodology designed for long-term reprogramming of neural circuits, sacral neurostimulation aims to produce more immediate nerve signaling effects. Several technical options in this mode of neurostimulation are described, in which stimulatory electrodes are applied transspinally or peripherally to the neural pathways of the sacral spinal cord. These options can be categorized as surgical, percutaneous, and transcutaneous techniques. Ongoing studies in this field may reveal the most applicable techniques and optimal parameters for inducing erections and other neuronally mediated functional responses in the pelvic region as well. In turn, sacral neurostimulation may contribute toward applying neurophysiological monitoring during pelvic surgeries as a potential advance for improving postoperative functional outcomes. This narrative review serves to present the novelty of sacral neurostimulation for intraoperative induction of penile erection and its possible use in intraoperative neurophysiological monitoring for pelvic surgery.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261468106"},"PeriodicalIF":3.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world comparative outcomes of darolutamide- versus abiraterone-based triplet therapy for metastatic hormone-sensitive prostate cancer: a retrospective cohort study.","authors":"I-Hsuan Alan Chen, Ren-In Chang, Chia-Cheng Yu, Tzu-Ping Lin, Chih-Yu Yang","doi":"10.1177/17562872261463076","DOIUrl":"10.1177/17562872261463076","url":null,"abstract":"<p><strong>Background: </strong>Triplet therapy with androgen deprivation therapy (ADT), docetaxel, and androgen receptor pathway inhibitors (ARPIs), either darolutamide or abiraterone, is one of the standard treatments for metastatic hormone-sensitive prostate cancer (mHSPC); however, no randomized trial has directly compared both ARPIs within this regimen. Given practical and financial constraints, a head-to-head randomized trial directly comparing these ARPIs may be unlikely.</p><p><strong>Objective: </strong>To compare the real-world effectiveness of darolutamide- versus abiraterone-based triplet therapy in patients with mHSPC.</p><p><strong>Design: </strong>Retrospective cohort study using a multinational electronic health record network.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX research network. Patients with mHSPC treated with darolutamide- or abiraterone-based triplet therapy were identified and balanced using propensity-score matching. The primary outcome was overall survival (OS), and the secondary outcome was time to next treatment (TTNT), defined by treatment switch. Prespecified subgroup analyses focused on age, cardiometabolic comorbidities, and polypharmacy-related medication use.</p><p><strong>Results: </strong>Among 1607 eligible patients, 1252 were included after propensity score matching (626 per group). Darolutamide-based triplet therapy was associated with longer OS compared with abiraterone (hazard ratio (HR) 0.42). A favorable difference in TTNT was also observed (HR 0.66). These associations were consistent across clinically relevant subgroups, including patients aged ⩾65 years and those with ischemic heart disease or diabetes mellitus. In polypharmacy-enriched subgroups, darolutamide-based therapy was consistently associated with more favorable OS and TTNT.</p><p><strong>Conclusion: </strong>In this large real-world analysis, darolutamide-based triplet therapy was associated with longer OS and TTNT compared with abiraterone-based triplet therapy in patients with mHSPC, particularly among older individuals and those with comorbidities. These findings are hypothesis-generating, suggesting that ARPI selection within triplet therapy may have clinically relevant implications, supporting the need for prospective studies.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261463076"},"PeriodicalIF":3.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13332278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}