BJU International最新文献

{"title":"A novel ureteric stent coating reduces encrustation and improves tolerability in a randomised trial","authors":"Nikita Vistunov, Ionel Valentin Popeneciu, Wolfgang Kram, Oliver Hakenberg, Florian Distler, Angelika Borkowetz, Wolfgang Hitzl, Sascha Pahernik, Stefan Milerski, Clemens Hüttenbrink","doi":"10.1111/bju.70487","DOIUrl":"https://doi.org/10.1111/bju.70487","url":null,"abstract":"Objectives To evaluate the effect of a novel sulfonic acid‐coated ureteric stent on encrustation and quality of life in patients with urolithiasis. Patients and Methods A prospective, randomised, controlled trial was conducted between April 2022 and March 2025 at two urological centres in Germany. In all, 100 patients requiring ureteric stenting due to urolithiasis were randomised into intervention and control groups. All patients received identical stents (6 F/28 cm); the stent in the intervention group incorporated a novel covalent coating. Stents were removed after 30 days during secondary stone treatment, followed by the encrustation weight assessment. Symptoms associated with the ureteric stent and quality of life were evaluated using the Ureteric Stent Symptom Questionnaire 7 days after stent placement and 7 days after stent removal. Results The final analysis included 95 patients assessed for the primary endpoint. Coated stents showed a 49.7% reduction in mean encrustation weight (mean difference 22.8 mg, 95% confidence interval [CI] 2.4–43.2; <jats:italic>P</jats:italic> = 0.006). The increase in lower urinary tract symptoms was 53.8% less in the coated‐stent group (Δ3.6 [95% CI 1.3–6] vs Δ7.8 [95% CI 2.8–12.8]; <jats:italic>P</jats:italic> = 0.002). Light physical activities improved by 33.9% (mean difference 0.76, 95% CI 0.08–1.44; <jats:italic>P</jats:italic> = 0.046), and the need for antimicrobial therapy was significantly lower for coated stents (7.1% vs 31.8%, <jats:italic>P</jats:italic> = 0.02; odds ratio 6.1, 95% CI 1.11–33.1). Additionally, patients in the coated‐stent group reported significantly less fatigue and exhaustion symptoms (mean difference 0.67, 95% CI 0.02–1.32; <jats:italic>P</jats:italic> = 0.03). Conclusion The novel sulfonic acid coating demonstrated significant benefits over standard ureteric stents by reducing encrustation and improving quality of life.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"27 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long‐term outcomes of augmentation cystoplasty for neurogenic lower urinary tract dysfunction after spinal cord injury","authors":"Ioannis Tsikopoulos, Sarah Knight, Marc A. Furrer, Thomas M. Kessler, Prashant Patel, Rizwan Hamid, Julian Shah, Richard Nobrega","doi":"10.1111/bju.70464","DOIUrl":"https://doi.org/10.1111/bju.70464","url":null,"abstract":"Objective To evaluate long‐term urodynamic, clinical, and complication outcomes following augmentation cystoplasty (AC) in patients with spinal cord injury (SCI) and refractory neurogenic lower urinary tract dysfunction (NLUTD), and to assess the role of adjunctive intradetrusor onabotulinumtoxinA injections. Patients and Methods We performed a retrospective cohort study of patients with SCI undergoing AC at a tertiary referral centre between 1988 and 2018. Inclusion required refractory NLUTD with documented urodynamic abnormalities and failure of conservative and minimally invasive therapies. Pre‐ and postoperative outcomes included maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), continence status, recurrent urinary tract infections (rUTIs), vesico‐ureteric reflux (VUR), and complications. A subgroup analysis evaluated outcomes following post‐augmentation intradetrusor onabotulinumtoxinA injections. Statistical comparisons were performed using paired <jats:italic>t</jats:italic> ‐tests. Results A total of 70 patients (47 male, 23 female) were included, with a mean (range) follow‐up of 19 (5–36) years. AC resulted in significant improvements in MCC (155–490 mL; <jats:italic>P</jats:italic> &lt; 0.001) and MDP (72–19 cmH <jats:sub>2</jats:sub> O; <jats:italic>P</jats:italic> &lt; 0.001). Continence was achieved in 67% of patients, with a further 24% reporting only occasional leakage. rUTIs and antimuscarinic use decreased postoperatively, and VUR improved in most affected patients. Long‐term complications included urolithiasis in 10%, malignancy in 4% (all adenocarcinoma), and spontaneous perforation in 1.5%. In patients requiring adjunctive botulinum toxin ( <jats:italic>n</jats:italic> = 18), significant improvements in MCC and MDP were observed in selected analyses ( <jats:italic>P</jats:italic> = 0.025 and <jats:italic>P</jats:italic> = 0.009, respectively). Conclusion Augmentation cystoplasty provides durable long‐term improvements in bladder capacity, storage pressures, and continence in patients with SCI with refractory NLUTD, with sustained protection of the upper urinary tract. Although associated with notable late complications, outcomes remain favourable with structured lifelong surveillance. Adjunctive intradetrusor onabotulinumtoxinA injections offers additional benefit in a subset of patients and may optimise long‐term bladder dynamics.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"54 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active surveillance for prostate cancer: evidence interpretation and research priorities","authors":"Takeshi Takahashi","doi":"10.1111/bju.70486","DOIUrl":"https://doi.org/10.1111/bju.70486","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"9 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved survival in newly diagnosed metastatic prostate cancer: a National Prostate Cancer Audit study.","authors":"Arjun Nathan, Matthew G Parry, Emily Mayne, Adrian Cook, Justin Liu, Raghav Varma, Will Cuningham, Joanna Dodkins, Marina Parry, Julie Nossiter, Ajay Aggarwal, Jan van der Meulen, Alison Tree, Noel Clarke","doi":"10.1111/bju.70432","DOIUrl":"https://doi.org/10.1111/bju.70432","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture risk and initiation of bone‐specific drug therapy following radical cystectomy with urinary diversion","authors":"Mieke Van Hemelrijck, Lars Holmberg, Hans Garmo, Truls Gårdmark, Henrik Kjölhede, Tomas Jerlström, Karin Söderkvist, Anders Ullén, Fredrik Liedberg, Karl Michaëlsson, Christel Häggström","doi":"10.1111/bju.70472","DOIUrl":"https://doi.org/10.1111/bju.70472","url":null,"abstract":"Objectives To assess the risk of fractures among patients with bladder cancer who underwent radical cystectomy (RC) with urinary diversion (UD), compared with matched referents from the general population. Patients/Subjects and Methods We identified 2908 patients who underwent RC between 2011 and 2019, and 13 669 matched referents in a nationwide, register‐based Swedish cohort study. Outcomes were femoral fracture, any fracture, and initiation of bone‐specific drug therapy (BDT). Cumulative incidence was estimated using competing‐risk analyses, and hazard ratios (HRs) were derived from multivariable Cox models stratified by sex. Additional analyses were conducted among patients with muscle‐invasive bladder cancer treated with curative radiotherapy ( <jats:italic>n</jats:italic> = 328). Results Compared to referents, RC with UD was associated with a higher cumulative incidence of fractures. Women had an increased risk of femoral fracture (HR 1.97, 95% confidence interval [CI] 1.25–3.10) and any fracture (HR 2.06, 95% CI 1.54–2.76), while men had an increased risk of any fracture (HR 1.51, 95% CI 1.22–1.88). No association was observed for initiation of BDT in either sex. In the additional cohort, men treated with radiotherapy had an increased risk of any fracture (HR 2.14, 95% CI 1.26–3.62), whereas estimates for women were imprecise. Conclusion Patients undergoing RC with UD experienced increased fracture risks, particularly women. Additional analyses suggest that fracture risk may be influenced by factors related to both bladder cancer and its treatment, although the strongest and most consistent associations were observed following RC with UD. These findings support increased attention to bone health in these patients.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"22 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic left renal vein transposition for nutcracker syndrome: side‐clamp to tailored reconstruction","authors":"Jinbin Xu, Zifeng Xu, Zhansen Huang, Qunxiong Huang, Sam Un Cheong, Gengguo Deng, Yuedian Ye, Weihao Liu, Xiaoming Li, Jiang Li, Tengcheng Li, Jieying Wu, Jinming Di","doi":"10.1111/bju.70482","DOIUrl":"https://doi.org/10.1111/bju.70482","url":null,"abstract":"Objective Our objective was to evaluate the safety and efficacy of staged, anatomy‐tailored robot‐assisted left renal vein (LRV) transposition procedures for the treatment of nutcracker syndrome (NCS). Patients and Methods This retrospective single‐centre study (2019–2025) included 88 patients stratified by technique: conventional ( <jats:italic>n</jats:italic> = 27), robotic side‐clamp two‐step ( <jats:italic>n</jats:italic> = 21), LRV‐proximal left gonadal vein (LGV) transposition ( <jats:italic>n</jats:italic> = 20), and LRV‐distal LGV transposition ( <jats:italic>n</jats:italic> = 20). The primary outcome was the renocaval pressure gradient (RPG), with secondary outcomes including operative metrics, symptom resolution, and complications. Median follow‐up was 12 months. Results Robot‐assisted LRV‐distal LGV transposition groups demonstrated superior perioperative outcomes to conventional surgery: operative time (median 200 vs 344 min; <jats:italic>P</jats:italic> &lt; 0.001), blood loss (36.5 vs 66.0 mL; <jats:italic>P</jats:italic> &lt; 0.001), and hospital stay (4.5 vs 8.0 days; <jats:italic>P</jats:italic> &lt; 0.001). Postoperative RPG was ≤3 mmHg in all patients. The LRV–proximal LGV transposition yielded the greatest RPG reduction (Δ2.8 mmHg) and lowest postoperative RPG (1.5 mmHg). Complete resolution of varicocele and pelvic/scrotal pain was achieved in all eligible patients undergoing the LRV–distal LGV transposition. Pain scores were low across all groups (mean pain score: 1.7). Conclusion The staged technical evolution in robotic LRV transposition, from the side clamp two‐step technique to anatomy‐tailored LRV–LGV transposition, demonstrated favourable renocaval pressure gradient normalization, symptom relief, and perioperative outcomes. Based on our single‐centre experience, we propose a preliminary anatomy‐tailored treatment algorithm: the side clamp two‐step technique for uncomplicated cases, LRV‐proximal LGV transposition for proximal LGV dilation (≥5 mm), and LRV‐distal LGV transposition for patients with varicocele or pelvic congestion. This framework serves as an institutional reference that warrants further multicentre validation.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"5 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ManUSPECTRAL - the Mannheim Urology HyperSPECTRAL Imaging Atlas of 17 Physiological Human Organs.","authors":"Alexander Rathenborg, Vera Klütz, Paula Grützner, Luisa Hartung, Greta Demmel, Christoph Julien Bender, Jan Sellner, Silvia Seidlitz, Caelan Max Haney-Aubert, Wahid Fattal, Tilmann Clanget, Berkin Özdemir, Samuel Knoedler, Gabriel Alexander Salg, Luisa Renner, Nicolas Carl, Cuyler Yu, Charlene Leung, Dominic Edelmann, Nicholas Schreck, Maurice Stephan Michel, Lena Maier-Hein, Karl-Friedrich Kowalewski","doi":"10.1111/bju.70467","DOIUrl":"https://doi.org/10.1111/bju.70467","url":null,"abstract":"<p><strong>Objectives: </strong>To establish a standardised intraoperative hyperspectral imaging (HSI) human organ reference dataset and to characterise spectral signatures across organ classes as a foundation for future computational and clinical applications.</p><p><strong>Subjects and methods: </strong>Intraoperative assessment of anatomical structures and tissue quality such as perfusion or malignancy remains largely subjective and lacks quantitative, spatially resolved standards. Spectral imaging is a promising technology to address this ambition containing information content far beyond regular red, green, and blue light (RGB) imaging. While HSI is progressively establishing itself in medicine with certified devices, the lack of human organ-specific reference datasets appears to be the key bottleneck for future applications. In this prospective observational study, 1095 hyperspectral recordings spanning a spectral range of 500-1000 nm were acquired during 159 urological procedures. Data were obtained using medically-certified HSI systems and expert-annotations across 17 anatomical organ classes. Median reflectance spectra and derived physiological indices (tissue oxygenation index, near-infrared perfusion index, tissue water index, organ haemoglobin index, tissue haemoglobin index) were analysed, and dimensionality reduction (principal component analysis, t-distributed stochastic neighbour embedding), cosine distance, linear mixed model (LMM) and centred kernel alignment were used to assess spectral differentiability.</p><p><strong>Results: </strong>Human organs demonstrated distinct and consistent spectral fingerprints. Cosine distance showed very low within-organ distances of 0.001-0.003, indicating high consistency of normalised spectra across subjects (i.e., patients) for the same organs. There were several organ pairs with elevated distances, e.g., bone vs multiple soft tissues with values up to ~0.042 indicating clearer spectral dissimilarity between those pairs. A LMM could quantify the spectral effects of the three influencing factors to be 49.51% for organ, 18.17% for subject and 32.32% for residuals (including repetition) as mean values across the recorded spectrum.</p><p><strong>Conclusion: </strong>The Mannheim Urology hyperSPECTRAL imaging atlas dataset (ManUSPECTRAL) (https://spectralverse-heidelberg.org/) provides the first standardised multi-organ hyperspectral reference dataset for human organs. By demonstrating consistent and separable organ-specific signatures, it establishes a quantitative foundation for future computational modelling and clinical validation studies for intraoperative tissue characterisation in surgery.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aquablation as salvage therapy for benign prostatic hyperplasia: an international multicentre study.","authors":"Anouk Leathead, Nick Lee, Adel Arezki, David Bouhadana, Liam Murad, Tarek Benzouak, Iman Sadri, Rosie Foucault, Aalya Hamouda, Jeffrey Sioufi, Ilan Ohana, Joshua Cabral, Margaret Gannon, Gregory Raster, David Nusbaum, Abdulla Alameeri, John Klein, Inderjit Singh, James Kearns, Shawn Marhamati, Alexander Glaser, Brian Helfand, Dean Elterman, Tiago Rodrigues, Kevin C Zorn","doi":"10.1111/bju.70481","DOIUrl":"https://doi.org/10.1111/bju.70481","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to evaluate the safety and effectiveness of Aquablation® as a salvage therapy in patients who underwent prior intervention for benign prostatic hyperplasia (BPH).</p><p><strong>Materials and methods: </strong>We retrospectively analysed 1887 consecutive men from the International Collaborative Aquablation Research Urology Society database between 2018 and 2024 who underwent Aquablation at one of four international centres. The cohort was divided into two groups based on the presence or absence of previous BPH intervention. Baseline characteristics, clinical and functional outcomes, and complication rates were compared between the two groups using analysis of variance and Kruskal-Wallis tests. Finally, exploratory sub-analyses were performed in the salvage therapy group based on the type of prior BPH intervention.</p><p><strong>Results: </strong>Among the study population of 1887 men, 109 (5.8%) patients had undergone prior BPH intervention, and the remaining 1778 (94.2%) patients served as a control cohort. Prostate volumes were similar between both groups (82.3 vs 78.0 mL; P = 0.18). There were no significant differences in perioperative complications, 30-day readmission rates, surgical retreatment rates, or sexual function outcome scores (all P > 0.05). There were also similar improvements in maximum urinary flow rates, post-void residuals, International Prostate Symptom Scores, and quality of life scores (all P > 0.05). When comparing outcomes based on the type of prior BPH intervention, there were no differences in terms of operative time, prostate volumes, presence of median lobe, or complication rates.</p><p><strong>Conclusion: </strong>We observed no statistically significant differences in safety or effectiveness for Aquablation as a salvage therapy for recurrent lower urinary tract symptoms after BPH intervention. Aquablation should be offered to men for whom prior procedures have failed and who want to preserve continence and sexual function.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence (\u0000 AI)\u0000 ‐enhanced journal club: integrating podcasts,\u0000 AI\u0000 , and social media in medical education","authors":"Mohamed Abouelenein,Muhammed Arif Ibis,Molly Nichols,Azhar Khan,Maria Satchi,Nicholas Raison,Kawa Omar,Francesca Kum,Tet Yap,Edward James Bass,Kalyan Gudaru,Shyaw Ahmed,Sanjith Gnanappiragasam,Fabio Castiglione,Omer Onur Cakir","doi":"10.1111/bju.70479","DOIUrl":"https://doi.org/10.1111/bju.70479","url":null,"abstract":"Objective To develop and evaluate an artificial intelligence (AI)‐assisted, multimedia journal club model that improves accessibility by transforming scientific articles into on‐demand educational formats distributed through digital platforms. Subjects and Methods This prospective single‐centre educational evaluation was conducted at King's College Hospital (London). Six AI‐enhanced journal club sessions were implemented between June and September 2025. Peer‐reviewed urology articles were processed using AI‐assisted tools to generate podcasts, slide presentations, short‐form video summaries, question‐and‐answer materials, and visual infographics. Content was distributed through clinician‐facing platforms including YouTube, Spotify, and social media. Two surveys evaluated educational impact: a format‐specific survey completed by 48 participants and a second survey assessing overall perceptions of the AI‐enhanced journal club completed by 19 participants. Results The AI‐generated podcast was the most preferred format (62.5%), followed by video summaries (16.7%) and slide presentations (8.3%). Participants reported greater engagement compared with traditional journal clubs, with 54.2% selecting the response option ‘much more engaged’. Format‐specific ratings were consistently high, particularly for podcasts (mean [standard deviation, SD] score for engagement 4.6 [0.6] and for clarity 4.8 [0.5]). In the second survey, overall ratings of the AI‐enhanced journal club were high across all domains, including engagement (mean [SD] score 4.8 [0.4]), clarity (mean [SD] score 4.8 [0.5]), time efficiency (mean [SD] score 4.7 [0.6]), and overall preference (mean [SD] score 4.9 [0.3]). Conclusion An AI‐assisted, multimodal journal club integrating podcasts, slides, and digital dissemination was associated with improved participant‐reported engagement and accessibility. This scalable model supports asynchronous learning and may complement traditional journal club formats in postgraduate medical education.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"36 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testosterone breakthrough and outcomes during intensified therapy in metastatic hormone‐sensitive prostate cancer: the ARASENS and LATITUDE trials","authors":"Xiyue Xiao, Xudong Ni, Yufan Zhao, Xiaomeng Li, Shanshan Wang, Hongkai Wang, Dingwei Ye, Junlong Wu, Yao Zhu","doi":"10.1111/bju.70474","DOIUrl":"https://doi.org/10.1111/bju.70474","url":null,"abstract":"Objectives To assess whether treatment‐period serum testosterone breakthrough &gt;35 ng/dL is associated with clinical outcomes during intensified therapy for metastatic hormone‐sensitive prostate cancer. Patients and Methods We performed <jats:italic>post hoc</jats:italic> analyses of the experimental arms of the ARASENS (darolutamide plus androgen deprivation therapy [ADT] and docetaxel; ClinicalTrials.gov identifier NCT02799602) and LATITUDE (abiraterone acetate plus prednisone and ADT; NCT01715285) phase III trials. Cohort‐specific fixed‐window landmark analyses classified exposure as any eligible testosterone result &gt;35 ng/dL after treatment initiation and through Day 147 in the LATITUDE trial or Day 266 in the ARASENS trial. Treatment‐initiation/Day‐1 and end‐of‐treatment measurements were excluded. Follow‐up began at the landmark. The primary outcome was overall survival (OS); the LATITUDE progression‐free survival (PFS) and the ARASENS time to castration‐resistant prostate cancer (CRPC) were progression endpoints. Multivariable Cox regression was primary; landmark and time‐dependent sensitivity analyses were also performed. Results At the landmark, 564 LATITUDE and 578 ARASENS patients were classifiable for OS. In the LATITUDE trial, breakthrough was associated with worse OS (adjusted hazard ratio [HR], 1.49, 95% confidence interval [CI] 1.07–2.08; <jats:italic>P</jats:italic> = 0.019); the PFS estimate was directionally similar but imprecise (HR 1.40, 95% CI 0.98–2.00; <jats:italic>P</jats:italic> = 0.065). In the ARASENS trial, the overall associations were not statistically significant for OS (HR 1.18, 95% CI 0.85–1.62; <jats:italic>P</jats:italic> = 0.322) or CRPC (HR 0.86, 95% CI, 0.60–1.23; <jats:italic>P</jats:italic> = 0.397). Exploratory piecewise modelling suggested time variation for CRPC (interaction <jats:italic>P</jats:italic> = 0.028). Conclusion Testosterone breakthrough &gt;35 ng/dL was associated with worse post‐landmark OS in the LATITUDE trial, whereas the overall associations with OS and CRPC in the ARASENS trial were not statistically significant. These within‐cohort findings are exploratory and do not establish causality, a difference between treatment mechanisms, or a clinical testosterone target.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"2 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149087317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}