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Highlights from the American Urological Association's 2026 Annual Meeting
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| Neoadjuvant Apalutamide Therapy Enhances Potency Preservation Following Radical Prostatectomy by Downstaging the Disease in Men with High-Risk Prostate Cancer: Results of a Randomized Three-Arm Phase II Trial
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| Anthony Zhang, MD
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| Anthony Zhang's AUA 2026 randomized phase II trial found that neoadjuvant apalutamide plus abiraterone/prednisone and GnRH agonist significantly improved 12-month potency recovery to 50% compared to 37.5% with apalutamide alone and 17.4% with surgery alone, while also reducing positive surgical margins to 15.4% versus 47.8% in the surgery-only arm.
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| Development and Clinical Implementation of a Simple Radium-223 Non-Completion Risk Calculator for Bone-Metastatic Castration-Resistant Prostate Cancer
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| Hiroshi Yaegashi, MD
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| Hiroshi Yaegashi's AUA 2026 study developed a simple 7-point risk calculator using five routine serum biomarkers to predict radium-223 treatment non-completion in 802 bone-metastatic CRPC patients. The model stratified patients into low-, intermediate-, and high-risk groups with treatment discontinuation rates of 13.4%, 42.9%, and 66.2% respectively, and corresponding median overall survival of 37.0, 18.0, and 9.0 months, providing a freely accessible web-based tool to support shared decision-making and optimize patient selection before initiating radium-223 therapy.
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| Referral from Urology to Oncology Practices for Patients with Metastatic Prostate Cancer in the Real World: A PRostatE Cancer dISease observatION (PRECISION) Data Platform Analysis
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| Neal Shore, MD, FACS
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| Neal Shore's AUA 2026 PRECISION analysis found that urology-to-oncology referrals for metastatic prostate cancer dropped from 37% in 2016 to 15.8% in 2023. Oncology referral was linked to greater use of taxanes, PARP inhibitors, and radioligand therapy plus PSA reductions, but over half of referred patients returned to urology within one month, underscoring urologists' central role and the need for coordinated multidisciplinary care.
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| Uptake of Doublet and Triplet Therapy for Men with De Novo Metastatic Castration Sensitive Prostate Cancer. Population-Based Study
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| Paolo Zaurito, MD
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| Paolo Zaurito's AUA 2026 population-based study of 9,294 men with de novo mCSPC from the Swedish National Prostate Cancer Register found that doublet therapy uptake increased from 19% in 2016 to 66% in 2024, while triplet therapy rose from 4% in 2021 to 17% in 2024. Concurrent with this treatment intensification, 3-year overall survival improved from 51% to 61%, with even greater gains in men under 65, demonstrating that guideline-recommended intensification strategies are translating into real-world survival benefits.
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| Does Triplet Therapy Improve Survival in Metastatic Hormone-Sensitive Prostate Cancer? A Bayesian Individual Patient Data Reanalysis
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| Soichiro Yoshida, MD
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| Soichiro Yoshida's AUA 2026 Bayesian reanalysis of eight phase III trials found that triplet therapy showed no clear overall survival advantage over doublet therapy in the overall mHSPC population, with only a 36% probability of any benefit and 11% probability of clinically meaningful benefit. In high-volume disease, the probability of any OS benefit increased to 90%, but the probability of clinically meaningful benefit remained modest at 19%, suggesting ADT plus ARAT doublet therapy remains the preferred standard for most patients, with triplet therapy selectively considered in high-volume disease.
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| Real-World Treatment Sequence and Completion Outcomes of Radium-223 With Enzalutamide in Metastatic Castration-Resistant Prostate Cancer
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| Takuma Kato, MD, PhD
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| Takuma Kato's AUA 2026 real-world study of 631 Japanese mCRPC patients found that radium-223 plus enzalutamide had similarly high treatment completion rates compared to radium-223 plus ADT alone with comparable safety and no significant increase in grade ≥3 toxicities. The combination arm showed significantly more favorable PSA kinetics and numerically longer median overall survival among treatment completers, supporting the feasibility and tolerability of combining radium-223 with enzalutamide in routine clinical practice.
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| Implementation of a Multidisciplinary Quality Initiative to Mitigate and Reduce the Side Effects of Androgen Deprivation Therapy (ADT) in Prostate Cancer Patients Based on the Prostate Cancer 360 (PC360) Working Group Recommendations
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| Jason Hafron, MD, CMO
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| Jason Hafron's AUA 2026 quality improvement study implemented the Prostate Cancer 360 multidisciplinary care framework across 270 men receiving long-term ADT, focusing on five core health domains: cardiovascular, bone, psychological, sexual, and metabolic/body composition health. Early results showed feasible integration of structured monitoring and improved care coordination, though gaps remained, supporting the PC360 Chronic Care Management model as a practical approach to proactively address ADT-associated morbidity through coordinated multidisciplinary longitudinal care rather than cancer treatment alone.
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| Testosterone Suppression and Recovery in Patients with Advanced Prostate Cancer Treated with Relugolix: An Interim Analysis of the OPTYX Study
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| Benjamin Lowentritt, MD, FACS
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| Benjamin Lowentritt's AUA 2026 interim analysis of the OPTYX real-world study found that relugolix achieved sustained testosterone suppression with >90% of patients reaching castrate levels and >66% achieving profound suppression by 6 months, consistent with the pivotal HERO trial. Following discontinuation, approximately 42% of evaluable patients recovered testosterone to normal levels within 6 months, while PSA remained suppressed with >65% maintaining PSA <0.2 ng/mL through 6 months post-treatment, supporting relugolix's clinical effectiveness and reversible testosterone suppression in routine practice.
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