We propose a sub-set of men (with negative mpMRI, PSAD<0.15ng/mL/cc and prior negative biopsy) who may safely avoid re-biopsy. Conversely, PBx should be considered in biopsy-naïve men, regardless of negative mpMRI, particularly those with PSAD>0.15ng/mL/cc.

Purpose: We report outcomes of hemigland high intensity focused ultrasound ablation as primary treatment for localized prostate cancer in the United States. Materials and Methods: A total of 100 consecutive men underwent hemigland high intensity focused ultrasound (December 2015 to December 2019). Primary end point was treatment failure, defined as Grade Group 2 or greater on followup prostate biopsy, radical treatment, systemic therapy, metastases or prostate cancer specific mortality. IIEF (International Index of Erectile Function), I-PSS (International Prostate Symptom Score) and 90-day complications were reported. Results: At study entry patients had very low (8%), low (20%), intermediate favorable (50%), intermediate unfavorable (17%) and high (5%) risk prostate cancer. Median followup was 20 months. The 2-year survival free from treatment failure, Grade Group 2 or greater recurrence, repeat focal high intensity focused ultrasound and radical treatment was 73%, 76%, 90% and 91%, respectively. Bilateral prostate cancer at diagnosis was the sole predictor for Grade Group 2 or greater recurrence (p[0.03). Of men who underwent posttreatment biopsy (58), 10 had in-field and 8 out-of-field Grade Group 2 or greater positive biopsy. Continence (zero pad) was maintained in 100% of patients. Median IIEF-5 and I-PSS scores before vs after hemigland high intensity focused ultrasound were 22 vs 21 (p[0.99) and 9 vs 6 (p[0.005), respectively. Minor and major complications occurred in 13% and 0% of patients. No patient had rectal fistula or died. Conclusions: Short-term results of focal high intensity focused ultrasound indicate safety, excellent potency and continence preservation, and adequate short-term prostate cancer control. Radical treatment was avoided in 91% of men at 2 years. Men with bilateral prostate cancer at diagnosis have increased risk for Grade Group 2 or greater recurrence. To our knowledge, this is the initial and largest United States series of focal high intensity focused ultrasound as primary treatment for prostate cancer.

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Objective To evaluate the impact of indocyanine green (ICG) for assessing ureteric vascularity on the rate of uretero‐enteric stricture formation after robot‐assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD). Patients and methods We identified 179 patients undergoing RARC and ICUD between January 2014 and May 2017, and divided the patients into two groups based on the utilisation of ICG for the assessment of ureteric vascularity (non‐ICG group and ICG group). We retrospectively reviewed the medical records to identify the length of ureter excised. Demographic, perioperative outcomes (including 90‐day complications and readmissions), and the rate of uretero‐enteric stricture were compared between the two groups. The two groups were compared using the t‐test for continuous variables and the chi‐squared test for categorical variables. A P < 0.05 was considered statistically significant. Results A total of 132 and 47 patients were in the non‐ICG group and the ICG group, respectively. There were no differences in baseline characteristics and perioperative outcomes including operating time, estimated blood loss, and length of stay. The ICG group was associated with a greater length of ureter being excised during the uretero‐enteric anastomosis and a greater proportion of patients having long segment (>5 cm) ureteric resection. The median follow‐up was 14 and 12 months in the non‐ICG and ICG groups, respectively. The ICG group was associated with no uretero‐enteric strictures compared to a per‐patient stricture rate of 10.6% and a per‐ureter stricture rate of 6.6% in the non‐ICG group (P = 0.020 and P = 0.013, respectively). Conclusion The use of ICG fluorescence to assess distal ureteric vascularity during RARC and ICUD may reduce the risk of ischaemic uretero‐enteric strictures. The technique is simple, safe, and reproducible. Larger studies with longer follow‐up are needed to confirm our findings.

Robotic partial nephrectomy outcomes are impacted by host factors, including tumor and patient characteristics. Awareness of this increased risk and its mitigation with expert patient selection are important for excellent robotic partial nephrectomy outcomes. Our meta-analysis provides comprehensive, objective, summary data of 10,506 patients, detailing discrete outcomes for discrete host factors to better inform urologists and patients considering robotic partial nephrectomy.

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Objective To compare outcomes of minimally invasive radical nephrectomy (MIS‐RN) and robot‐assisted partial nephrectomy (RAPN) in clinical T2a renal mass (cT2aRM). Patients and Methods Retrospective, multicentre, propensity score‐matched (PSM) comparison of RAPN and MIS‐RN for cT2aRM (T2aN0M0). Cohorts were PSM for age, sex, body mass index, American Society of Anesthesiologists (ASA) class, clinical tumour size, and R.E.N.A.L. score using a 2:1 ratio for RN:PN. The primary outcome was disease‐free survival (DFS). Secondary outcomes included overall survival (OS), complication rates, and de novo estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2. Multivariable (MVA) and Kaplan–Meier survival analyses (KMSA) were conducted. Results In all, 648 patients (216 RAPN/432 MIS‐RN) were matched. There were no significant differences in intraoperative complications (P = 0.478), Clavien–Dindo Grade ≥III complications (P = 0.063), and re‐admissions (P = 0.238). The MVA revealed high ASA class (hazard ratio [HR] 2.7, P = 0.044) and sarcomatoid (HR 5.3, P = 0.001), but not surgery type (P = 0.601) to be associated with all‐cause mortality. Increasing R.E.N.A.L. score (HR 1.31, P = 0.037), high tumour grade (HR 2.5, P = 0.043), and sarcomatoid (HR 2.8, P = 0.02) were associated with recurrence, but not surgery (P = 0.555). Increasing age (HR 1.1, P < 0.001) and RN (HR 3.9, P < 0.001) were predictors of de novo eGFR of <45 mL/min/1.73 m2. Comparing RAPN and MIS‐RN, KMSA revealed no significant differences for 5‐year OS (76.3% vs 88.0%, P = 0.221) and 5‐year DFS (78.6% vs 85.3%, P = 0.630) for pT2 RCC, and no differences for 3‐year OS (P = 0.351) and 3‐year DFS (P = 0.117) for pT3a upstaged RCC. The 5‐year freedom from de novo eGFR of <45 mL/min/1.73 m2 was 91.6% for RAPN vs 68.9% for MIS‐RN (P < 0.001). Conclusions RAPN had similar oncological outcomes and morbidity profile as MIS‐RN, while conferring functional benefit. RAPN may be considered as a first‐line option for cT2aRM.