#ESMO26 A subgroup analysis of the phase III POTOMAC trial in papillary-only high-risk NMIBC: 📌Papillary-only: DFS HR 0.56; 48-month DFS 84% vs 74% 📌T1 subgroup: DFS HR 0.48; 48-month DFS 85% vs 73% 📌High-risk recurrence: 13% vs 20% in papillary-only disease 📌 Fewer early high-risk events, BCG-unresponsive recurrences and cystectomies 📌The trade-off: Grade 3–4 AEs were 34% vs 16%. @UroToday @myESMO

🤖 I love robotic surgery—but not every case needs a robot🔪 Modified Makuuchi incision can be a safe, efficient option for complex urologic oncology cases. ✅ Massive tumors (>18 cm) ✅ Complex IVC thrombus (Levels I–IV) ✅ T4 disease ✅ Adrenocortical carcinoma ✅ Complex anatomy 👉 Haven’t tried a Makuuchi incision? Consider it for better upper intrabdominal exposure. 📖 doi.org/10.7759/cureus.10844…

It has been nearly 5 months since the FDA approved durvalumab + BCG for “BCG-naïve” high-risk #NMIBC based on the POTOMAC trial. There has been considerable discussion about the discordant results of the recent phase III trials evaluating BCG + immune checkpoint blockade. But I think we're overlooking a potentially important difference between these trials, one that could have major implications for how we interpret the results and counsel our patients. POTOMAC and CREST were positive trials, but unlike the negative ALBAN trial, both permitted enrollment of patients previously treated with BCG. To my knowledge, neither has reported how many patients had prior BCG exposure or whether the benefit of adding checkpoint blockade differs between previously treated and truly BCG-naïve patients. Given the additional toxicity, treatment burden, and cost of systemic checkpoint blockade, how can we adequately counsel patients receiving BCG for the first time without knowing the magnitude of benefit specifically in patients like them? I think we need to see these subgroup data from @AstraZeneca and @pfizer . 1/n @BladderCancerUS ; @BCAN_Research ; @SUO_YUO ; @UroOnc ; @FDA ; @chana_weinstock ; @AmerUrological

I practiced academic oncology for 10 years and now I am at a large community practice. In retrospect I realize how foolish I must have sounded when giving talks to the community. It's a different world in the real world.

How do we treat the very elderly with advanced bladder cancer in the era of EV + pembrolizumab, erdafitinib, and avelumab? With so many new agents available, patient selection and individualized sequencing matter more than ever — especially in frail or very old patients often excluded from trials. ascopubs.org/doi/10.1200/OP-… #BladderCancer @JCO_ASCO

🚽 Is Gem/Doce the Future for Bladder Cancer Treatment? Gem/Doce shows promise as a first-line treatment for BCG-naïve high-risk NMIBC, offering new hope during BCG shortages. 📈 Efficacy - 3-year high-grade recurrence-free survival is 80% 🔬 Tolerability - Only 8% stopped due to adverse reactions 📊 Future Potential - Phase 3 trials needed for standard care status #BladderCancer #GemDoce #ClinicalTrials tnyp.me/xRumFw21/x

Staying inside urology to avoid the turf war: HoLEP vs Aquablation for BPH. HoLEP to my eyes looks like a better operation, but only in the hands of a few very high-volume experts. Aquablation is more reproducible and more accessible. Which makes the RCT almost unanswerable (there are two open right now). Expert vs expert possibly favors HoLEP. Novice vs novice likely favors Aquablation. The trial tells you more about the operators than the operation. If I needed a procedure, I would want HoLEP by a world expert. But for mass adoption, perhaps Aquablation is better.