Javier Pérez Ardavín

🚨Correlation v causation🚨 ⚠️ Key limitations: 🧪 No pesticide exposure measured — distance from a golf course was the exposure proxy. ⏳ Timing mismatch — residence only 2–3 yrs before PD onset was used, despite PD’s long prodromal period. 📉 Weak dose-response — risk was highest 1–2 miles away, not <1 mile, with no significant distance gradient within 3 miles. 🏠 Differential missing data — 39% of controls vs 6.9% of cases lacked adequate residential history. 📊 Small reference group — only 9 PD cases lived >6 miles from a golf course, producing wide CIs.

🚨 PSMA-guided RT intensification for #ProstateCancer 🚨 @EuropeanUrology 👥 262 randomized (253 treated), 4 strata: salvage post-RP, high-risk, oligomet, salvage post-RT 📊 Phase 2 RCT, SOC RT vs PSMA-PET-guided RT to all detected sites ⏱️ Median f/u 66 mo ⚠️ Primary 5-yr failure-free survival 66% vs 62%, HR 0.80, p=0.14 (not met) ✅ BCFS favored PSMAgRT: 72% vs 65% (sHR 0.70, p=0.048) ✅ High-risk 81% vs 66%; post-RP 80% vs 68% (sHR 0.54, p=0.037) 🎯 Seeing more w/ PSMA doesn't mean treating more helps everyone. -High-risk & post-RP pts look like the target group -Pending phase 3 PATRON. 🔗 doi.org/10.1016/j.eururo.202… @AmerUrological @UroOnc @PCFnews @AmarUKishan @UrologyTimes @urotoday @SbrtSean @PCF_Science

🚨 Retzius-sparing RARP: better early continence, worse long-term cancer control in the first randomized trial 10-yr readout 🚨 @EurUrolOncol, post hoc analysis of an RCT 👥 120 men, NCCN low/intermediate risk PCa, randomized 1:1 RS vs anterior RARP ⏱️ Median f/u 77 mo, 20 progression events (BCR and/or any additional tx) ✅ 5-yr PFS: 80.2% RS vs 91.1% anterior (p=0.01) ✅ 10-yr PFS: 50.5% vs 82.0% ✅ Adjusted for CAPRA-S: HR 2.64 for progression w/ RS (95% CI 1.01 to 6.91) ⚠️ Signal held in negative-margin pts only: 5-yr 81.1% vs 96.1% (p=0.042), so not just a margin story ⚠️ RS arm had more pT3 (45% vs 23%) and numerically more PSMs (25% vs 13%) ⚠️ Small trial, oncology not the original endpoint, only 9 pts at risk at 10 yr, and the 2 surgeons had done just 60 RS cases total. Expert series suggest ~100 to flatten the learning curve 🎯 First randomized long-term evidence that the oncologic equivalence of RS RARP cannot be assumed. 👉Not a final verdict on RS in high-volume hands 🔗 doi.org/10.1016/j.euo.2026.0… @AmerUrological @UroOnc @SUO_YUO @PCF_Science @PCFnews @UrologyTimes @urotoday

🚨 Exercise improved QoL for patients on ADT for #prostatecancer & it costs less per QALY than most cancer drugs the NHS funds 🚨 🏋️‍♂️@TheLancetOncol STAMINA trial: 👥 700 men on ADT, median age 71.6, 34% metastatic, 19% on ARPI or chemo 📊 Randomized 5:4 vs an ACTIVE comparator: optimised usual care w/ clinician training and behavioural prompts 💊 12 mo supervised aerobic + resistance exercise in community gyms, dietary advice, behavioural support, free membership ✅ FACT-P +4.5 (p=0.0004), FACT-G +3.7, above the >3 point clinically important threshold ✅ Fatigue (FACIT-F) +1.9 (p=0.0068) ✅ £13,920 to £19,077 per QALY. Median ICER for NICE-approved oncology drugs: £30,000 ⚠️ Open label PROs, 97% of pts White, fatigue effect at the edge of MCID, physical outcomes unchanged ⚠️ 3 intervention-related SAEs, all recovered 🎯 This beat an already-enhanced control, in a population including metastatic pts, delivered through community gyms at scale. 👉I think many of us have been telling patients for years to exercise while on ADT to reduce side effects, now we have trial-grade data! *The figure in this post is not from the paper, based on tabular data!!! 🔗 doi.org/10.1016/S1470-2045(2… @AmerUrological @UroOnc @SUO_YUO @PCFnews @urotoday @UrologyTimes @CaPsurvivorship

🚨 Referring men w/ #ProstateCancer on ADT to a cardiologist lowered cholesterol, not heart attacks 🚨 🖊️@JAMAInternalMed, RADICAL PC-2: 👥 2,487 men w/ PCa starting ADT, 55 sites 📊 RCT: usual care vs routine cardiology/internist referral w/ statin for all ⏱️ Median f/u 5.8 yrs ✅ Cholesterol lower in treatment group ⚠️ CV death, MI, stroke, HF: sHR 1.08 (0.79 to 1.49). No difference ⚠️ The price: ~1,240 new specialist referrals, plus years of f/u visits, to move a lab value a statin script could have moved on day 1 🎯 Advice from this paper, skip the referral, just start the statin🤷 🔗 doi.org/10.1001/jamainternme… @AmerUrological @UroOnc @SUO_YUO @urotoday @UrologyTimes @PCF_Science @PCFnews @ManuMysore2