| Benign Prostatic Hyperplasia | ||
|---|---|---|
| Study | Comparison | Findings |
| COMBAT (Roehrborn 2008, 2yr results) | Tamsulosin vs dutasteride vs both vs placebo | Combination therapy has greater benefit than either therapy alone for BPH symptoms |
| GOLIATH (Thomas 2016) | TURP vs KTP for BPH | Similar efficacy at 2yr between both therapies |
| HYCAT (Roehrborn 1997) | Assess effect of a-blockers on PSA | PSA unaffected by terazosin |
| LIFT (Roehrborn 2013) | Prostates 30-80g randomized to UroLift or sham | UroLift improves urinary function compared with baseline and sham, no reported ejaculatory or erectile side effects |
| MTOPS (McConnell 2003) | Doxazosin vs finasteride vs both vs placebo | Combination therapy has greater benefit than either therapy alone for BPH symptoms |
| PLESS (Roehrborn 1999) | Effect of PSA and prostate volume on developing retention and need for BPH surgery | PSA and prostate volume are predictors of developing retention and need for BPH surgery, finasteride lowers these risks |
| Bladder Cancer | ||
| Study | Comparison | Findings |
| Grossman 2003 | NAC (MVAC x3) + cystectomy vs cystectomy only | NAC provided increased overall survival (57% vs 43%) and increased pT0 at cystectomy (38% vs 15%) |
| JAVELIN (Powles 2020) | Avelumab vs placebo after 1st line therapy for metastatic disease | Increased median overall survival (21mo vs 14mo) |
| KEYNOTE-057 (Balar 2021) | Pembrolizumab for T1 NMIBC | Initial response 41%, durable response 21% |
| RAZOR (Parekh 2018) | Open vs robotic cystectomy | Robotic cystectomy noninferior |
| Svatek 2005 | Cytology and cystoscopy as predictors of biopsy findings | If concerning lesion, almost always cancer (82%) If equivocal, no hx cancer, and negative cytology, 100% NPV for cancer If equivocal, no hx cancer, and positive cytology, 100% sensitive for cancer |
| Kidney Cancer | ||
| Study | Comparison | Findings |
| ARISER (Chamie 2017) | Girentuximab (antibody against G250) vs placebo in post-nephrectomy high risk RCC | No difference in disease free or overall survival |
| ASSURE (Haas 2016) | Sunitinib vs sorafenib vs placebo in post-nephrectomy high risk RCC | No difference in disease free or overall survival at 6yrs |
| ATLAS (Gross-Goupil 2018) | Axitinib vs placebo in pT3+ (post-nephrectomy) ccRCC | No difference in disease specific or overall survival |
| CARMENA (Mejean 2018) | Cytoreductive nephrectomy then sunitinib vs sunitinib only | Sunitinib alone is noninferior, CRN should not be used alone |
| COMPARZ (Motzer 2013) | Pazopanib vs sunitinib for metastatic RCC | Similar efficacy, safety and QoL favor pazopanib |
| EVEREST (Ryan 2022) | Everolimus vs placebo in pT2+ (post-nephrectomy) ccRCC | Non-significant improvement in recurrence free survival with everolimus |
| METEOR (Choueiri 2015) | Cabozantinib vs everolimus after metastatic progression after first-line therapy | Cabozantinib has increased disease-free and overall survival |
| PISCES (Escudier 2014) | Pazopanib vs sunitinib for metastatic RCC | Patients prefer pazopanib (70% vs 22%) |
| PROTECT (Motzer 2017) | Pazopanib vs placebo in pT2+ (post-nephrectomy) RCC | No difference in disease free or overall survival |
| SORCE (Eisen 2020) | sorafenib vs placebo in intermediate/high risk RCC | No difference in disease-free or overall survival |
| S-TRAC (Ravaud 2016) | Sunitinib vs placebo for locoregional ccRCC | 6.8 vs 5.6 yr disease free survival, no difference in overall survival |
| SURTIME (Bex 2019) | Cytoreductive nephrectomy then sunitinib vs sunitinib then cytoreductive nephrectomy then sunitinib | No clear improvement in survival with delayed CRN |
| Overactive Bladder | ||
| Study | Comparison | Findings |
| ARTISAN-SNM (Pezzella 2020) | Assess feasibility of rechargable SNM device | Rechargeable device is safe/efficacious |
| INSITE (Noblett 2018) | Assess efficacy of interstim (SNM) for less severe and more severe patients | SNM is efficacious for patients of all symptom severities |
| ROSETTA (Amundsen 2018) | 200U botox vs sacral neuromodulation for refractory urge incontinence | Similar treatment efficacy at 2yr, botox provided higher satisfaction but higher risk of UTI |
| SUMIT (Peters 2010) | PTNS vs sham for OAB | PTNS has significant benefit over sham (55% improvement vs 21%) |
| SYNERGY (Mueller 2018) | Solifenacin vs mirabegron vs combination | Combination therapy provides greatest benefit with minimal increase in side effects |
| Pediatrics | ||
| Study | Comparison | Findings |
| KIMONO (Westland 2013) | Identify risk factors for renal injury in solitary kidney patients | 1/3 develop renal injury by 10yo, risk increased if congenital anomaly present in solitary kidney |
| MOMS (Adzick 2011) | Prenatal intrautero vs postnatal repair of myelomeningocele | Prenatal repair reduces need for VP shunt and improves motor function, but carries maternal and fetal risks |
| PLUTO (Morris 2013) | Vesicoamniotic shunt vs conservative management of in-utero lower urinary tract obstruction in male fetuses | No significant improvement with shunting, shunt placement does have complication risks, only 31 patients included |
| RIVUR (NEJM 2014) | Antibiotics vs placebo for prevention of subsequent febrile UTI | Prophylaxis reduced risk of recurrence especially if baseline voiding dysfunction, but did not alter risk of renal scarring |
| Pelvic Organ Prolapse | ||
| Study | Comparison | Findings |
| OPTIMAL (Barber 2014) |
Uterosacral ligament suspension vs sacrospinous ligament fixation | No difference in outcomes |
| Peyronie Disease | ||
| Study | Comparison | Findings |
| IMPRESS (Gelbard 2013) |
Intralesional collagenase vs placebo | 34% average improvement |
| Localized Prostate Cancer | ||
| Study | Comparison | Findings |
| ERSPC (Schroder 2009) | Regular PSA screens vs no screens | 20% reduction in cancer-specific mortality with screening at 16yrs, requires screening 570 men to prevent 1 death |
| MRI-First (Rouvière 2019) | Systematic + targeted biopsy vs targeted biopsy only after prostate MRI | Best diagnosis obtained with combination of systematic + targeted biopsy, obtaining MRI prior to biopsy does not prevent need for systematic biopsy |
| PCPT (Thompson 2003) | Effect of finasteride on preventing prostate cancer | 25% reduction in cancer diagnoses but increased diagnosis high grade cancer (gland shrinkage may increase detection of clinically significant cancers), overall does not seem to affect mortality |
| PIVOT (Wilt 2012) | watchful waiting vs radical prostatectomy | No change in overall or cancer-specific mortality, but prostatectomy decreased progression risk (41% vs 68%) and decreased treatment for progression (34% vs 60%) |
| PLCO (Andriole 2012) | Regular PSA screens vs no screens | No reduction in cancer-specific mortality at 17yrs, but a lot of crossover contamination with PSA screening in the "unscreened" cohort |
| Pound 1999 | Observation of biochemical recurrence after prostatectomy | Recurrence does not happen without a rising PSA, 8-10yr median time from PSA rise to metastasis, GG1-3 develop metastases within 10yrs, GG4-5 develop metastases within 5yrs, 5yrs to develop metastases if PSA starts rising within 2yrs otherwise develop metastases within 10-15yrs, developmetastases within 5yrs if PSAdt < 10mo, development of metastases leads to death at median 5yrs |
| PRECISION (Kasivisvanathan 2018) | mpMRI + targeted biopsy vs standard biopsy alone | mpMRI more likely to detect cancer (38% vs 26%) and less likely to diagnose clinically insignificant cancer |
| PROMIS (Ahmed 2017) | mpMRI + template biopsy + saturation biopsy | mpMRI is more sensitive (93%) but less specific (41%) for clinically significant cancer compared to template biopsy, would help 27% avoid a biopsy, would help detect 18% more clinically significant cancer |
| ProtecT (Hamdy 2016) | observation vs prostatectomy vs XRT | No difference in cancer-specific mortality at 10yrs, but observation had increased disease progression (23% vs 5%) and more likely to start ADT (8% vs 5%) |
| REDUCE (Andriole 2010) | Effect of dutasteride on preventing prostate cancer | 23% reduction in cancer diagnoses but increased diagnosis high grade cancer |
| SELECT (Klein 2011) | Effect of selenium and/or Vitamin E on preventing prostate cancer | No benefit, Vitamin E appears to slightly increase cancer risk (17% from controls) |
| SPCG-4 (Bill-Axelson 2011) | watchful waiting vs radical prostatectomy | Prostatectomy increased overall survival by 12%, 2.9yr median increase at 23yrs follow-up |
| TACT (Klotz 2020) | Assess safety/efficacy of transurethral US ablation of prostate cancer (TULSA) | Device is safe/efficacious, with 79% negative biopsy at 12mo, 75% retained erectile function |
| Post-Prostatectomy XRT | ||
| Study | Comparison | Findings |
| Bastide | Adding ADT increased BCR-free rates with aXRT (83% vs 44% at 5yrs, 62% vs 29% at 7yrs) | |
| EORTC 22911 (Bolla 2012) | aXRT vs "wait and see" approach after radical prostatectomy | aXRT decreased locoregional recurrence (8% vs 17%), no difference in overall survival (26% vs 23%), decreased overall survival if negative surgical margins on specimen (HR 1.68) |
| GETUG-AFU17 (Sargos 2020) | aXRT vs sXRT after radical prostatectomy | Not statistically significant, but aXRT did not show event-free survival benefit and increased GU toxicity |
| RADICALS-RT (Parker 2020) | aXRT vs sXRT after radical prostatectomy | No difference in biochemical progression or need for hormonal therapy, aXRT more likely to cause side effects |
| RAVES (Kneebone 2020) | aXRT vs sXRT after radical prostatectomy | Non-inferiority not proven, but data seems to show similar efficacy, sXRT decreases overtreatment and has less GU toxicity |
| RTOG 96-01 (Shipley 2017) | sXRT + ADT vs sXRT alone after radical prostatectomy | salvage XRT + ADT showed increased survival benefit and decreased death from prostate cancer at 12yrs |
| SWOG 8794 (Thompson 2006) | aXRT vs "wait and see" approach after radical prostatectomy | At 10yrs, aXRT decreased locoregional recurrence (8% vs 22%), increased hormone-free survival(84% vs 66%), increased overall survival (74% vs 66%), NNT 9.1 for overall survival and 12.2 for metastatic disease |
| Metastatic Prostate Cancer | ||
| Study | Comparison | Findings |
| AFFIRM (Scher 2012) | mCRPC post-docetaxel, enzalutamide vs placebo | Improved progression-free and overall survival |
| ALSYMPCA (Parker 2013) | mCRPC + symptomatic bone mets, Rad 223 vs placebo | Improved overall survival |
| ARAMIS (Fizazi 2019) | non-mCRPC, darolutamide vs placebo | Improved progression-free survival |
| ARCHES (Armstrong 2019) | mHSPC, ADT + enzalutamide vs ADT | Improved progression-free and overall survival |
| CARD (de Wit 2019) | mCRPC w/ two prior therapies, cabazitaxel vs ART therapy | Improved overall survival |
| CHAARTED (Sweeney 2015) | mCRPC, ADT + docetaxel vs ADT | Improved overall survival |
| COU-AA-301 (de Bono 2011) | mCRPC post-docetaxel, abiraterone vs placebo | Improved progression-free and overall survival |
| COU-AA-302 (Ryan 2013) | mCRPC, chemo-naive, abiraterone vs placebo | Improved progression-free and overall survival |
| ENZAMET (Davis 2019) | mCSPC, enzalutamide vs bicalutamide | Improved progression-free and overall survival |
| FIRSTANA (Oudard 2017) | mCRPC, docetaxel vs cabazitaxel | No difference overall survival |
| GETUG-AFU15 (Gravis 2013) | mCRPC, ADT + docetaxel vs ADT + placebo | Overall survival not superior |
| HORRAD (Boeve 2019) | mCSPC, ADT vs EBRT + ADT | Improved PSA progression but no difference in overall survival |
| IMPACT (Kantoff 2010) | asymptomatic/minimally symptomatic mCRPC, Sipuleucel-T vs placebo | Improved overall survival |
| LATITUDE (Fizazi 2017) | mCSPC, abiraterone vs placebo | Improved progression-free and overall survival |
| NCIC PR.7 (Crook 2012) | post-XRT BCR, non-mCRPC, intermittent vs continuous ADT | Intermittent ADT is non-inferior for overall survival |
| PREVAIL (Beer and Tombal 2014) | mCRPC, chemo-naive, enzalutamide vs placebo | Improved progression-free and overall survival |
| PROFOUND (Hussain 2020) | mCRPC with progression on enzalutamide/abiraterone, Olaparib vs enzalutamide/abiraterone | Improved progression free and overall survival |
| PROSPER (Sternberg 2020) | non-mCRPC, enzalutamide vs placebo | Improved progression-free and overall survival |
| SPARTAN (Smith 2018) | non-mCRPC, apalutamide vs placebo | Improved progression-free survival |
| STAMPEDE (James 2017) | mostly mCRPC, ADT + docetaxel/abiraterone vs ADT | Docetaxel and abiraterone improved overall survival, ADT + XRT potential treatment for low-volume mCSPC |
| STRIVE (Penson 2016) | non-mCRPC, enzalutamide vs bicalutamide | Improved progression-free survival |
| SWOG-9346 (Hussain 2013) | mCRPC, intermittent vs continuous ADT | Did not confirm non-inferiority of iADT for overall survival |
| TAX 327 (Tannock 2004) | mCRPC, docetaxel + prednisone vs mitoxantrone + prednisone | Improved overall survival if dosed q3wk but not qweek |
| TERRAIN (Shore 2016) | non-mCRPC, enzalutamide vs bicalutamide | Improved progression-free survival |
| TITAN (Chi 2019) | mCSPC, ADT + apalutamide vs ADT | Improved progression-free and overall survival |
| TROPIC (de Bono 2010) | mCRPC post-docetaxel therapy, Cabazitaxel vs Mitoxantrone | Improved overall survival |
| Sexual Dysfunction | ||
| Study | Comparison | Findings |
| RECONNECT (Kingsberg 2019) | Bremelanotide vs placebo for female sexual interest disorder | Improves desire and decreases distress |
| Stones | ||
| Study | Comparison | Findings |
| Borghi 1996 | Increased (> 2L) vs normal fluid intake | Decreased stone rates over 5yrs compared to controls (27% vs 12%) |
| Borghi 2002 | Low calcium diet versus low protein + low salt + moderate calcium | Moderate calcium diet had a 50% reduction in stone events compared to low calcium diet |
| Lotan 2004 | Cost efficiency of metabolic stone workup | 1st time stone formers are most cost effectively managed w/ conservative therapy, but metabolic workup is more beneficial for recurrent stone formers |
| Stress Urinary Incontinence | ||
| Study | Comparison | Findings |
| CARE (Visco 2008) |
Effect of colposuspension at time of sacrocolpopexy (for POP) in patients without preoperative SUI | Colposuspension leads to less postoperative SUI |
| OPUS (Wei 2009) |
Effect of retropubic midurethral sling placement at time of anterior vaginal wall prolapse repair | RP-MUS placement decreases SUI rates (27% vs 43%), NNT 6.3 |
| SISTEr (Albo 2007) |
Pubovaginal sling vs Burch colposuspension | PVS has greater negative postop stress test (66% vs 49%), cure rate (47% vs 38%), less retreatment (4% vs 13%), but more likely to cause voiding dysfunction and cystitis |
| TOMUS (Kobashi 2017) |
Retropubic vs transobturator midurethral slings | Overall no difference in treatment success rates at 5yrs |
| VALUE (Nager 2012) |
Benefit of UDS before sling placement | No proven benefit to performing empiric UDS if clear SUI on exam |
| Testis Cancer | ||
| Study | Comparison | Findings |
| SWENOTECA (Tanstad 2011) | Comparison of management strategies for Stage I NSGCT | Relapse rates 12% surveillance, 1% BEP x1, 0% BEP x2, no difference in deaths |
| Upper Tract Urothelial Cancer | ||
| Study | Comparison | Findings |
| ODMIT-C (O'Brien 2011) | Postoperative intravesical mitomycin vs standard foley care after nephroureterectomy | Decreased risk of bladder tumors (AR=11%, RR=40%, NNT=9) |
| OLYMPUS (Kleinmann 2020) | Mitomycin hydrogel administration for existing UTUC | Complete response 59%, subset (70%) had sustained response at 1yr, 40% had side effects |
| POUT (Birtle 2018) | pT2-4 N0-3, adjuvant chemotherapy (gem/cis) vs surveillance | Survival 70% vs 51% (HR=0.49) |