Important Urology Studies

Benign Prostatic Hyperplasia
Study Comparison Findings
COMBAT
MTOPS
PLESS
Bladder Cancer
Study Comparison Findings
Grossman 2003 NAC (MVAC x3) + RC vs RC only NAC provided increased overall survival (57% vs 43%) and increased pT0 at cystectomy (38% vs 15%)
JAVELIN Avelumab vs placebo after 1st line therapy for metastatic disease Increased median overall survival (21mo vs 14mo)
KEYNOTE-057 Pembrolizumab for T1 NMIBC Initial response 41%, durable response 21%
RAZOR 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 Girentuximab (antibody against G250) vs placebo in post-nephrectomy high risk RCC No difference in disease free or overall survival
ASSURE Sunitinib vs sorafenib vs placebo in post-nephrectomy high risk RCC No difference in disease free or overall survival at 6yrs
ATLAS Axitinib vs placebo in pT3+ (post-nephrectomy) ccRCC No difference in disease specific or overall survival
CHECKMATE 914 Nivolumab + ipilimumab versus placebo in post-nephrectomy high risk RCC Results pending, expected 2023
COMPARZ Pazopanib vs sunitinib for metastatic RCC Similar efficacy, safety and QoL favor pazopanib
EVEREST everolimus vs placebo in pT2+ (post-nephrectomy) ccRCC Results pending, expected 10/2021 (can't wait!)
IMmotion010 Atezolizumab vs placebo in post-nephrectomy high risk RCC Results pending, expected 2024
KEYNOTE-564 Pembrolizumab vs placebo in post-nephrectomy high risk RCC Results pending, expected 2025
METEOR Cabozantinib vs everolimus after metastatic progression after first-line therapy Cabozantinib has increased disease-free and overall survival
PISCES Pazopanib vs sunitinib for metastatic RCC Patients prefer pazopanib (70% vs 22%)
PROSPER Nivolumab vs placebo in post-nephrectomy high risk RCC Results pending, expected 2023
PROTECT Pazopanib vs placebo in pT2+ (post-nephrectomy) RCC No difference in disease free or overall survival
RAMPART Durvalumab vs durvalumab + trelemimumab vs placebo in post-nephrectomy high risk RCC Results pending, expected 2034
SORCE sorafenib vs placebo in intermediate/high risk RCC No difference in disease-free or overall survival
S-TRAC Sunitinib vs placebo for locoregional ccRCC 6.8 vs 5.6 yr disease free survival, no difference in overall survival
CARMENA Cytoreductive nephrectomy then sunitinib vs sunitinib only Sunitinib alone is noninferior, CRN should not be used alone
SURTIME 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
ROSETTA
SYNERGY
Pediatrics
Study Comparison Findings
KIMONO
MOMS
PLUTO
RIVUR
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 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
PCPT 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 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 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 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%)
RADICALS-RT aXRT vs sXRT after radical prostatectomy No difference in biochemical progression or need for hormonal therapy, aXRT more likely to cause side effects
REDUCE Effect of dutasteride on preventing prostate cancer 23% reduction in cancer diagnoses but increased diagnosis high grade cancer
SELECT 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
Metastatic Prostate Cancer
Study Comparison Findings
AFFIRM (Scher 2012) mCRPC post-docetaxel, enzalutamide vs placebo Improved progression-free and overall survival
ALSYMPCA mCRPC + symptomatic bone mets, Rad 223 vs placebo Improved overall survival
ARAMIS non-mCRPC, darolutamide vs placebo Improved progression-free survival
Arches mHSPC, ADT + enzalutamide vs ADT Improved progression-free and overall survival
CARD mCRPC w/ two prior therapies, cabazitaxel vs ART therapy Improved overall survival
CHAARTED ECOG 3805 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 mCSPC, enzalutamide vs bicalutamide Improved progression-free and overall survival
FIRSTANA mCRPC, docetaxel vs cabazitaxel No difference overall survival
GETUG-AFU15 mCRPC, ADT + docetaxel vs ADT + placebo Overall survival not superior
Horrad mCSPC, ADT vs EBRT + ADT Improved PSA progression but no difference in overall survival
IMPACT 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 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 mCRPC with progression on enzalutamide/abiraterone, Olaparib vs enzalutamide/abiraterone Improved progression free and overall survival
PROSPER non-mCRPC, enzalutamide vs placebo Improved progression-free and overall survival
SPARTAN (Smith 2018) non-mCRPC, apalutamide vs placebo Improved progression-free survival
STAMPEDE mostly mCRPC, ADT + docetaxel/abiraterone vs ADT Docetaxel and abiraterone improved overall survival
STRIVE non-mCRPC, enzalutamide vs bicalutamide Improved progression-free survival
SWOG-9346 mCRPC, intermittent vs continuous ADT Did not confirm non-inferiority of iADT for overall survival
TAX 327 mCRPC, docetaxel + prednisone vs mitoxantrone + prednisone Improved overall survival if dosed q3wk but not qweek
TERRAIN non-mCRPC, enzalutamide vs bicalutamide Improved progression-free survival
TITAN mCSPC, ADT + apalutamide vs ADT Improved progression-free and overall survival
TROPIC mCRPC post-docetaxel therapy, Cabazitaxel vs Mitoxantrone Improved overall survival
Sexual Dysfunction
Study Comparison Findings
RECONNECT 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
(Brubaker 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
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)

Sources