INTRODUCTION:A predictive model from the Veterans Affairs National Health System estimates glomerular filtration rate (GFR) 1 year after partial nephrectomy (PN). The model demonstrated a coefficient of determination (R2) of 0.66, with 82% of patients having a postoperative estimated GFR within 30% of the predicted GFR (P30). The purpose of this study was to assess its performance in patients enrolled in the renal hypothermia trial. METHODS:The model was externally validated using data from the renal hypothermia randomized clinical trial where GFR was measured using 99mTc-DTPA (technetium-99m-Tc-diethylenetriaminepenta-acetic acid) plasma clearance pre-PN and 1 year post PN. Model performance was evaluated using R2, calibration slope, calibration plot, and precision (P10: within 10%; P20: within 20%; and P30: within 30%). RESULTS:The trial cohort included 175 patients with pre-PN and post-PN complete data. The R2 was 0.67. The model was reasonably precise with 73 patients within 10% of predicted GFR (P10 = 41.7%), 129 within 20% of predicted GFR (P20 = 73.7%), and 156 within 30% of predicted GFR (P30 = 89.1%). The calibration slope was 1.04, with good calibration across a wide range of baseline renal function. Limitations include modest sample size, predominantly Caucasian patients, and restriction to open PN, limiting generalizability. CONCLUSIONS:A recently developed model to predict postoperative GFR performed well when applied to clinical trial patients who had GFR measured using 99mTc-DTPA plasma clearance. This model can be used as a component of informed decision-making when counseling patients on expected outcomes following partial nephrectomy.

INTRODUCTION:Real-world data can complement trial analyses and validate biomarkers in metastatic castration sensitive prostate cancer (mCSPC) population. METHODS:A prospective, multi-center cohort study recruited mCSPC patients across Canada between 2018 to 2021. Baseline characteristics, treatment patterns, and clinical outcomes were reported. RESULTS:Two hundred and four mCSPC patients were enrolled, 87.3% with de-novo diagnoses, 63.2% with high-volume disease. Median PSA was 81 ng/ml (interquartile range [IQR] 19.3 - 339), median age 70 years, and 88.7% ECOG performance status of 0-1. 84.8% (n=173) received treatment intensification, mainly with ARPi (androgen receptor pathway inhibitors) (73%). A higher proportion of patients intensified with ARPi agents (56%) reached PSA nadir ≤0.2 ng/ml between 6-9 months of treatment initiation (PSA6-9mos≤0.2) compared to other treatments. Overall survival (OS) and time to castration-resistant prostate cancer (ttCRPC) were significantly better for PSA6-9mos≤0.2 compared with PSA6-9mos>0.2 [HR 10.68 (2.34-48.82) and 5.06 (1.81-14.14) respectively]. In multivariable analysis, PSA6-9mos>0.2 was significantly associated with poor 2-year survival [HR 29.32 (5.08-169.24)]. CONCLUSIONS:This multi-center prospective real-world mCSPC cohort confirms the prognostic significance of PSA nadir at 6-9 months in stratifying patient outcomes. mCSPC patients not achieving PSA nadir by 6-9 months could be considered for further treatment intensification.

Importance Patients with prostate cancer have a high burden of cardiovascular risk factors, often suboptimally controlled, and adverse cardiovascular outcomes. Objective To determine whether the routine referral of patients with prostate cancer to a cardiovascular specialist to implement a systematic risk factor strategy is more likely to reduce adverse cardiovascular outcomes and improve risk factor control than usual care. Design, Settings, and Participants This randomized clinical trial included patients with prostate cancer from 55 sites in 8 countries between 2015 and 2025. Eligible patients were diagnosed with prostate cancer during the past 12 months; had received treatment with androgen deprivation therapy (ADT) for the first time within the past 6 months; or planned to start ADT in the next month. Patients taking a statin with a systolic blood pressure of 130 mm Hg or lower were ineligible. Data were analyzed from May 25 to August 7, 2026. Intervention Patients were allocated in a 1:1 ratio to receive usual care alone or usual care plus routine referral to an internist or cardiologist. The specialists provided a systematic intervention, including a target of systolic blood pressure of 130 mm Hg or lower and a statin medication, irrespective of the patient’s cholesterol levels (even if not usual or guideline-driven practice); encourage smoking cessation; and provide guidance on diet and exercise. Main Outcomes and Measures Hierarchical composite of cardiovascular death, myocardial infarction, stroke, heart failure, suboptimal cholesterol (total cholesterol, >155 mg/dL [to convert to mmol/L, multiply by 0.0259]) and suboptimal blood pressure (systolic blood pressure, >130 mm Hg) as evaluated by the win ratio. Results The analysis included 2487 patients with prostate cancer (mean [SD] age, 68 [8] years). During median (IQR) follow-up of 5.8 (2.7-8.2) years, the win ratio in favor of the intervention was 1.60 (95% CI, 1.42-1.81), mostly attributable to lower cholesterol in the intervention group (mean difference, 12 mg/dL; 95% CI, 9-15 mg/dL) as a consequence of greater protocol-mandated statin use. Mean (SD) close-out systolic blood pressure values were 131.1 (16.9) mm Hg in the intervention group and 132.9 (18.3) mm Hg in the control group. There was no difference in time to cardiovascular death, myocardial infarction, stroke, or heart failure between groups (subdistribution hazard ratio, 1.08; 95% CI, 0.79-1.49). Conclusions and Relevance In this randomized clinical trial, routine referral of patients with prostate cancer to a cardiovascular specialist lead to improved outcomes, specifically through better cholesterol control. However, it is uncertain whether this reduced clinical cardiovascular events. Trial Registration ClinicalTrials.gov Identifier: NCT03127631

349 Background: Patients diagnosed with high- or very high risk (H/vHR) prostate cancer (PCa) are at substantial risk of disease recurrence, metastasis, and death after treatment. Historically, treatment paradigms for these patients have been similar to those with intermediate-risk (IR) disease [radiotherapy (RT) with androgen deprivation therapy (ADT) and radical prostatectomy (RP)] though there is a growing body of evidence supporting intensified systemic therapy in this group. To contextualize this emerging trial data, we characterized real world treatment patterns for these patients. Methods: We performed a retrospective population-based cohort study using province-wide linked administrative data in Ontario, Canada. We descriptively characterized initial treatment patterns (within 1 year of diagnosis) for men with H/vHR PCa and compared them to a concurrent cohort of patients with IR disease to assess differences in management. Results: We identified 13,206 patients diagnosed with H/vHR PCa from 2010-2021 who were compared to 18,365 with IR disease. Most patients received active treatment, though rates were statistically significantly higher in the H/vHR (n=12,606, 95.5%) than IR cohort (n=14,995, 81.6%; p<0.001; standardized diff 0.44). 6207 (47%) of patients in the H/vHR cohort and 7286 (40%) of patients in the IR cohort underwent RP (p<0.001; standardized difference 0.148). Median time to RP was 98 days in the HR cohort and 105 days in the IR cohort (Median time (Q1-Q3); p<0.003; standardized difference 0.11). 6321 (47.9%) of those with H/vHR disease and 7427 (40.4%) of those with IR disease underwent radiotherapy (p<0.001; standardized difference 0.150). Very few patients received intensified systemic therapy: 77 patients (0.2%) received chemotherapy and 49 (0.2%) received androgen receptor pathway inhibitors. While treatment patterns were similar, patients with H/vHR disease were more likely to progress to metastasis (46% vs 30%, p<0.001) and more rapidly (2.6 vs 4.3 years, p<0.001), with similar patterns observed for CRPC, mCRPC treatment, prostate cancer events, and death. Conclusions: Despite higher rates of treatment, patients with H/vHR localized disease experience significantly worse clinical outcomes than those with IR. These data highlight the need for therapies which can improve clinical outcomes in this patient population, such as the potential use of intensified systemic therapies including Androgen Receptor Pathway Inhibitors (ARPIs).

353 Background: Patients (pts) with localized high-risk/very high-risk prostate cancer (PCa) have an elevated risk of metastases and Prostate Cancer (PC)-specific death following local therapy. This risk is significantly higher for patients with a persistently elevated PSA (pPSA) after Radical Prostatectomy (RP) We aim to better understand the current management strategies for this population using real world data. Methods: We performed a retrospective population-based cohort study using province-wide linked administrative data from 2010-2022, in Ontario, Canada. Patterns of patient management in the intermediate (IR)/High-/very high risk (h/vHR) LPC patients who underwent RP with persistently elevated PSA≥0.1 ng/ml were analyzed. Results: In this retrospective cohort between 2010-2021, 31,571 patients diagnosed with LPC were identified. Cohorts were stratified by IR (58.2%, n=18,365) and H/vHR (41.8%, n=13,206). Overall, 13493 pts with IH/HvHR received RP as their treatment for LPC, from which 314 pts (Intermediate Risk=127; High-Very high risk=187) had a persistently positive PSA after RP. 46.8% (n=147) of pts with pPSA received RT, 40.4% (n=127) ADT and 21.7% (n=68) RT+ADT as their next line of treatment (p=<.0001; SD=0.880). PSA value after RP and immediately preceding start of next line of therapy was 0.6 ng/ml (Median IQR: 0.2-1.5 ng/ml) in the RT subgroup and 5.8 ng/ml (Median IQR 2.9-10.5 ng/ml) and 0.9 ng/ml in ADT and ADT+RT groups respectively (Median IQR 0.2-4.3 ng/ml; p=<.0001). Median (IQR) time to CRPC was 9 years (7-11.3) in pts without a pPSA and 7.4 years (5.2-10) in patients with a persistent PSA (P=<.0001). Conclusions: Patients who do not achieve a PSA<0.1 ng/ml after radical prostatectomy have a worse prognosis. LPC patients should be monitored closely after RP to identify the sub-population with persistent PSA that could benefit from additional therapies intensified systemic therapies including Androgen Receptor Pathway Inhibitors (ARPIs). Time to progression to CRPC, PC event, and mortality by persistent PSA status among patients with RP. Persistent PSA Label Total No Yes P Value Variable (Sample size) N=14,084 N=13,770 N=314 Time to CRPC n (%) 186 (1.3%) 148 (1.1%) 38 (12.1%) <.0001 Median (IQR), Years 9.1 (7-11.3) 9 (7-11.3) 7.4 (5.2-10) <.0001 Time to PC event n (%) 6,001 (42.6%) 5,744 (41.7%) 257 (81.8%) <.0001 Median (IQR), Years 6.7 (1.9-3.6) 6.8 (1.5-10) 0.8 (0.4-4) <.0001 PSA value before RP (PSA test closest to RP) Median (IQR), (1) ng/ml 6.7 (5.1-9.6) 6.7 (5.0-9.6) 9.0 (5.9-12.8) <.0001

OBJECTIVE:To compare clinically significant prostate cancer (CS-PCa) detection by transperineal (TP) compared to transrectal (TR) magnetic resonance imaging (MRI)-ultrasonography (US) fusion prostate biopsy. PATIENTS AND METHODS:Males with abnormal prostate MRI (one or more lesion[s], Prostate Imaging-Reporting and Data System [PI-RADS] score ≥3) consenting to prostate biopsy were enrolled in a randomised control trial (NCT03936127) performed at single-site tertiary care referral centre from October 2022 to June 2024. The patients were randomised to either TP or TR biopsy approach. The primary outcome was CS-PCa (International Society of Urogenital Pathology Grade Group ≥2). Subgroup analysis of the primary outcome was stratified by lesion location (posterior, anterior; and apex, middle, base) and PI-RADS score. Secondary outcomes were detection of any grade PCa, infection, and patient pain score. RESULTS:In total, 233 patients were randomised (119 patients with 168 lesions in the TP group and 114 patients with 151 lesions in the TR group). CS-PCa was detected in: 61% (73/119; 95% confidence interval [CI] 52-70%) for TP and 54% (62/114; 95% CI 45-64%) for TR (relative risk [RR] 1.13, 95% CI 0.93-1.38, P = 0.23). Adjusted CS-PCa detection rates were higher for TP in anterior lesions: 29% (95% CI 15-49%) vs 16% (95% CI 7-31%) (RR 1.81, 95% CI 1.05-3.12; P = 0.03) and PI-RADS score 4 lesions: 51% (95% CI 39-62%) vs 30% (95% CI 19-43%) (RR 1.77, 95% CI 1.13-2.76; P = 0.01), with no difference in apical lesions (RR 0.91, 95% CI 0.60-1.37; P = 0.65). The median (interquartile range) pain score was 3 (2-4) in the TP group and 2 (1-5) in the TR group (P = 0.09). There were no urinary tract infections or urosepsis events in either group. No patient was withdrawn due to adverse events. CONCLUSIONS:In this trial, we failed to demonstrate a statistically significant, increase in the detection of CS-PCa using TP compared to TR biopsy. There were no sepsis events and biopsy was tolerated in both patient groups. MRI-US fusion prostate biopsy using a TP approach may be more advantageous for anterior and smaller lesions, higher powered studies are needed.

Prostate cancer is the most diagnosed cancer among Canadian men, except non-melanoma skin cancers. Prostate-specific antigen (PSA) screening can enable early detection, but it is not formally recommended in Canada. Nonetheless, opportunistic screening persists, influenced by US practices and some Canadian guidelines that support screening. This study provides a detailed analysis of trends in prostate cancer incidence, mortality, stage distribution, and net survival in the context of evolving PSA screening guidelines. Prostate cancer case (1984–2022) and death (1984–2023) data were primarily from the Canadian Cancer Registry and the Canadian Vital Statistics Death database, respectively. Joinpoint regression identified incidence and mortality trends. Net survival was determined using the Pohar Perme estimator. Following the introduction of PSA screening, the prostate cancer age-standardized incidence rate among men aged 50–74 increased 1.8% annually until 2007 (p = 0.006) before declining at an annualized rate of −5.9% (p = 0.005) until 2014. Among men aged ≥75, incidence declined at −3.2% annually from 1992 to 2015 (p < 0.001). The prostate cancer age-standardized mortality rate (ASMR) among men aged 50–74 fell at an annualized rate of −4.3% between 1994 and 2010 (p = 0.022), but the decline slowed thereafter. The ASMR among men aged ≥75 continuously declined after a peak in 1995, with the greatest change noted before 2012. From 2010 to 2017, stage IV prostate cancer incidence increased across all 10-year age groups, peaking among men aged 60–69 at 4.1% annually (p < 0.001). Among men aged 50–74, the corresponding annualized increase was 3.7% (p = 0.010), while among men aged ≥75, it was 3.1% (p < 0.001). Although stage IV net survival among men aged 50–74 increased from 49.4% in 2010–2011 to 56.6% in 2016–2017, all-stage net survival declined slightly after 2011, concurrent with a shift towards a greater proportion of stage IV cases. Prostate cancer outcomes in Canada reflect US PSA screening recommendations. Organized and thoughtful screening may represent an opportunity to decrease the rising late-stage incidence.

INTRODUCTION: The management of prostate cancer (PCa) is rapidly evolving. Treatment and diagnostic options grow annually, however, high-level evidence for the use of new therapeutics and diagnostics is lacking. In November 2022, the Genitourinary Research Consortium held its 3rd Canadian Consensus Forum (CCF3) to provide guidance on key controversial areas for management of PCa. METHODS: A steering committee of eight multidisciplinary physicians identified topics for discussion and adapted questions from the Advanced Prostate Cancer Consensus Conference 2022 for CCF3. Questions focused on management of metastatic castration -sensitive prostate cancer (mCSPC); use of novel imaging, germline testing, and genomic profiling; and areas of non -consensus from CCF2. Fifty-eight questions were voted on during a live forum, with threshold for "consensus agreement" set at 75%. RESULTS: The voting panel consisted of 26 physicians: 13 urologists/uro-oncologists, nine medical oncologists, and four radiation oncologists. Consensus was reached for 32 of 58 questions (one ad -hoc). Consensus was seen in the use of local treatment, to not use metastasis -directed therapy for low -volume mCSPC, and to use triplet therapy for synchronous high -volume mCSPC (low prostate -specific antigen). Consensus was also reached on sufficiency of conventional imaging to manage disease, use of germline testing and genomic profiling for metastatic disease, and poly (ADP-ribose) polymerase (PARP) inhibitors for BRCA-positive prostate cancer. CONCLUSIONS: CCF3 identified consensus agreement and provides guidance on >30 practice scenarios related to management of PCa and nine areas of controversy, which represent opportunities for research and education to improve patient care. Consensus initiatives provide valuable guidance on areas of controversy as clinicians await high-level evidence.

ObjectiveTo illustrate how experts efficiently navigate a “slowing down moment” to obtain optimal surgical outcomes using the neurovascular bundle sparing during a robotic prostatectomy as a case study.DesignA series of semistructured interviews with four expert uro-oncologists were completed using a cognitive task analysis methodology. Cognitive task analysis, CTA, refers to the interview and extraction of a general body of knowledge. Each interview participant completed four 1 to 2-hour semistructured CTA interviews. The interview data were then deconstructed, coded, and analyzed using a grounded theory analysis to produce a CTA-grid for a robotic prostatectomy for each surgeon, with headings of: surgical steps, simplification maneuvers, visual cues, error/complication recognition, and error/complication management and avoidance.SettingThe study took place at an academic teaching hospital located in an urban center in Canada.ParticipantsFour expert uro-oncologists participated in the study.ResultsVisual cues, landmarks, common pitfalls, and technique were identified as the 4 key components of the decision-making happening during a slowing down moment in the neurovascular bundle sparing during a robotic prostatectomy.ConclusionThe data obtained from the CTA is novel information identifying patterns and cues that expert surgeons use to inform their surgical decision-making and avoid errors. This decision-making knowledge of visual cues, landmarks, common pitfalls and techniques is also generalizable for other surgical subspecialties. Surgeon educators, surgical teaching programs and trainees looking to improve their decision-making skills could use these components to guide their educational strategies.

Importance:Among cancer surgeries, patients requiring open radical cystectomy have the highest risk of red blood cell (RBC) transfusion. Prophylactic tranexamic acid (TXA) reduces blood loss during cardiac and orthopedic surgery, and it is possible that similar effects of TXA would be observed during radical cystectomy. Objective:To determine whether TXA, administered before incision and for the duration of radical cystectomy, reduced the number of RBC transfusions received by patients up to 30 days after surgery. Design, Setting, and Participants:The Tranexamic Acid During Cystectomy Trial (TACT) was a double-blind, placebo-controlled, randomized clinical trial with enrollment between June 2013 and January 2021. This multicenter trial was conducted in 10 academic centers. A consecutive sample of patients was eligible if the patients had a planned open radical cystectomy for the treatment of bladder cancer. Intervention:Before incision, patients in the intervention arm received a loading dose of intravenous TXA, 10 mg/kg, followed by a maintenance infusion of 5 mg/kg per hour for the duration of the surgery. In the control arm, patients received indistinguishable matching placebo. Main Outcomes and Measures:The primary outcome was receipt of RBC transfusion up to 30 days after surgery. Results:A total of 386 patients were assessed for eligibility, and 33 did not meet eligibility. Of 353 randomized patients (median [IQR] age, 69 [62-75] years; 263 male [74.5%]), 344 were included in the intention-to-treat analysis. RBC transfusion up to 30 days occurred in 64 of 173 patients (37.0%) in the TXA group and 64 of 171 patients (37.4%) in the placebo group (relative risk, 0.99; 95% CI, 0.83-1.18). There were no differences in secondary outcomes among the TXA group vs placebo group including mean (SD) number of RBC units transfused (0.9 [1.5] U vs 1.1 [1.8] U; P = .43), estimated blood loss (927 [733] mL vs 963 [624] mL; P = .52), intraoperative transfusion (28.3% [49 of 173] vs 24.0% [41 of 171]; P = .08), or venous thromboembolic events (3.5% [6 of 173] vs 2.9% [5 of 171]; P = .57). Non-transfusion-related adverse events were similar between groups. Conclusions and Relevance:Results of this randomized clinical trial reveal that TXA did not reduce blood transfusion in patients undergoing open radical cystectomy for bladder cancer. Based on this trial, routine use of TXA during open radical cystectomy is not recommended. Trial Registration:ClinicalTrials.gov Identifier: NCT01869413.

Background: Biparametric MRI (bpMRI) of the prostate is an alternative to multiparametric MRI (mpMRI), with lower cost and increased accessibility. Studies investigating the positive predictive value (PPV) of bpMRI-directed compared with mpMRI-directed targeted biopsy are lacking in the literature. Purpose: To compare the PPVs of bpMRI-directed and mpMRI-directed targeted prostate biopsies. Materials and Methods: This retrospective cross-sectional study evaluated men who underwent bpMRI-directed or mpMRI-directed transrectal US (TRUS)-guided targeted prostate biopsy at a single institution from January 2015 to December 2022. The PPVs for any prostate cancer (PCa) and clinically significant PCa (International Society of Urological Pathology grade >= 2) were calculated for bpMRI and mpMRI using mixed-effects logistic regression modeling. Results: A total of 1538 patients (mean age, 67 years +/- 8 [SD]) with 1860 lesions underwent bpMRI-directed (55%, 849 of 1538) or mpMRI-directed (45%, 689 of 1538) prostate biopsy. When adjusted for the number of lesions and Prostate Imaging Reporting and Data System (PI-RADS) score, there was no difference in PPVs for any PCa or clinically significant PCa ( P = .61 and .97, respectively) with bpMRI-directed (55% [95% CI: 51, 59] and 34% [95% CI: 30, 38], respectively) or mpMRI-directed (56% [95% CI: 52, 61] and 34% [95% CI: 30, 39], respectively) TRUS-guided targeted biopsy. PPVs for any PCa and clinically significant PCa stratified according to clinical indication were as follows: biopsy-naive men, 64% (95% CI: 59, 69) and 43% (95% CI: 39, 48) for bpMRI, 67% (95% CI: 59, 75) and 51% (95% CI: 43, 59) for mpMRI ( P = .65 and .26, respectively); and active surveillance, 59% (95% CI: 49, 69) and 30% (95% CI: 22, 39) for bpMRI, 73% (95% CI: 65, 89) and 38% (95% CI: 31, 47) for mpMRI ( P = .04 and .23, respectively). Conclusion: There was no evidence of a difference in PPV for clinically significant PCa between bpMRIand mpMRI-directed TRUSguided targeted biopsy.

INTRODUCTION:In patients with prostate cancer (PCa), the identification of an alteration in genes associated with homologous recombination repair (HRR) has implications for prognostication, optimization of therapy, and familial risk mitigation. The aim of this study was to assess the genomic testing landscape of PCa in Canada and to recommend an approach to offering germline and tumor testing for HRR-associated genes.METHODS:The Canadian Genitourinary Research Consortium (GURC) administered a cross-sectional survey to a largely academic, multidisciplinary group of investigators across 22 GURC sites between January and June 2022.RESULTS:Thirty-eight investigators from all 22 sites responded to the survey. Germline genetic testing was initiated by 34%, while 45% required a referral to a genetic specialist. Most investigators (82%) reported that both germline and tumor testing were needed, with 92% currently offering germline and 72% offering tissue testing to patients with advanced PCa. The most cited reasons for not offering testing were an access gap (50%), uncertainties around who to test and which genes to test, (33%) and interpreting results (17%). A majority reported that patients with advanced PCa (74-80%) should be tested, with few investigators testing patients with localized disease except when there is a family history of PCa (45-55%).CONCLUSIONS:Canadian physicians with academic subspecialist backgrounds in genitourinary malignancies recognize the benefits of both germline and somatic testing in PCa; however, there are challenges in accessing testing across practices and specialties. An algorithm to reduce uncertainty for providers when ordering genetic testing for patients with PCa is proposed.

ObjectiveTo assess if estimated glomerular filtration rate (eGFR) can replace measured GFR (mGFR) in partial nephrectomy (PN) trials, using data from a randomised clinical trial.Patients and methodsWe conducted a post hoc analysis of the renal hypothermia trial. Patients underwent mGFR with diethylenetriaminepentaacetic acid (DTPA) plasma clearance preoperatively and 1 year after PN. The eGFR was calculated using the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) creatinine equations incorporating age and sex, with and without race: 2009 eGFRcr(ASR) and 2009 eGFRcr(AS), and the 2021 equation that only incorporates age and sex: 2021 eGFRcr(AS). Performance was evaluated by determining the median bias, precision (interquartile range [IQR] of median bias), and accuracy (percentage of eGFR within 30% of mGFR).ResultsOverall, 183 patients were included. Pre‐ and postoperative median bias and precision were similar between the 2009 eGFRcr(ASR) (−0.2 mL/min/1.73 m2, 95% confidence interval [CI] −2.2 to 1.7, IQR 18.8; and −2.9, 95% CI −5.1 to −1.5, IQR 15, respectively) and 2009 eGFRcr(AS) (−0.3 mL/min/1.73 m2, 95% CI −2.4 to 1.5, IQR 18.8; and −3.0, 95% CI −5.7 to −1.7, IQR 15.0, respectively). Bias and precision were worse for the 2021 eGFRcr(AS) (−8.8 mL/min/1.73 m2, 95% CI −10.9 to −6.3, IQR 24.7; and −12.0, 95% CI −15.8 to −8.9, IQR 23.5, respectively). Similarly, pre‐ and postoperative accuracy was >90% for the 2009 eGFRcr(ASR) and 2009 eGFRcr(AS) equations. Accuracy was 78.6% preoperatively and 66.5% postoperatively for 2021 eGFRcr(AS).ConclusionThe 2009 eGFRcr(AS) can accurately estimate GFR in PN trials and could be used instead of mGFR to reduce cost and patient burden.

In this single-center retrospective study, multiparametric and biparametric prostate MRI showed no statistically significant difference in NPV for clinically significant prostate cancer, including in subgroups of patients on active surveillance and with no prior prostate cancer history.