Background and objective:Many men referred from primary care entering magnetic resonance imaging (MRI)-based prostate cancer (PCa) pathways have an MRI without abnormalities, highlighting the need to improve MRI risk stratification. Optimising this process in primary care could reduce unnecessary referrals and MRIs. This study aimed to develop a prediction model incorporating the International Prostate Symptom Score (IPSS) to improve MRI risk stratification and reduce hospital referrals and MRIs in biopsy-naïve men with suspected PCa in primary care. Methods:We prospectively identified men with suspected PCa referred from primary care to a Dutch teaching hospital in 2022-2023. Standard work-up included IPSS and upfront biparametric MRI. Study outcomes included Prostate Imaging Reporting and Data System (PI-RADS) ≥ 4, the number of potentially reduced hospital referrals and subsequent MRIs, and missed PCa cases. Men with an abnormal digital rectal examination (DRE) were excluded from model development, as they have a direct indication for MRI according to current guidelines. Multivariable logistic regression identified predictors of PI-RADS ≥ 4. Model performance was assessed using the area under the curve (AUC), and clinical utility was evaluated with decision curve analysis using a predefined threshold probability of 20%. Key findings and limitations:Of 409 men, 334 without abnormal DRE were included in the model development cohort; 30% (101/334) had PI-RADS ≥ 4, of whom 59% (60/101) had significant PCa (International Society of Urological Pathology [ISUP] grade group ≥ 2). Prostate-specific antigen (PSA) and IPSS were independent predictors of PI-RADS ≥ 4. The model showed fair discrimination (AUC = 0.68; 95% confidence interval [CI] = 0.62-0.74). Decision curve analysis showed greater net benefit than 'treat none' across all thresholds and greater net benefit than 'treat all' between 17% and 30%. At a 20% threshold, 23% of MRIs could be avoided, while 3.9% of all patients would not be referred despite having a positive MRI (13% of positive MRI findings), including eight cases of missed significant PCa. Limitations include the lack of external validation. Conclusions and clinical implications:Incorporating IPSS in primary care for biopsy-naïve patients with suspected PCa improves risk stratification for MRI and offers an easily available parameter to optimise diagnostic pathways.

BACKGROUND:Magnetic resonance imaging (MRI), introduced into European (2019) and Dutch (2020) guidelines, reshaped prostate cancer (PCa) diagnostics by altering biopsy indications and strategies. In expert-center studies MRI-based diagnostics reduces biopsy rates and ISUP Grade Group (GG) 1 detection, while maintaining or increasing GG ≥ 2 detection compared to systematic biopsies. We evaluated nationwide biopsy outcomes during MRI adoption in routine practice in the Netherlands. METHODS:Retrospective nationwide study of histopathology reports from all diagnostic biopsies in men without prior PCa in the Netherlands (2015-2021), retrieved from the Dutch nationwide pathology databank (Palga). Outcomes included annual biopsy volumes and proportions cancer-negative, GG1 and GG ≥ 2 biopsies. MRI-related terminology served as a proxy for MRI use. ISUP GG concordance between biopsy and radical prostatectomy (RP), defined as identical highest GG in biopsy and RP specimen, was assessed. The Mann-Kendall test evaluated monotonic time trends. RESULTS:Among 127,856 biopsies (116,711 men), annual diagnostic biopsy numbers decreased from 18,719 (2015) to 17,094 (2021; -8.7%, p = 0.13). Cancer-negative biopsies declined from 49% to 29% (p = 0.003), while GG ≥ 2 detection increased from 30% to 53% (p = 0.002). GG1 detection minimally decreased (20% to 18%, p = 0.02). MRI terminology in pathology reports increased (8.2% to 51%) and biopsy-RP GG concordance improved (51% to 60%, p = 0.007). Analyses could not adjust for increased opportunistic PSA screening or adjunct diagnostic tool use. CONCLUSIONS:Nationwide Dutch pathology data show improved diagnostic efficiency and efficacy over time, with fewer biopsies, fewer cancer-negative biopsies, and increased GG ≥ 2 detection. These findings coincide with rising estimated MRI uptake, suggesting MRI-driven diagnostic improvements.

Background Intermediate-risk prostate cancer (PCa) is currently managed with radical whole-gland therapies, such as radical prostatectomy (RP) or radiotherapy (RT). While effective, these treatments can significantly impact quality of life (QoL), particularly in relation to urinary incontinence and erectile dysfunction. Focal therapy poses a promising alternative for whole-gland treatment in this specific patient population; however, current evidence has primarily been limited to phase I and II studies. Robust prospective evidence is needed to determine whether focal therapy can be considered a safe alternative for management of intermediate-risk PCa. The objective of this randomised controlled trial (RCT) is to evaluate the oncological effectiveness, QoL and cost-effectiveness of focal therapy compared with radical treatment as standard of care.Methods This ENFORCE focal study is designed as a multicentre RCT with six participating centres that perform focal therapy in the Netherlands. Patients are included after receiving informed consent and are thereafter 1:1 randomised between focal therapy, consisting of high-intensity focused ultrasound, irreversible electroporation or transurethral ultrasound ablation and radical treatment, consisting of RT or RP. A total of 356 patients will be enrolled. This study has two co-primary endpoints, oncological effectiveness at 36 months (non-inferiority) and QoL at 12 months (superiority) both of which must be met to demonstrate overall trial success. Follow-up will be at least 3 years, with a maximum of 5 years to gain information regarding long-term outcomes. The set follow-up visits are 6 weeks, 3 months, 6 months, 12 months and yearly thereafter. At the follow-up visits, clinical data will be collected, and questionnaires regarding QoL and costs will be administered. Furthermore, at 9 months and 18 months, prostate-specific antigen will be monitored in alignment with European guidelines on follow-up after RP and RT. Primary analyses will be conducted using intention-to-treat analyses.Ethics and dissemination Ethical approval has been obtained from the Medical Research Ethical Committee Oost-Nederland (NL83913.091.23, primary approval in December 2023; last approved version 10 July 2025). The results will be submitted for publication in peer-reviewed medical journals, and data will be accessible.Trial registration NCT06223295.

Prostate-specific antigen (PSA) monitoring is the cornerstone of prostate cancer (PC) follow-up after radical prostatectomy (RP) and radiotherapy (RT). St. Antonius Hospital (Nieuwegein/Utrecht, The Netherlands) launched the Automatic PSA Project in 2022 for automated digital communication of PSA results. PSA results are reviewed by a clinical team, and stable results are sent via automated messages; while rising PSA prompts referral to a urologist. Automated digital communication of PSA results reduces clinician and outpatient workloads and costs and patient travel. We evaluated the patient acceptability of this approach using the Service User Technology Acceptability Questionnaire. Eligible patients had undergone RP or RT, had stable PSA levels 6 mo after treatment, and had access to the patient portal. Participation was voluntary and limited to men without significant functional symptoms. Between January 2023 and September 2024, 100/325 participants in the project completed the questionnaire. Most men were aged ≥65 yr, had moderate to high digital skills, and had undergone RP (91%). Overall acceptability was high (median score 5.27, interquartile range 4.98-5.75), 72% considered digital PSA communication a suitable replacement, and 95% regarded it as a valuable addition to standard care. Privacy concerns were low. Selection bias could not be ruled out. Digital PSA communication appears to be acceptable and sustainable for selected patients, supporting broader implementation in future PC care.

OBJECTIVES:To evaluate whether nodal maximum standardised uptake value (SUVmax) improves the positive predictive value (PPV) of prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computerised tomography (CT) for detecting lymph node invasion (LNI) in prostate cancer (PCa), and to develop clinical decision tools to guide decision-making for patients with low- and high-volume nodal disease. PATIENTS AND METHODS:This international multicentre study included patients with histopathologically confirmed PCa who underwent preoperative PSMA-PET and robot-assisted radical prostatectomy with extended pelvic lymph node dissection (2016-2023). Sensitivity, specificity, PPV, and negative predictive value (NPV) for LNI detection were calculated, defining a positive test as non-physiological PSMA uptake classified according to the Prostate Cancer Molecular Imaging Standardised Evaluation (PROMISE) molecular imaging Tumour-Node-Metastasis (miTNM) system. Receiver operating curves analysis identified optimal nodal SUVmax cut-offs for pelvic LNI. Logistic regression assessed predictors for pathological N1 stage (pN1) and high-volume nodal disease (four or more positive nodes). Clinical decision tools were developed to stratify patients into three risk groups for pN1 and high-volume nodal disease. RESULTS:A total of 521 patients were included, with a median (interquartile range) age of 66 (61-71) years and prostate-specific antigen (PSA) level of 9.9 (6.6-17.0) ng/mL. The PSMA-PET showed 45.0% sensitivity, 94.3% specificity, 64.7% PPV, and 88.3% NPV for LNI detection. Adding nodal SUVmax ≥4.9 improved the PPV to 81.1% and sensitivity to 71.4% and, combined with a PSA level ≥10 ng/mL, magnetic resonance imaging (MRI) T-stage ≥T3a, and miT-stage ≥T3a, identified 95% of pN1 cases in the high-risk group. High-volume nodal disease was found in 3.8%, including 1.1% in miN0 patients. Nodal SUVmax ≥7.2, MRI T-stage ≥T3a, and miN2 (multiple suspicious LNs) were predictors for high-volume nodal disease and, combined in a clinical decision tool, excluded all low-risk patients for high-volume nodal disease. CONCLUSION:Nodal SUVmax improves PPV of PSMA-PET for nodal staging and aids in excluding high-volume nodal disease. Clinical decision tools integrating nodal SUVmax with relevant clinical parameters demonstrate potential to guide individualised nodal management. These findings warrant external validation in larger cohorts.

Patients with metastatic prostate cancer (mPCa) are eligible for germline genetic testing. This study assessed the experiences of mPCa patients undergoing genetic testing after being counselled by non-genetic healthcare professionals (ngHCPs: urologists, oncologists, nurses). We assessed the psychosocial impact, decision-making difficulties and knowledge of genetics. In a prospective cohort study across 15 hospitals in the Netherlands, genetic testing was discussed and requested by ngHCPs. Patients completed questionnaires shortly after receiving pre-test genetic counselling and 4 weeks and 6 months after receiving their genetic test results. Anxiety, depression, distress, decisional conflict regarding genetic testing, decision regret and knowledge of genetics were assessed. Of 767 patients who received germline genetic testing, 5% to 8% experienced clinically significant anxiety or depression at some point in time. Although up to 49% of participants had significantly elevated distress scores as assessed with the Distress Thermometer, more than 90% stated that the testing process did not affect their feelings of distress. Patients with high educational levels had more favourable outcomes than patients with low educational levels on distress and decisional conflict (odds ratios 0.36 [0.23-0.57] and 0.44 [0.21-0.93], respectively). Furthermore, only 50% of the knowledge questions about genetics were answered correctly. To conclude, germline genetic testing within a mainstreaming pathway does not lead to increased levels of general anxiety or depression in most mPCa patients. However, the poorer outcomes on several psychosocial measures for patients with low educational levels are a point of concern.

Samenvatting In dit internationale, retrospectieve multicenteronderzoek werden 476 mannen geïncludeerd met gelokaliseerde of lokaal gevorderde prostaatkanker, zonder aanwijzingen voor lymfekliermetastasen (miN0). Alle patiënten ondergingen voorafgaand aan een radicale prostatectomie een PSMA PET/CT en MRI ter stadiëring (2016–2023). De studie onderzocht de toegevoegde waarde van PSMA PET/CT in het voorspellen van de biochemische recidiefvrije overleving (BRFS). De minimale follow-up betrof zes maanden. Met behulp van multivariabele Cox-regressieanalyse werden PSA, biopsie ISUP GG, MRI T‑stadium en PSMA PET T‑stadium geïdentificeerd als onafhankelijke voorspellers van BRFS. Patiënten met T3b op beide modaliteiten lieten een tweejaars BRFS van 19% zien, in tegenstelling tot 58% bij T3b alleen op MRI ( p = 0,03). De auteurs concluderen dat lokale stadiëring op basis van PSMA PET/CT een toegevoegde prognostische waarde heeft, naast MRI.

INTRODUCTION/BACKGROUND:A recent study reported that patients with residual urothelial carcinoma of the bladder subsequent to neoadjuvant/induction chemotherapy (NAIC) prior to RC exhibited inferior oncological outcomes in comparison to pathological stage-matched patients who underwent upfront RC. Our hypothesis is that this may be ascribed to variations in preoperative CT-stage rather than the impact of chemotherapy. PATIENTS AND METHODS:This retrospective multicentre study included 513 patients who underwent RC for cT2-4N0-3M0 disease between 2010 and 2017. Patients were categorized based on pathological outcomes: pathological complete response (pCR, (y)pT0N0), complete downstaging (pCD, (y)pT0/is/a/1N0) and residual muscle-invasive and/or node positive disease (rMIBC, (y)pT2-4N0 and/or (y)pN1-3). RESULTS:Of the total cohort, 175 (34.1%) patients underwent NAIC+RC, while 338 (65.9%) underwent upfront RC. NAIC+RC patients exhibited lower age and CCI-scores, along with higher cT&N-stage (all P-values < .001). The mOS was 60.5 months for NAIC+RC and 49.4 months for upfront RC (P-value = .171). In patients with rMIBC, survival was inferior after NAIC+RC compared to upfront RC. However, the clinical stage distribution between NAIC+RC and upfront RC was imbalanced, with 3% versus 49% cT2N0 patients and 47% versus 9% cT4b and/or N+ patients, respectively. Following adjustments for cT & N-stage, age, and CCI-scores in multivariable Cox proportional-hazards analysis, worse OS was associated with upfront RC (HR 1.52, [95% CI, 1.11-2.10], P-value = .009). CONCLUSION:The observed inferior survival in cT2-4N0-3M0 patients with rMIBC after NAIC+RC compared to those undergoing upfront RC resulted from worse preoperative characteristics, including clinical stage. The representation of clinical disease stage should not be overlooked in survival analyses.

INTRODUCTION:It is important to actively involve patients with cT1 renal masses in treatment decision-making. Patient decision aids (PtDAs) support patients and health care professionals (HCPs) in shared decision-making. The aim of this study was to develop a Dutch PtDA for cT1 renal masses and to test its acceptability and usability. METHODS:This was a user-centered mixed-methods design. Cocreation process with HCPs from several hospitals and a patient representative, with input from (a) a needs assessment study (semistructured interviews and questionnaires) and (b) acceptability and usability testing (think-aloud sessions and semistructured interviews), guided by the International Patient Decision Aids Standards (IPDAS) criteria. Compatibility with the IPDAS criteria was evaluated (c). RESULTS:In total, 12 patients with cT1 renal masses and 56 HCPs participated. The PtDA consists of 3 components: (1) a decision aid handout demonstrating an overview of treatment options; (2) an online decision aid with information on renal cell carcinoma, treatment options, and values-clarification exercises; and (3) a personal decision aid summary. Both patients and HCPs highly appreciated the PtDA and were able to navigate through it. The PtDA fulfills all 12 IPDAS criteria. CONCLUSIONS:We systematically developed a PtDA for cT1 renal masses. The PtDA was found acceptable and usable by patients and HCPs. The PtDA is currently being implemented in routine care.

The aim of the SDM-RCC study is to evaluate the impact of a comprehensive shared decision-making (SDM) intervention for patients with renal cell carcinoma (RCC) on the decision-making process and outcomes. The intervention includes online patient decision aids (PtDAs) and training of health care professionals (HCPs) in the use of PtDAs and SDM. The study is a multicenter, prospective pretest-posttest cohort in six Dutch hospitals, focusing on patients with localized or metastatic RCC. The primary outcome is the observed quality of the decision-making process, measured using OPTION-5 scores. Secondary outcomes include perceived quality of the decision-making process, decision quality, and implementation of the intervention (user statistics and interviews). Quantitative analysis will be performed on questionnaire data, while qualitative analysis will be performed on interviews using coding based on established frameworks. The study results could improve understanding of the decision-making process for RCC patients from patient, HCP, and observer perspectives. The SDM tool implemented is expected to support the decision-making process. Patient summary We are conducting a trial on the effects of a tool to support shared decision-making by patients with kidney cancer who are facing treatment decisions. This paper outlines the protocol that will be used for the trial.

Background and purpose:A sub-fractionation workflow enables a substantial reduction in planning target volume (PTV) margin in prostate cancer (PCa) patients by reducing systematic motion during magnetic resonance (MR)-guided radiotherapy. This study assessed geometric and reconstructed dose outcomes in patients treated with a tight-margin sub-fractionation workflow on a combined linear accelerator with a 1.5 T MRI scanner (MR-Linac). Materials and methods:We evaluated the sub-fractionation workflow with tight margins (2-3 mm) on 128 PCa patients who completed treatment with 5 × 7.25 Gy (36.25 Gy total dose). A traffic light protocol was applied based on residual motions to detect patients with unexpectedly large motions. When 'red' traffic light criteria were met, plans with larger margins (5 mm isotropic) were adopted for subsequent fractions. Intra- and inter-fraction dose accumulation was performed via an in-house developed deformable image registration algorithm. Results:A total of 89 % (114/128) of patients completed treatment with the initial tight margins. The mean 3D intrafraction shifts were 1.0 mm (SD: 0.6 mm) in the group with the tight margins and 1.9 mm (SD: 1.5 mm) in the patient group who switched to large margins. The median accumulated D99% was 34.9 Gy (interquartile range: 34.0-35.3 Gy) for patients with prostate shifts who switched to larger margins. In 57 % (8/14) of these patients, the accumulated D99% was above the threshold of 34.4 Gy. Conclusions:Tight margins of 2-3 mm can be safely applied for at least 95 % (122/128) of the PCa patients undergoing a sub-fractionation workflow on a 1.5 T MR-linac.

PSMA PET/CT outperforms conventional imaging for detecting pelvic nodal and distant metastasis, but its role regarding local staging and risk stratification remains unclear. This study aims to evaluate the association between PSMA PET/CT characteristics and biochemical recurrence-free survival (BRFS) after robot-assisted radical prostatectomy (RARP) in patients with prostate cancer. In this international multicentre retrospective study, we analyzed 476 patients with localized or locally advanced miN0 prostate cancer, staged with PSMA PET/CT and MRI before RARP (2016–2023). Predictors of BRFS were identified using univariate and multivariate Cox regression with backward elimination based on Akaike information criterion (AIC). Kaplan-Meier analysis assessed the association of clinical stage by MRI, PSMA PET, and their combination with BRFS. In total 476 patients were included with a median follow-up of 18.0 months (IQR 6.9–29.3). Of the 127 BCRs, 101 (79.5

BACKGROUND AND OBJECTIVE:The European Association of Urology (EAU)-recommended follow-up schedule after radical prostatectomy (RP)-biannual prostate-specific antigen (PSA) testing for 3 yr, followed by annual testing-does not take into account variations in biochemical recurrence (BCR) risk. Therefore, we propose an optimised, risk-adapted PSA monitoring schedule for the first 5 yr after RP, stratifying patients into BCR-based risk groups, to reduce unnecessary PSA testing without compromising BCR detection rates. METHODS:Men were diagnosed with localised prostate cancer in 2015-2016, who underwent primary RP, with undetectable PSA levels <6 wk after RP, as identified in the nationwide Netherlands Cancer Registry. The outcome measures included BCR-free survival (BCR defined as PSA ≥0.1 ng/ml). Cox proportional hazards models were used to identify three risk groups; Kaplan-Meier curves illustrated BCR-free survival rates. The average BCR risk per PSA follow-up consultation in the current EAU schedule was used as a threshold to determine consultations needed in the revised risk-based schedule. KEY FINDINGS AND LIMITATIONS:In total, 1043 patients were included in the study. Significant predictors for BCR included PSA at diagnosis, pT stage, pN stage, pathological International Society of Urological Pathology grade group, and positive surgical margins. Stratification (based on hazard ratio) resulted in 43% low-risk (15% BCR), 42% intermediate-risk (36% BCR), and 15% high-risk (72% BCR) patients. The overall 5-yr BCR-free survival rate was 62% (95% confidence interval 58-66). Low-risk patients required four, intermediate-risk patients required eight, and high-risk patients required ten consultations in the revised schedule over the first 5 yr, reducing 18% of consultations compared with the EAU schedule, with 3% delayed BCR detection. Study limitations include a potential bias due to informative censoring. CONCLUSIONS AND CLINICAL IMPLICATIONS:This optimised risk-adapted PSA monitoring schedule following RP reduced the number of unnecessary PSA tests, particularly in low-risk patients, without compromising BCR detection rates.

OBJECTIVE:Patient decision aids (PtDAs) can support shared decision-making (SDM) by providing information about options, pros and cons and eliciting personal preferences. The aim of this study was to develop and test the acceptability and usability of a PtDA for patients with metastatic clear-cell renal cell carcinoma (RCC), the most common type of metastatic kidney cancer. METHODS:User-centered mixed methods design. Co-creation process with stakeholders guided by the International Patient Decision Aids Standards (IPDAS) criteria, consisting of three main elements: (a) a needs assessment; (b) acceptability and usability testing; and (c) compatibility assessment with IPDAS criteria. RESULTS:Thirteen RCC patients and 29 healthcare professionals (HCP) participated in this study. Co-creation sessions were held with nine HCPs and a patient representative. Needs assessment (a) showed that patients lacked real treatment choices and wanted information on all treatment options, including life expectancy, side effects, psychological, and lifestyle advice. HCPs expect a PtDA to improve information delivery and patient engagement. A three-component PtDA was developed and tested (b), with positive feedback from both patients and professionals. The tool meets all 12 IPDAS criteria (c). CONCLUSIONS:The web-based PtDA was developed and adapted to address unmet needs and found to be acceptable and usable by patients and HCPs. PRACTICE IMPLICATIONS:The use of this tool could contribute to high quality, patient-centered and appropriate care for metastatic clear cell RCC patients in the Netherlands.

BACKGROUND:Novel nomograms predicting lymph node involvement (LNI) of prostate cancer (PCa) including PSMA PET information have been developed. However, their predictive accuracy in external populations is still unclear. PURPOSE:To externally validate four LNI nomograms including PSMA PET parameters (three Muehlematter models and the Amsterdam-Brisbane-Sydney model) as well as the Briganti 2012 and MSKCC nomograms. METHODS:Patients with histologically confirmed PCa undergoing preoperative MRI and PSMA PET/CT before radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) were included. Model discrimination (AUC), calibration and net benefit using decision curve analysis were determined for each nomogram. RESULTS:A total of 437 patients were included, comprising 0.7% with low-risk disease, 39.8% with intermediate-risk disease, and 59.5% with high-risk disease. Among them, 86 out of 437 (19.7%) had pN1 disease. The sensitivity and specificity of PSMA PET/CT for the detection of LNI were 47.7% (95% CI: 36.8-58.7) and 95.4% (95% CI: 92.7-97.4), respectively. Among predictive models, the Amsterdam-Brisbane-Sydney model achieved the highest discrimination (AUC: 0.81, 95% CI: 0.76-0.86), followed by Muehlematter Model 1 (AUC: 0.79, 95% CI: 0.74-0.85), both with good calibration but slight systematic overestimation of risks across all thresholds. The MSKCC and Briganti 2012 models had AUCs of 0.68 (95% CI: 0.61-0.74) and 0.67 (95% CI: 0.61-0.73), respectively, and both had moderate calibration. Decision curve analysis indicated that the Amsterdam-Brisbane-Sydney model provided superior net benefit across thresholds of 5-20%, followed by the Muehlematter Model 1 nomogram showing benefit in the 14-20% range. Using thresholds of 8% for the Amsterdam-Brisbane-Sydney nomogram and 15% for Muehlematter Model 1, ePLND could be spared in 15% and 16% of patients, respectively, without missing any LNI cases. CONCLUSION:External validation of the Muehlematter Model 1 and Amsterdam-Brisbane-Sydney nomograms for predicting LNI confirmed their strong model discrimination, moderate calibration, and good clinical utility, supporting their reliability as tools to guide clinical decision-making.

De oncologische uitkomsten bij patiënten met primair gemetastaseerd hormoonsensitief prostaatcarcinoom (mHSPC) variëren sterk. PSMA-PET/CT wordt steeds vaker toegepast bij de stadiëring van prostaatcarcinoom (PCa) in de primaire setting, vanwege de hogere sensitiviteit ten opzichte van CT en botscans. Moleculaire informatie, zoals de SUVmax, kan prognostische waarde hebben in aanvulling op de klassieke indeling in laag- versus hoogvolume gemetastaseerde ziekte. Dit onderzoek exploreerde de associatie tussen de SUVmax en oncologische uitkomsten bij patiënten met primair mHSPC. Dertig patiënten met primair mHSPC die bij diagnose een PSMA-PET/CT ondergingen, werden retrospectief geanalyseerd. De SUVmax van de primaire tumor en de metastatische laesies werd vastgelegd. Als primaire uitkomstmaten golden tijd tot castratieresistent prostaatcarcinoom (CRPC) en de algehele overleving. Cox- en Kaplan-Meier (KM)-analyses werden toegepast. De mediane follow-up bedroeg 7,7 jaar. Drieëntwintig patiënten ontwikkelden CRPC en veertien overleden. De SUVmax van zowel de primaire tumor als de metastasen was niet geassocieerd met de tijd tot CRPC of met de algehele overleving, in de univariate en de multivariate analyse. Hoewel de follow-up lang is, vormde de kleine populatie een beperking. In dit exploratieve onderzoek werd geen associatie gevonden tussen de SUVmax van de lokale tumor of de metastasen en oncologische uitkomsten bij patiënten met mHSPC. Mogelijk kunnen andere PSMA-afgeleide parameters oncologische uitkomsten nauwkeuriger voorspellen.

Landelijk wordt er op de gynaecologische bekkenbodempoli’s een opvallende toename gevoeld van patiënten met verzakkingsklachten na een radicale cystectomie. Voor patiënten kan dit een fors verlies aan kwaliteit van leven betekenen en voor bekkenbodemgynaecologen is dit een enorm lastig te behandelen klacht vanwege de veranderde anatomie en het ontbreken van steunweefsel van de voorwand van de vagina. In dit artikel willen we aandacht vragen voor deze complicatie, de mogelijke oorzaken, de klachten waarmee patiënten zich presenteren en de behandelopties. We tonen de uitkomsten van een korte enquête onder urologen en doen een voorstel welke vrouwen een orgaansparende behandeling kan worden aangeboden.