🚨 Start ADT + ARPI & metabolic dysfunction follows, often in just a few months🚨 @JAMAOnc 👥 16,924 men w/ #ProstateCancer starting ADT + ARPI, no prior metabolic dx 📊 12-mo cumulative incidence: 🔺 New HTN 83% 🔺 Dyslipidemia 52% 🔺 Metabolic syndrome 39% ⏱️ Median time to 1st abnormality: 1 mo. MetS: 2.6 mo 🔗 doi.org/10.1001/jamaoncol.20… @AmerUrological @PCFnews @PCF_Science @UroOnc @UrologyTimes @urotoday @renalandurology

🚨 Half of focal therapy for #ProstateCancer in the US is happening where no guideline supports it 🚨 @JAMA_current research letter 👥 1,179,384 pts w/ nonmetastatic PCa, NCDB 2010 to 2023 📊 15,672 (1.3%) got focal therapy ⚠️ 51% was in low, high, or very high risk disease. -No guideline supports routine use in ANY risk group outside trials or registries ⚠️ Low risk held flat (1.8% to 2.2%) and favorable intermediate is rising (2.1% to 2.9%) while marketing and&reimbursement expand ⚠️ Focal therapy more likely w/ age ≥75 (adjusted probability 22.9%), community centers (7.6% vs 2.5% academic), nonprivate insurance ✒️From the accompanying editorial "Volume of this kind shows diffusion, not benefit." 🎯 Key points 1⃣In low risk this converts surveillance candidates into procedure pts 2⃣In high risk it is undertreatment. 3⃣Repeated use is building "an aura of legitimacy the data have not earned." We owe pts trials, not marketing. 🔗 Study: doi.org/10.1001/jama.2026.12… 🔗 Editorial: doi.org/10.1001/jama.2026.16… @QDTrinh @DrSpratticus @AmerUrological @UroOnc @SUO_YUO @urotoday @UrologyTimes @PCF_Science @PCFnews

🚨 PROTEUS: perioperative apalutamide moves into high-risk localized #prostatecancer Just out in @NEJM 🧬 2109 men w/ high-risk localized or locally advanced PCa randomized to ADT + apalutamide vs ADT + placebo around radical prostatectomy. 🎯 Both stated primary endpoints met. ⚠️ But the trial deserves nuance. Thread 🧵 #ASCO26 @ASCO @PCF_Science