Nader Awad

Across urology, the message is clear. Everyone has ignored the RCT evidence and the associated decision analysis pubmed.ncbi.nlm.nih.gov/41105637/ on ePLND. At AUA I had numerous conversations with folks presenting posters on PLND who hadn't even read the ePLND RCT.

#AUA26 Kidney-sparing therapy in UTUC continues to evolve. Dr. Coleman presented updated 2026 data from the phase III ENLIGHTED trial evaluating padeliporfin vascular-targeted photodynamic therapy (VTP). 🔥 2026 update: • ORR: 88% • CR: 70% • Recurrence: 8% • Progression: 4% 🚨Most AEs were grade 1–2 and transient (median duration: 5 days), with only 2 grade 3 treatment-related SAEs reported. @UroToday @AmericanUrological

@DrSpratticus @urotoday @TylerSbrt @UroCancer @CaPsurvivorship @PCaParker @Prof_Nick_James @wandering_gu Great slides which confirms what many urologists feel, that this group of patients take on greater risk having surgery, for minimal benefit. There are prominent urology voices who present M1 cases at conferences and somehow justify surgery

For those that couldnt make it to #AUA26, especially those at #ESTRO26, here were some of the slides for the "Pro" RT to primary in M1a disease. @TylerSbrt @UroCancer @CaPsurvivorship @PCaParker @Prof_Nick_James @wandering_gu

@nataliagandur @DrCastroPena @OncoAlert @APCCC_Lugano @Silke_Gillessen @AOmlin @declangmurphy @DrYukselUrun @yekeduz_emre @AmandaNizamMD @NazliDizman @scocmem @BertrandTOMBAL @tompowles1 @brian_rini @gu_onc @urologysummit Toxicity from multimodal approach is high. If you can buy your patient time from being on ADT and salvage RT, then that is worth considering. What does surgery add if they are likely to fail and need salvage in the first year post surgery?

⭐ Surgery in high-risk prostate cancer — when is it enough? @OncoAlert @APCCC_Lugano #APCCC26 @Silke_Gillessen @AOmlin Presented by @declangmurphy 🔹 Super clear, dynamic and clinically practical talk — thank you! 🔹 Key messages: 🔹 1. Not all high-risk prostate cancer is the same → risk stratification is essential 🔹 2. Surgery alone may be reasonable in carefully selected patients 🔹 3. Best candidates: lower-volume high-risk disease, favorable high-risk features, negative metastatic staging 🔹 4. Very high-risk / STAMPEDE-like patients often require a multimodality approach 🔹 5. The role of PLND is being redefined, especially in the PSMA PET era 🔹 6. cN1 disease is shifting toward pelvic RT ± systemic therapy rather than surgery alone 🔹 Take-home: Surgery remains important — but the key is patient selection, risk biology and integration within multimodality care. @Uromigos @KOSJ12 @Tylersbrt @DrSpratticus #ProstateCancer #UroOncology #Oncology

In cisplatin-ineligible patients with muscle-invasive bladder cancer, enfortumab vedotin–pembrolizumab plus surgery led to better event-free survival (74.7%, vs. 39.4%) and overall survival (79.7%, vs. 63.1%) than surgery alone at 2 years. Full phase 3 KEYNOTE-905 trial results and Research Summary: nejm.org/doi/full/10.10…

💫🌟KEYNOTE-905 is not just positive, it is practice-shifting in MIBC @NEJM @OncoAlert In cisplatin-ineligible patients, perioperative enfortumab vedotin + pembrolizumab delivers a magnitude of benefit we rarely see: 🔹 N = 344 🔹 2-year EFS: 74.7% vs 39.4% (HR 0.40) 🔹 2-year OS: 79.7% vs 63.1% (HR 0.50) 🔹 pCR: 57.1% vs 8.6% 1️⃣ This is more than efficacy, it’s access to cure in a historically underserved population. 2️⃣ The depth of response (pCR ~57%) signals true biological impact, not just disease control. 3️⃣ Toxicity is higher, but the benefit forces us to rethink risk–benefit in this setting. 💡 We are no longer asking if this works. We are asking: how do we integrate it into real-world practice? nejm.org/doi/full/10.10… @ecancer @urotoday @MedicalwatchHQ @urologysummit @ASCOPres @MattGalsky @DrYukselUrun @montypal @PGrivasMDPhD @tompowles1 @shilpaonc @neerajaiims @UroDocAsh @TiansterZhang @gbanna74 @katy_beckermann @DrKarineTawagi @ravikanesvaran #BladderCancer #GUOncology #OncoTwitter #Immunotherapy

@ClevelandClinic Launches Polycystic Kidney Disease Study Using KetoCitra® And Ren-Nu™ Ketogenic Nutrition Program. --> Story here: santabarbaranutrients.com/blogs/news/cle…

For those of us who still do some laparotomies. Small vs Large Bites for Abdominal Midline Incisions jamanetwork.com/journals/jamas…

@PenelopeFigtree A few people have asked what I do. Here is a link to what I tell patients. I don’t tell them anymore and just get them to watch the video youtube.com/watch?v=Jw9bw5…

@PenelopeFigtree Low carb works in 6 weeks. I use it to shrink livers before surgery.

What about low carb first !

@hubermanlab What is the optimal deep:rem times/ratios

Most everything that increases deep sleep will lessen your REM and vice versa. So do as you will with Pinealon GH secretagogues etc but be aware of this. In any case, cool-cold-warm (subjective bed temps across 6.5-8hrs of sleep) is what provides best deep & REM sleep balance.

@ChapinMD @DrSpratticus @urotoday @UroOnc @Uroweb @wandering_gu @BogdanaSchmidt @CanesDavid @DrMLChua @HimanshuNagarMD @AmarUKishan @piet_ost @alison_tree @declangmurphy What is the relevance of symptoms? How does it change anything if they have symptoms? I still do it for cancer screening. I see 1-2 % of CaP patients picked up on Dre alone. ie N PSA

@DrSpratticus @urotoday @UroOnc @Uroweb @wandering_gu @BogdanaSchmidt @CanesDavid @DrMLChua @HimanshuNagarMD @AmarUKishan @piet_ost @alison_tree @declangmurphy DRE probably not needed for screening alone. But I still perform it in men with suspected cancer, prior to biopsy of an MRI lesion, and in anyone considering prostatectomy for staging.

#EAU26 DRE not recommended for asymptomatic men. What are people’s thoughts on need for routine DRE in era of MRI? @ChapinMD @urotoday @UroOnc @Uroweb @wandering_gu @BogdanaSchmidt @CanesDavid @DrMLChua @HimanshuNagarMD @AmarUKishan @piet_ost @alison_tree @declangmurphy

Cytoreductive nephrectomy in metastatic RCC has evolved. Not routine anymore. Start immunotherapy first. Restage. Operate only on responders. It’s no longer dogma — it’s biology-driven strategy. #RCC #KidneyCancer #Immunotherapy #MVOnco

It’s disappointing to me that TURBT continues to be dismissed as a “low-priority” procedure in so many training programs. This single step defines the entire course for a bladder cancer patient. Accurate diagnosis, precise staging, and the choice of therapy all hinge on a high quality TURBT. And the “advanced genomic analysis and molecular profiling” these same programs love to promote? It all begins with adequate, high-quality tissue obtained through a TURBT. Yet incomplete resections leave behind residual tumor in up to 78% of cases at restaging, leading to higher recurrence rates and unnecessary progression. If we are serious about improving outcomes in NMIBC - and even MIBC - we must treat TURBT with the respect it deserves: structured, deliberate training curricula, hands-on attending involvement, and real performance metrics. This is why the @IBCG_BladderCA will make this one of the focus topics of our retreat this year, #IBCG26 @UrogerliMD @JoshMeeks @bbmdmsk @siadaneshmand @RobertoContieri @paolo_gontero @ParamMariappan @joanfundi @jteoh_hk @spsutkaMD @WorldBladderCan @BladderCancerUS @drgaganprakash @SUO_YUO @veerukasi

Final long-term outcomes of a phase II trial + expanded cohort (N=126) of NAC for high-risk localized UTUC. 15-20% complete response (ypT0 N0) and 60-70% overall response (<ypT2 N0) rates. Responders achieved 90% CSS at 7 years. @EUplatinum @UrologyMSK doi.org/10.1016/j.euru…

🤖🆚🗡️ Robotic vs open partial nephrectomy for complex kidney tumors 👏Tested in an RCT (OpeRa trial) @Annals_Oncology 🔑🔑 Takeaways: ⚖️ 30-day complications: no significant difference (RAPN 37% vs OPN 46%) ⏱️ RAPN = longer OR + warm ischemia time 🏥 RAPN = shorter hospital stay 💊 Less opioids, less pain 😊 Better QoL through POD30 ⭐️ RAPN not clearly safer, but easier on patients in the short term — even for intermediate/high-complexity tumors 🔗shorturl.at/dUbgk @urotoday @renalandurology @UrologyTimes

@NTFabiano Folie a deux

Depression may be contagious via a dysfunctional mirror neuron system. Happiness is also contagious via this same system.

@TylerSbrt @EurUrolOncol @urotoday @OncoAlert @PCF_Science @gu_onc @AmerUrological @Uroweb @NikiSushentsev @Tristan_Radiol @lissmike @LambAlastair @RenuEapen @dr_coops @LoebStacy @mleapman @wandering_gu @andreasroder1 I wonder what the addition of Psma pet would add? Are there plans to investigate its benefit for AS?

Have you ever wondered how keto and low carb diets actually work? Here are the scientific as well as the practical answers.