Urology: the figure that decides is almost never the one you are given
Three examples make the point. Five-year survival for localised prostate cancer is published at 100% by the American registry and 102.3% by the NHS: a percentage above one hundred cannot be a proportion of survivors, it is net survival, and what it mainly measures is that screened men are healthier than the general population. Age, prostate volume and flow together explain only 13% of the variation in urinary symptoms. And in the placebo arm of the large MTOPS trial, 80% of what was called progression was a rise in a questionnaire score. These figures describe populations, not one patient. Noria Health arranges a full urological work-up near Brussels within 24 to 48 hours.
The questions we are asked
- Should I have my PSA tested?
- I have localised prostate cancer, should it be operated on now?
- What do I actually risk if I choose monitoring?
- What are the real side effects of surgery and radiotherapy?
- I get up at night and my flow is poor, does it need treating?
- Are the newer techniques as good as standard resection?
- I had a kidney stone, how do I avoid the next one?
What the figures say
| What is measured | The figure | Source and year |
|---|---|---|
| Prostate cancer mortality at 15 years, active monitoring | 3.1% | ProtecT, NEJM, 2023 |
| Prostate cancer mortality at 15 years, prostatectomy | 2.2%, p for the three-arm comparison 0.53 | ProtecT, 2023 |
| Metastases at 15 years, monitoring against immediate treatment | 9.4% against 4.7% | ProtecT, 2023 |
| Men in the monitoring arm eventually treated by 15 years | 61.1% | ProtecT, 2023 |
| Men needed to invite to screening to avoid one death | 456 (306 to 943) | ERSPC, NEJM, 2025 |
| Overdiagnosis among screen-detected cancers | 23% to 42% | Draisma, JNCI, 2009 |
| Share of urinary symptom variation explained by age, volume and flow | 13% | Girman, 1995 |
| Effect of prostate drugs beyond placebo | 1.35 to 3.67 points, relevance threshold 4 | Yuan, Medicine, 2015 |
| Mortality of transurethral resection of the prostate | 0.10% | Reich, J Urol, 2008 |
Those nine lines say one thing. In urology the gap between the figure that reassures and the figure that lets you decide is very wide. A five-year survival of 100% says nothing about whether a treatment helps, when fifteen-year survival without immediate treatment is 96.6%. A treatment that gains three points on a thirty-point questionnaire does not change a life the way an operation that adds 162% of flow does. Both exist, and it is worth knowing which one is being proposed.
What Noria Health does in urology, and what it does not do
Noria Health arranges a full urological work-up near Brussels within 24 to 48 hours: clinical examination, PSA with its kinetics, multiparametric MRI of the prostate and targeted biopsy where the imaging justifies it, flow measurement and post-void residual, kidney and bladder ultrasound, and metabolic work-up in the case of stones. The report is issued within 24 hours, follow-up is structured at D14, D30 and D90, and surgery is considered only around day 10 if it is needed.
What Noria Health does not do: recommend one strategy over another at a distance in localised cancer, or propose a procedure on prostate volume alone. Acute urinary retention, heavy blood in the urine, fever with loin pain, or rapidly developing bone pain are matters for the emergency services in your country, immediately, not for an appointment.
Who reviewed this page
Noria Health editorial team.
The urology articles
- Prostate: 3.1% mortality at 15 years under monitoring, 2.2% after surgery
- A bothersome prostate: volume and flow explain only 13% of symptoms
- Prostate: PSA, MRI, should you be screened?
- Kidney stones and urinary disorders, preventing recurrence and protecting the kidney
Have your case reviewed. Noria Health arranges a specialist consultation near Brussels and confirms feasibility within 24 to 48 hours. Open a case.