Here, Linxweiler and Junker provide an update on our understanding of the functional role of extracellular vesicles in urological malignancies and discuss their applicability as diagnostic, prognostic and predictive biomarkers in the three most prevalent urological cancers.

Imber et al. summarize current knowledge of the risks of financial toxicity in patients with localized prostate cancer, proposing a framework of contributing factors, and discuss emerging assessment strategies to inform future research efforts.

Emerging evidence suggests that the seminal microbiome has implications for the reproductive health of men, their partner, and even the health of their offspring. In this Review, the authors describe the current evidence for a seminal microbiome and consider what the future holds for this field of research.

In this Review, Morris et al. summarize the mechanisms through which ²²³Ra exerts its biological effects in metastatic castration-resistant prostate cancer, discuss potential ²²³Ra combination therapies and provide future perspectives for targeted alpha-particle therapy.

Despite improved surgical techniques and the development of transplants, therapeutic options for men who have penile disorders or who have sustained trauma to the penis are limited and erectile function can rarely be rescued. In this Review, the authors discuss regenerative approaches to tissue engineering the tunica and corpora to improve outcomes in these patients.

In this Review, Narayan and Dahm summarize innovations in clinical trial design that have led to practice-changing developments in the treatment of urological cancers and offer a perspective on improving trial design in the future.

In men with hormone-sensitive prostate cancer, enzalutamide and apalutamide improve overall survival compared with androgen deprivation therapy alone. Also, radiotherapy of the primary tumour is beneficial in patients with low tumour burden. In the non-metastatic castration-resistant setting, a positive trial for darolutamide was reported. In the metastatic castration-resistant setting, the role of cabazitaxel in treatment sequencing was clarified.

New data show that prostate-specific membrane antigen (PSMA) PET–CT can reveal the anatomical location of prostate cancer recurrences in patients diagnosed with nonmetastatic castration-resistant disease according to conventional imaging. The findings necessitate a new evaluation of the role of PSMA PET–CT in this setting compared with standard-of-care imaging and treatment approaches.