News & Views in 2011

More effective treatment strategies are desperately needed for non-muscle-invasive bladder cancer due to the high costs of therapy and surveillance, and the substantial risk of ongoing recurrence or progression to muscle-invasive disease. A recent paper reviews the state of the art regarding combination intravesical chemotherapy and hyperthermia for bladder cancer.

Prostate cancer screening in the PSA era is controversial and the most appropriate measures for diagnosis are widely debated. Vickers and colleagues recently suggested that using PSA velocity in screening offers little benefit compared with traditional markers; however, elimination of this test from practice or guidelines may be premature.

The development of the Guy's stone score represents a notable effort to predict the likelihood of stone-free outcomes in patients undergoing percutaneous nephrolithotomy. However, it requires reassessment with more rigorous end points in a larger patient population.

A recent prospective, randomized study comparing the outcomes of laparoscopic and robot-assisted prostatectomy provides some of the best contemporary evidence of the superiority of the robotic procedure in terms of postoperative erectile function. A similarly high-quality comparison of robotic and open prostatectomy must now be warranted.

High hospital and surgeon volumes have now been shown to have a significant effect on mortality after radical cystectomy, but a standard minimum volume to identify centers associated with better outcomes has not been established. Other factors, such as hospital infrastructure and resources, can influence surgical outcome and should be included in quality of care assessment.

Bone metastases from prostate cancer are detected with staging bone scans. New research supports existing guidelines on the appropriate referral criteria for bone scans and shows that a specific subgroup of patients with prostate cancer who are at low risk of bone metastases do not require a staging bone scan.

Clinical staging of muscle-invasive bladder cancer remains limited by volume criteria used to identify nodal metastases. The development of accurate predictive models that identify patients at high risk of nodal disease, such as the one described here, is essential to optimize treatment planning for this group of patients.

Bladder management is an important aspect of the management of patients with spinal cord injury (SCI). A device capable of performing ambulatory urodynamics on individuals with SCI has recently been developed; however, the benefit of ambulatory urodynamics in patients with SCI is disputed.

A large, randomized, phase III study has shown that denosumab, a monoclonal antibody targeting RANK ligand, is more effective than zoledronic acid for preventing skeletal morbidity in castration-resistant prostate cancer. Although denosumab is convenient to administer and well tolerated, its use is likely to be limited by economic considerations.

A recent network meta-analysis of α-blockers, antibiotics and other drug therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) found that they provided modest-to-no benefit for this condition, confirming previous findings. However, a casual reading of the article may give a false impression of the efficacy and appropriateness of these drugs.

As we strive to practice evidence-based medicine, using sophisticated analytical methods to guide our clinical decisions is alluring. Clinicians must, however, be fully aware of the influence of limited data, as with surgical procedures such as pediatric pyeloplasty, and innocent assumptions that could substantially affect the conclusions of such analysis.

In the past, premature ejaculation (PE) has been considered a psychogenic condition, treated with psychotherapy. Our growing understanding of PE pathophysiology has increased the scientific community's interest in a symptom that is seen across many sexual pathologies. Is it possible to approach PE with traditional medicine approaches, such as acupuncture?

The authors of a recent study propose to expand the criteria for “good surgical outcome” for robot-assisted laparoscopic radical prostatectomy (RARP), a relatively new procedure. Without level 1 evidence to support such clinical innovations, it is vital that surgeons adopt critical self-appraisal in order to improve the reporting of outcomes.

Perineal radical prostatectomy (PRP) is one of the oldest surgical procedures for prostate cancer, but its use has declined over the past 30 years. New studies show that PRP is not only minimally invasive but beneficial from an economic perspective and should not yet be abandoned in the treatment of early prostate cancer.

Patients with bladder acontractility often rely on clean intermittent catheterization (CIC) for bladder emptying. A recent study has reported that successful latissimus dorsi detrusor myoplasty (LDDM) allows volitional voiding and removes the need for long-term CIC.

Cancer survivors often report difficulties with memory and concentration—sometimes referred to by patients as “chemobrain” or “chemofog”. The results from two recent studies suggest that, while chemotherapy itself may not be associated with cognitive impairment, some patients might already be experiencing cognitive difficulties before treatment is even started.

Assessment of voiding function after female sling surgery varies and patients are often discharged with a catheter, which can cause discomfort and complications, including infection. Management protocols using force of stream measurements could reduce catheter use and enable rapid discharge of women from hospital after sling surgery.

Although new treatments can prolong progression-free and overall survival in patients with renal cell carcinoma (RCC), the cure rate remains low and surgical resection of the primary tumor and metastases are still the most important treatment options to eliminate RCC or achieve long-term progression-free survival.

Radical prostatectomy can damage urinary function, causing incontinence. This incontinence typically resolves by the end of the first postoperative year, but it can be expedited by pelvic floor muscle exercises (PFME). A recent randomized controlled trial has demonstrated that PFME can be effective even when started years after surgery.

The potential of the prostate cancer antigen 3 (PCA3) urine assay to aid prostate cancer diagnosis and minimize unnecessary biopsies has been extensively studied. Results from three recent studies that compared the performance of PCA3 with PSA underscore the advancement and future challenges for this new diagnostic biomarker.