Opinion

Despite its prevalence, morbidity and mortality, bladder cancer remains grossly under-recognized as a public health concern and underfunded scientifically. In this article, Kaplanet al. discuss bladder cancer awareness and funding pitfalls, physician reimbursement policy, areas of future research and the integration of bladder cancer into the coordinated health-care era.

In this Perspectives article, Elterman et al. discuss the health inequalities that face men in the 21st century and consider ways in which urologists can lead the emerging subspecialty of 'male health'.

In this Perspectives article, Rodriguez-Nieves and Macoska discuss relationships between prostatic tissue inflammation (from ageing, infection, or other inflammatory disease processes), prostatic tissue fibrosis, lower urinary tract dysfunction (LUTD), and BPH, as well as highlighting recent advances in the use of antifibrotic therapeutic agents for treating LUTD.

In this Perspectives article, Centenera et al. chronicle the development of ex vivoculture models that utilize tumour material from men with prostate cancer and discuss the advantages, limitations, and potential applications of these systems to expedite the evaluation of novel drugs for the treatment of prostate cancer.

In this Perspectives article, the author presents his theory that pressure has shaped the morphology of the prostate over time, and discusses the implications this might have on the longstanding debate of the relationship between BPH and prostate cancer.

Increasing evidence has shown that a solid tumour can 'hijack' pre-existing blood vessels and integrate them into the tumour vasculature during expansion. In this Perspectives article, Chao-Nan Qian argues that this process—vessel co-option—likely occurs in clear cell renal cell carcinoma, along with the complementary processes of vessel remodelling and extratumoural angiogenesis.

Follicle-stimulating hormone (FSH) administration is effective in patients with hypogonadotropic hypogonadism, which suggests it might be useful in patients with oligozoospermia and normal FSH levels. Although, many studies have evaluated the efficacy of FSH in these patients, in this Perspectives article, the authors argue that FSH can be effective in idiopathic oligozoospermic men if patients are carefully selected.

In this Perspectives article, Orsted and Bojesen provide an overview of the literature relating to an association between BPH and prostate cancer, including data from epidemiological studies,in vitrostudies, autopsy studies, and randomized controlled trials. They discuss how the measurement of PSA has affected detection and management of the two conditions, and how PSA screening policy is likely to have influenced study findings. They also consider the pathophysiological mechanisms that might explain the observed association between the two diseases, as well as the possible clinical implications of this association.

In this Perspectives article, Sharifi and Chang discuss the predominant steroid transformation pathways that regulate dihydrotestosterone synthesis in castration-resistant prostate cancer (CRPC). They consider the role of steroidogenesis in the development of resistance to abiraterone and MDV3100 and offer their opinions regarding the way in which clinical validation of the androgen pathway has affected our understanding of the fundamental mechanisms of CRPC.

Undifferentiated 'cancer stem cells' (CSCs) are at the base of the tumour hierarchy, driving tumour growth and propagation. In this Perspectives article, the authors argue precise preclinical studies are needed to delineate prostate tumour cell hierarchy. Only then will the development of efficient differentiation agents—drugs that drive CSCs to differentiated cells that are susceptible to therapy—be possible.

Sexual medicine represents one of the newest medical specialties—indeed it has only recently been recognized as a specialty in its own right. Although research in sexual medicine is at the cutting edge of some of the newest techniques, obstacles remain. Here, Cellek and Giraldi discuss the challenges faced by sexual medicine as a field, including funding difficulties, taboos and female sexual dysfunction.

The current diagnostic techniques for prostate cancer (including serum PSA level measurement) lack sufficient specificity and sensitivity to determine the aggressiveness of the disease and to identify appropriate treatment. Thus, additional biomarkers are needed that can facilitate early diagnosis, determine the patient's prognosis and predict responses to a given therapeutic intervention. In this Perspectives article, the authors argue that patented biomarkers are the closest to market and can be used to assess progress in this field.

Five primary prostanoids are synthesized by the cyclooxygenase enzymes, COX 1 and COX 2: the prostaglandins PGE₂, PGF_2α, PGI₂, PGD₂, and thromboxane A2. High levels of these signaling molecules have been implicated—in both animal models and human studies—in decreased functional bladder capacity and micturition volume, and increased voiding contraction amplitude. In this Perspectives article, the authors describe the role of prostanoids in bladder physiology, summarize the findings from animal model and human studies, and discuss the clinical use of prostanoids in the treatment of functional bladder disorders.

Although it provides the standard diagnostic tool for prostate cancer, the performance of TRUS-guided biopsy is constrained by the biomechanical attributes of the sampling strategy, resulting in suboptimal detection efficiency of each core. In this Perspectives, Ahmed et al. propose using a biomedical-engineering approach—a uniform grid sampling strategy to improve the detection efficiency of prostate biopsy.

XMRV was identified in samples isolated from prostate cancer tissues in 2006, but has since been shown to have arisen from the genetic recombination of two viral genomes carried in the germ-line DNA of mice. Here, Sfanos et al. chart the rise and fall of XMRV from its initial detection in 2006, via claims of its role in prostate cancer, to the 2011 report of its recombinant origin, and explain why they believe XMRV has no role in prostate cancer pathogenesis.

Cisplatin-based chemotherapy is standard of care for patients with transitional cell bladder cancer; however, many of these patients suffer from renal impairment and are considered unfit for such treatment. Nicholson discusses whether this degree of caution is warranted, and what alternatives should be considered in patients for whom cisplatin is genuinely contraindicated.

Partial nephrectomy is associated with ischemia–reperfusion injury caused by vascular clamping. However, ischemia is not a vital part of the procedure, and nonclamping surgery can be carried out. In this Perspectives, the authors review the evidence regarding clamping and nonclamping partial nephrectomy, and discuss their own surgical experiences with these techniques.

Controlled tissue cooling has been used therapeutically for decades to mitigate the negative effects of traumatic, ischemic, and surgical insults. Finley proposes that since recovery of urinary continence and erectile function is improved when localized hypothermia is used during radical prostatectomy, similar benefits might be observed for other types of radical pelvic surgery.

Hydrogen sulfide is a gaseous transmitter that shares features with nitric oxide (a key gaseous transmitter in erectile function) and has been shown to be involved in vascular homeostasis. In this Perspectives, the authors present available evidence in support of a physiological role for hydrogen sulfide in penile homeostasis and propose that drugs that manipulate this molecule could be an alternative therapy for erectile dysfunction.

The high degree of etiological heterogeneity in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) represents a considerable diagnostic and management challenge. In this Perspectives article, the authors propose a new phenotyping system that they believe will help advance our understanding of the mechanistic basis of this syndrome and subsequently move us closer to developing treatments intended to cure patients with CP/CPPS.