Essay

Hettel and Sharifi discuss how germlineHSD3B1 1245A>C variant status influences outcomes of men with prostate cancer receiving androgen deprivation therapy, indicating its utility as a predictive biomarker. Metabolic effects of variant HSD3B1status highlight a potential requirement to modify current treatment frameworks.

Outcomes of patients with high-risk, localized renal cancer depend on optimal patient stratification, surgical management, and systemic therapy selection. Blick et al. discuss the current knowledge on these topics and provide an overview of interventions that are currently being investigated in clinical trials.

Lower urinary tract obstruction is a morbid congenital anomaly that can be treated prenatally. Kilby & Morris discuss the importance of accurate diagnosis and case selection to optimize outcomes ofin utero intervention, before reviewing the evidence and outcome data for in uterovesicostomy, vesicoamniotic shunting and fetal cystoscopy.

Optimization of the care that paediatric patients with congenital urological anomalies receive as they transition to adult health care could improve clinical outcomes and quality of life. Dan Wood discusses the challenges associated with the provision of lifelong urological care, highlighting the need for development of academic and health systems.

Changes in health-care policy have brought the issue of performance reporting to the fore. In this Perspectives, Smaldone and Uzzo discuss how the Kubler-Ross 'five stages of grief' model could help provide insight into why physicians are reluctant to accept emerging quality-reporting mechanisms.