Opinion in 2012

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.