Opinion in 2016

Reichard and Klein present clinical and molecular data that stand against removing the cancer descriptor from Gleason score 3 + 3 = 6 prostate cancer. They argue that the evidence of a lack of malignancy is inconclusive and that a change in classification might result in poor patient outcomes.

Asia is an emerging centre of growth in the field of urology owing to large and varied patient populations, the availability of a trained workforce, the use of English as a common language, and overall low costs. Asian urology has immense potential to expand in areas in which it currently lags behind, especially research. In this Perspective, Kumar uses a strength–weakness–opportunities–threats (SWOT) analysis to discuss the current state of urology in Asia and comment on the future direction of this field in this region.

Despite large numbers of patients being affected by stones, a surprising lack of knowledge exists on the relevance of stone compositions and pathological features to the outcomes of patients with stones. Here authors describe the potential of new technologies such as high-resolution endoscopes, and micro-CT imaging to address this lack of knowledge.

Miah and colleagues discuss differences between Gleason pattern 3 and pattern 4 prostate cancer that make the designation of pattern 3 disease as a lethal disease uncertain and argue in favour of dropping the label cancer for Gleason score 3 + 3 = 6 tumours.

Central sensitization, resulting in a disproportionately painful response to peripheral signals of a regular intensity has been implicated in a variety of chronic pain syndromes, including interstitial cystitis. In this Perspective, the authors describe a potential role of central sensitization in idiopathic overactive bladder, a condition characterized by altered sensations of urinary urgency with no apparent pathological alterations.

Selection of treatment for a patient with prostate cancer is often based on age and life expectancy. However, life expectancy estimates are often calculated solely on the basis of chronological age, overlooking comorbid conditions and their severity, which affect life expectancy. Here, the authors discuss how factors other than chronological age should be used to assess life expectancy and enable the most appropriate treatment options to be selected. Older, healthy patients might be able to tolerate more-aggressive treatments than their age might indicate, and younger patients with numerous comorbid conditions could avoid harsh therapy if inappropriate.