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New research confirms that elderly patients with bladder cancer are clearly undertreated and women with high-risk noninvasive disease have worse outcomes than their male counterparts. Aggressive treatment can benefit both of these patient groups and should be offered and discussed appropriately.
Intermittent androgen deprivation can reduce treatment-related adverse effects in men with prostate cancer. Data from the recent SWOG-9346 trial show a nonsignificant improvement in median overall survival in patients treated with continuous therapy compared with intermittent therapy, but are these data likely to change clinical practice?
Bladder cancer risk assessment is currently based on an individual's age and history of exposure to known carcinogens. A new report illustrates how interactions between cigarette smoking and germline genetic variation can identify those at particularly high risk, who could be targeted in future bladder cancer prevention and screening efforts.
Meijer and colleagues review recent imaging advances to detect cancerous nodes in patients with prostate cancer. Improved detection of involved nodes enable a more personalized approach in patient selection and treatment planning for lymph node irradiation.
In this Review, Ischia and So discuss the expression of heat shock proteins (HSPs) in bladder cancers and their utility as diagnostic and prognostic biomarkers. They also cover the role of HSPs in mediating the BCG response, as well as resistance to radiotherapy and chemotherapy. Furthermore, they briefly discuss novel therapies that target HSPs in the treatment of bladder cancers.
Most clinical trials of chemotherapeutics for advanced bladder cancer have shown limited benefits, so new prognostic markers and effective treatment strategies are necessary. Yoshino et al. discuss the microRNAs that have been identified as potential oncogenes or tumour suppressors, as well as those that have been implicated as prognostic biomarkers, in bladder cancer.
In this Review, Marignol and colleagues evaluate the potential involvement of hypoxia in the deregulated expression of notch receptors, ligands, and targets in prostate cancer cells and consider the likely involvement of hypoxia and notch signalling in disease progression, treatment resistance, and the identification of novel therapeutic targets for prostate cancer.
Rahnama'i and colleagues highlight the emerging role of selective phosphodiesterase (PDE) inhibitors in the management of functional voiding disorders. Although much remains unknown about the role of these enzymes in the human bladder, accumulating evidence suggests that PDE5 inhibitors alleviate lower urinary tract symptoms in men, and could be a useful adjunct to α blocker therapy.
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.
