Volume 11 Issue 1, January 2014

In the quest for reduced morbidity from radical treatments, tissue-sparing focal therapies are being developed to treat men with localized prostate cancer. However, which patients are most suitable for these experimental therapies remains unclear. One population-based study suggests that the majority of patients are suitable candidates.

In a recent retrospective institutional analysis, the prognosis of patients with muscle-invasive bladder cancer improved over time after surgical intervention. Indeed, duration of survivorship after radical cystectomy was inversely correlated with risk of mortality, suggesting that follow-up regimens should be modelled according to this parameter.

A randomized trial involving 460 women with stress urinary incontinence compared physiotherapy with midurethral-sling surgery. We question whether the results, showing higher rates of improvement and cure for surgery than for physiotherapy, should change best practice and clinical practice guideline recommendations.

Patients treated with two or more courses of BCG for high-risk non-muscle-invasive bladder cancer are at increased risk of second-site primary tumours of the upper urinary tract and prostatic urethra. A new study highlights the importance of looking for urothelial cancer in extravesical disease sites.

Indocyanine green dye continues to be adopted in robot-assisted surgical procedures; its role has expanded from partial nephrectomy to now include reconstructive procedures. Further studies are required to evaluate whether it is simply an interesting tool in the armamentarium or a technique that can improve patient outcomes.

After biochemical recurrence following radical prostatectomy, external beam radiation therapy (EBRT) reduces the risk of prostate-cancer-specific mortality. However, many men with a detectable serum PSA level will never experience clinical progression. New definitions of biochemical recurrence could help to determine the most appropriate candidates and time points for salvage EBRT.

Bladder cancer recurrence after radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) is a common occurrence. A new nomogram, based on retrospective analysis of a large multicentre cohort, has been shown to predict the risk of intravesical recurrence. Despite limitations, this model could help clinicians to provide personalized postoperative management.

Evaluating the functional aspects of genetic variation in prostate cancer would advance our understanding of its aetiology and enable population stratification for screening. Eeles et al. provide an overview of the current evidence on the germline genetic variants in prostate cancer development, as well as the association of these variants with clinical outcomes.

Although abiraterone can largely be considered a success in castration-resistant prostate cancer (CRPC), some patients still acquire resistance. In this Review, the authors describe the field of CYP17 inhibition for CRPC, of which abiraterone is the prime candidate, and describe ongoing medicinal chemistry and clinical efforts to improve CYP17 inhibition while mitigating adverse effects.

Hampson et al. discuss the epidemiology, pathogenesis, aetiology, and evaluation of anterior male urethral strictures. They also consider some current controversies in urethroplasty, such as the management of failed hypospadias repair and long or complex strictures, as well as the use of dorsal versus ventral onlay grafting.

In surgical procedures, there is a delicate balance between preventing thromboembolism by maintaining thromboprophylaxis, and avoiding excessive bleeding. Patients requiring treatment for urinary stones are often taking antithrombotic medication, or have an underlying bleeding disorder. This Review brings together the current recommendations for perioperative management of thromboprophylaxis in lithotripsy.

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.