Volume 11 Issue 4, April 2014

Although multiple systemic treatment options are available for men with castration-resistant prostate cancer, there is a paucity of data regarding optimal sequencing of these drugs. A recent study suggests that cabazitaxel exerts antitumour activity in men who have been pretreated with docetaxel and abiraterone or enzalutamide.

Focal therapy of prostate cancer enables treatment of the index lesion while sparing the rest of the gland and surrounding vital structures, thereby decreasing the risk of morbidity. As clinicians acknowledge its potential, the recently published multidisciplinary consensus is timely and provides new insight into trial design for focal therapy.

A newly published randomized controlled trial shows that pelvic floor muscle training can significantly reduce prolapse symptoms compared with provision of a prolapse lifestyle advice leaflet and no muscle training. However, the important role of surgery in the treatment of these women must be taken into account.

Advances in available treatments for metastatic renal cell carcinoma affect the prevalence, morbidity, and mortality associated with skeletal-related events (SREs) owing to metastatic bone lesions. A newly published report shows that the prevalence and in-hospital mortality of SRE-associated hospitalizations are decreasing, while the associated costs are increasing.

New research shows that high-risk and intermediate-risk prostate cancers are being treated with brachytherapy alone, deviating from both guidelines and expert opinion. These findings should force intense introspection and scrutiny amongst clinicians, and encourage them to consider whether they are practicing evidence-based medicine.

Epidemiological studies suggest that the prevalence of prostate cancer in Asian men is lower than the rates observed in Asian populations resident in Western countries and in native Western individuals. Conversely, the proportion of prostate cancer cases that are metastatic seems to be higher in Asian countries. In this Review, these trends and the factors that might underlie them, particularly the influence of screening programmes, are comprehensively discussed.

In this article, Nadal et al. review the pathological features, biology, clinical characteristics, and diagnostic challenges of SCC of the prostate, summarize the available treatment options, and highlight promising therapeutic strategies.

In addition to surgical transurethral resection of the bladder tumour, intravesical chemotherapy with mitomycin C (MMC) is commonly used for the treatment of non-muscle-invasive bladder cancer. In this Review, approaches to optimizing MMC therapy through enhanced delivery, as well as maintenance and/or combination treatment regimens, are discussed.

BPH–LUTS and erectile dysfunction commonly coexist, and both respond to phosphodiesterase 5 inhibitors. In the opinion of Cellek et al., the underlying pathology of both conditions can be explained by microvascular dysfunction, a vicious cycle of hypoxia, vasoconstriction, altered smooth muscle contractility, and degeneration of autonomic neurons and ganglia.