Volume 13 Issue 12, December 2016

Resistance to abiraterone or enzalutamide is a major medical burden — the duration of benefit is highly variable and cross-resistance often occurs when these two agents are given sequentially. Blood-based analysis of androgen receptor splice variants and AR copy number gain or mutations could enhance understanding of the mechanisms of resistance and improve management of patients with castration-resistant prostate cancer.

Surgeon–scientists have made fundamental discoveries that have revolutionized medicine. A recent report raises the spectre of a future without surgeon–scientists, owing to an increasing need for clinical productivity and burdensome administrative responsibilities. A pathway forward is needed, to protect and nurture the surgeon–scientist — a critical participant in academic medicine.

The compliance of physicians to current guidelines for asymptomatic microhaematuria is limited and the evidence supporting asymptomatic microhaematuria as an effective screening tool for the early detection of bladder cancer is weak. Medical or surgical treatment is indicated in 13–35% of patients with asymptomatic microhaematuria, albeit mostly for benign conditions, which are more commonly the cause. The high prevalence of asymptomatic microhaematuria in the general population means that this condition poses a considerable challenge to the health-care system.

Recent evidence from series of small renal mass biopsy samples and methodologically robust meta-analyses provides improved guidance on cost–benefit trade-offs for diagnosis and management of this disease. Renal mass biopsy sampling should be reserved for situations in which it will affect management decisions – which it will not do for all patients.

Large-scale randomized trials in early-stage prostate cancer are rare. Data from the recent ProtecT trial enables a cautious endorsement of active monitoring for early-stage, screen-detected prostate cancer: cancer-specific survival was high regardless of treatment approach (monitoring, surgery or radiation). How these findings apply to contemporary prostate cancer care requires careful evaluation.

Urological complications remain among the most common, and the most bothersome of all complications in patients with a previous spinal cord injury. Minimizing the risks of these various complications, including incontinence, urinary retention, urinary tract infection and bladder cancer requires sustainable long-term management. In this Review, the author describes the optimal management strategy, while outlining the various unmet needs in the management of these patients.

A need for improved serum diagnostic tests for testicular germ cell tumours (GCTs) exists owing to the unsatisfactory performance of currently used markers. In this Review, Murray and colleagues discuss the current serum diagnostic tests for testicular GCTs, including α-fetoprotein, human chorionic gonadotrophin and lactate dehydrogenase, and the future use of novel universal biomarkers such as microRNAs.

The management of upper-tract urinary stones has dramatically changed towards an increase in the use of ureteroscopic treatment, driven by technological advances. In this Review, Weiss and Shah discuss the unique advantages and disadvantages of the two basic principles for treating stones ureteroscopically — dusting and basketing.

MicroRNA secretion pathways are dysregulated in cancer, making them attractive candidate molecules for liquid biopsies and studies have shown that they are noninvasive diagnostic, prognostic and surveillance markers in urological carcinomas. However, methodological and analytical pitfalls exist and require addressing to enable future translation of microRNA analysis into clinical practice.