Volume 13 Issue 7, July 2016

The results of the Scandinavian Prostate Cancer Group-7 trial highlight the benefit of adding radiotherapy to endocrine treatment in men with unfavourable-risk prostate cancer. Further scientific advances in radiation technologies, pharmacotherapy and imaging modalities raise questions about the future of radical prostatectomy in this patient group.

A new grading system for prostate cancer — which categorizes tumours from grade group 1 (least aggressive) to grade group 5 (most aggressive) — has been endorsed by the editors of five major urology journals.

Two large prostate screening trials showed apparently conflicting results, providing evidence for both mortality reduction and absence thereof. A modelling study has now assessed the effect of referral and treatment patterns on cost-effectiveness of PSA screening, which might shed further light on the issue by expanding the available empirical data.

The prostate gland is the major male reproductive gland involved in male fertility. In this Review, the authors discuss the reproductive function of the prostate gland, summarizing physiological and molecular mechanisms that connect prostate homeostasis with male fertility and describing how these mechanisms are associated with prostatic diseases. They highlight the central role of Zn²⁺and citrate in regulating activities of the prostate epithelium, discuss the influence of bacteria-related prostate inflammation on male fertility, and note the potential role of prostatic inflammation in the development of prostatic hyperplastic growth and prostate carcinogenesis.

Laparoscopic techniques are subject to continuous change and benefit from new developments. Robot-assisted surgery has substantially revolutionized laparoscopy, increasing its distribution; however, it is associated with considerable costs. In this Review, Rassweiler and Teber discuss technical improvements, developing technologies and speculate on the future of minimally invasive surgery and laparoscopy in urology.

Extreme hypofractionation of radiotherapy is a novel treatment modality for patients with organ-confined prostate cancer. Arcangeli and Greco summarize the results of clinical trials investigating moderate and extreme hypofractionation regimens, highlight challenges to the routine use of extreme hypofractionation and discuss areas for further clinical research.

The genomic landscape of testicular germ cell tumour (TGCT) risk is dominated by inherited genetic factors, which are highly polygenic in nature. Here, the authors discuss results from genome-wide association studies that have identified risk loci associated with TGCT risk.KIT–KITLGsignalling is currently the major pathway that is implicated in TGCT formation.

The management of advanced renal cell carcinoma (RCC) has dramatically changed over the past decade. In this Review, the authors discuss the development of novel immunotherapies to treat RCC, including inhibitors of checkpoint receptors, vaccines, T-cell agonists, and chimeric antigen receptor T cells.