Volume 13 Issue 8, August 2016

Given a recent update from the PLCO trial reporting that over 90% of men in the 'usual care' arm underwent some degree of PSA testing, the PLCO can no longer accurately be called a trial of screening versus no screening — nor can it be included as such in meta-analyses or guideline statements.

A multidisciplinary expert panel from the American Society of Clinical Oncology has endorsed the updated European Association of Urology guidelines for the management of muscle-invasive bladder cancer, with one exception. The panel also provides additional clarification of several recommendations.

For nearly two decades, carbonic anhydrase IX (CAIX) expression has been investigated as a prognostic marker in renal cell carcinoma (RCC). During this time, CAIX-directed treatments have emerged, including ¹⁷⁷Lu-labelled girentuximab. A small phase II study highlights modest efficacy and a concerning safety profile associated with this compound in patients with metastatic RCC.

Quality-of-life (QoL) outcomes using patient-reported standardized questionnaires are understudied in the field of small renal masses, but are highly relevant for patients who have several treatment options. A recent study has compared QoL outcomes in patients undergoing primary intervention or active surveillance for this malignancy.

In a recent study, men ≥80 years who received external beam radiotherapy (EBRT) for prostate cancer lived longer than those who were observed. Greatest benefits were reported in men with moderate or aggressive disease, and those with few comorbidities. The study also emphasizes the large proportion of men who went untreated after diagnosis.

Radical cystectomy and urinary diversion is the gold-standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer. Ureteroenteric anastomotic stricture has a reported prevalence of up to 10%, and such strictures have serious consequences that can lead to loss of kidney function and infectious complications. Here, the authors discuss the pathophysiology, diagnosis, risk factors, and management of ureteroenteric anastomotic strictures and describe ways in which stricture risk can be minimized.

Gender dysphoria — distress associated with being assigned to the wrong gender and experiencing oneself as the nonnatal gender — can affect individuals of any age. However, treatment of gender-dysphoric children and adolescents is controversial. In this Review, Costa and colleagues discuss the data supporting hormonal treatment to delay puberty in gender-dysphoric children, and the considerations for managing these patients.

Cannabinoid receptors and their agonists, endocannabinoids, can be detected throughout the urinary tract. However, despite a paucity of well-tolerated agents for patients with lower urinary tract symptoms (LUTS), clinical targeting of this system has remained largely overlooked. In this Review, the authors describe the current evidence for a role of cannabinoids in micturition and as a treatment for LUTS.

Mathieu et al. review current data on the effect of lymphovascular invasion on disease outcomes in patients with bladder cancer and assess its utility in informing clinical decision-making as a prognostic marker or indicator for early intervention.

Central sensitization, resulting in a disproportionately painful response to peripheral signals of a regular intensity has been implicated in a variety of chronic pain syndromes, including interstitial cystitis. In this Perspective, the authors describe a potential role of central sensitization in idiopathic overactive bladder, a condition characterized by altered sensations of urinary urgency with no apparent pathological alterations.