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This issue is a special Focus Issue on sexual medicine, including articles on sexuality and sexual function in transgender persons and stem cell therapy for penile fibrosis.
Image of prostate cancer patient-derived organoids supplied by Hatem Sabaawy, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.
Immunotherapy and tumour microenvironment modulation are potential new treatment approaches for metastatic prostate cancer, but patient selection might be key to delivering therapeutic benefit. In the past year, four studies have suggested that DNA mismatch repair alterations and CDK12 aberrations are biomarkers of response to immune checkpoint inhibitors.
2018 has been an exciting year for imaging in urology, especially in the field of prostate cancer. In this context, multiparametric MRI and molecular imaging targeting prostate-specific membrane antigen provide practice-changing developments for detection and diagnostic work-up.
Since the discovery and confirmation of the human urobiome, highly influential studies to characterize this microbial community and understand how it relates to human health and disease have been undertaken. Technological advances will improve information about the status of the urobiome for clinicians.
For the management of bladder cancer, 2018 has been characterized by deepened knowledge on the molecular basis of invasive bladder cancer and its potential interaction with existing therapies, optimization of the use of immune checkpoint inhibitors, and emerging early signals on new therapeutic classes for advanced disease.
The treatment of metastatic kidney cancer is rapidly evolving with the shift from immune checkpoint inhibitor monotherapy to combination therapy. In 2018, the combination of nivolumab–ipilimumab received regulatory approval and multiple positive clinical trials were reported with combinations of PD-1 or PD-L1 inhibitors in conjunction with antiangiogenic drugs.
In this Review, the authors describe the current preclinical research into stem cell therapy for the treatment and prevention of penile fibrotic disorders, including Peyronie’s disease, urethral stricture and corpora cavernosa fibrosis, and highlight their specific mechanisms of antifibrotic activity.
The penis is a diverse and rapidly evolving structure, much more complex than its fundamental function — sperm transfer — would seem to require. In this Review, experts in the field discuss the drivers of penis evolution, and consider how the penis might be an ideal characteristic on which to focus in studies to link phenotype with genotype.
Sexual arousal in women comprises two components: genital arousal and subjective arousal. For some women, genital arousal enhances subjective arousal; for others, the two types of arousal are desynchronous. In this Review, Meston and Stanton describe the mechanisms and the relationship between genital and subjective arousal and consider how they assist in diagnosis and treatment of sexual arousal dysfunction and development of treatments for female sexual arousal dysfunction.
Transgender persons can be affected by sexual dysfunctions before, during, after, because of, and despite therapy. In this Review, experts in the field discuss trans sexuality across the gender dysphoric spectrum, and suggest ways in which trans persons can be supported in their sexuality and sexual function.