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The treatment of patients with the PD1 inhibitor pembrolizumab yields benefit in the second-line metastatic urothelial cancer setting. Two new trials have studied pembrolizumab monotherapy in other patients with urothelial carcinoma: an open-label phase II trial has enrolled patients with high-risk BCG-refractory non-muscle-invasive disease, and a phase III trial has compared three first-line treatment options for patients with metastatic disease. However, these trials have shown conflicting results.
Serum PSA testing can identify men with clinically significant prostate cancer but exposes many more men to the diagnosis of indolent tumours. Benafif and colleagues have published the results of the BARCODE1 pilot study, in which they propose using germline single-nucleotide polymorphisms to identify men with a genetic risk of developing prostate cancer. Based on their preliminary findings, changing the current prostate cancer screening paradigm will be a challenge.
Neuroendocrine prostate cancer predominantly develops from adenocarcinoma following a period of androgen suppressive treatment. Outcomes in patients with this disease are poor; the understanding of the molecular mechanisms behind its development will improve future targeted therapy options.
Senescent cells and their secretome — the senescence-associated secretory phenotype (SASP) — cause a systemic pro-inflammatory state, contributing to an inflammatory microenvironment. In this article, the authors discuss the presence of senescent cells and the SASP in the ageing prostate and the evidence for a role of senescence in BPH and prostate cancer, as well as possible therapeutic targeting of these pathways in the future.
Bacillus Calmette–Guérin (BCG) has been used to prevent tuberculosis for a century and is also a standard approach for the treatment of non-muscle-invasive bladder cancer. However, BCG also has a plethora of non-specific effects that occur via the induction of trained immunity and have raised the hypothesis that BCG vaccination could be used to protect against coronavirus disease 2019 (COVID-19). In this Perspective, the authors describe the history of BCG, discuss the mechanisms of its effects, and consider its potential role during the COVID-19 pandemic.
Society guidelines recommend incorporating palliative care into standard oncological care. However, misconceptions regarding palliative care are common — notably, palliative care and treatments seeking to cure or prolong life are not mutually exclusive. In this article, the authors discuss the integration of palliative care into surgical urologic oncology and consider palliative care guidelines, indications for palliative care use, and how the field of urologic oncology can adopt best practices.
