Volume 6 Issue 6, June 2009

We need a fresh approach to conducting clinical trials. Our present system is in serious need of an overhaul. Regulatory guidelines need to be re-evaluated, as they present significant barriers and cause delays.

The role of male circumcision in reducing sexually transmitted infections is controversial. A series of recently published papers add to the growing body of evidence that male circumcision might reduce carriage of penile human papillomavirus (HPV).

Unfortunately, interim analyses of the long-awaited ERSPC and PLCO trial data have generated conflicting conclusions. Here, two European authors speculate as to the reasons underlying this contradiction, while highlighting clinically relevant points that are supported by both studies. Particular attention is paid to the potential consequences of overdiagnosis and overtreatment.

Two groundbreaking trials have this year reported conflicting results as to the benefit of screening for prostate cancer. Careful interpretation in the light of contemporary data is needed to reveal the value of this intervention.

The introduction of WHO standards for PSA assays is a step forward for improving the comparability of these tests. Our current clinical decision limits, however, were validated using traditional calibrators. The threshold for biopsy must be adjusted when using the new standards.

When a patient presents for assessment of prostate cancer risk, do serial measurements of PSA provide more-useful information than determination of a single PSA concentration? The authors of a new systematic review contend that the answer to this question is 'no'. Stacy Loeb cautions against hasty abandonment of PSA kinetics.

The variable nature of duplex system ureteroceles, combined with the lack of controlled trials assessing their treatment, makes them a challenging prospect to urologists. Balancing potential risks of treatment against predicted outcomes is paramount, with the aim of minimizing the likelihood of urinary tract infections, preserving existing functionality, and preventing bladder dysfunction and incontinence.

Molecular evidence indicates that 18F-labeled 2-fluoro-2-deoxy-D-glucose (FDG) accumulates in prostate tumors. Hossein Jadvar from the University of Southern California summarizes these data, and provides an overview of imaging techniques currently used to evaluate various aspects of prostate cancer, before outlining current clinical experience of FDG-PET for the evaluation of this disease.

Drawing on their own considerable experience, Coen and Zietman from Harvard Medical School assess the current clinical utility of proton beam therapy for prostatic malignancy. Comparison with other approaches such as intensity-modulated radiation therapy highlights the potential of this promising but expensive modality.

Here, Ooi and co-workers present a 40-year-old man who developed acute-onset bilateral painless swelling of the scrotum, and was diagnosed with acute idiopathic scrotal edema. Although rare in adult males, this condition should be considered in the differential diagnosis of acute scrotal swellings, in order to avoid unnecessary surgery.

In this Case Study, Sahai and colleagues report on a 15-year-old boy who sustained grade V renal trauma, with associated splenic injury and renal vein thrombosis. The authors use the case to illustrate that conservative management of grade V blunt renal trauma is possible in a hemodynamically stable patient.

The authors present a 57-year-old woman with advanced renal cell carcinoma (RCC) and a tumor thrombus extending into the vena cava. She received neoadjuvant sunitinib, which shrank the tumor thrombus, and enabled laparoscopic radical nephrectomy to be performed. The case highlights the potential of targeted agents before surgery in RCC.