Volume 7 Issue 10, October 2010

Initial results of the REDUCE trial suggest that dutasteride decreases the incidence of prostate cancer in men with persistently elevated PSA; however, questions have emerged about the drug's effect on the incidence of high-grade cancer. Adjustment for post-randomization confounders, however, brings the true benefit of this drug into clearer focus.

In the PROG 95-09 trial, higher-dose radiation therapy improved the 10-year biochemical recurrence rate among patients with localized prostate cancer without worsening patient-reported quality-of-life outcomes. This study provides valuable information on health-related quality of life associated with high-dose radiation therapy for prostate cancer, which may assist physicians when counseling patients on their available treatment options.

The recommended treatment for adrenocortical cancer (ACC) is surgical excision. Two studies have compared open versus laparoscopic adrenalectomy for tumor excision in patients with ACC, and have drawn different conclusions on the effectiveness of laparoscopic adrenalectomy in these patients.

The MiniArc^™ sling is a next generation midurethral sling that is placed through a single incision with anchoring tips that fix into the obturator muscles. A new study reports 12-month success rates for this sling ranging from 85–91%, depending on the outcome measure evaluated, with a low rate of adverse events. Despite these encouraging results, long-term data are needed to demonstrate distinct advantages of the MiniArc^™ over existing slings, combined with proven efficacy and safety.

The Surgical Care Improvement Project (SCIP) aims to reduce complications by ensuring adherence to a number of procedural criteria. The findings of a recent study imply that adherence to individual SCIP infection-prevention measures may not be an effective measure of quality. Rather, 'all-or-none' compliance with multiple SCIP recommendations is required if hospitals are to achieve quality-improvement outcomes.

Prostate cancer localization has been greatly improved by the emergence of 3T and multiparametric MRI technologies. Raz et al. provide a clear and comprehensive description of the MRI sequences that can be used to detect prostate tumors before focusing on the patient populations that might benefit most from these technical advances.

Intermittent androgen suppression is neither inferior nor superior to continuous therapy for cancer control, but has significant advantages in respect to adverse effects, quality of life and cost. In this Review the authors present the key evidence supporting the efficacy of intermittent androgen suppression, and highlight how current data can be applied to everyday clinical practice.

Focal therapy has the potential to become a 'middle ground' between active surveillance and radical treatment for prostate cancer by combining minimal morbidity, cancer control, and scope for re-treatment. In this article, the authors outline the energy modalities available for use in focal therapy, review the current evidence, and discuss future directions for this type of treatment.

Growing understanding of the complex cellular, neural and integrative physiology of the bladder offers new insights into the causative mechanisms of overactive bladder. Here, the authors review the diagnosis and therapy of this challenging clinical condition. They discuss new developments in our understanding of the pathophysiology of overactive bladder, and outline how these might lead to formulation of novel treatments.

In this Case Study, the authors describe a patient with Birt–Hogg–Dubé syndrome—a genetic disorder that confers increased susceptibility to renal cancer—who developed small-cell neuroendocrine carcinoma of prostatic or bladder origin. They outline the genetic and immunohistochemical analyses that were performed in an attempt to understand the behavior of this rare and highly malignant tumor.