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The potential of the prostate cancer antigen 3 (PCA3) urine assay to aid prostate cancer diagnosis and minimize unnecessary biopsies has been extensively studied. Results from three recent studies that compared the performance of PCA3 with PSA underscore the advancement and future challenges for this new diagnostic biomarker.
Prostate cancer screening often detects indolent cancers—defined as those which would never cause morbidity or mortality if left undetected and untreated. Unnecessary treatment of indolent cancer is a problem associated with this 'overdetection'. Active surveillance is a management strategy for low-risk cancers which can decrease the overtreatment burden.
Active surveillance (AS) is an option for low-risk prostate cancer. Accurate risk assessment is paramount to select patients for definitive intervention and to avoid overtreatment. Although inaccurate, PSA and Gleason score changes remain common treatment triggers. Biopsy before AS is initiated could avoid misclassification and the need for serial biopsy.
Functional MRI techniques are increasingly being used for prostate cancer imaging, but their implementation differs markedly among institutions. A set of recommendations has now been published in an attempt to standardize protocols; however, the guidelines were devised without the use of evidence-based data, and require further scrutiny.
The pathogenesis and treatment of prostate cancer is complex and challenging, and the development of useful biomarkers for disease progression would be extremely valuable to clinicians and patients making treatment decisions. In this Review, the authors suggest a series of algorithms, making up a clinical 'roadmap' of prostate cancer pathogenesis and management. This device could help in identifying points in the prostate cancer timeline where biomarkers are most needed.
Historically, detrusor overactivity has served as a clinical biomarker for overactive bladder, although there is a significant lack of evidence to support its use. Here, Cartwright and colleagues describe the hunt for new biomarkers of overactive bladder, including measurements of urinary, genetic and anatomical parameters.
Here, the authors briefly describe the mechanisms of citrate therapy for hypocitraturic nephrolithiasis before summarizing the available data on different dietary therapies, including lemonade, carbonated beverages and protein intake.
Testicular microlithiasis has been linked to the testicular dysgenesis syndrome, and is thought to be a precursor of testicular germ cell tumor. In this Review, the authors discuss the prevalence of testicular microlithiasis, and its pathogenesis, including a putative link with β–estradiol. They also consider the differing management strategies for three main patient groups diagnosed with testicular microlithiasis.
This Case Study describes the management of a patient with a fumarate hydratase (FH)-deficient type-2 papillary renal cell carcinoma. On the basis of results fromin vitro experiments, the authors decided to treat the patient with the glycolytic inhibitor 2DG (2-deoxy-D-glucose), a new anticancer drug that is currently in clinical development.
