Volume 8 Issue 7, July 2011

A recent prospective, randomized study comparing the outcomes of laparoscopic and robot-assisted prostatectomy provides some of the best contemporary evidence of the superiority of the robotic procedure in terms of postoperative erectile function. A similarly high-quality comparison of robotic and open prostatectomy must now be warranted.

Bone metastases from prostate cancer are detected with staging bone scans. New research supports existing guidelines on the appropriate referral criteria for bone scans and shows that a specific subgroup of patients with prostate cancer who are at low risk of bone metastases do not require a staging bone scan.

Clinical staging of muscle-invasive bladder cancer remains limited by volume criteria used to identify nodal metastases. The development of accurate predictive models that identify patients at high risk of nodal disease, such as the one described here, is essential to optimize treatment planning for this group of patients.

High hospital and surgeon volumes have now been shown to have a significant effect on mortality after radical cystectomy, but a standard minimum volume to identify centers associated with better outcomes has not been established. Other factors, such as hospital infrastructure and resources, can influence surgical outcome and should be included in quality of care assessment.

The development of the Guy's stone score represents a notable effort to predict the likelihood of stone-free outcomes in patients undergoing percutaneous nephrolithotomy. However, it requires reassessment with more rigorous end points in a larger patient population.

Controversy exists over the safety of testosterone replacement therapy (TRT) with regard to the initiation, promotion, aggressiveness, and progression of prostate cancer. In their Review, Goldenberg and colleagues argue the importance of classic early literature on the concept of a testosterone threshold level and the implications for use and safety of TRT, as well as describe the biological effects of TRT for testosterone deficiency.

Inhibition of 5α-reductase has the potential to be extremely useful in the treatment of prostate cancer. However, the two largest trials to investigate the use of such drugs showed that, although the overall incidence of cancer was reduced, detected tumors were more aggressive than in patients treated with placebo. In this Review, the authors consider the mechanism of 5α-reductase inhibitors in the treatment of prostate cancer, and discuss the controversies surrounding their use in clinical practice.

Postoperative radiotherapy can reduce the risk of biochemical recurrence in prostate cancer and improve survival. Three large randomized trials have provided evidence that adjuvant radiotherapy is effective; however, no such evidence exists for salvage radiotherapy, despite the fact that it can be as effective as adjuvant therapy in most men. In this Review, the authors discuss the evidence for and against both types of postoperative radiotherapy, and offer recommendations based on the available data.

Extended pelvic lymph node dissection has been shown to markedly improve oncologic outcomes in patients with urothelial carcinoma of the bladder, but the value of lymphadenectomy in the management of upper tract urothelial carcinoma (UTUC) is less clear. In this Review, the authors discuss whether routine regional lymph node dissection can be recommended for UTUC on the basis of the available evidence.

Overactive bladder, in which patients have urinary urgency and incontinence, is a bothersome condition and treatment can be challenging. Here, in this Review, Barroso and Lordêlo discuss the use of electrical nerve stimulation for the treatment of overactive bladder in children. The mechanisms of action, technique, and available clinical results for this treatment modality are described.