Volume 9 Issue 5, May 2012

A recent survey of radiation oncologists has evaluated barriers to surveillance rather than adjuvant therapy for postorchiectomy management of stage I seminoma. The findings suggest that providers are underestimating the late toxicity of radiation therapy in these patients.

Cross-sectional imaging, endoscopic evaluation and biopsy are the mainstay of preoperative evaluation and staging of patients with upper tract urothelial carcinoma (UTUC), despite their limitations in accurate prediction of grade, stage and oncologic outcome. Multivariable models incorporating numerous clinical factors, including novel tumor markers will improve our ability to deliver personalized treatment.

In the last 3 years, three major trials involving patients with advanced germ cell testicular tumors have investigated dose-intense alternatives to standard BEP (bleomycin, etoposide, and cisplatin) therapy. All three trials failed to reach their accrual targets and none was able to demonstrate improved results.

The Bone Scan Index (BSI) is a methodology used to quantify bone metastases and monitor changes under treatment. However, BSI is manually calculated and is, therefore, tedious and time-consuming to use, so it is not routinely implemented. A new automated platform to calculate BSI should help to increase its use.

In this Review, Cimador and colleagues discuss the published evidence relating to clinical decision making when managing an adolescent patient with varicocele. The emerging role of color Doppler ultrasonography (CDUS) is considered at various stages of clinical management, with a particular focus on the clinical utility of hemodynamic parameters obtained by preoperative and follow-up CDUS.

In this Review, Trabulsi and colleagues discuss deficiencies in our current QOL measurement system and make recommendations for assessing QOL for specific subpopulations of patients. They consider the effect of ethnicity on QOL for patients with prostate cancer, with a particular focus on white, African American, Latin American, and Asian men. They also review some of the QOL issues that are known to affect men who have sex with men, a subpopulation of patients that is under-represented in prostate cancer care.

Here, Alva and colleagues discuss current management options for patients with nonmetastatic upper tract urothelial cancer (UTUC), considering the rationale for perioperative chemotherapy, reviewing existing evidence for adjuvant and neoadjuvant chemotherapy, and contemplating future directions for UTUC management.

The synchronized function of prostate cells depends on intercellular communication within multicellular compartments; its disturbance has long been suggested to be integral to prostate carcinogenesis. Some data point to stage-specific functions of connexins, which form intercellular gap junctions that are involved in the metabolic and electrical coupling of cells, in prostate cancer development. In this Review, the authors describe the functions of connexins and gap junctions during the different stages of prostate cancer development, in the context of the functional links between connexin expression and prostate cell differentiation.

Five primary prostanoids are synthesized by the cyclooxygenase enzymes, COX 1 and COX 2: the prostaglandins PGE₂, PGF_2α, PGI₂, PGD₂, and thromboxane A2. High levels of these signaling molecules have been implicated—in both animal models and human studies—in decreased functional bladder capacity and micturition volume, and increased voiding contraction amplitude. In this Perspectives article, the authors describe the role of prostanoids in bladder physiology, summarize the findings from animal model and human studies, and discuss the clinical use of prostanoids in the treatment of functional bladder disorders.