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Neoadjuvant targeted therapy can be used in patients with unresectable locally advanced, locally recurrent or metastatic renal cell carcinoma to induce cytoreduction before surgical resection. The efficacy of this multimodal therapy is still unproven, however, and must be balanced against a potential higher risk of perioperative complications.
Renal medullary carcinoma has been almost exclusively diagnosed in patients with sickle cell anemia. O'Donnell et al. present a case of this rare and aggressive cancer in an adult with no detectable hemoglobinopathies. They describe both the histopathological features of the disease, and the systemic chemotherapies used to treat it.
In this Review, the authors discuss the potential of testicular germline stem cells as a substrate for cell-based therapies. Although at an early stage, research in this field is progressing rapidly. If their promise is fulfilled, such cells could be applied to a range of therapeutic indications, including tissue reconstruction and fertility restoration.
Current imaging modalities lack sufficient sensitivity and specificity for the noninvasive staging of lymph nodes in genitourinary cancers. In this Review, Mouli and colleagues from Northwestern University discuss the potential role of lymphotropic nanoparticles—which selectively accumulate in benign lymph nodes—in enhancing the MRI detection of nodal metastases.
The targeting of angiogenesis is a growing area of cancer therapy.In vivo imaging techniques allow the noninvasive evaluation of changes in tumor vasculature in response to antiangiogenic agents. Zee et al. provide an overview of MRI, CT, PET and ultrasound techniques, highlighting their application in renal, prostate and bladder cancer.
The publication last year of large trials of PSA screening in prostate cancer has rekindled interest in alternative noninvasive markers for this disease. Here, Ploussard and de la Taille discuss the range of potential urinary biomarkers in prostate cancer, and the current clinical data on their utility in disease detection and staging.
The relationship between trial registration and publication is not straightforward. Although registries and editorial requirements receive some attention from researchers, study protocol changes, omissions and suppressions are the rule. Such practices deny patients and their health-care providers access to unbiased clinical information on which to base decisions.
Intravesical instillation with live, attenuated Mycobacterium Bacillus Calmette-Guérin (BCG) is an effective therapy for bladder cancer. Two recent analyses provide new insight into the clinical efficacy of BCG versus chemotherapy with mitomycin C in intermediate-risk and high-risk bladder cancer.
The capacity of traditional noninvasive diagnostic procedures such as microhematuria testing and urine cytology to be used as stand-alone screening techniques for urothelial carcinoma is limited. New qualitative and quantitative molecular screening modalities can detect alterations that are often exclusively associated with this disease. Mitra and Cote propose incoporating both traditional approaches and molecular tests into a risk-based screening strategy.
Multimodal treatment utilizing combined androgen suppression and radiotherapy has improved survival rates for patients with high-risk prostate cancer. Rosenthal and Sandler provide a timely summary of the clinical trials that have been carried out in this area, as well as discussing recent advances in dose-escalated radiotherapy and adjuvant chemotherapy.
