News & Views

A recent systematic review on worldwide declining trends in sperm counts has fuelled alarming reports in national and international news media. However, methodological issues exist with data gathering and analysis precluding any conclusion and no solid data exist to indicate increasing frequency of couple infertility during past decades.

Antimicrobial resistance in Neisseria gonorrhoeae compromises gonorrhoea treatment globally and vaccines might be the only sustainable solution for gonorrhoea control. A new study for the first time provides a proof of principle for protection with ∼31% effectiveness against gonorrhoea, owing to cross-protection by the outer membrane vesicle Neisseria meningitidis serogroup B vaccine (MeNZB).

Galeterone is a steroid 17-α-hydroxylase/17,20 lyase and androgen receptor antagonist intended for patients with prostate cancer. Similar to abiraterone, galeterone has a steroid scaffold structure and mimics natural ligands; thus, these agents are metabolized by the same enzymes that synthesize or degrade naturally occurring steroids, which can result in attenuated efficacy.

Results of the STAMPEDE and LATITUDE trials, which investigated the addition of abiraterone and prednisone to androgen-deprivation therapy in advanced prostate cancer, have renewed interest in 'complete androgen blockade', a concept originally described by Fernand Labrie in the 1980s. However, whether this treatment regimen should become standard of care remains to be seen.

In clinical studies, mirabegron has been shown to cause a small increase in heart rate with a slight increase in QTc interval, as indicated on electrocardiograms. The mechanisms of these effects are unclear. The findings of a recent study might provide some new clues, although, the relevance of these new observations to the treatment of patients with overactive bladder syndrome have yet to be established.

The advent of molecular methods for the identification and characterization of the microbiome has led researchers to understand the role of the microbiota in various clinical conditions. Research by Cavarretta and colleagues has revealed the presence of microbial dysbiosis and its potential relationship with pathophysiology in the prostate tumour microenvironment. This finding could potentially enable future investigations that clarify the role of the microbiota in the development of prostate cancer and its future management, from a different perspective.

Life expectancy after primary treatment for localized prostate cancer is long, so the importance of functional outcomes and quality-of-life measures cannot be underestimated. Careful assessment of the data, with an emphasis on patient selection, definition of clinical significance, and length of follow-up duration, is essential.

Increased evidence that prostate-cancer-specific mortality can be reduced using serum PSA screening, in addition to the increasing role of active surveillance in reducing overtreatment underlies the revised USPSTF recommendation, which now supports selective use of PSA testing. However, this recommendation should not be interpreted as a license to return to the unthinking use of PSA testing of men between 50 to 70 years of age.

Sepsis is an infrequent but serious adverse risk of transrectal ultrasonography-guided prostate biopsy. A new study evaluated whether the use of single-dose ertapenem, a broad-spectrum antibiotic, resulted in increased carbapenem resistance following biopsy. However, physicians need to carefully consider the risks of antibiotic resistance when balancing the benefit of broad-spectrum antibiosis against a 1% risk of sepsis.

Despite a rapid increase in the use of anticancer immunotherapy, our understanding of the mechanisms of action and the patients' responses remains limited. The discovery of immune inhibitory markers in the tumour microenvironment following immunotherapy should improve our understanding and might enable us to better apply combination therapies.

The comparative efficacy of drugs for the management of overactive bladder syndrome (OAB) remains undefined. A new indirect treatment comparison demonstrates similar efficacy of mirabegron versus several antimuscarinic drugs and onabotulinum toxin A in a number of outcome measures. Head-to-head trials of these agents are still required to optimize the management of patients with OAB.

Advances in understanding of prostate cancer biology and improved treatment options have changed management of metastatic prostate cancer. Escape of the malignancy from the prostatic capsule no longer means that treatment is focused on limiting systemic spread, and data suggest that local treatment of the prostate is beneficial, even in men whose tumour has spread.

Testosterone replacement therapy use has been increasing; however, a gap exists in patients' understanding of this therapy and its associated risks, and available online resources might not be bridging this gap. Action should be taken to provide patients with accessible credible information.

Data from an immunohistochemical study reveal abundant expression of β₃-adrenoceptors on cholinergic nerves of the human urinary bladder. This finding suggests that the effects of β₃-adrenoceptor agonists on overactive bladder are not mediated simply through direct inhibition of bladder smooth muscle cell excitability, but might involve a more complex mechanism, including an inhibitory effect on cholinergic nerve terminals.

The 2017 ASCO guidelines present six well-reasoned recommendations for the management of small renal masses. We expand these recommendations to contextualize the use of renal tumour biopsy, clarify when active surveillance could be more inclusive, and highlight nuances in surgical decision making for patients with anatomically complex tumours and a normal contralateral kidney.

Intermittent sunitinib treatment is a feasible first-line approach in patients with renal cell carcinoma (RCC), providing a median progression-free survival duration of 37.6 months. Cyclic re-introduction of sunitinib after a treatment break might increase the duration of a response owing to resistance to tyrosine kinase inhibitors being largely dependent on reversible changes in gene expression. Biomarkers are needed to enable selection of the best candidates for intermittent treatment.

Transvaginal mesh for pelvic organ prolapse (POP) is more controversial than ever. The largest randomized trial yet suggests transvaginal mesh or grafts are of no benefit in primary POP repair. Furthermore, a population study looks back at complication rates from pelvic floor mesh surgery over the past two decades.

Determining what constitutes a low level of testosterone is a major point of confusion in the field of testosterone deficiency — also known as hypogonadism. A recent article adds to the controversy by proposing a new, lower threshold for normal testosterone concentrations on the basis of harmonized reference ranges.

The prognostic value of lymph node yield on oncological outcomes after radical nephroureterectomy with lymph node dissection in patients with upper tract urothelial carcinomas is unclear. Careful consideration and dedicated research of why, how and for whom lymph node dissection is appropriate are imperative to ensure improvements in patient survival.

Amongst the many causes of male-factor infertility, a diagnosed viral cause is a rather infrequent aetiological factor¹. However, a recent study has illustrated that Zika virus infections affect not only developing fetuses in pregnant women, but are also a threat to fertility in men. Whether this threat could be managed or mitigated remains uncertain.