News & Views

In a recent study, men ≥80 years who received external beam radiotherapy (EBRT) for prostate cancer lived longer than those who were observed. Greatest benefits were reported in men with moderate or aggressive disease, and those with few comorbidities. The study also emphasizes the large proportion of men who went untreated after diagnosis.

A multidisciplinary expert panel from the American Society of Clinical Oncology has endorsed the updated European Association of Urology guidelines for the management of muscle-invasive bladder cancer, with one exception. The panel also provides additional clarification of several recommendations.

For nearly two decades, carbonic anhydrase IX (CAIX) expression has been investigated as a prognostic marker in renal cell carcinoma (RCC). During this time, CAIX-directed treatments have emerged, including ¹⁷⁷Lu-labelled girentuximab. A small phase II study highlights modest efficacy and a concerning safety profile associated with this compound in patients with metastatic RCC.

A new grading system for prostate cancer — which categorizes tumours from grade group 1 (least aggressive) to grade group 5 (most aggressive) — has been endorsed by the editors of five major urology journals.

The results of the Scandinavian Prostate Cancer Group-7 trial highlight the benefit of adding radiotherapy to endocrine treatment in men with unfavourable-risk prostate cancer. Further scientific advances in radiation technologies, pharmacotherapy and imaging modalities raise questions about the future of radical prostatectomy in this patient group.

Two large prostate screening trials showed apparently conflicting results, providing evidence for both mortality reduction and absence thereof. A modelling study has now assessed the effect of referral and treatment patterns on cost-effectiveness of PSA screening, which might shed further light on the issue by expanding the available empirical data.

Prior reports demonstrate a near-zero risk of prostate-cancer death among patients with very low-risk tumours managed on active surveillance (AS). However, outcomes from an AS cohort in Sweden suggest that observing men with low-risk and intermediate-risk tumours carries a small — but significant — risk of treatment failure and death from prostate cancer.

Human kidneys have many features in common with those of other species, but also unique properties. A detailed human–mouse comparison of the genetic programme governing early events in nephron formation has revealed interspecies differences that could explain how nephron number in adult kidneys is determined.

Sexual health, even into older age, is important to many people. A new paper reports that older men with hypogonadism who take testosterone experience significant improvements in sexual activity, erectile function and libido. Testosterone therapy has long been a matter of interest (and controversy) for physicians, and this study is a landmark one that is worthy of further discussion.

The various clinical guidelines on the workup and initial management of a patient presenting with haematuria are based on limited scientific evidence. Survey data suggest that these guidelines are inconsistently applied, perhaps owing to variations between guidelines and the lack of higher level evidence. Nonetheless, based on existing evidence and appropriate risk stratification, Nielsen and Qaseem describe a haematuria workup that is safe, appropriately aggressive, and cost-effective.

Angiogenesis has not yet been validated as a therapeutic target in advanced urothelial carcinoma. However, a recent phase II trial has suggested that ramucirumab — a vascular endothelial growth factor (VEGF) receptor-2 antibody — combined with second-line docetaxel, might be beneficial.

A study investigating the mortality attributed to urolithiasis over a 15-year period has noted an increasing rate of death with a simultaneous rise in stone prevalence. However, the exact mechanisms by which nephrolithiasis causes death remains unclear.

Recurrences can occur in up to 30% of surgically managed patients with localized renal cell carcinoma. Existing uro-oncological guidelines differ in recommendations of surveillance protocols and identification of patients at risk. A recent study shows that the existence of differing guidelines results in inadequate harms, cancer control and costs.

Although the increased use of androgen deprivation therapy for prostate cancer might be improving survival, a recent large retrospective cohort study that analysed hospital medical record data indicates that long therapy duration is associated with an increased risk of Alzheimer's disease.

The ability of computers to derive the Gleason score of a tumour directly from the pixel-to-pixel variations that encompass radiological texture has been shown to be accurate. However, the methodology did not mirror the daily clinical task that radiologists face. Further research is required to validate the applicability of this technique.

Active surveillance is a safe and cost-effective method to manage patients with recurrent papillary, low-grade, Ta bladder tumours. New long-term data from a large patient cohort confirm previous findings that emphasize the benefits of limiting the number of surgical procedures requiring anaesthesia and hospitalization in these, often elderly, patients.

Tolvaptan, an arginine vasopressin receptor antagonist, decreases urinary supersaturation in kidney stone formers by considerably increasing diuresis, suggesting that this drug might be an effective therapy for reducing the risk of developing kidney stones in these patients.

The positive association between hospital case volume and surgical outcomes is well established in cancer care. Recent reports have increasingly indicated that this relationship also applies to other cancer disciplines, including radiation therapy. Characterizing the extent to which cancer centre experience drives oncological outcomes is critical for patient decision making.

Luteinizing-hormone-releasing hormone (LHRH) agonists as androgen deprivation therapy (ADT) for men with advanced prostate cancer are usually administered indefinitely on a fixed schedule. However, using testosterone level to guide ADT in these patients could lead to reductions in cost and some symptomatic improvements.

Testosterone supplementation therapy is an effective therapy for hypogonadism but can lead to the suppression of spermatogenesis. A new study investigated the effects of enclomiphene citrate, the trans isomer of clomiphene, on serum hormone levels and sperm counts in men with secondary hypogonadism.