News & Views

Prostate-specific membrane antigen-targeted positron emission tomography has revolutionized prostate cancer diagnostics and holds the potential to advance metastases-directed therapy through, among other treatments, ablative radiotherapy.

Prognostic models are crucial for optimal management of patients with renal cell carcinoma (RCC) after surgery. Multiple clinico-pathological models to predict cancer outcomes in these patients exist and seem to have reached their performance ceiling. Future research needs to identify new prognostic markers and to consider when and how prognostic models for RCC are implemented into practice.

In this prospective trial in oligometastatic renal cell carcinoma (RCC), the first of its kind, stereotactic ablative body radiotherapy was delivered successfully in lieu of systemic therapy. This strategy should be considered in selected patients with oligometastatic RCC.

Robotic-assisted radical prostatectomy has similar oncological outcomes to open retropubic prostatectomy, but improved potency outcomes. Surgeon skill and degree of nerve sparing, patient age and preoperative potency are the greatest predictors of postoperative potency outcomes. Bhat and colleagues present potency and quality-of-life outcomes from a very high-volume robotic surgery study.

Sperm characteristics are routinely assessed in fertility clinics as decisive factors to select sperm for improved intracytoplasmic sperm injection (ICSI) outcomes. A recent study suggests that, in patients with non-obstructive azoospermia, no specific defect or combination of abnormalities in testicular sperm precluded chance of pregnancy, while also suggesting sperm motility and acrosome defects are the proxies relevant to ICSI outcomes.

A striking disproportionate burden of prostate cancer incidence and mortality exists between men of West African ancestry and men of European ancestry. Identifying distinct tumour genetic biomarkers and immunomodulating signals in patients with diverse genetic ancestry might reduce the disparities in prostate cancer prognosis, treatment outcomes and mortality in high-risk racial groups.

Trends in vasectomy use are controversial, but rates might be declining over time. Several factors could contribute to this apparent decrease, which warrant consideration before definitive conclusions are made.

Multidrug-resistant Neisseria gonorrhoeae is a global health problem, and the development of a vaccine is considered essential for the effective control of gonorrhoea. The use of outer membrane vesicle vaccines to prevent N. gonorrhoeae infection has garnered considerable interest, and a recent study using a mouse model of experimental gonococcal infections adds support for this approach.

Andolfi et al. report on the largest single-institution case series of robot-assisted laparoscopic pyeloplasty (RAL-P) in infants. Transitioning from RAL-P in older children to infants seems to have more to do with patient and port positioning, instrument size and intra-abdominal space than robotic surgical technique.

Serum PSA testing can identify men with clinically significant prostate cancer but exposes many more men to the diagnosis of indolent tumours. Benafif and colleagues have published the results of the BARCODE1 pilot study, in which they propose using germline single-nucleotide polymorphisms to identify men with a genetic risk of developing prostate cancer. Based on their preliminary findings, changing the current prostate cancer screening paradigm will be a challenge.

Balancing diversity on panels at academic medical conferences demonstrates a commitment to the principles of diversity and inclusion. However, it seems we have a long way to go in urology, where two-thirds of sessions at major urology meetings still consist of all-male speaker panels.

The treatment of patients with the PD1 inhibitor pembrolizumab yields benefit in the second-line metastatic urothelial cancer setting. Two new trials have studied pembrolizumab monotherapy in other patients with urothelial carcinoma: an open-label phase II trial has enrolled patients with high-risk BCG-refractory non-muscle-invasive disease, and a phase III trial has compared three first-line treatment options for patients with metastatic disease. However, these trials have shown conflicting results.

Radiotherapy is one of the most effective modalities for cancer treatment, but radiation-associated secondary malignancies are important potential morbidities. Here, we highlight a recent article that examines radiation-associated muscle-invasive bladder cancer and explore how we as clinicians should consider the management of secondary malignancies.

A new phase I clinical trial has demonstrated that belzutifan provides a route to sustained inhibition of hypoxia-inducible factor 2α in humans that is well tolerated and could be useful in the treatment of advanced clear cell kidney cancer.

Evidence for the existence of racial disparities in semen parameters is increasing, exemplified by a recent study in men from white, Black and Asian populations. However, reference standards for semen parameters might not account for these disparities.

Most localized prostate cancer can be cured with radiotherapy. Over the past decade, treatment courses have been shortened with no deterioration in cure rate or adverse effects. Now, a small phase II trial has tested whether radiation could be delivered as a single treatment.

The BJU International paper by van de Grift and colleagues includes important data outlining the long-term cosmetic and functional outcomes for masculinizing surgery in patients born with differences in sex development. This overview highlights some of the important findings and their context in what can be a controversial subject.

COVID-19 has had a substantial effect on patients with kidney stones, such as delays in care and increased anxiety and use of opioids. Mitigating these effects in the future could involve an online physician-based discussion as a part of the overall treatment strategy to help patients with their queries, apprehensions and ultimately their decision-making.

With increasing global life expectancy comes increasing health conditions. Robotic-assisted radical prostatectomy (RARP) is traditionally offered to patients under the age of 75 years. However, a new study on RARP in patients aged over 75 years has demonstrated outcomes that will challenge this convention.

Radical cystectomy is advocated for patients with high-risk non-muscle-invasive bladder cancer who develop disease recurrence following BCG therapy. A retrospective series suggests that a delay in radical cystectomy attributable to failure of salvage bladder-preserving therapies in this patient cohort is safe. However, a closer analysis of the study reveals inherent case selection that might limit such conclusions.