News & Views in 2015

Renal cell carcinoma (RCC) is rare in childhood, and pathological diagnosis and optimal treatment approach of paediatric RCC remains a challenge. A recent study describes a large cohort of 120 children with RCC, providing important epidemiological and clinical information; however, a number of questions remain regarding the optimal medical and surgical therapy.

A large validation study on the effect of single nucleotide polymorphisms on outcome and adverse events in sunitinib-treated patients with metastatic renal cell carcinoma (mRCC) only confirmed that ABCB1 and CYP3A5 variants are associated with progression-free survival and dose reductions, respectively. Does this mean 'game over' for polymorphism research in mRCC?

Targeted MRI–transrectal ultrasonography (MRI–TRUS) fusion biopsy is emerging as a powerful new technique to more accurately diagnose clinically significant prostate cancer. A recent study comparing the performance of MRI–TRUS fusion biopsy with the traditional 12-core approach found that this new approach might not be as effective as previously observed.

Recent studies in metastatic castration-sensitive prostate cancer have highlighted the potential benefits of giving systemic treatment with androgen deprivation earlier. Although such an approach might significantly improve survival, data showing such an effect may not be available for many years after trial initiation, and intermediate end points might facilitate future studies.

Brain white matter (axonal) abnormalities associated with interstitial cystitis/bladder pain syndrome in women suggest that neuropathological brain alterations exist in, and might contribute to, chronic pelvic pain syndromes. Advancing our knowledge of central neuropathic mechanisms, which might initiate and/or maintain these syndromes, will help target pain-related neuroplasticity and identify future treatments.

Data from the ARISER trial indicate that carbonic anhydrase IX (CAIX) score predicts risk of recurrence and survival after curative nephrectomy in patients with localized high-risk clear cell renal carcinoma. Should CAIX staining be quantified to stratify risk after nephrectomy in all such patients?

Prostate cancer survivors face a myriad of unique physical, psychological and emotional challenges during the often lengthy survivorship experience. Efforts to better characterize the unmet needs of this large patient population will undoubtedly improve the quality of survivorship care we offer to our patients.

Treatment with cabazitaxel is associated with improved survival in patients with metastatic castration-resistant prostate cancer. Bahl et al. recently reported that patient-reported quality-of-life metrics were stable—with a trend towards improvements with increasing numbers of treatment cycles—in 112 patients treated with cabazitaxel in the UK.

Interest in multiparametric MRI (mpMRI) for pre-operative prediction of extracapsular extension (ECE) by prostate cancer is growing. As unsuspicious findings on mpMRI cannot rule out ECE, complementary predictors based on clinical and biopsy sample characteristics are needed to risk-stratify patients and plan surgery. Image-guided biopsy might be key in this endeavour.

Most metastatic lymph nodes in patients with prostate cancer go undetected by current imaging techniques and limited pelvic lymph node dissection (PLND), as they are small and located in difficult-to-reach areas. As the only current alternative is an extended PLND, the search for more accurate imaging techniques continues.

Many imaging techniques are currently used for detection of local or distant prostate cancer recurrences after primary treatment. A new retrospective registry study raises concerns about the pertinence of imaging test use after primary prostate cancer treatment. These findings emphasize the need for consensual guidelines on imaging in this setting.

Despite its excellent prognosis, optimal management of stage I seminoma remains controversial, with variations in expert opinion and international guidelines, particularly in terms of uncertainty regarding long-term treatment complications. Recent population-based reports shed new light on the subject, and help clarify the important, unresolved clinical questions that require further research to answer.

In a new study examining treatment responses to enzalutamide in men with metastatic castration-resistant prostate cancer, enzalutamide following abiraterone acetate resulted in lower PSA responses and shorter progression-free survival times compared with treatment-naive patients. Cytotoxic therapy might be the better approach for patients failing first-line antihormonal treatment.

Testosterone substitution in male hypogonadism is a recognized tool to treat symptomatic patients. Various forms of this treatment exist including a long-acting intramuscular form using testosterone undecanoate given at approximately 3-monthly intervals. Safety aspects inherent to the intramuscular injection of a medication in an oily vehicle have to be recognized.

The ELM-PC 5 phase III randomized, double blind, multicentre trial comparing treatment with orteronel plus prednisone with placebo plus prednisone failed to show an overall survival benefit for orteronel therapy. Several possible reasons exist for the lack of a positive result in this study.

Treatment options in patients with unresectable advanced penile cancer are limited owing to a lack of large, randomized prospective studies. A recent multicentre trial evaluated the use of gemcitabine plus cisplatin in such patients but the results were disappointing. What is the future of systemic therapy for advanced penile cancer?

Changes in health-related quality of life following the diagnosis and treatment of patients with non-muscle-invasive bladder cancer (NMIBC) remain poorly understood. A new study suggests that diagnosis and treatment of NMIBC might affect mental health as well as sexual, urinary and bowel function.

Data comparing tests designed to predict the likelihood of finding significant prostate cancer on biopsy are limited. A comparison of two such tests—the Prostate Health Index (phi) and prostate cancer antigen 3 (PCA3) score—has found that phi outperforms PCA3 for predicting clinically significant prostate cancer.

Numerous clinical practice guidelines on the treatment of localized prostate cancer exist, but methodological quality varies considerably. A new report evaluates published guidelines, assessing the rigour and applicability of the recommendations and suggesting areas that require improvement.

Over the past few years the management of patients with metastatic renal cell carcinoma has changed substantially. Although the development of targeted therapies has improved the prognosis of many patients with renal cell carcinoma, a large subset of patients who might benefit from targeted therapies do not receive such treatments.