Viewpoint

Screening for diseases is a fact of modern medicine. For prostate cancer, the issue is complex, as the overall benefit to patients is far from clear. In this Viewpoint, the advantages of early detection and treatment with PSA screening are weighed up against the risks of overdiagnosis and unnecessary treatment.

This Viewpoint documents recent developments in the field of renal cortical tumors, focusing on the current status of open partial nephrectomy. The author argues that nephron-sparing surgery is under-utilized, and that the current trend for urologic surgeons to adopt laparoscopic radical nephrectomy as a minimally invasive alternative could have important consequences for overall renal function.

Over the years, the International Continence Society (ICS) has produced a series of standardization reports concerning the terminology of lower urinary tract function. In this Viewpoint, the authors highlight the advantages of using standardized ICS terminology in both clinical and scientific practice.

For patients with benign prostatic hyperplasia, pharmacologic treatment has emerged as an attractive alternative to surgical intervention; however, there are unresolved questions regarding nonsurgical approaches. The author reviews the evidence to address one such question: whether a combination of two drugs provides greater symptomatic relief than standard monotherapy.

Ablative modalities are gaining currency as viable treatment options in selected renal cancer patients, but outcome data remain relatively premature. In this Viewpoint, John Pattaras and Fray Marshall discuss the limitations and uncertainties surrounding one of the most studied modalities for renal tumor ablation.

Prostate cancer nomograms are valuable tools for the discussion of treatment options with patients, but their ability to change patient decisions or improve outcomes remains unproven. In this Viewpoint, Alan Stapleton and Carole Pinnock discuss the limitations and uncertainties surrounding these tools, such as changes in source population clinical profiles over time, and parallel changes in the usefulness of prognostic factors.

Statistical analysis is an essential part of clinical practice, since the very concept of evidence-based medicine hinges on sound interpretation of clinical data. Using the Scandinavian prostatectomy versus watchful waiting study as a practical example, Andrew Vickers presents two common errors: accepting the null hypothesis and misinterpreting the lower statistical power of overall versus cancer-specific survival, and warns of the dangers of forgetting these basic principles.

Accurate staging of clinically localized prostate cancer is crucial to ensure patients receive optimal management and counseling. Despite the growing number of diagnostic modalities, however, accurate staging remains a challenge. In this Viewpoint, Mitchellet al. discuss the relative merits of tried and tested and newly emerging staging techniques.

Overactive bladder is a common urologic disorder with a number of etiologies and evolving treatment options. The two primary management strategies are drug therapy and sacral neurostimulation, both areas of recent developments with the emergence of new medications and refinement of surgical techniques. In this Viewpoint, Apurba Pathak and Sherif Aboseif discuss the relative merits, and drawbacks, of these very different approaches.

Artificial neural networks (ANNs) have been developed for various applications in prostate cancer management, but their ability to perform in this setting remains controversial. In this Viewpoint, authors from the University Hospital Charité present the case for ANNs, and argue that urologists should be using these tools in clinical decision-making.

The role of the adult urologist in the care of children is diminishing, as opinion over who should handle pediatric urological conditions has shifted in favor of the dedicated pediatric urologist. Christopher Woodhouse discusses the issues surrounding this controversy and presents his view on how adult urologists can best contribute to the care of children with urological diseases.

In response to Thomas Ahlering's Viewpoint published in our December 2004 issue, Bertrand Guillonneau argues that there are no robust and reliable data to support the use of robot-assisted laparoscopic radical prostatectomy over a conventional laparoscopic approach. He concludes that it is wiser to invest in a laparoscopic training program.

Empirical evidence indicates that the number of small renal lesions being identified is rising. Typically treated with nephrectomy or partial nephrectomy, Stephen Solomon shares his view on the emerging role of radiofrequency ablation and cryotherapy in the management of small renal tumors.

Laparoscopic radical prostatectomy (LRP) is a product of the evolution of standard open to minimally invasive surgery. The next step on this evolutionary path has been the emergence of robotic LRP. Here, Thomas Ahlering presents his view of the comparative benefits and pitfalls of these two techniques.

Witjes and Debruyne outline how recent investigations of indications for intravesical chemotherapy might affect current strategies for the management of superficial bladder cancer. Recommendations for the use of chemotherapeutics are made on the basis of the risk of recurrence and progression of this increasingly common disease.

Hollenbeck and Montie discuss the potential benefits and pitfalls of early extirpative surgery for T1 bladder cancer. The authors identify risk factors that, in their opinion, should prompt clinicians to consider radical cystectomy rather than a more conservative regimen of resection, chemotherapy and immunotherapy.

Diagnosis and treatment of chronic prostatitis are presently based on unsupported assumptions and a nonvalidated classification scheme. Here, Richard Alexander summarizes research by the Chronic Prostatitis Collaborative Research Network that challenges the assumptions and indicates that ongoing empiric administration of antimicrobial drugs to men with long-standing prostatitis should be abandoned.