Articles in 2020

Here, the authors describe the characteristics of an ideal screening test for prostate cancer and examine why PSA fails to meet these attributes. They discuss whether an abbreviated MRI protocol could be an alternative or additional screening test for prostate cancer and explore its inherent challenges and potential solutions.

The precise mechanism of action by which BCG acts in bladder cancer therapy is unclear. BCG induces a non-specific enhancement of the biological function of innate immune cells, creating an immunological memory known as trained immunity. In this Perspective, the authors propose that trained immunity could be an important mechanism mediating BCG immunotherapy and could contribute to a personalized approach to BCG therapy in patients with bladder cancer.

Lacerda Mariano and Ingersoll discuss how bacterial urinary tract infection affects the bladder, focusing on the development of immune responses and the cells and pathways that mediate immunity. They also highlight therapeutic approaches to bladder infection that are currently under development.

A new study describes the effects of androgen status on the different cell types in mouse and human prostates, illustrating the potential of single-cell RNA sequencing to study specific biological processes in unprecedented detail. Translating these new insights into clinical use will increase precision and personalization of prostate cancer treatment.

In this Review, Jackson and colleagues discuss the critical role of the urothelium in both normal urinary tract development and in congenital abnormalities of the urinary tract. Urothelial remodelling in congenital obstructive uropathy is also discussed.

Anti-PD1 and anti-PDL1 immunotherapy has transformed urothelial carcinoma treatment. Pembrolizumab is the only immunotherapy agent shown to have survival benefit compared with standard chemotherapy after progression on platinum-containing chemotherapy. Initial National Institute for Health and Care Excellence (NICE) approval was based on efficacy data, but the final appraisal report rejected use of pembrolizumab owing to treatment cost.

On 11 March 2020, the World Health Organization declared SARS-CoV-2 and its associated disease, COVID-19, a global pandemic. Across the world, governments took action to slow the spread and hospitals rushed to accommodate an influx of patients with this highly infectious and lethal disease. The urology departments in Ann Arbor, Michigan, USA, and Herlev and Gentofte, Copenhagen, Denmark — which are linked by the pre-existing CopMich Collaborative — had to respond with massive changes to the organization, staffing and workload of their teams. In this Viewpoint, authors from different urological subspecialties and at different career stages reflect on their experiences during the pandemic. Although their countries’ responses to the COVID-19 pandemic differed radically, the similarities between the responses in Copenhagen and Michigan demonstrate the universal characteristics of medicine and the value of teamwork, flexibility and collaboration.

In this Review, Perera et al. explain the concept and schedule protocols of intermittent androgen deprivation therapy (ADT) for patients with prostate cancer and discuss current evidence on safety, feasibility and benefits of intermittent ADT compared with continuous ADT.

Detection of positive nodes in men with moderate-risk to high-risk penile cancer and impalpable inguinal nodes is an important step in the therapeutic pathway. Detection using dynamic sentinel node biopsy with patent blue dye and radioisotope is associated with false negatives; indocyanine green might offer an alternative adjunct to improve detection rates.

The introduction of dedicated diagnostic guidelines for compulsive sexual behaviour disorder in the ICD-11 provides an opportunity to improve diagnosis and research into the disorder’s aetiology, assessment and therapy. For patients who consider their sexual behaviour uncontrollable, the interplay between excitatory and inhibitory factors could be in dysbalance. In this Review, Briken describes the aetiology and background of this often misunderstood disorder and provides a comprehensive approach to diagnosis and treatment.

Although the inequalities and injustices faced by Black people are not new, they have recently become a talking point worldwide. Urology is not immune to these biases. It is time for change.

Postoperative sexual function is most often unchanged or improved after treatment of pelvic organ prolapse. Nevertheless, some women experience sexual disorders and/or de novo dyspareunia after repair. Patient counselling is emerging as an important step before surgical prolapse repair.

Kidney stone disease is common and can be associated with alterations in urinary solute composition. Here, the authors outline general approaches for stone prevention, describe current understanding of the genetic influences underlying kidney stone formation and discuss the implications of a correct diagnosis for the clinical management of recurrent stone formers.

The management pathways of advanced renal cell carcinoma (RCC) have considerably evolved in the past 5 years, presenting a particular challenge during the coronavirus disease 2019 (COVID-19) pandemic. In this Comment, we propose a management algorithm on the basis of the current evidence to safely manage patients with advanced RCC during this pandemic.

Prostate Cancer Diagnosis and Treatment Enhancement Through the Power of Big Data in Europe (PIONEER) is a European network of excellence for big data in prostate cancer, consisting of 32 private and public stakeholders from 9 countries across Europe. In this Perspectives article, the authors introduce the PIONEER project and describe its aims and plans for ultimately improving prostate cancer care through the use of big data.