News & Views

  • News & Views |

    Immune checkpoint therapy is beneficial for patients with advanced bladder cancer; however, trials generally exclude patients with comorbidities or uncommon histologies. The SAUL trial demonstrates that atezolizumab is safe and efficacious in a patient population that more accurately reflects the real-world scenario, but its benefit might still be limited in historically poorly performing populations.

    • Tyler F. Stewart
    •  & Daniel P. Petrylak
  • News & Views |

    The concept that resistance against androgen receptor (AR) signalling inhibitors is explained by AR variants (ARVs) has spread as a seductive meme. However, two problems have delayed the translation of these findings to clinical practice: the complexity of the mechanism of action and the challenging development of clinical decision-making tools involving ARVs.

    • Florian Handle
    •  & Frank Claessens
  • News & Views |

    A new ecological analysis has shown that antimicrobial consumption is positively associated with decreased antimicrobial susceptibility in Neisseria gonorrhoeae across European countries. Efforts at the policy, provider and community level need to be strengthened to address and help mitigate the continued emergence of antimicrobial resistance in N. gonorrhoeae.

    • Huan V. Dong
    •  & Jeffrey D. Klausner
  • News & Views |

    A new study describes antitumour cell activity inherent in the extracellular matrix of porcine urinary bladder, which is not the result of direct tumour cell killing but is indirectly mediated through immune cells. The findings highlight opportunities to explore shared interests of the tissue engineering and regenerative medicine and the immunology and cancer communities.

    • Stephen F. Badylak
  • News & Views |

    The PROSPER, SPARTAN, and ARAMIS trials demonstrated the efficacy of enzalutamide, apalutamide, and darolutamide, respectively, to extend metastasis-free survival in men with nonmetastatic castration-resistant prostate cancer. However, questions remain regarding patient selection for these agents, particularly concerning adverse effects, patient PSA doubling time, and cost and formulary considerations.

    • Celestia Higano
  • News & Views |

    In the absence of standards of care and defined best treatments for localized prostate cancer, Internet search engines provide patients with first information — or often misinformation. Clinicians need to guide patients to sources of high-quality evidence on focal ablative treatments for prostate cancer.

    • Sangeet Ghai
    •  & John Trachtenberg
  • News & Views |

    The FDA’s approval of the first point-of-care total PSA test for prostate cancer has the potential to improve patient care by streamlining PSA testing. However, a Clinical Laboratory Improvement Amendments waiver is needed before this test can be fully integrated into clinical care.

    • Alexa R. Meyer
    •  & Michael A. Gorin
  • News & Views |

    Health-related quality of life encompasses a wide range of experiences and is especially relevant for men with prostate cancer. A recent study reports that across disease stages, overall self-reported health status and urinary and bowel function were good, but sexual function was poor. Overall, men face prostate cancer with resilience.

    • Mark S. Litwin
  • News & Views |

    Results of recent trials have shown the superiority of mpMRI to TRUS-guided systematic biopsy for detecting clinically significant prostate cancer. However, only performing an mpMRI risks missing MRI-invisible lesions and, therefore, there might be added value in performing both targeted and systematic biopsies in biopsy-naive patients.

    • Amir H. Lebastchi
    •  & Peter A. Pinto
  • News & Views |

    In patients with metastatic renal cell carcinoma, risk stratification according to the Memorial Sloan Kettering Cancer Center or the International Metastatic Renal Cell Carcinoma Database Consortium classification systems is a crucial part of clinical assessment and essential for guiding management. New research has now demonstrated that disagreement in risk-group classification is common and prognostically relevant.

    • Tobias Klatte
    •  & Grant D. Stewart
  • News & Views |

    Continence in nursing home residents declines over time, probably owing to an increase in physical disability and impaired mobility as much as to lower urinary tract dysfunction. A need remains for appropriately skilled assessments of continence care, leading to multicomponent management of continence in this vulnerable group of patients.

    • Adrian Wagg
  • News & Views |

    Multiparametric MRI (mpMRI) has revolutionized prostate cancer diagnosis and risk stratification, but the question remains regarding what it is that we see (or don’t see) on mpMRI. A new study by Houlahan and colleagues now offers insight into the molecular characteristics of a tumour that influence mpMRI visibility.

    • Mark Emberton
  • News & Views |

    Reassurance provided by pre-exposure prophylaxis (PrEP) for HIV might lead to increased sexual risk-taking in men who have sex with men (MSM), potentially increasing the risk of transmitting other infections. A recent study has shown increased transmission of hepatitis C virus (HCV) in this population, suggesting a need for HCV screening.

    • Douglas S. Krakower
    •  & Kenneth H. Mayer
  • News & Views |

    The use of optogenetic strategies in biomedicine therapeutics has the potential to provide nonpharmacological modulation of nervous system function. The development of integrative, implantable, remote-powered devices is an advance towards translation of these strategies, with the potential for precision, revolutionary treatment of complex or refractory disease-related or trauma-related symptoms.

    • Warren M. Grill
    •  & Jennifer J. DeBerry
  • News & Views |

    Chronic inflammation in the prostate is a suspected risk factor for prostate cancer. Burns and colleagues implicate chronic inflammation in prostate cancer development, albeit from an unexpected source — the gastrointestinal tract. This new study implicates a history of inflammatory bowel disease with an increased risk of a prostate cancer diagnosis.

    • Karen S. Sfanos
    •  & Corinne E. Joshu
  • News & Views |

    A large genomic study of upper tract urothelial carcinoma and bladder tumours reveals differences in mutational frequencies and demonstrates a clonal relationship between paired tumours. In addition to these genomic insights, a combined tumour and germline genetic analysis approach is suggested to improve the identification of patients with Lynch syndrome.

    • Lars Dyrskjøt
  • News & Views |

    The long-term outcomes of the first prospective, multi-institutional, single-arm study of patients with prostate cancer treated with salvage radical prostatectomy after disease recurrence following radiotherapy have recently been published. Durable oncological control was reported, possibly because most patients had low-risk or intermediate-risk prostate cancer at initial diagnosis and the biochemical progression-free survival interval was long.

    • Gaëtan Devos
    •  & Steven Joniau
  • News & Views |

    The extent of pelvic lymph node dissection at the time of radical cystectomy is debated as it might affect oncological outcomes in patients with bladder cancer. Gschwend et al. now demonstrate that the survival benefit is small and that the study might need to be repeated with a larger cohort.

    • Fiona C. Burkhard
    •  & George N. Thalmann
  • News & Views |

    Preliminary results from TRITON2 demonstrate efficacy of the poly(ADP-ribose) polymerase (PARP) inhibitor rucaparib in ~50% of patients with metastatic castration-resistant prostate cancer and inactivation of BRCA1/BRCA2. However, those with ATM and CDK12 mutations do not seem to benefit. An improved homologous recombination deficiency test must be developed and alternative treatments defined for these subsets of patients.

    • Jun Luo
    •  & Emmanuel S. Antonarakis
  • News & Views |

    Matta et al. report that men with prostate cancer who underwent surgery or radiotherapy, but not active surveillance, had greater odds of receiving antidepressants than controls. However, methodological limitations preclude the interpretation of a psychological benefit for men on active surveillance. Screening for distress and referral to evidence-based intervention should be a priority.

    • Suzanne K. Chambers
    •  & Peter Heathcote
  • News & Views |

    A recently published study has evaluated metabolism in human clear cell renal carcinomas (ccRCCs) using intraoperative [13C]glucose infusion during surgical procedures. The findings demonstrate aerobic glycolysis and repression of the Krebs cycle, confirming the existence of the Warburg effect in ccRCC tumours in vivo.

    • Daniel R. Crooks
    •  & W. Marston Linehan
  • News & Views |

    The results of the RAZOR trial of robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer show that robotic surgery is noninferior. However, care must be taken before widespread adoption of this modality, as superiority has not yet been established.

    • Fiona C. Burkhard
  • News & Views |

    A polygenic risk score (PRS) analysis reported that familial testicular germ cell tumours (TGCTs) were significantly enriched for TGCT risk alleles and that ≥84% were attributable to polygenic enrichment, supporting the polygenic aetiological basis of familial TGCT. Clinical application will first require improved TGCT screening and early detection tools.

    • Mark H. Greene
    •  & Ruth M. Pfeiffer
  • News & Views |

    A recently published cohort study of 650 men undergoing prostate biopsy showed no association between current alcohol intake and overall prostate cancer risk, but did report an association between regular drinking during adolescence and early adulthood and high-grade prostate cancer.

    • Carlo La Vecchia
  • News & Views |

    The FDA recently expanded the indication for enzalutamide for the treatment of all men with metastatic and nonmetastatic castration-resistant prostate cancer on the basis of the PROSPER trial. Now that both disease states can have the same treatment, the need to thoroughly identify metastatic lesions is questioned.

    • Hanson Zhao
    •  & Stephen Freedland
  • News & Views |

    Applying the principles of ‘omics’ to urinary tract infection opens up exciting diagnostic and management avenues. Urinary cell-free DNA can be used to gain new insight not only into the spectrum of pathogens present in host urine but also their likelihood to cause disease.

    • Rhana Hassan Zakri
    •  & Jonathon Olsburgh
  • News & Views |

    With the emergence of increasingly potent androgen deprivation therapy, rates of treatment-emergent small-cell neuroendocrine prostate cancer are increasing. In a recent prospective study, Aggarwal and colleagues defined the frequency and clinical and genomic characteristics of these tumours.

    • Magdalena M. Grabowska
    •  & Robert J. Matusik
  • News & Views |

    Platinum-based chemotherapy continues to be linked with the subsequent development of various solid tumours. In a large analytical study of >5,800 survivors of testicular cancer, Groot and colleagues observed statistically significant dose-dependent increases in gastrointestinal cancer incidence after platinum-based chemotherapy, providing evidence for a potential dose-dependent relationship.

    • Chunkit Fung
    •  & Lois B. Travis
  • News & Views |

    A recent study has shown a decline in testosterone prescriptions since media reports of potential increased cardiovascular risk in 2014. The phenomenon of medical hysteria accounts for this reduced prescribing, as numerous subsequent studies provide substantial evidence of reduced cardiovascular risk and other important benefits with testosterone therapy for men with testosterone deficiency.

    • Abraham Morgentaler
  • News & Views |

    Immune checkpoint inhibitors targeting programmed cell death 1 (PD-1) or programmed cell death 1 ligand 1 (PD-L1) have had limited clinical impact in prostate cancer. To find a niche for immune checkpoint inhibition in this disease, future strategies might require improved biomarker-based patient selection or combination strategies to enhance in vivo immune activity.

    • Ravi A. Madan
    •  & James L. Gulley
  • News & Views |

    The European Medicines Agency (EMA) and FDA have recently restricted the indications for first-line pembrolizumab and atezolizumab to patients with programmed cell death 1 ligand 1 (PD-L1)-high advanced urothelial carcinoma, a decision made following interim analyses from the ongoing Keynote-361 and IMvigor130 phase III trials. Questions remain on the magnitude of inferior survival and standardized implementation of PD-L1 testing.

    • Min Yuen Teo
    •  & Jonathan E. Rosenberg
  • News & Views |

    New data have confirmed the genomic diversity of low-risk prostate cancer. Improved understanding of the heterogeneity of this disease has implications for disease management and has the potential to change treatment for patients in the future.

    • Vidit Sharma
    •  & R. Jeffrey Karnes
  • News & Views |

    Cytoreductive nephrectomy, a standard approach for de novo metastatic renal cell carcinoma in the era of cytokine therapy, has been upheld during the age of targeted therapy on the basis of retrospective data. Now, the first level I prospective data from the CARMENA and SURTIME trials challenge this standard.

    • Sumeet Bhanvadia
    •  & Sumanta K. Pal
  • News & Views |

    A recent study reports widespread decreases in PSA screening, prostate cancer diagnoses, and use of active treatment modalities since the 2011–2012 United States Preventive Services Task Force (USPSTF) recommendation against PSA screening. The updated 2017 USPSTF guideline, which embraces individualized decision-making, suggests the pendulum swung too far, but must not prompt a return to indiscriminate screening.

    • Katherine Fleshner
    •  & Sigrid V. Carlsson
  • News & Views |

    Use of multiparametric MRI for detection of prostate cancer has been increasing and two recent studies have provided high-quality evidence advocating its integration into the diagnostic protocol. A new paradigm for detection of prostate cancer in the era of PROMIS and PRECISION should be adopted globally.

    • Tatenda Nzenza
    •  & Declan G. Murphy
  • News & Views |

    The Guttmacher–Lancet Commission’s report on Sexual and Reproductive Health and Rights for All coincides with raised awareness of this topic as a result of global movements such as #metoo. However, weak political leadership, increasing fragmentation of services, and sustained underfunding pose a threat to sexual and reproductive health globally.

    • Neha Pathak
    •  & Shema Tariq
  • News & Views |

    The detection of 78 bacterial species in the urinary tracts of 77 catheterized female patients further emphasizes that the urinary tract is not sterile. However, many questions arise from these findings, not the least of which is what these organisms are doing in the urinary tract.

    • Gregor Reid
  • News & Views |

    Metastatic prostate cancer has traditionally been treated with systemic therapy alone, but the issue of oligometastatic disease raises the question of whether local therapy — radical prostatectomy or prostate radiotherapy — should be performed. A number of phase III trials should improve our understanding of metastatic disease and lead to better care of our patients.

    • Judd W. Moul
  • News & Views |

    Dose-intensified radiotherapy is widely used in prostate cancer treatment but its effect on distant metastasis and overall survival is unclear. A large randomized clinical trial to evaluate the role of external-beam-based dose intensification without androgen deprivation therapy in intermediate-risk disease shows that dose escalation can reduce distant metastases.

    • Pirus Ghadjar
    •  & Thomas Wiegel
  • News & Views |

    The role of 5α-reductase inhibitors (5-ARI) in prostate cancer chemoprevention remains a controversy, as cancer prevention trials with 5-ARIs have shown a decreased incidence of low-grade prostate cancer but a potential increased risk in high-grade disease. Recent studies have shed light on the long-term safety of 5-ARIs in terms of influencing prostate cancer risk.

    • Cindy H. Chau
    •  & William D. Figg
  • News & Views |

    The FDA recently approved the second-generation antiandrogen apalutamide for the treatment of men with nonmetastatic castration-resistant prostate cancer on the basis of metastasis-free survival data from the SPARTAN trial. However, whether apalutamide is clinically superior to enzalutamide and whether early or late treatment is preferable remains to be defined.

    • Robert Chandler
    •  & Johann de Bono
  • News & Views |

    Prostate MRI has reached the point of being a mature technology with an established clinical need, so the modality is here to stay. Accordingly, it is incumbent upon the radiology community to find practical solutions for the ongoing variability in interpretation and diagnostic performance of this technique.

    • Rajan T. Gupta
    •  & Andrew B. Rosenkrantz
  • News & Views |

    Bladder cancer molecular subtypes are promising for predicting patient outcomes. In contrast to most reports to date that used unsupervised clustering methods, a new study has demonstrated the value of a tumour differentiation signature based on normal biological expression patterns characteristic of basal or differentiated urothelial cells.

    Refers to Mo, Q. et al. Prognostic power of a tumour differentiation gene signature for bladder urothelial carcinomas. J. Natl Cancer Inst. https://doi.org/10.1093/jnci/djx243 (2018)

    • Robert T. Jones
    •  & Dan Theodorescu
  • News & Views |

    The past decade has witnessed an accelerated trend towards freeze-all or frozen embryo transfer cycles in reproductive medicine. However, the results of two recent randomized controlled trials seem to indicate that this deliberate shift in practice towards frozen embryo transfer cycles was premature and perhaps even misguided.

    • Zev Rosenwaks
    •  & Nigel Pereira
  • News & Views |

    A recent study suggests modulation of luteinizing hormone signalling within the hypothalamic–pituitary–gonadal axis and downstream transcriptional effects caused by sustained ibuprofen use. However, this study cannot be used to draw any clinical conclusions regarding effects of ibuprofen on male androgenic or reproductive health. Thus, the andrological effects of its use remain unclear and would benefit from further investigation.

    • Ajay K. Nangia
    •  & Derek Jensen
  • News & Views |

    Different methods for detecting circulating tumour cells (CTCs) in the blood of patients with cancer yield distinct results with regard to cell counts and CTC subpopulations. This observation underlines the urgent need for comprehensive standardization and validation of novel CTC technologies in order to facilitate their introduction into clinical practice.

    • Claudia Hille
    •  & Klaus Pantel
  • News & Views |

    Preventative use of serum PSA screening is controversial and generally undertaken as a shared decision between doctor and patient. A new study identifies a link between individuals' numeracy, or facility with quantitative concepts, and their understanding of the risk reduction benefits of PSA testing.

    • Vigneshwar Subramanian
    •  & Michael W. Kattan
  • News & Views |

    Most genetic analyses of prostate cancer have studied white men. A new study compares the genetic landscape of prostate cancer in Chinese men, reporting both similarities and differences. This finding highlights the need for studies to include all races and paves the way for future personalized medicine approaches for prostate cancer across races.

    • Stephen Freedland
  • News & Views |

    Results of two large randomized controlled trials have challenged the use of medical expulsive therapy for the management of ureteral calculi. A new trial now shows that tamsulosin is effective in patients with distal calculi >5 mm in size, demonstrating that the effectiveness of MET depends on stone size and location.

    • Kelly A. Healy
    •  & Ojas Shah