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  • News & Views |

    The PRECISION trial demonstrated the ability of using multiparametric MRI to improve the diagnosis of clinically significant prostate cancer whilst reducing over-diagnosis of clinically insignificant cancer compared with systematic biopsy. Concerns remained about patients who were not biopsied owing to negative scans. A new study applies the PRECISION strategy to a contemporary cohort to answer these concerns.

    • Jonathan Sussman
    •  & Abhinav Sidana
  • News & Views |

    MRI-guided transurethral ultrasound ablation is an exciting, minimally invasive technology with the potential to provide targeted ablation of prostate cancer tissue. At 3 years, functional outcomes remain good with 76% remaining free from salvage treatment. Future studies using a focal approach may provide evidence for widespread uptake of this technology.

    • Rohith Arcot
    •  & Thomas J. Polascik
  • News & Views |

    Retzius-sparing prostatectomy is an alternative approach to standard robot-assisted radical prostatectomy. Many surgeons advocate this technique as data suggest that it provides better early functional results than the standard approach without compromising oncological outcomes.

    • Antonio Galfano
    •  & Aldo Massimo Bocciardi
  • News & Views |

    Young-adult cancer survivors report psychosocial distress from infertility. National guidelines recommend pretreatment referrals for sperm cryopreservation, but a study examining use of stored semen among survivors concluded that low uptake might equate to economic unfeasibility. However, examination of sociodemographic factors and psychosocial outcomes suggests that maintaining future opportunities for parenthood might outweigh the ongoing storage costs.

    • Leena Nahata
    •  & Gwendolyn P. Quinn
  • News & Views |

    Disruption of the circadian clock has been associated with pathological conditions including obesity, type 2 diabetes mellitus, cancer, depression and neurodegenerative diseases. Disturbed sleep patterns have now been associated with reduced erectile function. The mechanisms behind this effect are unclear but could include hypoxia signalling and low testosterone.

    • Linda Vignozzi
    •  & Mario Maggi
  • News & Views |

    Antimicrobial resistance in Neisseria gonorrhoeae compromises gonorrhoea treatment worldwide. Novel and optimized treatments and/or treatment strategies that effectively eradicate the infection with low selection of resistance are imperative. A new prospective clinical study provides further evidence that resistance-guided treatment of gonorrhoea with single-dose oral ciprofloxacin is efficacious in relevant settings and can reduce the selection pressure for resistance.

    • Magnus Unemo
  • News & Views |

    Pooled clinical trial data reveal that antibiotics worsen progression-free survival and overall survival in patients with locally advanced and metastatic urothelial cancer receiving anti-PDL1 therapy. Consensus guidelines for antibiotic use in these patients, as well as diagnostic tools and corrective measures, are needed to decrease primary resistance to immune checkpoint inhibitors.

    • Lisa Derosa
    •  & Laurence Zitvogel
  • News & Views |

    Personalized decision-making is the ultimate goal of managing men with lower urinary tract symptoms caused by benign prostatic obstruction. Urodynamics can provide valuable information in these patients and a recent multicentre randomized trial has highlighted important findings warranting consideration, as well as indicating that further insights are needed.

    • Sachin Malde
    •  & Eskinder Solomon
  • News & Views |

    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.

    • Wout Devlies
    •  & Frank Claessens
  • News & Views |

    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.

    • Shilpa Gupta
    •  & Ashish M. Kamat
  • News & Views |

    Bladder cancer outcomes differ between men and women. Elucidating this sexual dimorphism, genomic analyses found differing molecular subtype distributions and androgen response activities in muscle-invasive bladder cancer in men and women. Together with knowledge of cancer driver genes, biomarkers and clinical characteristics, these findings will hopefully lead to sex-based personalized research and management of bladder cancer.

    • Benjamin Pradere
    •  & Shahrokh F. Shariat
  • News & Views |

    Electronic cigarette (e-cigarette) use has risen rapidly over the past decade, despite limited knowledge of the risk of carcinogenesis and broader health implications. A recent systematic review summarizes the current evidence on carcinogen biomarkers in the urine of e-cigarette users. The findings warrant consideration and indicate that further insights are urgently needed.

    • Michael Rink
  • News & Views |

    Extirpative surgery for all patients with upper tract urothelial carcinoma (UTUC) risks overtreatment and associated morbidity. Endoscopic approaches are particularly applicable for low-risk disease albeit with the potential for ipsilateral upper tract recurrence. Adjuvant and ablative intracavitary therapies are current and future strategies that could improve disease outcomes and increase adoption of kidney preservation for UTUC.

    • Jay D. Raman
  • News & Views |

    A subgroup analysis of the RTOG 9601 trial, which stratified participants according to their pretreatment serum PSA levels, suggests disparate responses to therapy and potentially concerning cardiac and neurological effects in some men. However, subgroup analyses are notoriously difficult to interpret and the data should be considered with caution before changes are made to clinical practice.

    • Alan Dal Pra
    •  & Alan Pollack
  • News & Views |

    A pilot trial of low-carbohydrate diet after definitive treatment for localized prostate cancer stopped early owing to futility but provides intriguing results in secondary analyses. The study offers an important opportunity to highlight caveats in data interpretation and to consider requirements for successful future research on dietary interventions in men with prostate cancer.

    • Crystal S. Langlais
    •  & June M. Chan
  • News & Views |

    A new trial evaluated whether neoadjuvant use of the tumour vaccine GVAX plus cyclophosphamide with androgen deprivation therapy (ADT) would augment antitumour immunity. ADT alone led to increased CD8+ T cell infiltration but also increases in regulatory cell populations. The results suggest that ADT should be used with treatments targeting the recruitment and persistence of these regulatory populations.

    • Melissa Gamat-Huber
    •  & Douglas G. McNeel
  • News & Views |

    A new study reports the 5-year patient-reported outcome data from a population-based cohort of men with localized prostate cancer. These findings in conjunction with data on survival, treatment burden and treatment cost can assist clinicians in explaining to newly diagnosed patients the likely effects of modern management options on quality of life.

    • Rebecca Mercieca-Bebber
    •  & Martin R. Stockler
  • News & Views |

    A randomized controlled trial has shown no statistically significant effect of low-intensity shockwave therapy when added to standard postprostatectomy pharmaceutical penile rehabilitation. Although this trial had a number of limitations, it adds to a body of literature that shows little effect of this therapy and emphasizes the need for development of effective therapeutic options for these patients.

    • Maarten Albersen
  • News & Views |

    No clear consensus exists for managing biochemically recurrent prostate cancer after prostatectomy. Interpretation of new data from the JCOG0401 trial warrants consideration of imaging techniques, prostate-specific antigen (PSA) levels at time of salvage radiotherapy (SRT), use of SRT ± salvage androgen deprivation therapy based on PSA levels, and the interval to biochemical failure.

    • Nicholas G. Zaorsky
    •  & Amar U. Kishan
  • News & Views |

    The optimal treatment sequences to maximize the clinical benefit for patients with metastatic castration-resistant prostate cancer (mCRPC) have not been defined. A new prospective, randomized trial on optimal sequencing of enzalutamide and abiraterone acetate plus prednisone in mCRPC investigated whether one regimen resulted in superior outcomes.

    • Benjamin L. Maughan
    •  & Emmanuel S. Antonarakis
  • News & Views |

    In a recent study, Nobles et al. report that a substantial proportion of posts to an online forum on sexually transmitted infections were seeking diagnostic help. Forum users might perceive benefits to online crowd-based diagnosis, but this approach risks spreading harmful misinformation. More research is needed on crowd-based digital approaches to improve sexual health.

    • Joseph D. Tucker
    •  & Suzanne Day
  • News & Views |

    New data show that prostate-specific membrane antigen (PSMA) PET–CT can reveal the anatomical location of prostate cancer recurrences in patients diagnosed with nonmetastatic castration-resistant disease according to conventional imaging. The findings necessitate a new evaluation of the role of PSMA PET–CT in this setting compared with standard-of-care imaging and treatment approaches.

    • Piet Ost
  • News & Views |

    Data from a new study suggests that prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) imaging is superior to 18F-fluciclovine PET for detecting biochemical recurrence in men with prostate cancer. However, whether one of these radiotracers improves patient survival over the other is unknown and further research is needed to determine which has the greater effect.

    • Baris Turkbey
    •  & Peter L. Choyke
  • News & Views |

    The relationship between testosterone therapy and prostate cancer continues to challenge historic and current beliefs. A new cohort analysis revealed a ~33% reduction in prostate cancer incidence in men with increased testosterone use. The mechanisms underlying this protective effect are unclear, but these findings challenge current paradigms and warrant further investigation.

    • Linda My Huynh
    •  & Thomas E. Ahlering
  • News & Views |

    A recent study showed a correlation between clinical patient features and antibiotic resistance in patients with urinary tract infection (UTI). As resistance to antibiotics cannot be reversed, managing its emergence is of the utmost importance. Improving surveillance data will enable selection of appropriate antibiotics and help reduce the development of resistance.

    • Florian M. Wagenlehner
    •  & Kurt G. Naber
  • News & Views |

    The ideal first-line treatment of cisplatin-ineligible patients with metastatic urothelial carcinoma (mUC) remains unknown pending results of randomized trials. Although mUC tumours are sensitive to chemotherapy, response durations are short. A new retrospective study provides data on the effectiveness of first-line PD-1/PD-L1 inhibitors compared with carboplatin-based chemotherapy in this setting.

    • Andrea B. Apolo
  • News & Views |

    Oxytocin antagonists seem to have potential as a treatment option for premature ejaculation (PE), but the parameters of their use are vague. Two recently published studies highlight the need for large-scale trials to elucidate the value of these drugs in the treatment of PE.

    • Murat Gul
    •  & Ege Can Serefoglu
  • News & Views |

    Clinical and pathological risk grouping defines management in localized prostate cancer. Recent work suggests men with high-risk prostate cancer can be further subdivided into three risk groups (favourable high-risk, standard high-risk and very-high-risk) and that these groups correlate with measures of genomic risk, testing of which is increasingly being integrated into risk prediction.

    • Bashir Al Hussein Al Awamlh
    •  & Jonathan E. Shoag
  • News & Views |

    In a recently published study, surveys of transgender individuals on hormone therapy provide insight into the self-reported effects of medication where previous thinking was only speculative. Still, controlled studies are required to avoid overinterpreting the clinical significance of specific findings in the context of what might be expected in the general population.

    • Joshua D. Safer
  • News & Views |

    The US Preventive Services Task Force has issued a grade A recommendation that clinicians offer pre-exposure prophylaxis (PrEP) to people at high risk of acquiring HIV. Currently, many fewer individuals receive PrEP than those who would benefit from it; whether PrEP can have a real impact on reducing the global burden of HIV is yet to be determined.

    • Jared M. Baeten
  • News & Views |

    Intensifying systemic therapy improves outcomes in metastatic prostate cancer. As apalutamide and enzalutamide join abiraterone and docetaxel as treatment options for patients, the choice of therapy for individual patients becomes more complex. We anticipate precision targeted and immune therapies will build on the advances of recently completed large-scale trials.

    • Ryan P. Kopp
    •  & Tomasz M. Beer
  • 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 |

    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 |

    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 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