News & Views

Bladder cancer progression to microscopically distinct variants such as sarcomatoid, small cell, micropapillary and plasmacytoid is associated with more aggressive clinical behaviour than conventional carcinoma. Advances in molecular profiling led to the identification of molecular subtypes of bladder cancer and provided insights into disease progression to aggressive variants.

In the SELENIB trial, selenium and vitamin E were compared with placebo as chemoprevention for non-muscle-invasive bladder cancer (NMIBC). No difference versus placebo was observed in recurrence-free interval (RFI) with selenium, but vitamin E was associated with worse RFI. Selenium and vitamin E cannot be recommended in chemoprevention for NMIBC. Furthermore, patients with NMIBC taking supplemental vitamin E should be made aware of its potential association with worse RFI.

Sexual interactions between members of the same sex are common but the reasons for these behaviours are not always clear. Results from a study across mammals suggest that increased same-sex behaviour evolved with sociality and might reduce conflict, although increased male–male sexual interactions are associated with increased adult killing.

Much of the Y chromosome has remained obscure owing to the challenge of sequencing repetitive genomic regions. Recently, the Y chromosome has been fully sequenced, revealing extensive heterochromatic areas and 41 new protein-coding genes. Furthermore, 43 Y chromosomes have been sequenced, showing extensive multi-sample variation and providing promising insights into male infertility.

Positive surgical margins are an independent risk factor for biochemical recurrence after radical prostatectomy. However, the identification of residual cancer by eye is highly limited, and frozen sections are not always available or possible for all margins. Prostate-specific membrane antigen-targeted fluorescence guidance might close this gap and enhance the surgeon’s eye.

The relationship between smoking, ethnicity and bladder cancer is complex and multifaceted, with substantial public and personal health as well as clinical implications. New evidence supports that targeted smoking cessation efforts among high-risk populations could reduce the burden of bladder cancer.

Sexually transmitted infections (STIs) remain public health concerns. Doxycycline post-exposure prophylaxis to prevent STIs is a novel promising intervention, which in a new study caused an ∼65% reduction in incident STIs. However, long-term effects on STI prevalence, microbiomes and antimicrobial resistance among STI pathogens, non-STI pathogens and commensals need to be monitored.

The current serum tumour markers α-fetoprotein, human chorionic gonadotrophin, and lactate dehydrogenase show limited value for testicular cancer relapse detection. A recent study highlights that false-positive elevations in follow-up monitoring are common and, conversely, many patients do not have elevations despite proven relapse. These findings highlight the potential for circulating microRNAs to be used as improved biomarkers for relapse detection.

The cellular action of SARS-CoV-2, the virus responsible for the COVID-19 global pandemic, is dependent on a specific combination of receptors and cofactors. These proteins are now known to be expressed in normal kidney tubule tissue and renal cell carcinoma cells, representing possible targets for budding therapeutic modalities.

New evidence suggests that patients undergoing robotic-assisted radical cystectomy for non-metastatic bladder cancer experience better response in terms of days alive and out of the hospital than patients undergoing open radical cystectomy. The robotic approach was associated with improved post-operative mobilization, decreased transfusion requirement and reduced burden on perceived quality of life.

Immune system activation is necessary for BCG-mediated tumour immunity in non-muscle-invasive bladder cancer. However, mounting evidence supports the notion that dysfunctional activation, in the form of immune exhaustion, might contribute to BCG failure. Thus, an exhaustion signature, arising in treated tumours, could act as a predictive marker for BCG therapy.

Genetics has a role in predisposition towards prostate cancer, and an accurate prediction of prostate cancer risk can be made using polygenic risk scores. New evidence suggests that this risk is modifiable through lifestyle changes, but only in men at a high genetic risk of developing prostate cancer.

Muscle-invasive bladder cancer (MIBC) remains a deadly disease, despite aggressive surgical and systemic chemotherapeutic treatments. New treatment modalities are needed. A novel intravesicle drug delivery device for neoadjuvant treatment of MIBC has been developed, and preliminary results on the efficacy and safety of this system are available.

The BIONIKK trial is the first prospective biomarker-driven randomized trial in metastatic clear cell renal cell carcinoma. This trial demonstrates the feasibility of using a transcriptomic biomarker that reflects intrinsic disease biology to optimize treatment efficacy and shows that all patients might not require combination treatment.

The highest risk of death from prostate cancer is associated with increased waist circumference, increased blood pressure, hypertension, type 2 diabetes and obesity; thus, therapies that can reduce blood glucose levels have the potential to improve patient outcomes. The therapeutic benefits of low-carbohydrate and fasting-mimicking diets in patients with prostate cancer have been investigated in two recent studies.

Prognostic models incorporating clinical and pathological parameters might assist clinicians in counselling and surveillance of patients following surgical resection of renal cell carcinoma (RCC). Variability exists in the risk classification of individual patients in each model as well as the performance of each model in different RCC subtypes.

The extent, duration and causes of alterations in the testes caused by SARS-CoV-2 are unclear. A new study has documented the effects of SARS-CoV-2 infection on the testes of a golden Syrian hamster model; however, the relevance of these findings to non-severe human infection is questionable.

Artificial intelligence (AI)-based models can potentially reduce workload and assist general pathologists in reaching genitourinary pathologists’ performance. A recent large-scale competition to develop generalizable AI models for prostate cancer detection and grading has shown success; implementation of such models positions them beyond hype and as today’s reality.

Sexual adverse effects from prostate cancer treatment are a substantial burden for patients. An online biopsychosocial sexual rehabilitation intervention for patients with prostate cancer (TrueNTH) was implemented in several cancer centres in the USA. Outcomes from this intervention show no improvements in sexual satisfaction after 6 months; however, earlier resumption of sexual activities was observed 3 months after the intervention.

Genitourinary microorganisms could have detrimental effects on male fertility owing to increased production of reactive oxygen species and generation of oxidative stress, which can lead to sperm DNA damage. Diagnostic genitourinary microorganism screening could help in understanding the reasons for infertility and refine infertility diagnosis and treatment.