News & Views in 2012

A recent study shows that recommended bone mineral testing is rarely performed in men with prostate cancer receiving androgen deprivation therapy. Although these patients are at increased risk of fragility fracture, the reported incidence, from prospective randomized trials, is low. As a result, bone density testing for these men requires careful consideration.

Whether or not inguinal lymphadenectomy benefits patients with superficial penile carcinoma and clinically impalpable lymph nodes is a controversial issue. New evidence supports active surveillance for patients with T1G1 tumours and inguinal lymphadenectomy for those with T1G3 cancer, but the optimal management of patients with T1G2 disease remains unclear.

A recent meta-analysis evaluating the relationship between type 2 diabetes mellitus and prostate cancer provides strong evidence to support an inverse association between the two conditions. However, the influence of factors such as severity, duration and treatment of diabetes, and the influence of other metabolic disorders should also be considered and investigated further.

Stem-cell therapy has the potential to regenerate tissue and cure disease—an approach preferable to many current treatments that simply mitigate symptoms. Currently, there is no approved medical therapy for Peyronie disease; a recent study suggests stem cells could provide an intriguing treatment option for this difficult-to-treat tissue defect.

Research has revealed what we already suspected—randomized controlled trials are lacking in the field of bladder cancer. Many areas require further investigation, and we must try to incentivize clinicians to perform the much-needed trials. A newly established patient advocacy group will be invaluable in this endeavour.

A large Swedish population-based study has shown that 15-year prostate-cancer-related mortality rates are negligible for men with low-risk cancers treated noncuratively, but significant for those with intermediate-risk and high-risk tumours. Such data support current trends towards active surveillance for low-risk disease and aggressive multimodal treatment for advanced carcinomas.

Active surveillance has become increasingly popular as a management option for localized prostate cancer. Although widely viewed as a means to enable men with low-risk prostate cancer to avoid or defer the effects of whole-gland radical therapy, two new studies demonstrate that it might be a safe approach in intermediate-risk disease.

The plethora of treatment options available for localized prostate cancer can make the patient's decision regarding which therapy to undergo a difficult one. A recent study has investigated the effect of using a decision aid to provide patients with enough information to make an informed decision about their therapy.

A Taiwanese study has established an association between bladder pain syndrome (BPS) and prior diagnosis of urinary stones. The study authors suggest that stones initiate a process that results in BPS. An alternative hypothesis is that patients with BPS are more likely to undergo imaging, revealing incidental stones.

Owing to a lack of universally accepted guidelines for the treatment of occult stress urinary incontinence at the time of surgery for pelvic organ prolapse, one-step and two-step approaches have been used—but which is the best choice?

Radiofrequency ablation and cryoablation of the small renal mass have emerged as treatment options for patients who are not surgical candidates or who elect not to undergo surgery. Besides concerns regarding the definition of treatment success and the difficulty of salvage procedures, incomplete ablation might potentially create a tumour microenvironment that promotes cancer progression.

Reasons why men discontinue a medication that successfully addresses their erectile dysfunction have been investigated often. A recent study adds few new reasons for discontinuation, but does report which medical conditions result in men discontinuing due to PDE5 inhibitors not being able to restore their erectile function.

The screening and treating of prostate cancer is a complex and controversial issue, which seems to have inspired much media coverage. We must be careful to ensure the less-newsworthy facts and limitations of high-profile trials, such as PIVOT, are not lost in media hype.

The availability of PDE5 inhibitors has significantly altered the way in which erectile dysfunction (ED) is treated. Some major issues have emerged since the advent of PDE5 inhibitor use for ED, especially in relation to recreational use in young, healthy men and the role of confidence in erectile ability.

Counterfeit medicines sold online are a global scourge. Although erectile dysfunction drugs are well known to be heavily counterfeited, illicit vendors are rapidly expanding to other drugs and devices in the sexual health arena. International multidisciplinary cooperation is needed to address key patient safety concerns resulting from such markets.

Finding effective treatment for chronic vulvar pain—vulvodynia—is a challenge. Although two new studies answer critical questions regarding treatment effectiveness for two interventions, both studies found that approximately 40% of women still experience pain during sex (dyspareunia) despite treatment. Is this as good as it gets for these women?

New and very expensive forms of radiotherapy, such as intensity-modulated radiation therapy and proton therapy, have taken over the localized prostate cancer market. But is there enough evidence to justify their increased utilization and if so, how can we possibly afford them?

High-intensity focused ultrasound (HIFU) represents a fairly new treatment option for focal therapy of prostate cancer. However, studies evaluating its efficacy have not provided strong data to support the use of HIFU in the majority of patients. Thus, high-profile studies investigating feasibility of the modality in terms of adverse effects seem premature.

The results from two new randomized trials suggest that urodynamic assessment might not be necessary to select patients for stress incontinence surgery. However, whether these findings change clinical practice remains to be seen.

Initial results from the STAMPEDE trial of androgen deprivation therapy with and without celecoxib in patients with prostate cancer have shown that celecoxib does not confer benefit. Despite this negative finding, this multiarm, multistage trial will be informative of future clinical trial design, particularly as new agents become available for prostate cancer.