News & Views in 2014

The antiandrogen bicalutamide is commonly used in combination with medical or surgical castration in men with prostate cancer. With combined androgen blockade, the usual dose of bicalutamide is 50 mg per day, but evidence suggests that higher doses might be beneficial.

The presence of urolithiasis has been shown to be associated with an increased risk of bone fracture in men and women, particularly in adolescent males and females aged 30–39 years and 70–79 years. This increased risk of fracture in patients with urolithiasis may have important implications for public health.

The contemporary plea for a more liberal pathological definition of insignificant prostate cancer was recently challenged by Schiffmann and colleagues, who advocate a return to the original, stringent 0.5 ml tumour volume threshold. This cut-off point would render fewer men eligible for active surveillance programmes.

Management of biochemically recurrent prostate cancer can be determined by the use of nomograms based on risk factors, but this approach might not lead to selection of optimal courses of treatment for individual patients. Choline-PET–CT imaging can identify the sites of recurrence in these patients, enabling personalized treatment choices depending on the presence of localized or metastatic disease.

In the field of advanced prostate cancer, a number of therapeutic agents are now available. The sequence of administration of medications with distinct mechanisms of action, toxicities and efficacies, will have a critical role in disease outcomes. The identification of biomarkers predicting response will help to determine the appropriate therapeutic sequence.

Medical intervention for transgender adolescents is a controversial issue but a recently published article describing long-term psychological outcomes using 'the Dutch model' of care should help to silence critics and reassure the growing number of clinicians treating this patient population.

Bone scanning for radiographical staging of prostate cancer is common; however, its current use in clinical practice is not in line with the published guidelines. A recent study comparing the performance of current practice with that of guideline recommendations found that following the American Urological Association guidelines consistently for newly diagnosed patients with prostate cancer would result in better outcomes.

During the month of November, the Movember Foundation challenges men to grow a moustache in an effort to raise vital funds and awareness for the often ignored health issues affecting the male population. Global health-care delivery and policies, which have focussed on women's, children's and minority's health for the past few decades, need now address these issues.

Multidiscliplinary teams (MDTs) are increasingly used to aid decision-making in the care of patients with cancer, but their clinical value can be difficult to quantify. A prospective study has now assessed the use of MDTs for patients with urological cancers. Future refinement of MDT organization is required to optimize effectiveness.

A fundamental shift in the understanding, detection and treatment of prostate cancer has occurred over the past 10 years, especially in the use of screening, active surveillance, novel therapies and radical surgery. These discoveries have changed how clinicians and patients approach prostate cancer.

The prostate is still largely assessed by random biopsy, but developments in prostate MRI and fusion with transrectal ultrasonography (TRUS) have made targeted biopsy of the prostate a reality. MRI/TRUS techniques promise to address the issues of overdiagnosis and underdiagnosis in prostate cancer.

Over the past decade, management of common urological problems has metamorphosed in the field of female urology and voiding dysfunction; from treatment of routine stress urinary incontinence (SUI) with synthetic sling placement, to management of refractory overactive bladder (OAB) with neuromodulation.

Several advances in kidney cancer have occurred over the past decade, including the discovery of mutations in chromatin remodelling genes and genomic heterogeneity in clear cell renal cell carcinoma (ccRCC). Altered metabolic patterns in ccRCC and papillary RCC have become apparent, and new drugs for ccRCC have been approved.

Erectile dysfunction remains a frequent sequela of radical prostatectomy, owing to injury to the cavernous nerves that innervate the penile erectile tissue. Over the last decade, many strategies have been proposed to minimize the duration of denervation and prevent irreversible structural changes from occurring in the corpora cavernosa.

Evaluation of patient outcomes does not encompass all survivorship issues after prostate cancer treatment. Addressing the effect that these issues have on men's lives remains a great challenge; therefore, the American Cancer Society Prostate Cancer Survivorship Care Guidelines are a welcome addition to the medical literature.

The international and African urology communities lost a great academic leader and mentor when Professor Chris Heyns died suddenly on 2^nd August 2014. He chaired a meeting as President of the South African Urology Association (SAUA) just hours before his death, making the shock of losing him even more intense.

The past decade has seen many notable contributions to bladder cancer research. Here, we highlight the international efforts in the field, with findings from Europe, USA and China, as well as papers resulting from international cooperation. We anticipate the next 10 years will see even greater collaborative and international efforts.

Lee et al. have highlighted the influence of surgical wait time on oncologic outcomes after surgery for upper-tract urothelial carcinoma (UTUC). The length of surgical wait time in UTUC should be <1 month for nephroureterectomy. Despite some limitations of the study, this message is important for clinicians in their daily practice.

Biopsy of small renal masses (SRMs) that look like renal cell carcinoma (RCC) continues to be debated and most patients undergo treatment without tissue diagnosis. At least 20% of SRMs are benign and most RCCs are low-grade and will grow slowly. Routine biopsy should be adopted to reduce unnecessary surgery.

Patients with prostate cancer are known to be affected by higher levels of depression than their peers. Patients with this combination are less likely to undergo definitive treatment and have lower rates of survival. A new study has investigated the likelihood of a diagnosis of depression prior to prostate cancer.