News & Views in 2015

Androgen deprivation combined with external beam radiotherapy improves the overall survival of patients with localized prostate cancer but might be associated with adverse effects that influence their health and quality of life. When considering this medication, clinicians must be aware of the increased risk of cardiac mortality in patients with moderate or severe comorbidity.

Mirabegron has been shown to cause relaxation of the isolated mouse urethra, partly through blockade of α_1A-adrenoceptors and α_1D-adrenoceptors. However, although this effect might be an interesting pharmacological in vitro observation, it seems to have no relevance for the clinical use of mirabegron in the treatment of the overactive bladder.

Biomarkers predicting response to chemotherapy in patients with muscle-invasive bladder cancer (MIBC) have the potential to better select patients for treatment and to improve outcomes of this aggressive disease. Results from a new study bring us a step closer to individualizing treatment through use of a three-gene signature to predict response to neoadjuvant chemotherapy.

Elective pelvic nodal irradiation (EPNI) remains a controversial area in prostate cancer management. Two articles published in the International Journal of Radiation, Oncology, Biology and Physics present additional data regarding the benefits of EPNI for patients with high-risk prostate cancer, suggesting that EPNI confers no benefit in overall survival or biochemical-progression-free survival.

Effectiveness of an innovative online psychological intervention and forum was investigated in a three-arm randomized controlled trial. Improvements in several elements of psychological distress were observed in men with prostate cancer who had access to both the intervention and the forum over a 10-week period.

The results of the phase III CHAARTED trial investigating androgen deprivation therapy (ADT) plus docetaxel for men with metastatic hormone-sensitive prostate cancer challenge the long-established standard of care of ADT alone for these men. The next step will be to integrate these results into clinical practice.

Studies using rodent and adult human prostate stem-progenitor cell models indicate that exposure to bisphenol A (BPA) during development increases susceptibility of the prostate gland to premalignancy later in life. A novel human organoid model has now been generated to study the effects of BPA on embryonic human prostate development.

The profile of diseases that specifically affect men has increased in recent years, and charities have had a major role in raising public awareness and funding for these conditions. Now that these charities have gained attention, their influence in the field of men's health should be assessed.

In a recent issue of JAMA, Lewis et al. present long-term data on the likelihood of a link between pioglitazone and the risk of bladder cancer and ten other cancers. Their findings contradict previous concerns regarding the safety of pioglitazone, and add to the controversy surrounding interpretation of rare adverse events associated with prescription drugs.

Is the overtreatment era drawing to a close? New data from the CaPSURE study demonstrate that US urologists are now firmly embracing active surveillance for low-risk prostate cancer.

The RTOG trial investigated the survival benefit of chemotherapy combined with androgen deprivation therapy (ADT) in patients with high-risk nonmetastatic prostate cancer after radiotherapy. However, the 10-year overall survival data showed no difference between treatments; thus, chemotherapy is unlikely to improve the overall survival in patients with nonmetastatic prostate cancer.

Evolving over time, the Gleason scoring system has remained a crucial tool for prognosis and treatment decision making in prostate cancer. A recent study proposes a modification to the current Gleason system that should more accurately risk stratify patients and enable clinicians to make more appropriate treatment decisions.

Robust preclinical models of prostate cancer are required as clinical management of men with this disease evolves, and increasing genomic understanding makes currently available cell lines less relevant. A novel orthotopic xenograft mouse model is state of the art for preclinical models of prostate cancer.

The need for invasive urodynamic functional studies prior to the surgical treatment of uncomplicated female stress incontinence has been questioned following the findings of recent randomized controlled trials. But how generalizable are these research findings to the urogynaecological population in practice?

In men, human papillomavirus (HPV) infection can cause two different types of external genital lesions: condylomata (genital warts) and penile intraepithelial neoplasia (PeIN). A new study provides clinical and molecular data on the progression of HPV infection to condylomata and PeIN, as well as virus genotype information that might be useful for vaccine preparation.

Androgen receptor splice variants might be associated with castration resistance in prostate cancer as well as resistance to hormonal therapies including abiraterone and enzalutamide. New data demonstrate that splice variants can form dimers with each other as well as with the full-length androgen receptor, and that dimerization is required for androgen-independent transcriptional activation of target genes.

A low urinary flow rate without clinical symptoms is frequently observed in boys after surgical correction of hypospadias. Whether this reduced flow rate is relevant and needs further correction is an ongoing debate, as long-term follow-up data are lacking.

A newly published study used whole-genome sequencing of multiple prostate tumour foci from several patients with intermediate-risk prostate cancer to track evolutionary patterns and delineate the marked intrapatient molecular heterogeneity of this disease. Their findings have potential implications for the development of clinical prognostic and predictive biomarkers.

Alterations in metabolism are fundamental to the development and progression of renal cell carcinoma (RCC). Through use of a combined proteomic and metabolomic analysis approach, a new paper enhances our understanding of the metabolomic alterations that occur in RCC and highlights new therapeutic targets.

Optimizing first-line therapies to reduce the risk of permanent adverse effects is increasingly important in children treated for nonmetastatic, unilateral Wilms tumour. The long-term effects of radical nephrectomy on renal function have not been well studied but new data have given some insight into the lasting outcomes of this surgery.