Perspectives in 2018

In this Opinion, Brennen and Isaacs present their embryonic reawakening theory of BPH. They hypothesize that an inflammatory transition–periurethral zone microenvironment caused by continuous exposure to urinary components and/or autoantigens promotes recruitment of mesenchymal stem cells and generates a paracrine-inductive stroma that reinitiates benign neoplastic nodular growth.

Despite having efficacy without a survival benefit in castration-resistant prostate cancer, ketoconazole has considerable advantages such as low cost. Here, the authors discuss the clinical experience with ketoconazole, emphasizing treatment timing and sequencing, and highlight patient populations that might benefit.

In this Timeline article, the authors discuss studies that have improved our understanding of prostate cancer and influenced management of this disease.

Despite the considerable detrimental effects associated with penectomy, squamous cell carcinoma (SCC) of the penis is most commonly treated with surgery. However, SCC at other locations can be successfully managed using chemotherapy and radiation. Here, Jonathan Tward makes a case for organ-sparing treatments for penile cancer, based on data from treatment of SCC at other body sites.

Active surveillance protocols rely on the premise that low-risk disease remains indolent. Thus, understanding environmental factors that promote the progression of indolent disease towards aggressive stages is important to manage men on these programmes. In this Perspectives, the authors describe the data regarding the roles of dietary calcium and vitamin D in prostate cancer and consider whether intake should be modified in men with the disease.

In this Perspectives, the authors present a new model of urothelial carcinogenesis that incorporates the role of telomerase activation. They also highlight the potential of targeting telomerase as a therapeutic approach for bladder cancer.