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Understanding risk factors for prostate cancer is an important step towards personalized, risk-adapted early detection and prevention. Epidemiological studies, which are commonly used to identify risk factors, are prone to detection bias. This bias could substantially affect the observed relationship between putative risk factors and prostate cancer diagnosis.
Recent advances have been exciting in the genomics of and targeted therapeutics for renal cell carcinoma (RCC). New agents have been approved for advanced RCC, a novel agent targeting hypoxia-inducible factor 2α has shown considerable promise and molecular characterization of papillary RCC provides the foundation for development of targeted therapeutic approaches for this disease.
In 2012, the United States Preventive Services Task Force issued a Grade D recommendation for PSA screening — in essence, a recommendation for cessation of prostate cancer screening in all US men. In this Review, the authors discuss the effect of this statement on prostate cancer incidence and dynamics, as well as changes in attitudes to screening of patients and health-care providers in the USA.
Recommendations based on high-level evidence for diagnosis, treatment and follow-up monitoring of upper tract urothelial carcinomas (UTUCs) are lacking and decision-making is often based on data from lower tract urothelial carcinoma. Here, Baard et al. review diagnostic tests for UTUC, describe efforts to improve lesion visualization, and propose an algorithm that integrates diagnosis, treatment, and clinical risk-stratification.
Lower urinary tract symptoms (LUTS) are common comorbidities in patients with Parkinson disease, or multiple system atrophy, and these can have considerable negative effects on patients' quality of life. In this Review, the authors describe the prevalence, diagnosis and management of LUTS in patients with PD or MSA, including the key differences in LUTS between patients with these disorders, which can, in some patients, enable a differential diagnosis.
Fournier's gangrene is a life-threatening urological emergency, which requires prompt treatment with fluid resuscitation, debridement, and reconstruction. In this Review, Hagedorn and Wessells describe the contemporary management of Fournier's gangrene, and discuss prognostic tools, therapeutics, and follow-up care of this rare but debilitating disorder.
Onabotulinumtoxin A and sacral neuromodulation are options for treating women with refractory urge urinary incontinence. Both of these treatment options provide symptomatic relief and have advantages and drawbacks. Discussion with patients regarding the risks and benefits of each therapy is critical for informed treatment choice.
Multiple BCG strains are used for intravesical instillation treatment of non-muscle-invasive bladder cancer but no large randomized studies comparing these strains are available. To enable creation of new BCG-related agents that overcome the instabilities of the current formulations, molecular examination of BCG's mechanisms of action is required.
Functional urological disorders, like their gastrointestinal counterparts, are interrelated and characterized by a chronic course and treatment resistance. Poor outcomes might be attributable to underlying psychological and psychiatric disorders, as the co-occurrence of functional disorders with mood and anxiety disorders is common. In this Review, the authors describe the hypothetical bladder–gut–brain axis, and explain how it is a useful framework under which this interaction can be studied.
