Articles in 2020

Organ-sparing surgery for the management of penile cancer is a dogma underpinned by previous research demonstrating no change in cancer-specific survival in cases of local recurrence. However, a new multicentre study of 897 patients treated with glansectomy for penile cancer challenges this view.

The COVID-19 pandemic has resulted in a substantial increase in waiting times for cystoscopies, prompting concerns of delayed diagnoses and substandard surveillance of bladder cancer. Expanding the role of urinary biomarkers in diagnostic and surveillance pathways could be a strategy to address this problem, and several novel biomarkers have shown promise for this purpose.

This Review summarizes the manifestations of inter-tumoural and intra-tumoural heterogeneity in primary and metastatic prostate cancer, emphasizing the contribution of genomics studies and discussing the importance of phenotypic changes. The authors also critically discuss the implications for clinical management and research.

In medicine and society exist two pandemics. One, COVID-19, has recently emerged and has been widely acknowledged. The other — systemic racism — has been silently deadly for centuries. Now is the time to recognize the impact of this other pandemic and to eradicate it.

At Nature Reviews Urology, we have pledged to strive towards improving diversity in our field. As a step towards this goal, this Viewpoint presents the experiences of 10 Black urologists. Their stories illustrate the importance of perseverance and emphasize the essential role of community and mentorship to raise up our peers and colleagues, to support and encourage Black urologists and lead to a more diverse field of urology in the future.

Multiparametric MRI enables early detection of progression and reclassification in patients with low-risk prostate cancer on active surveillance and offers the potential to reduce unnecessary biopsies. However, the reliability and reproducibility of MRI-directed surveillance during follow-up is unclear. A recent study highlights the potential and current shortcomings of this approach.

The PRECISION trial demonstrated the ability of using multiparametric MRI to improve the diagnosis of clinically significant prostate cancer whilst reducing over-diagnosis of clinically insignificant cancer compared with systematic biopsy. Concerns remained about patients who were not biopsied owing to negative scans. A new study applies the PRECISION strategy to a contemporary cohort to answer these concerns.

MRI-guided transurethral ultrasound ablation is an exciting, minimally invasive technology with the potential to provide targeted ablation of prostate cancer tissue. At 3 years, functional outcomes remain good with 76% remaining free from salvage treatment. Future studies using a focal approach may provide evidence for widespread uptake of this technology.

Retzius-sparing prostatectomy is an alternative approach to standard robot-assisted radical prostatectomy. Many surgeons advocate this technique as data suggest that it provides better early functional results than the standard approach without compromising oncological outcomes.

New and more effective treatments are urgently needed for bladder cancer. This Review discusses the role of nectin-4 as a therapeutic target for enfortumab vedotin (an antibody–drug conjugate) in locally advanced and metastatic urothelial carcinoma and outlines related clinical data.

Management of rare genitourinary malignancies often depends on individual physicians’ discretion, resulting in non-standardized care. Furthermore, patients experience worse clinical outcomes than patients with common malignancies. Collaborative efforts such as the Global Society of Rare Genitourinary Tumors (GSRGT) are therefore necessary.

Many aspects of human male reproduction can be modulated by cannabinoids and endocannabinoids (eCBs). Preclinical studies have shown that the endocannabinoid system (ECS) is involved in negative modulation of testosterone secretion, but the effect of in vivo exposure to cannabinoids on spermatogenesis remains a matter of debate. An improved understanding of the complex crosstalk between cannabinoids and eCBs might enable targeting of the ECS for modulation of human fertility.