Reviews & Analysis

PSA screening for prostate cancer has been a controversial topic for some time, particularly in relation to older men. In 2008, the US Preventive Services Task Force recommended against routine screening for men age 76 years or over. But have these guidelines changed screening practice? The short answer is no.

Cytotoxic lymphocyte antigen-4 (CTLA-4) blockade plus vaccine as a combination therapy strategy to promote the immune response to cancer has demonstrated similar toxicities to anti-CTLA-4 monotherapy. As anti-CTLA-4 therapy has demonstrated clinical efficacy, continued exploration and optimization is warranted and must include investigations of combination strategies and management of adverse events.

The essential element of a multidisciplinary approach to patient care brings together prostate cancer specialists to educate patients and involve them in their medical decisions, which brings with it many benefits. Now, there is evidence that this approach also improves clinical outcomes in prostate cancer.

Although early studies of gastrocystoplasty reported good long-term outcomes with few adverse effects, some more recent studies have contradicted this view—a recent report has shown high complication rates and poor outcomes. The use of the technique remains controversial and can be recommended only in a select group of patients.

New data suggest that microRNAs of the miR-371∼373 and miR-302 clusters are promising biomarkers for serum-based detection of malignant germ cell tumours (MGCTs). PCR quantification of these noncoding RNAs can improve the accuracy of MGCT diagnosis, providing greater sensitivity and specificity than traditional markers such as α-fetoprotein and human chorionic gonadotrophin.

A new nomogram for estimating the change in probability of recovering erectile function and continence after radical prostatectomy has been proposed based on retrospective analysis of a heterogeneously treated cohort. Although the study offers some novel findings into the natural history of postoperative functional recovery, it is limited by the retrospective heterogeneous design.

The Bone Scan Index (BSI) is a methodology used to quantify bone metastases and monitor changes under treatment. However, BSI is manually calculated and is, therefore, tedious and time-consuming to use, so it is not routinely implemented. A new automated platform to calculate BSI should help to increase its use.

The comparative efficacy of radiofrequency ablation and partial nephrectomy remains poorly defined for the treatment of small renal masses. A recent retrospective study has found equivalent long-term oncologic outcomes with these two treatment approaches for patients with histology-confirmed T1a renal cell carcinoma. However, the study cohort was highly selected.

A recent survey of radiation oncologists has evaluated barriers to surveillance rather than adjuvant therapy for postorchiectomy management of stage I seminoma. The findings suggest that providers are underestimating the late toxicity of radiation therapy in these patients.

Cross-sectional imaging, endoscopic evaluation and biopsy are the mainstay of preoperative evaluation and staging of patients with upper tract urothelial carcinoma (UTUC), despite their limitations in accurate prediction of grade, stage and oncologic outcome. Multivariable models incorporating numerous clinical factors, including novel tumor markers will improve our ability to deliver personalized treatment.

In the last 3 years, three major trials involving patients with advanced germ cell testicular tumors have investigated dose-intense alternatives to standard BEP (bleomycin, etoposide, and cisplatin) therapy. All three trials failed to reach their accrual targets and none was able to demonstrate improved results.

Laparoendoscopic single site (LESS) surgery is increasingly performed for a multitude of urologic procedures. There has been considerable debate regarding the benefit of LESS surgery. Laboratory evaluation of acute-phase markers in patients receiving conventional laparoscopic and LESS nephrectomy provides new insight.

Studies have reported an increase in the use of nephron-sparing surgery (NSS) since 2002, but quality of life (QOL) may be decreased in patients managed with partial versus radical nephrectomy. These reports have highlighted existing challenges in ensuring delivery of NSS in appropriate candidates while balancing risks to mortality, morbidity and QOL.

Despite great interest in the role of endothelial dysfunction as a predictor of both major adverse cardiovascular events and erectile dysfunction, there are currently no validated diagnostic tools available. A new noninvasive device has been proposed for the early detection of penile endothelial dysfunction in patients with erectile dysfunction.

Randomized trials on prostate cancer screening are limited by logistical and temporal issues. Modeling can be useful to estimate the results for alternative scenarios not examined in the studies and to explain sources of variation between trials.

Acute urinary retention (AUR) remains one of the greatest challenges faced by a clinician when treating BPH and bladder outlet obstruction. Most importantly, bladder outlet obstruction can be extremely distressing for the patient. A number of therapeutic options are available.

Assessment of the clinical validity of the 2004 WHO grading system for bladder cancer staged pTa revealed three important aspects: the presence of substantial interobserver variability; that tumor grade is analogous to stage; and that the system has prognostic value (as low-grade tumors progress, but do so sporadically).

One very important issue faced by clinicians managing patients with prostate cancer is whether after initiating a man on a pure luteinizing-hormone-releasing hormone (LHRH) antagonist, he should then be switched to a longer-acting depot LHRH agonist. New evidence suggests that this therapeutic approach is both safe and effective.

What is the optimum technique for delivering botulinum toxin to the bladder? Injection techniques vary worldwide and are unstandardized, and there is no consensus regarding whether technique actually matters. Most specialists believe that location and depth of injection is unlikely to alter efficacy, but studies have both confirmed and disputed these opinions.

Pelvic organ prolapse (POP) is a common problem experienced by women. A recent research article examined the outcomes of women with POP treated with laparoscopic promontofixation. This technique—a relatively new approach to POP surgery—was associated with symptom improvements and a low rate of recurrence.