Reviews & Analysis

Metastatic prostate cancer has traditionally been treated with systemic therapy alone, but the issue of oligometastatic disease raises the question of whether local therapy — radical prostatectomy or prostate radiotherapy — should be performed. A number of phase III trials should improve our understanding of metastatic disease and lead to better care of our patients.

Dose-intensified radiotherapy is widely used in prostate cancer treatment but its effect on distant metastasis and overall survival is unclear. A large randomized clinical trial to evaluate the role of external-beam-based dose intensification without androgen deprivation therapy in intermediate-risk disease shows that dose escalation can reduce distant metastases.

The role of 5α-reductase inhibitors (5-ARI) in prostate cancer chemoprevention remains a controversy, as cancer prevention trials with 5-ARIs have shown a decreased incidence of low-grade prostate cancer but a potential increased risk in high-grade disease. Recent studies have shed light on the long-term safety of 5-ARIs in terms of influencing prostate cancer risk.

The FDA recently approved the second-generation antiandrogen apalutamide for the treatment of men with nonmetastatic castration-resistant prostate cancer on the basis of metastasis-free survival data from the SPARTAN trial. However, whether apalutamide is clinically superior to enzalutamide and whether early or late treatment is preferable remains to be defined.

Bladder cancer molecular subtypes are promising for predicting patient outcomes. In contrast to most reports to date that used unsupervised clustering methods, a new study has demonstrated the value of a tumour differentiation signature based on normal biological expression patterns characteristic of basal or differentiated urothelial cells.

Refers to Mo, Q. et al. Prognostic power of a tumour differentiation gene signature for bladder urothelial carcinomas. J. Natl Cancer Inst. https://doi.org/10.1093/jnci/djx243 (2018)

Prostate MRI has reached the point of being a mature technology with an established clinical need, so the modality is here to stay. Accordingly, it is incumbent upon the radiology community to find practical solutions for the ongoing variability in interpretation and diagnostic performance of this technique.

The past decade has witnessed an accelerated trend towards freeze-all or frozen embryo transfer cycles in reproductive medicine. However, the results of two recent randomized controlled trials seem to indicate that this deliberate shift in practice towards frozen embryo transfer cycles was premature and perhaps even misguided.

A recent study suggests modulation of luteinizing hormone signalling within the hypothalamic–pituitary–gonadal axis and downstream transcriptional effects caused by sustained ibuprofen use. However, this study cannot be used to draw any clinical conclusions regarding effects of ibuprofen on male androgenic or reproductive health. Thus, the andrological effects of its use remain unclear and would benefit from further investigation.

Different methods for detecting circulating tumour cells (CTCs) in the blood of patients with cancer yield distinct results with regard to cell counts and CTC subpopulations. This observation underlines the urgent need for comprehensive standardization and validation of novel CTC technologies in order to facilitate their introduction into clinical practice.

Preventative use of serum PSA screening is controversial and generally undertaken as a shared decision between doctor and patient. A new study identifies a link between individuals' numeracy, or facility with quantitative concepts, and their understanding of the risk reduction benefits of PSA testing.

Data suggest that chemotherapy is a sound treatment option for urothelial cancer across the disease spectrum. However, despite a twofold increase in survival in patients receiving chemotherapy, it does not seem to be offered to all patients.

Most genetic analyses of prostate cancer have studied white men. A new study compares the genetic landscape of prostate cancer in Chinese men, reporting both similarities and differences. This finding highlights the need for studies to include all races and paves the way for future personalized medicine approaches for prostate cancer across races.

Results of two large randomized controlled trials have challenged the use of medical expulsive therapy for the management of ureteral calculi. A new trial now shows that tamsulosin is effective in patients with distal calculi >5 mm in size, demonstrating that the effectiveness of MET depends on stone size and location.