Reviews & Analysis

Systemic inflammation has been linked with cancer development and progression. C reactive protein (CRP) is a useful marker of systemic inflammation. CRP levels could predict survival in patients with urological cancers, and the incorporation of CRP into prognostic models improves the models' predictive accuracy. The analysis of CRP kinetics could predict tumor aggressiveness and response to treatment. In this Review, Saito and Kihara discuss the usefulness of CRP as a prognostic biomarker in urological cancers, including renal cell carcinoma, bladder cancer and prostate cancer.

Wnt signaling is thought to have an important role in the development of several human cancers, but its role in renal cell carcinoma (RCC) seems to be distinct from other cancer types. In this Review, the authors describe our current understanding of Wnt signaling and the action of several endogenous Wnt antagonists in the context of RCC, and discuss how study of these proteins might lead to the development of effective new targeted therapies for patients with this malignancy.

For years, the standard protocol when performing a partial nephrectomy has been to leave a drain for monitoring postoperative complications, such as urinary fistulae and hemorrhage. Contemporary literature is now suggesting that, in select cases, drain placement (with its associated morbidity) might be unnecessary.

The erectile function domain of the International Index of Erectile Function score is a widely used patient-reported outcome metric and a frequent clinical trial end point. Rosen and colleagues determined minimal clinically important difference (MCID) values for this score to overcome discrepancies between statistical significance and clinical significance. Before these MCIDs are implemented in the clinic, urologists should be aware of the advantages and limitations of this instrument.

There are several options for treating clinically localized renal tumors in the elderly, ranging from active surveillance to radical nephrectomy. Reduced renal function is associated with increased cardiovascular mortality, so maintaining renal function is of the utmost importance. Personalized therapy should be based on tumor location, comorbidities and general health status rather than tumor size and patient age.

Prostate cancer screening has led to an increase in transrectal-ultrasonography (TRUS)-guided prostate biopsies. However, clinicians are becoming increasingly concerned that fluoroquinolone-resistant organisms are the cause of infectious complications in patients who have undergone this procedure. Two separate studies have shown that patients treated with fluoroquinolone prior to transrectal biopsy are at an increased risk of infectious complications.

Urothelial carcinoma of the bladder (UCB) is the fifth most common cancer in the USA; therefore, the identification of patients with high-risk disease is important for timely and appropriate treatment. UCB has two clinical manifestations: noninvasive lesions that recur but rarely progress, and muscle-invasive lesions that progress aggressively and are associated with poor outcome. In this Review, Prasad et al. define the high-risk UCB and the associated clinical, histological and genetic factors. They also describe the treatment options and provide a brief description of future efforts in bladder cancer research.

The authors discuss a novel strategy of increasing the elevated intracellular levels of reactive oxygen species, which result from aberrantly-regulated signaling pathways, to a lethal level in tumor cells only. The selective death of cancer cells might be exploited in order to develop highly effective and specific therapeutic strategies with minimal side effects for the treatment of urothelial carcinoma.

Although prolactin's action on the mammary gland is well known, it is also found in the circulation of males and its receptor (PRLR) is expressed in the prostate. Furthermore, studies have supported the contribution of the canonical PRLR-Jak2-Stat5a/b pathway to prostate cancer tumorigenesis and progression. In this Review, the authors discuss the data regarding the role of prolactin in the prostate and consider the therapeutic potential of targeting prolactin signaling pathways in the treatment of advanced prostate cancer.

Members of transient receptor potential (TRP) superfamily are expressed in lower urinary tract (LUT) tissues, where they are mainly involved in nociception and mechanosensory transduction and represent potential targets for treating LUT disorders. In this Review, the authors discuss the evidence for a pivotal role of TRPV1, TRPV2, TRPV4, TRPM8, and TRPA1 in normal and pathological LUT function and consider the therapeutic strategies that might arise from targeting these channels.

International prostate symptom score is widely used to evaluate lower urinary tract symptoms in patients with benign prostatic hyperplasia. However, the questions can be difficult to understand for some patients, leading to inaccurate treatment decisions. A visual prostate symptom score could overcome this limitation, but should be further investigated.

For decades, complete removal of the kidney with all the contents of the Gerota's fascia (including the adrenal gland) has been a standard procedure for treating renal cell carcinoma (RCC). Two recent articles argue against routine adrenalectomy, and encourage adrenal preservation for the vast majority of patients with RCC.

Ho and colleagues outline the requirements of focal therapy for prostate cancer and discuss the limitations of current imaging modalities and prostate biopsy techniques to meet them. They go on to describe how a robotic system might overcome these deficiencies and review the types of robotic prostate biopsy that have been reported.

Recent data indicate that sphingosine kinase 1 (SK1), a lipid enzyme with oncogenic properties, has a critical role in the progression of many cancers. In this Review, the authors describe the mechanisms of SK1 signaling and the molecular basis for targeting SK1 in cancer, with particular focus on prostate cancer.

The prostate gland expresses several components of the endocannabinoid system. In this Review, Díaz-Laviada outlines the anti-proliferative effect of cannabinoids on prostate cancer cells and the signaling pathways underlying cannabinoid action, before discussing the molecular targets and signaling pathways modulated by cannabinoids in prostate cancer cells.

Passing kidney calculi can be excruciatingly painful for patients, likened to childbirth in intensity. The mechanism of the simple act of passing a stone, however, is not well understood. A recent research article examined a novel approach for optimizing kidney stone clearance—sleep position, a simple noninvasive concept that might improve urinary stone passage.

Vesicoureteral reflux (VUR) a common urological anomaly in children, and can result in reflux-associated nephropathy, which is a major cause of childhood hypertension and chronic renal failure. In this Review, the authors discuss the pathogenesis of VUR, and consider genetic syndromes and gene loci that have been associated with the disorder.

Radiation exposure is inevitable when using fluoroscopy for ureteroscopic procedures. However, there are numerous acute adverse effects of radiation, and the long-term effects are unclear. Thus, efforts to minimize the use and duration of fluoroscopy are essential for the benefit of not only the patients, but also the surgeons carrying out the procedure.

A multicenter randomized trial comparing a trocar-guided mesh kit to anterior colporrhaphy for treatment of cystocele adds to evidence that transvaginal mesh for treatment of anterior vaginal prolapse improves anatomical outcomes at the expense of greater complications. Careful consideration of benefits and risks is required when considering transvaginal mesh for prolapse repair.

The European Organisation for Research and Treatment of Cancer (EORTC) tables estimate risks of tumor recurrence and progression in patients following transurethral resection of non-muscle-invasive bladder cancer. But how well do the predictive accuracy and discriminative ability of the tables stand up in patients administered bacillus Calmette–Guérin (BCG)?