Reviews & Analysis

New research confirms that elderly patients with bladder cancer are clearly undertreated and women with high-risk noninvasive disease have worse outcomes than their male counterparts. Aggressive treatment can benefit both of these patient groups and should be offered and discussed appropriately.

Here, Sridhar and co-authors describe the applications of robotic technology in combination with image guidance in the surgical, including organ preserving, management of prostate cancer. Although several of these platforms have been developed in the diagnostic setting, their use in surgical and nonexcisional interventions is increasing.

The presence of lymph node metastases is one of the most important prognostic factors after radical prostatectomy. However, not all patients with node-positive prostate cancer have the same risk of cancer-specific death and stratification can help identify those patients with few lymph node metastases who could expect a better prognosis.

In this Perspectives article, Centenera et al. chronicle the development of ex vivoculture models that utilize tumour material from men with prostate cancer and discuss the advantages, limitations, and potential applications of these systems to expedite the evaluation of novel drugs for the treatment of prostate cancer.

Intermittent androgen deprivation can reduce treatment-related adverse effects in men with prostate cancer. Data from the recent SWOG-9346 trial show a nonsignificant improvement in median overall survival in patients treated with continuous therapy compared with intermittent therapy, but are these data likely to change clinical practice?

In this Review, Marignol and colleagues evaluate the potential involvement of hypoxia in the deregulated expression of notch receptors, ligands, and targets in prostate cancer cells and consider the likely involvement of hypoxia and notch signalling in disease progression, treatment resistance, and the identification of novel therapeutic targets for prostate cancer.

In this Review, Van der Kwast and Roobol consider the risk of overdiagnosis of PSA-detected prostate cancers and reassess the pathological definition of insignificant prostate cancer based on an extensive literature review.

Meijer and colleagues review recent imaging advances to detect cancerous nodes in patients with prostate cancer. Improved detection of involved nodes enable a more personalized approach in patient selection and treatment planning for lymph node irradiation.

Most clinical trials of chemotherapeutics for advanced bladder cancer have shown limited benefits, so new prognostic markers and effective treatment strategies are necessary. Yoshino et al. discuss the microRNAs that have been identified as potential oncogenes or tumour suppressors, as well as those that have been implicated as prognostic biomarkers, in bladder cancer.

Bladder cancer risk assessment is currently based on an individual's age and history of exposure to known carcinogens. A new report illustrates how interactions between cigarette smoking and germline genetic variation can identify those at particularly high risk, who could be targeted in future bladder cancer prevention and screening efforts.

Current biopsy techniques and clinical disease assessment of prostate cancer frequently fail to accurately stratify men according to risk. Recent advances in biopsy techniques, imaging, molecular genetics, and biomarkers could enable physicians to improve risk stratification at the individual level, thereby improving patient management for prostate cancer.

Although technical advances have enabled the delivery of precise radiotherapeutic doses to prostate tumours, reducing the dose given to surrounding tissues, radiotherapy-associated toxicity can not be completely avoided. This Review describes the possible methods to reduce late rectal injury as well as the patient-specific characteristics that the radio-oncologist should consider.

In this Review, Ischia and So discuss the expression of heat shock proteins (HSPs) in bladder cancers and their utility as diagnostic and prognostic biomarkers. They also cover the role of HSPs in mediating the BCG response, as well as resistance to radiotherapy and chemotherapy. Furthermore, they briefly discuss novel therapies that target HSPs in the treatment of bladder cancers.

Rahnama'i and colleagues highlight the emerging role of selective phosphodiesterase (PDE) inhibitors in the management of functional voiding disorders. Although much remains unknown about the role of these enzymes in the human bladder, accumulating evidence suggests that PDE5 inhibitors alleviate lower urinary tract symptoms in men, and could be a useful adjunct to α blocker therapy.

In this Perspectives article, the author presents his theory that pressure has shaped the morphology of the prostate over time, and discusses the implications this might have on the longstanding debate of the relationship between BPH and prostate cancer.

New research has shown that African American men have a significantly higher rate of non-organ-confined prostate cancers than their white counterparts. Is now the time to finally consider changing the criteria for active surveillance based on ethnic risk?

Currently, there is no consensus on the optimal follow-up protocol for localized renal cancer after surgery. A new study reveals that existing protocols vary widely, leading to differences in diagnostic radiation exposure and cost. Cumulative ionizing radiation exposure has been suggested to cause second malignancy, but further research is required.

Methylated genes have been proposed as diagnostic and prognostic biomarkers for patients with both muscle-invasive and non-muscle-invasive bladder cancer. In this Review, the authors describe the body of evidence on gene methylation and the associations with progression, recurrence and survival, which might contribute to clinical decision-making and individualized treatment.

The lack of standardized nomenclature and level 1 evidence has led to controversy regarding pelvic lymph node dissection during radical prostatectomy. However, the knowledge of metastases presence and location can be valuable to guide therapy. Including internal iliac nodes in standard dissection can improve metastasis detection, with minimal added risk of complications.

Testicular germ cell tumours are the most common malignancy in young adult males. Recent data suggest that the predominant histological subtype appears to be shifting towards seminomas, which is mirrored in an increasing age at presentation. However, as nonseminomatous tumours present earlier, recent declines in its incidence might be more informative of overall trends.