Reviews & Analysis

Prostate-specific membrane antigen (PSMA) is expressed by prostate cancer cells as well as endothelial cells within the neovasculature of a number of malignancies including renal cell carcinoma (RCC). PET radiotracers that target PSMA have shown great promise for imaging RCC. Agents that target PSMA also have the potential to be used as therapeutics in patients with this malignancy.

Enhanced recovery after surgery (ERAS) pathways are increasingly used for patients undergoing radical cystectomy, but data on their benefits are still sparse. A new paper charts improvements in patient outcomes during a 10-year period. An optimized, defined ERAS protocol is certainly important, but the ERAS culture of consistency, performance measurement, and continual adoption of best practice are also crucial.

A recent systematic review on worldwide declining trends in sperm counts has fuelled alarming reports in national and international news media. However, methodological issues exist with data gathering and analysis precluding any conclusion and no solid data exist to indicate increasing frequency of couple infertility during past decades.

Owing to the limited operating space available, robot-assisted approaches have been rapidly adopted for procedures involving the retroperitoneal space. In this Review the authors describe the outcomes of patients undergoing robot-assisted procedures, including partial nephrectomy, radical nephrectomy, retroperitoneal lymph node dissection, nephroureterectomy and adrenalectomy, in addition to the potential of novel techniques.

WNT signalling pathway components are potentially important in prostate tumours, particularly in the development of castration-resistant prostate cancer and in the prostate tumour microenvironment. Here, Murillo-Garzón and Kypta describe our current understanding of WNT signalling in prostate cancer and discuss the potential of drugs that target this pathway.

The clinical relevance of variant histology in urinary bladder cancer has been increasing, resulting in new classifications of urothelial cancers by the WHO in 2016 and highlighting the importance of an accurate morphological description of pathological specimens for the therapeutic management of patients with bladder cancer.

Ginzburg et al. review the evolving role of focal ablative therapies in the management of small renal masses. They describe the techniques, the role of image guidance, pretreatment biopsy, and post-treatment surveillance, as well as data on safety, oncological, and functional outcomes.

Prostate cancer biology seems to be distinct among men of different ethnicities and races, as demonstrated by remarkable differences in the frequency ofERG oncogenic activation. In this Review, Sedarsky and colleagues discuss worldwide ERGalteration frequencies and consider how the data can be affected by variations in assay platforms and specimen types, as well as ethnic and geographical classifications, in order to realize the potential of precision medicine for men with prostate cancer.

Antimicrobial resistance in Neisseria gonorrhoeae compromises gonorrhoea treatment globally and vaccines might be the only sustainable solution for gonorrhoea control. A new study for the first time provides a proof of principle for protection with ∼31% effectiveness against gonorrhoea, owing to cross-protection by the outer membrane vesicle Neisseria meningitidis serogroup B vaccine (MeNZB).

High-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands suspicious for carcinoma are two prostate cancer diagnoses without standardized follow up and treatment pathways. In this Review, Tosoian and colleagues describe data that have shed light on these phenomena. The improved understanding of the implications of the presence of HGPIN and atypical glands on prostate biopsy means that clinical recommendations can be made for the management of patients with these diagnoses.

Patients with bladder cancer have a substantially increased risk of prostate cancer, compared with that of the general male population, and a diagnosis of concomitant prostate cancer can contribute to inferior outcomes, particularly in patients with muscle-invasive bladder cancer. Here, the authors describe the outcomes of such patients, in addition to the optimal treatment and management strategies and future research needs.

Galeterone is a steroid 17-α-hydroxylase/17,20 lyase and androgen receptor antagonist intended for patients with prostate cancer. Similar to abiraterone, galeterone has a steroid scaffold structure and mimics natural ligands; thus, these agents are metabolized by the same enzymes that synthesize or degrade naturally occurring steroids, which can result in attenuated efficacy.

Low-intensity extracorporeal shockwave therapy (Li-ESWT) has gained popularity as a noninvasive treatment for erectile dysfunction (ED), with the potential to cure, rather than simply provide symptomatic relief. However, the quality of data regarding this treatment option is variable, and drawing conclusions is a challenge. In this Review, a team of expert authors describe the rationale and potential mechanisms of Li-ESWT for ED and discuss the available evidence for its clinical use.

Results of the STAMPEDE and LATITUDE trials, which investigated the addition of abiraterone and prednisone to androgen-deprivation therapy in advanced prostate cancer, have renewed interest in 'complete androgen blockade', a concept originally described by Fernand Labrie in the 1980s. However, whether this treatment regimen should become standard of care remains to be seen.

In clinical studies, mirabegron has been shown to cause a small increase in heart rate with a slight increase in QTc interval, as indicated on electrocardiograms. The mechanisms of these effects are unclear. The findings of a recent study might provide some new clues, although, the relevance of these new observations to the treatment of patients with overactive bladder syndrome have yet to be established.

In this Perspective, Ng and colleagues detail the development of the Asian Men's Health Report (AMHR), detailing challenges faced during its creation. Men's health reports can support the development of men's health policies and the AMHR can be used as to guide for the production of men's health reports and to promote men's health globally.

Varicocele is the most common correctable cause of male infertility, but some men with varicoceles are able to father children, even without intervention, and so the link between varicoceles and male infertility remains a matter of debate. Oxidative stress seems to be a central mechanism of testicular damage; however, no single theory to explain the differential effect of varicoceles on infertility has been suggested. In this Review, a panel of expert authors discuss the epidemiology and pathophysiology of varicocele-related infertility, and consider the optimal treatment for men with varicocele.

Muscle-invasive bladder cancer (MIBC) is an aggressive disease associated with high morbidity and mortality. In this Perspective, the authors describe the timeline of advances in treating MIBC, including radical cystectomy with pelvic lymph node dissection, the creation of increasingly sophisticated urinary diversions, use of cisplatin-based neoadjuvant chemotherapy, bladder-sparing protocols, and immunotherapy.

Aberrations in telomere biology occur in prostate cancer tumorigenesis and progression. Graham and Meeker review the role of shortened telomeres in prostate tumour pathogenesis, including genomic instability and mutations. They describe the clinical utility of assessment of telomere dysfunction and the therapeutic potential of treatments targeting telomerase and telomeres.

Brachytherapy offers an excellent treatment option for definitive and salvage treatment of prostate cancer, with excellent oncological outcomes, limited toxic effects, and good quality of life for patients. However, use of prostate brachytherapy has been declining. In this comprehensive Review, Zaorsky and colleagues consider the evolution of brachytherapy from its inception to contemporary practice, from historical background to current indications and contraindications, underlying radiophysics and technical aspects, cost, and clinical outcomes.