Reviews & Analysis

In this Consensus Statement, the pathology panel of the International Society of Paediatric Oncology–Renal Tumour Study Group (SIOP–RSTG) present the pathology and molecular biology protocol for Wilms tumours in the UMBRELLA SIOP-RTSG 2016 protocol.

The results of the RAZOR trial of robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer show that robotic surgery is noninferior. However, care must be taken before widespread adoption of this modality, as superiority has not yet been established.

Intravesical device-assisted therapies, such as radiofrequency-induced thermochemotherapeutic effect, conductive hyperthermic chemotherapy, and electromotive drug administration, have shown promising efficacy for non-muscle-invasive bladder cancer. Here, Tan and Kelly describe the evidence for these technologies and summarize efficacy, safety, and tolerability outcomes.

A recently published cohort study of 650 men undergoing prostate biopsy showed no association between current alcohol intake and overall prostate cancer risk, but did report an association between regular drinking during adolescence and early adulthood and high-grade prostate cancer.

A polygenic risk score (PRS) analysis reported that familial testicular germ cell tumours (TGCTs) were significantly enriched for TGCT risk alleles and that ≥84% were attributable to polygenic enrichment, supporting the polygenic aetiological basis of familial TGCT. Clinical application will first require improved TGCT screening and early detection tools.

The FDA recently expanded the indication for enzalutamide for the treatment of all men with metastatic and nonmetastatic castration-resistant prostate cancer on the basis of the PROSPER trial. Now that both disease states can have the same treatment, the need to thoroughly identify metastatic lesions is questioned.

Applying the principles of ‘omics’ to urinary tract infection opens up exciting diagnostic and management avenues. Urinary cell-free DNA can be used to gain new insight not only into the spectrum of pathogens present in host urine but also their likelihood to cause disease.

In this Opinion, Brennen and Isaacs present their embryonic reawakening theory of BPH. They hypothesize that an inflammatory transition–periurethral zone microenvironment caused by continuous exposure to urinary components and/or autoantigens promotes recruitment of mesenchymal stem cells and generates a paracrine-inductive stroma that reinitiates benign neoplastic nodular growth.

With the emergence of increasingly potent androgen deprivation therapy, rates of treatment-emergent small-cell neuroendocrine prostate cancer are increasing. In a recent prospective study, Aggarwal and colleagues defined the frequency and clinical and genomic characteristics of these tumours.

Platinum-based chemotherapy continues to be linked with the subsequent development of various solid tumours. In a large analytical study of >5,800 survivors of testicular cancer, Groot and colleagues observed statistically significant dose-dependent increases in gastrointestinal cancer incidence after platinum-based chemotherapy, providing evidence for a potential dose-dependent relationship.

A recent study has shown a decline in testosterone prescriptions since media reports of potential increased cardiovascular risk in 2014. The phenomenon of medical hysteria accounts for this reduced prescribing, as numerous subsequent studies provide substantial evidence of reduced cardiovascular risk and other important benefits with testosterone therapy for men with testosterone deficiency.

Despite having efficacy without a survival benefit in castration-resistant prostate cancer, ketoconazole has considerable advantages such as low cost. Here, the authors discuss the clinical experience with ketoconazole, emphasizing treatment timing and sequencing, and highlight patient populations that might benefit.

Immune checkpoint inhibitors targeting programmed cell death 1 (PD-1) or programmed cell death 1 ligand 1 (PD-L1) have had limited clinical impact in prostate cancer. To find a niche for immune checkpoint inhibition in this disease, future strategies might require improved biomarker-based patient selection or combination strategies to enhance in vivo immune activity.

The European Medicines Agency (EMA) and FDA have recently restricted the indications for first-line pembrolizumab and atezolizumab to patients with programmed cell death 1 ligand 1 (PD-L1)-high advanced urothelial carcinoma, a decision made following interim analyses from the ongoing Keynote-361 and IMvigor130 phase III trials. Questions remain on the magnitude of inferior survival and standardized implementation of PD-L1 testing.

Radical cystectomy plus concurrent pelvic lymph node dissection (PLND) provides oncological benefit and useful prognostic information. However, a lack of consensus exists regarding the optimal PLND template. Here, the authors describe and discuss the use of different PLND templates.

New data have confirmed the genomic diversity of low-risk prostate cancer. Improved understanding of the heterogeneity of this disease has implications for disease management and has the potential to change treatment for patients in the future.

In this Timeline article, the authors discuss studies that have improved our understanding of prostate cancer and influenced management of this disease.

Cytoreductive nephrectomy, a standard approach for de novo metastatic renal cell carcinoma in the era of cytokine therapy, has been upheld during the age of targeted therapy on the basis of retrospective data. Now, the first level I prospective data from the CARMENA and SURTIME trials challenge this standard.

Renal cell carcinomas (RCCs) harbour mutations in genes encoding chromatin modifiers, which have integral roles in genome maintenance and epigenetic regulation. Here, the authors review the mutational landscape and roles of chromatin modifiers as co-drivers in RCC, highlighting therapeutic opportunities.

A recent study reports widespread decreases in PSA screening, prostate cancer diagnoses, and use of active treatment modalities since the 2011–2012 United States Preventive Services Task Force (USPSTF) recommendation against PSA screening. The updated 2017 USPSTF guideline, which embraces individualized decision-making, suggests the pendulum swung too far, but must not prompt a return to indiscriminate screening.