Reviews & Analysis

Men with prostate cancer often respond to androgen-deprivation therapy only to later relapse and develop lethal castration-resistant disease. Two models-adaptation and selection-have been described to explain how the disease progresses to this stage. In this Review, the authors describe each model and show that both models might contribute to advanced prostate cancer.

Screening for prostate cancer is a controversial topic within the field of urology. Instead of adopting a 'one size fits all' approach, physicians are likely to perform personalized risk assessment to minimize the risk of negative consequences, such as anxiety, unnecessary testing and biopsies, overdiagnosis, and overtreatment. In this Review, Monique J. Roobol and Sigrid J. Carlsson focus on the effects of shifts in attitude towards PSA testing on risk stratification.

A recent study shows that recommended bone mineral testing is rarely performed in men with prostate cancer receiving androgen deprivation therapy. Although these patients are at increased risk of fragility fracture, the reported incidence, from prospective randomized trials, is low. As a result, bone density testing for these men requires careful consideration.

Whether or not inguinal lymphadenectomy benefits patients with superficial penile carcinoma and clinically impalpable lymph nodes is a controversial issue. New evidence supports active surveillance for patients with T1G1 tumours and inguinal lymphadenectomy for those with T1G3 cancer, but the optimal management of patients with T1G2 disease remains unclear.

Follicle-stimulating hormone (FSH) administration is effective in patients with hypogonadotropic hypogonadism, which suggests it might be useful in patients with oligozoospermia and normal FSH levels. Although, many studies have evaluated the efficacy of FSH in these patients, in this Perspectives article, the authors argue that FSH can be effective in idiopathic oligozoospermic men if patients are carefully selected.

A recent meta-analysis evaluating the relationship between type 2 diabetes mellitus and prostate cancer provides strong evidence to support an inverse association between the two conditions. However, the influence of factors such as severity, duration and treatment of diabetes, and the influence of other metabolic disorders should also be considered and investigated further.

Long-term survival rates for patients with the most common childhood genitourinary cancers—Wilms tumour, rhabdomyosarcoma and germ cell tumour (GCT)—are generally excellent, which has highlighted the need to minimize the long-term complications of treatments. In this Review, the authors discuss the late effects of treating these childhood cancers and consider the need for regular surveillance of childhood cancer survivors.

The diagnosis and treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) is hampered by the lack of knowledge of basic urinary bladder function and pathophysiology. Consequently, most therapies are off label. In this Review, the authors bring together the available data on intravesical treatments for BPS/IC and discuss the need for more high-quality randomized controlled trials.

Stem-cell therapy has the potential to regenerate tissue and cure disease—an approach preferable to many current treatments that simply mitigate symptoms. Currently, there is no approved medical therapy for Peyronie disease; a recent study suggests stem cells could provide an intriguing treatment option for this difficult-to-treat tissue defect.

Research has revealed what we already suspected—randomized controlled trials are lacking in the field of bladder cancer. Many areas require further investigation, and we must try to incentivize clinicians to perform the much-needed trials. A newly established patient advocacy group will be invaluable in this endeavour.

Oxidative stress is the central element contributing to infertility in men with varicocele, to which the testis responds by way of a number of mechanisms, including heat stress. In this comprehensive Review, Agarwal et al. discuss these responses, which have their own implications in exacerbating the underlying oxidative stress and on the subsequent infertility.

In this Review, Elashry and Tawfik evaluate recent developments regarding instruments (occlusion devices and accessories) and techniques for preventing upward stone migration during ureteroscopic lithotripsy, with a particular focus on technical applications.

In this Perspectives article, Orsted and Bojesen provide an overview of the literature relating to an association between BPH and prostate cancer, including data from epidemiological studies,in vitrostudies, autopsy studies, and randomized controlled trials. They discuss how the measurement of PSA has affected detection and management of the two conditions, and how PSA screening policy is likely to have influenced study findings. They also consider the pathophysiological mechanisms that might explain the observed association between the two diseases, as well as the possible clinical implications of this association.

Current evidence suggests that oxidative stress is the central element contributing to infertility in men with varicocele. In this second part of their two-part Review, Hamada et al. discuss the clinical parameters and treatment options for men with varicocele-associated male infertility, focussing on alleviating oxidative stress as the major parameter and target for therapy.

A large Swedish population-based study has shown that 15-year prostate-cancer-related mortality rates are negligible for men with low-risk cancers treated noncuratively, but significant for those with intermediate-risk and high-risk tumours. Such data support current trends towards active surveillance for low-risk disease and aggressive multimodal treatment for advanced carcinomas.

Active surveillance has become increasingly popular as a management option for localized prostate cancer. Although widely viewed as a means to enable men with low-risk prostate cancer to avoid or defer the effects of whole-gland radical therapy, two new studies demonstrate that it might be a safe approach in intermediate-risk disease.

The plethora of treatment options available for localized prostate cancer can make the patient's decision regarding which therapy to undergo a difficult one. A recent study has investigated the effect of using a decision aid to provide patients with enough information to make an informed decision about their therapy.

Bladder function is often compromised in juvenile patients with posterior urethral valves (PUV). Although many surgical options are available to treat this condition in infancy, individuals often have risk factors for sexual and fertility dysfunctions later in life, such as cryptorchidism and renal failure. In this Review, Taskinen et al. discuss these risk factors in detail.

In this Review, Boyd and colleagues provide a comprehensive overview of the complex genetic landscape of prostate cancer and the extensive heterogeneity that defines this disease. In addition, they discuss the clinical utility of genomics data.

A Taiwanese study has established an association between bladder pain syndrome (BPS) and prior diagnosis of urinary stones. The study authors suggest that stones initiate a process that results in BPS. An alternative hypothesis is that patients with BPS are more likely to undergo imaging, revealing incidental stones.