Reviews & Analysis

Multiparametric MRI (mpMRI) findings are not always accurate in patients with a previous negative prostate biopsy. Truong et al. have developed a nomogram to identify patients with previous negative prostate biopsy who are at elevated risk of harbouring benign histology and should undergo repeat biopsy.

Our biological understanding of TGCTs has been improved using sequencing, and molecular profiles associated with the genomic evolution and development of cisplatin resistance have been identified. The genomics of variants underpinning TGCT predisposition is being delineated. Studies of circulating microRNAs have demonstrated their potential for noninvasive diagnosis and disease monitoring.

In the past year, the results of three studies in the field of prostate cancer imaging — the prostate MR imaging study (PROMIS), an analysis of the cost-effectiveness of various diagnostic strategies based on PROMIS data, and a retrospective analysis of a prostate-specific membrane antigen (PSMA)-directed PET radiopharmaceutical — have been published that could have lasting effects on clinical practice.

Implementing a successful penile transplantation programme requires a multidisciplinary approach to overcome social, institutional, and patient-related obstacles. The literature in 2017 presents controversial ethical solutions, novel research models to evaluate immunosuppression, and long-term patient reports that help advance the field towards developing successful penile transplantation programmes.

Several immune checkpoint inhibitors have been approved for use in metastatic urothelial carcinoma and could be clinically useful alone or in combination. However, they are associated with various immune-related adverse events and specific immune-related patterns of response. In this Review, the authors discuss the data supporting the use of checkpoint inhibition and consider how to optimize therapy to reduce and manage the effects of these therapies.

Major advances in the management of all stages of upper tract urothelial carcinoma have been made in 2017. Radical nephroureterectomy can be valuable in patients with metastatic disease and adjuvant platinum-based chemotherapy can improve outcomes in those with advanced disease. Kidney-sparing surgery with early follow-up ureterorenoscopy has shown benefit in patients with low-grade tumours. Avoiding unnecessary ureterorenoscopy might decrease intravesical tumour recurrence.

Landmark papers published in 2017 have advanced our understanding of the molecular heterogeneity of urothelial cancer, provided insights into the genomic evolution of the disease in the context of metastasis and therapy, and established new treatment standards for patients with previously limited treatment options.

Despite its prevalence, sexual pain in women is poorly understood as it exists at the intersection of different biopsychosocial disciplines. In this Review, experts in the field describe how confusion remains at the nosological, aetiological, theoretical, methodological, and treatment levels and how a psychosocial approach can help to overcome this lack of consensus to improve theoretical models and effective treatments.

Cystine capacity is an assay for assessing urinary cystine saturation and risk of a stone episode in patients with cystinuria. Lowering the threshold for this test improves its sensitivity, potentially enabling relaxation of follow-up regimens for patients at lowest risk of stone episodes and dose modification of medications for those at highest risk.

In this Review, Woldu and colleagues describe the implications of Rho GTPase signalling aberrations in the development of malignancy, including urothelial carcinoma. This signalling pathway has the potential for therapeutic targeting in this disease, but much work is necessary before current laboratory-based research can be translated into the clinic.

In this Review, the authors describe the role of the NO–sGC–cGMP signalling pathway in disease pathophysiology of urogenital tissue. They discuss advances in directly targeting sGC to enhance cGMP production independently using NO-independent stimulators and activators of sGC and the potential of these molecules for treating urogenital disorders.

Felsenstein and Theodorescu discuss advances in therapy response prediction in patients with bladder cancer based on tumour genomics. They summarize current clinical approaches and future requirements in personalized precision medicine including targeted as well as immunotherapeutic strategies.

Randomized trials of screening for localized prostate cancer on the basis of crude PSA thresholds and 6–12-core template biopsies had disappointing results. To improve patient outcomes, novel diagnostic tools with a high discriminative ability for clinically significant cancer are needed. The use of MRI can improve detection at biopsy without disproportionate increases in costs.

Current advances in the understanding of penile carcinogenesis provide the possibility for new personalized and actionable targeted therapeutic approaches to improve outcomes in men with advanced penile cancer. Targeting the human epidermal growth factor receptor pathway showed promising results in a recent phase II trial of first-line therapy with dacomitinib.

A new publication finds that varicocele repair might improve semen quality enough to enable couples who are awaiting in vitro fertilization or intrauterine insemination to attempt natural conception or less-invasive assisted reproductive techniques. The approach is interesting because it seeks to establish varicocele treatment as one step in a multimodal path to parenthood.

The Renal Tumour Study Group of the International Society of Paediatric Oncology (SIOP–RTSG) has developed a new protocol for the diagnosis and treatment of childhood renal tumours, the UMBRELLA SIOP–RTSG 2016 (the UMBRELLA protocol). In this Consensus Statement, members of SIOP–RTSG outline the rationale for the recommendations in the protocol.

Sfanos et al. discuss the potentially procarcinogenic role of prostatic infections and inflammation in prostate pathogenesis. They summarize findings that suggest that an aberrant microbiome together with an inflammatory microenvironment are involved in the initiation of prostate cancer precursor lesions.

Many emerging opportunities exist for microfluidics in male infertility diagnosis and treatment, and promising microfluidic approaches are under investigation for addressing male infertility. In this Review, the authors describe and discuss these approaches for sperm analysis and selection.

The introduction of immune checkpoint inhibition has improved the outcomes of a subset of patients with muscle-invasive bladder cancer (MIBC); however, the majority of patients fail to respond to this approach. In this perspective, the authors describe the evidence for use of radiotherapy in combination with immune checkpoint inhibition to enhance the immunogenicity of patients' tumours and therefore enhance responsiveness to immune checkpoint inhibition in patients with advanced-stage MIBC.

A new study provides a comprehensive catalogue of the genetic changes in Wilms tumour. Understanding the interplay between genetic and epigenetic aberrations during tumorigenesis and clonal evolution is fundamental to enabling prediction of who is at risk and which tumours will relapse when so many are curable.