Volume 17 Issue 2, February 2020

Many interesting studies on urological infection have been published in the past year including nonantibiotic therapy for acute cystitis, the utility of the Acute Cystitis Symptom Score, specific identification of health-care-associated urinary tract infection and a multidisciplinary approach to prostatitis.

The role of testosterone in female sexuality is still controversial. In 2019, a meta-analysis and a Position Statement on testosterone therapy for hypoactive sexual desire disorder in menopausal women and a Position Statement on the potential sexual adverse effects of hormonal contraception have begun to close this gender gap.

In 2019, the Bladder Cancer Molecular Taxonomy Group (BCMTG) presented a consensus molecular classification comprising six subtypes of muscle-invasive bladder cancer (MIBC). The non-luminal subtypes were the most consistent with previous models. Subsequent studies in 2019 have revealed molecular heterogeneity among the luminal subtypes and their possible clinical ramifications.

In men with hormone-sensitive prostate cancer, enzalutamide and apalutamide improve overall survival compared with androgen deprivation therapy alone. Also, radiotherapy of the primary tumour is beneficial in patients with low tumour burden. In the non-metastatic castration-resistant setting, a positive trial for darolutamide was reported. In the metastatic castration-resistant setting, the role of cabazitaxel in treatment sequencing was clarified.

The treatment paradigm for treatment-naive metastatic clear cell renal cell carcinoma continued to evolve in 2019 as three phase III randomized controlled trials were reported comparing sunitinib with combination immune checkpoint inhibitors and VEGF-targeted therapy. Pembrolizumab plus axitinib and avelumab plus axitinib became new treatment options for untreated patients, irrespective of risk group or PD-L1 expression.

In 2019, quality improvement has been a central theme throughout leading articles on nephrolithiasis. Real-world outcomes were published on the natural history of stones and residual fragments, patient compliance with medical therapy and treatment-related opioid use. In-depth review of these topics will enhance provider–patient counselling and shape future paradigms in stone disease.

An energetic interplay between tumour and immune cells leads to metabolic competition in the tumour ecosystem, an effect that could be targeted to boost immune checkpoint inhibition. In this Review, the authors discuss cancer cell and immune cell metabolism and consider the potential therapeutic targets within these processes.

In this Review, Siva and colleagues discuss the uses of (PSMA)–positron emission tomography (PET) beyond its role in conventional prostate cancer imaging. PSMA could have utility in other genitourinary malignancies and oligometastatic prostate cancer, theranostics, selection and guidance of radiotherapy fields, as well as the assessment of response to treatment.

In this Review, the authors describe the current evidence showing the stimulatory effect of tumour innervation and neurosignalling in prostate cancer. They discuss the clinical and epidemiological evidence and the potential of using nerves and neurosignalling for diagnosis, prognosis and treatment of prostate cancer.