Review Articles in 2005

Diabetes mellitus is associated with a number of different vascular and neurologic problems that can lead to the development of bladder dysfunction, erectile dysfunction and retrograde ejaculation. This review by Domenico Fedele examines the mechanisms that lead to the development of these urologic problems in patients with diabetes, and discusses appropriate treatment and management options.

Up to half of patients with VHL develop malignant renal lesions. Urologists handling these cases are faced with the challenge of optimizing control of often bilateral multifocal tumors while maximizing preservation of kidney function. Robert Grubb and colleagues assess the relative merits of different management strategies, and present the molecular processes underlying VHL that might be targeted by new treatments.

The management of erectile dysfunction has been transformed since the first oral phosphodiesterase type 5 (PDE-5) inhibitor sildenafil (Viagra^®) was approved in the late 1990s. The PDE-5 inhibitors developed subsequently (tadalafil [Cialis®] and vardenafil [Levitra®]) differ in important ways from their predecessor. Here, Alberto Briganti and his colleagues compare and contrast the pharmacokinetics, pharmacodynamics, safety and efficacy of these three drugs.

A comprehensive overview of the state-of-the-art in the evaluation and treatment of male infertility, a problem with diverse etiology that affects 10% of couples. Including several simple algorithms to guide the physician's management decisions, this Review takes an evidence-based medicine approach to provide comment on the relevant merit of conservative and assisted-reproduction strategies.

Decision analysis is crucial to the formulation of treatment strategies. This classical approach relies on the predictive power of statistical models, which can be represented graphically as nomograms. Designed to facilitate simple and rapid calculation of probabilities for individual patients, Michael Kattan assesses the utility of several of these nomograms for management of clinically localized prostate cancer.

Biochemical recurrence after radical prostatectomy or radiation therapy for prostate cancer is increasingly common. The existence of multiple definitions complicates detection of biochemical recurrence and determination of its clinical significance. Here, Ward and Moul assess the relative merits of various definitions, and treatment options including salvage prostatectomy, radiation therapy and cryotherapy, and hormonal treatments.

High intensity focused ultrasound (HIFU) is a promising technology for the treatment of a number of urologic cancers, although currently its only routine use is in the treatment of prostate cancer. This review by Christian Chaussy and colleagues discusses the technology behind HIFU and the evidence for its use in different urologic tumors.

With the increase in prevalence of prostate cancer following the introduction of PSA screening, most cancers are now detected at an early stage. In patients with 'good-risk' prostate cancer there is a risk of overtreatment, but it is important that this should be balanced with the possibility of undertreating those at risk of disease progression.

The use of pubovaginal slings for the treatment of female stress urinary incontinence is commonplace, but the search for the 'ideal' sling material continues. There are many biological and synthetic materials available for this use. Here, the authors review the efficacy data for these different materials and slings.

Despite the numerous androgen receptor gene polymorphisms that have been identified, no specific polymorphism has been linked with an increased risk of prostate cancer. Arun Singh and coauthors discuss these variations in the androgen receptor and their associated mechanisms. Studies relating to their importance in the development of prostate cancer are also reviewed.

There are few treatment options available for men with hormone-refractory prostate cancer. The main focus of this review is on the data from phase II and phase III trials examining the use of docetaxel in men with hormone-refractory prostate cancer. The mechanism of action of this drug, and its applications in urothelial cancers, are also discussed.

Following the outcome of the Prostate Cancer Prevention Trial, and with data accruing for other agents, primary chemoprevention of prostate cancer is becoming a realistic strategy for managing cancers that are identified early. The evidence relating to the different candidate agents for chemoprevention of prostate cancer is reviewed.

This Drug Insight examines the mechanisms behind the antioxidant lycopene, and its association with the health promoting effects attributed to the consumption of tomatoes and tomato extracts. Data on the anticancer properties of lycopene are compelling, but it is too early to attribute all the health benefits of tomatoes to this compound.

Despite the amount of research that has gone into producing vaccines against cancer, these vaccines have yet to show clinical benefit. This article by J Vieweg and J Dannull reviews the current status of vaccination strategies for prostate cancer, and gives an update on the different stages in their development.

Despite improvements in surgical and radiotherapeutic techniques, a significant number of patients with locally advanced bladder cancer remain at a high risk of developing systemic disease. Jorge Garcia and Robert Dreicer discuss the conflicting evidence available for the use of neoadjuvant and adjuvant chemotherapy for bladder cancer.