Perspectives in 2021

Penile cancer is a growing health-care concern worldwide. Despite its rarity, penile cancer has a disproportionate impact on some countries, as the location with the highest incidences are invariably those with low resources and few registries or trials. In this Perspective, the authors discuss how global collaboration and centralization of care can help to improve management of penile cancer worldwide, but especially in areas where resources are limited.

Early studies in patients and animal models have suggested that SARS-CoV-2 can access the reproductive system and could have effects on fertility. In this Perspective, Edenfield and Easley present the evidence for mechanisms of infection of reproductive cells by SARS-CoV-2 and consider the potential for testicular dysfunction in patients who have had COVID-19.

COVID-19 has been shown to be associated with a higher mortality rate in men than in women. In this Perspectives article, the authors posit that this disparity is due to a failure to invest in men’s health and discuss the biological, social and economic factors that have contributed to the sex disparities in mortality from COVID-19, as well as considering how a streamlined men’s health programme with the urologist in a central role could address these issues.

The prostate is divided into the peripheral, transition and central zones, which have different prostate cancer incidences and prognoses. Differences between the zones suggest their potential roles in tumour aggressiveness, but treatment of prostate cancer remains zonal agnostic. Improved understanding of the zones and their roles in tumorigenesis could improve prostate cancer management.

Trials evaluating novel therapies in the neoadjuvant setting must have clearly defined study elements and appropriately selected end points to ensure the applicability of the trial and enable interpretation of the study results. In this Perspectives, the authors describe the findings of a public workshop jointly sponsored by the US Food and Drug Administration and the Bladder Cancer Advocacy Network, which discussed key elements and end points when designing trials of neoadjuvant therapy for muscle-invasive bladder cancer.

Society guidelines recommend incorporating palliative care into standard oncological care. However, misconceptions regarding palliative care are common — notably, palliative care and treatments seeking to cure or prolong life are not mutually exclusive. In this article, the authors discuss the integration of palliative care into surgical urologic oncology and consider palliative care guidelines, indications for palliative care use, and how the field of urologic oncology can adopt best practices.

Bacillus Calmette–Guérin (BCG) has been used to prevent tuberculosis for a century and is also a standard approach for the treatment of non-muscle-invasive bladder cancer. However, BCG also has a plethora of non-specific effects that occur via the induction of trained immunity and have raised the hypothesis that BCG vaccination could be used to protect against coronavirus disease 2019 (COVID-19). In this Perspective, the authors describe the history of BCG, discuss the mechanisms of its effects, and consider its potential role during the COVID-19 pandemic.

Premature ejaculation is thought to affect up to one-third of men, but a considerable proportion of patients do not meet the diagnostic criteria and do not, therefore, receive treatment for their symptoms. In this Perspectives article, the authors propose a new taxonomy for premature ejaculation, to encompass the subclinical disorder and its co-occurrence with erectile dysfunction, with a view to improving patient management.