Review Articles in 2019

Here, Linxweiler and Junker provide an update on our understanding of the functional role of extracellular vesicles in urological malignancies and discuss their applicability as diagnostic, prognostic and predictive biomarkers in the three most prevalent urological cancers.

Imber et al. summarize current knowledge of the risks of financial toxicity in patients with localized prostate cancer, proposing a framework of contributing factors, and discuss emerging assessment strategies to inform future research efforts.

Emerging evidence suggests that the seminal microbiome has implications for the reproductive health of men, their partner, and even the health of their offspring. In this Review, the authors describe the current evidence for a seminal microbiome and consider what the future holds for this field of research.

In this Review, Morris et al. summarize the mechanisms through which ²²³Ra exerts its biological effects in metastatic castration-resistant prostate cancer, discuss potential ²²³Ra combination therapies and provide future perspectives for targeted alpha-particle therapy.

Despite improved surgical techniques and the development of transplants, therapeutic options for men who have penile disorders or who have sustained trauma to the penis are limited and erectile function can rarely be rescued. In this Review, the authors discuss regenerative approaches to tissue engineering the tunica and corpora to improve outcomes in these patients.

In this Review, Narayan and Dahm summarize innovations in clinical trial design that have led to practice-changing developments in the treatment of urological cancers and offer a perspective on improving trial design in the future.

The molecular mechanisms involved in papillary renal cell carcinoma (pRCC) development and drug resistance are diverse. In this Review, the authors summarize the current understanding of the mechanisms of resistance to currently used therapies in pRCC and make recommendations for future preclinical and clinical studies.

A number of targetable molecular alterations and resistance mechanisms have been identified in metastatic castration-resistant prostate cancer (mCRPC). As our understanding of the genomic landscape of mCRPC increases, biomarker-driven clinical trials investigating targeted therapies will enable an increasingly personalized approach to its treatment.

Urogenital tuberculosis can be easily overlooked owing to non-specific symptoms, varying manifestations and a lack of awareness of the disease. In this Review, Muneer and colleagues provide a comprehensive overview of the epidemiology, pathogenesis, clinical features, diagnosis and management of this disease.

Schneider et al. review the multifaceted immunoregulatory responses in the pathophysiology and treatment of bladder cancer, focusing on immune checkpoints and the various immune cells of the tumour microenvironment. They discuss alterations of these immune regulators, their clinical relevance and therapeutic targeting strategies.

Intravesical chemotherapy is a mainstay of treatment for non-muscle-invasive bladder cancer; however, the biology of the bladder means that intravesical therapy is limited by washout of the agent during voiding and systemic effects caused by absorption through the bladder wall. In this Review, the authors consider novel approaches to improving the pharmacokinetics of intravesical chemotherapy, such as chemohyperthermia, sustained release devices, and nanoparticle conjugation.

The risk of pelvic nodal involvement in patients with high-risk prostate cancer has led to the development of whole-pelvis radiotherapy (WPRT); however, this approach remains controversial. In this Review, the authors discuss the mixed data surrounding WPRT and consider how advanced imaging techniques and ‘big data’ mining could improve patient selection and optimize WPRT by improving localization of subclinical disease.

In this Review, Stabile and colleagues describe the current status of the role of mpMRI in prostate cancer diagnosis, its clinical application and consider its future direction in this disease.

In this Review, the authors discuss the molecular and histopathological evidence supporting pathology-driven therapy for advanced bladder cancer, including rare histological subtypes of urothelial carcinoma and non-urothelial carcinomas, and highlight novel molecular taxonomies, relevant biomarkers and promising future therapies.

This Review by Ricketts and Linehan comprehensively summarizes the findings of The Cancer Genome Atlas analyses of renal cell carcinoma and their clinical implications. The authors highlight unique and shared features of the tumour histological subtypes, their predictive power and their possible utility as therapeutic targets.

Physical activity has been shown to help erectile dysfunction (ED); however, the use of physical activity to actually treat ED is limited, and explicit guidelines are required. In this Review, Allen describes mechanisms underlying the effect and suggests an exercise treatment programme for ED.

Increasing evidence suggests that patients undergoing trimodality bladder-preserving treatment (TMT) and radical cystectomy have comparable outcomes but many continue to be offered surgery. This Review discusses the development of TMT and highlights how technological and biological advances could inform personalized treatment strategies.

Tissue engineering using different cell types and tissue scaffolds offers a promising alternative to substitution urethroplasty, which can be associated with complications, restenosis and poor quality of life. In this Review, the authors describe advances in tissue engineering for urethral replacement and consider the future of the field.

In this Review, the authors discuss the emerging oncogenic roles of long non-coding RNAs in prostate, kidney and bladder cancers, highlighting unique opportunities to improve diagnosis, treatment and precision medicine strategies in these genitourinary malignancies.

In this Review, Amarasekera and colleagues consider the effect of prostate cancer diagnosis and treatment on men in sexual minority groups, including men who have sex with men and transgender women as well as men with HIV, and discuss how and why efforts to study this population are complicated and evolving.