Articles in 2019

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.

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.

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.

New data show that prostate-specific membrane antigen (PSMA) PET–CT can reveal the anatomical location of prostate cancer recurrences in patients diagnosed with nonmetastatic castration-resistant disease according to conventional imaging. The findings necessitate a new evaluation of the role of PSMA PET–CT in this setting compared with standard-of-care imaging and treatment approaches.

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.

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.

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.

Cancer care is currently experiencing rapid development in novel therapeutics, with an associated rise in treatment costs. These changes not only create a critical challenge for therapeutic decision-making but also highlight the need to prioritize therapies of high clinical and economic value. Health technology assessment methodology is a novel approach that could help guide value-based decision-making.