News & Views

Radical cystectomy is advocated for patients with high-risk non-muscle-invasive bladder cancer who develop disease recurrence following BCG therapy. A retrospective series suggests that a delay in radical cystectomy attributable to failure of salvage bladder-preserving therapies in this patient cohort is safe. However, a closer analysis of the study reveals inherent case selection that might limit such conclusions.

More than 50 clinical trials are currently exploring the combination of immunotherapy and other approved treatments for advanced prostate cancer. The results from a phase II trial of sipuleucel-T with or without radium-223 in patients with metastatic castration-resistant prostate cancer were recently published with intriguing findings.

Genomic alterations in metastatic castration-resistant prostate cancer can be identified in plasma circulating tumour DNA. A large cohort analysis shows reliable detection of clinically relevant alterations through targeted cell-free DNA sequencing with a commercial platform, paving the way for liquid biopsy technology to be integrated into routine clinical practice.

An effective transurethral resection of bladder tumour (TURBT) is essential to achieve safe tumour clearance and to determine the biological potential of the cancer. Attention to surgical detail within a set-up that embraces evidence-based practice, training, quality standards, prospective audit and feedback will facilitate these objectives.

The value of proton therapy in managing prostate cancer is not yet defined. A recent study has reported promising long-term results for patients with localized prostate cancer who received proton therapy. However, results from ongoing clinical trials are required before determining the role of proton therapy for this indication.

Adiposity and skeletal muscle mass have been shown to be prognostic for mortality in several cancers. In a recent study, CT imaging at diagnosis was used to determine whether components of body composition were associated with survival in men with advanced prostate cancer.

MRI has become an established tool in the diagnosis, management and treatment of localized prostate cancer. However, standardized guidelines on reporting prostate MRI have not yet been developed. A recent consensus study proposes a certification framework for reporting prostate MRI in the UK.

Rare genitourinary cancers have historically been challenging to treat given the scarcity in incidence, inadequacy of data on treatment and lack of general consensus to guide routine therapy. A phase II multicentre trial shows efficacy of nivolumab and ipilimumab in several cohorts of patients with rare genitourinary cancers.

A new study reports that selected patients with short life expectancy can safely undergo partial nephrectomy with perioperative outcomes that approximate those of patients with long life expectancy. The authors suggest that extensive centre and/or surgeon experience, a robot-assisted approach, and off-clamp and simple enucleation techniques might facilitate favourable outcomes in these challenging patients.

Organ-sparing surgery for the management of penile cancer is a dogma underpinned by previous research demonstrating no change in cancer-specific survival in cases of local recurrence. However, a new multicentre study of 897 patients treated with glansectomy for penile cancer challenges this view.

Multiparametric MRI enables early detection of progression and reclassification in patients with low-risk prostate cancer on active surveillance and offers the potential to reduce unnecessary biopsies. However, the reliability and reproducibility of MRI-directed surveillance during follow-up is unclear. A recent study highlights the potential and current shortcomings of this approach.

The PRECISION trial demonstrated the ability of using multiparametric MRI to improve the diagnosis of clinically significant prostate cancer whilst reducing over-diagnosis of clinically insignificant cancer compared with systematic biopsy. Concerns remained about patients who were not biopsied owing to negative scans. A new study applies the PRECISION strategy to a contemporary cohort to answer these concerns.

MRI-guided transurethral ultrasound ablation is an exciting, minimally invasive technology with the potential to provide targeted ablation of prostate cancer tissue. At 3 years, functional outcomes remain good with 76% remaining free from salvage treatment. Future studies using a focal approach may provide evidence for widespread uptake of this technology.

Retzius-sparing prostatectomy is an alternative approach to standard robot-assisted radical prostatectomy. Many surgeons advocate this technique as data suggest that it provides better early functional results than the standard approach without compromising oncological outcomes.

Young-adult cancer survivors report psychosocial distress from infertility. National guidelines recommend pretreatment referrals for sperm cryopreservation, but a study examining use of stored semen among survivors concluded that low uptake might equate to economic unfeasibility. However, examination of sociodemographic factors and psychosocial outcomes suggests that maintaining future opportunities for parenthood might outweigh the ongoing storage costs.

Disruption of the circadian clock has been associated with pathological conditions including obesity, type 2 diabetes mellitus, cancer, depression and neurodegenerative diseases. Disturbed sleep patterns have now been associated with reduced erectile function. The mechanisms behind this effect are unclear but could include hypoxia signalling and low testosterone.

Antimicrobial resistance in Neisseria gonorrhoeae compromises gonorrhoea treatment worldwide. Novel and optimized treatments and/or treatment strategies that effectively eradicate the infection with low selection of resistance are imperative. A new prospective clinical study provides further evidence that resistance-guided treatment of gonorrhoea with single-dose oral ciprofloxacin is efficacious in relevant settings and can reduce the selection pressure for resistance.

Pooled clinical trial data reveal that antibiotics worsen progression-free survival and overall survival in patients with locally advanced and metastatic urothelial cancer receiving anti-PDL1 therapy. Consensus guidelines for antibiotic use in these patients, as well as diagnostic tools and corrective measures, are needed to decrease primary resistance to immune checkpoint inhibitors.

Personalized decision-making is the ultimate goal of managing men with lower urinary tract symptoms caused by benign prostatic obstruction. Urodynamics can provide valuable information in these patients and a recent multicentre randomized trial has highlighted important findings warranting consideration, as well as indicating that further insights are needed.

A new study describes the effects of androgen status on the different cell types in mouse and human prostates, illustrating the potential of single-cell RNA sequencing to study specific biological processes in unprecedented detail. Translating these new insights into clinical use will increase precision and personalization of prostate cancer treatment.