News & Views in 2022

New evidence suggests that patients undergoing robotic-assisted radical cystectomy for non-metastatic bladder cancer experience better response in terms of days alive and out of the hospital than patients undergoing open radical cystectomy. The robotic approach was associated with improved post-operative mobilization, decreased transfusion requirement and reduced burden on perceived quality of life.

Immune system activation is necessary for BCG-mediated tumour immunity in non-muscle-invasive bladder cancer. However, mounting evidence supports the notion that dysfunctional activation, in the form of immune exhaustion, might contribute to BCG failure. Thus, an exhaustion signature, arising in treated tumours, could act as a predictive marker for BCG therapy.

Genetics has a role in predisposition towards prostate cancer, and an accurate prediction of prostate cancer risk can be made using polygenic risk scores. New evidence suggests that this risk is modifiable through lifestyle changes, but only in men at a high genetic risk of developing prostate cancer.

Muscle-invasive bladder cancer (MIBC) remains a deadly disease, despite aggressive surgical and systemic chemotherapeutic treatments. New treatment modalities are needed. A novel intravesicle drug delivery device for neoadjuvant treatment of MIBC has been developed, and preliminary results on the efficacy and safety of this system are available.

The BIONIKK trial is the first prospective biomarker-driven randomized trial in metastatic clear cell renal cell carcinoma. This trial demonstrates the feasibility of using a transcriptomic biomarker that reflects intrinsic disease biology to optimize treatment efficacy and shows that all patients might not require combination treatment.

The highest risk of death from prostate cancer is associated with increased waist circumference, increased blood pressure, hypertension, type 2 diabetes and obesity; thus, therapies that can reduce blood glucose levels have the potential to improve patient outcomes. The therapeutic benefits of low-carbohydrate and fasting-mimicking diets in patients with prostate cancer have been investigated in two recent studies.

Prognostic models incorporating clinical and pathological parameters might assist clinicians in counselling and surveillance of patients following surgical resection of renal cell carcinoma (RCC). Variability exists in the risk classification of individual patients in each model as well as the performance of each model in different RCC subtypes.

The extent, duration and causes of alterations in the testes caused by SARS-CoV-2 are unclear. A new study has documented the effects of SARS-CoV-2 infection on the testes of a golden Syrian hamster model; however, the relevance of these findings to non-severe human infection is questionable.

Artificial intelligence (AI)-based models can potentially reduce workload and assist general pathologists in reaching genitourinary pathologists’ performance. A recent large-scale competition to develop generalizable AI models for prostate cancer detection and grading has shown success; implementation of such models positions them beyond hype and as today’s reality.

Sexual adverse effects from prostate cancer treatment are a substantial burden for patients. An online biopsychosocial sexual rehabilitation intervention for patients with prostate cancer (TrueNTH) was implemented in several cancer centres in the USA. Outcomes from this intervention show no improvements in sexual satisfaction after 6 months; however, earlier resumption of sexual activities was observed 3 months after the intervention.

Genitourinary microorganisms could have detrimental effects on male fertility owing to increased production of reactive oxygen species and generation of oxidative stress, which can lead to sperm DNA damage. Diagnostic genitourinary microorganism screening could help in understanding the reasons for infertility and refine infertility diagnosis and treatment.

Prostate-specific membrane antigen-targeted positron emission tomography has revolutionized prostate cancer diagnostics and holds the potential to advance metastases-directed therapy through, among other treatments, ablative radiotherapy.

Prognostic models are crucial for optimal management of patients with renal cell carcinoma (RCC) after surgery. Multiple clinico-pathological models to predict cancer outcomes in these patients exist and seem to have reached their performance ceiling. Future research needs to identify new prognostic markers and to consider when and how prognostic models for RCC are implemented into practice.

In this prospective trial in oligometastatic renal cell carcinoma (RCC), the first of its kind, stereotactic ablative body radiotherapy was delivered successfully in lieu of systemic therapy. This strategy should be considered in selected patients with oligometastatic RCC.