Articles in 2018

A recently published cohort study of 650 men undergoing prostate biopsy showed no association between current alcohol intake and overall prostate cancer risk, but did report an association between regular drinking during adolescence and early adulthood and high-grade prostate cancer.

A polygenic risk score (PRS) analysis reported that familial testicular germ cell tumours (TGCTs) were significantly enriched for TGCT risk alleles and that ≥84% were attributable to polygenic enrichment, supporting the polygenic aetiological basis of familial TGCT. Clinical application will first require improved TGCT screening and early detection tools.

The FDA recently expanded the indication for enzalutamide for the treatment of all men with metastatic and nonmetastatic castration-resistant prostate cancer on the basis of the PROSPER trial. Now that both disease states can have the same treatment, the need to thoroughly identify metastatic lesions is questioned.

Applying the principles of ‘omics’ to urinary tract infection opens up exciting diagnostic and management avenues. Urinary cell-free DNA can be used to gain new insight not only into the spectrum of pathogens present in host urine but also their likelihood to cause disease.

In this Opinion, Brennen and Isaacs present their embryonic reawakening theory of BPH. They hypothesize that an inflammatory transition–periurethral zone microenvironment caused by continuous exposure to urinary components and/or autoantigens promotes recruitment of mesenchymal stem cells and generates a paracrine-inductive stroma that reinitiates benign neoplastic nodular growth.

With the emergence of increasingly potent androgen deprivation therapy, rates of treatment-emergent small-cell neuroendocrine prostate cancer are increasing. In a recent prospective study, Aggarwal and colleagues defined the frequency and clinical and genomic characteristics of these tumours.

Platinum-based chemotherapy continues to be linked with the subsequent development of various solid tumours. In a large analytical study of >5,800 survivors of testicular cancer, Groot and colleagues observed statistically significant dose-dependent increases in gastrointestinal cancer incidence after platinum-based chemotherapy, providing evidence for a potential dose-dependent relationship.

In this Comment, McGregor and Sonpavde discuss the rationale and potential for immunotherapy in advanced penile squamous cell carcinoma, highlighting associations with human papillomavirus infection and a tumour-site agnostic immunotherapy indication, which form the basis of ongoing clinical trials.

A recent study has shown a decline in testosterone prescriptions since media reports of potential increased cardiovascular risk in 2014. The phenomenon of medical hysteria accounts for this reduced prescribing, as numerous subsequent studies provide substantial evidence of reduced cardiovascular risk and other important benefits with testosterone therapy for men with testosterone deficiency.

Despite having efficacy without a survival benefit in castration-resistant prostate cancer, ketoconazole has considerable advantages such as low cost. Here, the authors discuss the clinical experience with ketoconazole, emphasizing treatment timing and sequencing, and highlight patient populations that might benefit.