Volume 14 Issue 7, July 2017

The comparative efficacy of drugs for the management of overactive bladder syndrome (OAB) remains undefined. A new indirect treatment comparison demonstrates similar efficacy of mirabegron versus several antimuscarinic drugs and onabotulinum toxin A in a number of outcome measures. Head-to-head trials of these agents are still required to optimize the management of patients with OAB.

Sepsis is an infrequent but serious adverse risk of transrectal ultrasonography-guided prostate biopsy. A new study evaluated whether the use of single-dose ertapenem, a broad-spectrum antibiotic, resulted in increased carbapenem resistance following biopsy. However, physicians need to carefully consider the risks of antibiotic resistance when balancing the benefit of broad-spectrum antibiosis against a 1% risk of sepsis.

Life expectancy after primary treatment for localized prostate cancer is long, so the importance of functional outcomes and quality-of-life measures cannot be underestimated. Careful assessment of the data, with an emphasis on patient selection, definition of clinical significance, and length of follow-up duration, is essential.

Advances in understanding of prostate cancer biology and improved treatment options have changed management of metastatic prostate cancer. Escape of the malignancy from the prostatic capsule no longer means that treatment is focused on limiting systemic spread, and data suggest that local treatment of the prostate is beneficial, even in men whose tumour has spread.

3D organoids are valuable tools for increasing understanding of disease biology. In this Review, the authors describe how successful application of organoids into urological cancer research can further our understanding of these diseases and provide preclinical cancer models to aid precision medicine.

Brachytherapy offers an excellent treatment option for definitive and salvage treatment of prostate cancer, with excellent oncological outcomes, limited toxic effects, and good quality of life for patients. However, use of prostate brachytherapy has been declining. In this comprehensive Review, Zaorsky and colleagues consider the evolution of brachytherapy from its inception to contemporary practice, from historical background to current indications and contraindications, underlying radiophysics and technical aspects, cost, and clinical outcomes.

The risk of urinary incontinence and other lower urinary tract (LUT) symptoms increases substantially with advancing age; however, such symptoms can emerge in otherwise healthy individuals. In this Review, the authors describe the changes in LUT physiology that take place during the ageing process, and whether or not these changes arise as a consequence of 'normal', healthy ageing, or unaddressed pathology.