Volume 17 Issue 5, May 2020

A new study reports the 5-year patient-reported outcome data from a population-based cohort of men with localized prostate cancer. These findings in conjunction with data on survival, treatment burden and treatment cost can assist clinicians in explaining to newly diagnosed patients the likely effects of modern management options on quality of life.

In this Review, Meeks et al. summarize heterogeneity in bladder cancer and how it affects tumour biology and clinical care. They describe current knowledge of tumour evolution, genomic heterogeneity and different tumour subtypes, as well as morphological heterogeneity seen in variant bladder cancer histology. They also discuss the influence of heterogeneity on treatment decision making, drug development and clinical trial design.

Liquid biopsy techniques, especially the use of plasma circulating tumour DNA (ctDNA) analysis, are a convenient, fast and non-invasive approach to the diagnosis and monitoring of urological cancers, and could enable selection of targeted therapy before clinical and radiographic changes occur. In this Review, the authors discuss the uses of liquid biopsy and plasma ctDNA analysis in particular, and consider how it could be used in clinical practice now and in the future.

Management strategies used to treat prostate cancer often lead to treatment resistance, which can arise via a mechanism of cellular rewiring, whereby the tumour cell alters its signalling to escape the effects of therapy. Understanding these mechanisms could enable the development of improved and combination treatment regimens, to minimize treatment failures and improve outcomes.