A new 3D method of calculating contact surface area (CSA) for renal tumours is reported in Urologic Oncology. This method can reliably predict perioperative outcomes following robot-assisted partial nephrectomy (RAPN). Several scores can be used to assess renal tumour complexity and complications, including R.E.N.A.L. and PADUA, but these scores were developed prior to the concept of 3D reconstruction

Diagnosis of clear cell renal cell carcinoma (ccRCC) is challenging, particularly as [18F]FDG PET–CT is not routinely recommended. Novel single-domain antibody (sdAb) tracers could be useful in cancer imaging owing to their small size and high target recognition. In the first part of a study published in the Journal of Nuclear Medicine, Zhou et al. analysed CD70 expression in RCC and normal kidney

Percutaneous nephrolithotomy (PCNL) is the main surgical option for the management of large or complex renal stones. A study in the Journal of Urology investigated whether immersive virtual reality (iVR) could improve surgical planning and clinical outcomes in patients undergoing PCNL. Patients undergoing PCNL (n = 175) were randomly allocated to a CT-only or CT plus iVR group. The iVR models incorporated

Nerve-sparing surgery is the standard approach used in radical prostatectomy to enhance functional outcomes, but secondary resection might be needed in case of uncertainty regarding the complete removal of the tumour. However, direct visual guidance for resecting positive surgical margins (PSMs) during secondary resection is lacking. In a study published in BJU International, a 3D-printed prostate

Efficacious neoadjuvant therapy is an unmet need in cisplatin-ineligible patients with muscle-invasive bladder cancer (MIBC). Several early-phase clinical trials have investigated the use of immune checkpoint inhibitors (ICIs) in this context, with some promising results. A study in Nature Medicine set out to test whether the efficacy of ICIs could be improved in combination with other therapies. Cretostimogene

Poly(ADP-ribose) polymerase inhibition (PARPi) is an effective therapy for castration-resistant prostate cancer (CRPC) with defects in homologous recombination repair (HRR) genes. However, resistance to PARPi can arise, for example via mutations that restore BRCA function. Reversion mutations in HRR genes can result in PARPi resistance, but these cannot arise in patients with homozygous mutations,

Results of the PEACE-1 open-label, randomized, controlled, phase III trial have been published in The Lancet. In this study, the efficacy and safety of adding prostate radiotherapy to the treatment regimen in de novo metastatic castration-sensitive prostate cancer was investigated. In total, 1,172 men were randomly assigned to receive standard of care or standard of care plus abiraterone, plus radiotherapy

A novel, endocrine-disrupting property of the perfluoroalkyl substance perfluorooctanoic acid (PFOA) affecting androgen metabolism has been discovered. This discovery has implications for our understanding of the effect of PFOA on the actions of androgens. In spectrofluorimetric inhibitor screens and inhibition studies, PFOA was identified to potently, competitively and specifically inhibit aldo-keto

A rare intermediate population of basal cells expressing luminal markers has been identified. Markers of this cell population include Nkx3.1, Pbsn, C1rb, Fgl1 and Mmp7. In these cells, termed Basal-B cells, activated JAK–STAT signalling was identified and its inhibition reduced expression of the markers characterizing these cells. Inflammation increased Basal-B cell-to-luminal cell transdifferentiation

In a phase III, double-blind, randomized, active-controlled trial, receipt of twice-yearly subcutaneous lenacapavir every 26 weeks as pre-exposure prophylaxis (PrEP) significantly reduced HIV incidence in cisgender men, transgender women, transgender men and gender non-binary persons. Of 3,265 included participants, 2 in the lenacapavir group were diagnosed with HIV (0.10 per 100 person-years) compared

The robot-assisted approach to radical prostatectomy has enabled same-day discharge. A substantial concern associated with this practice could be haemorrhage, but sound and thorough robot-assisted radical prostatectomy haemostasis surgical techniques that were introduced to prevent bleeding mitigate this phenomenon.

In March 2024, we convened a symposium to consider the state of the art regarding the mechanisms and management of congenital obstructive uropathy caused by bladder outlet obstruction, at which overarching themes emerged and opportunities for research were discussed to fill key knowledge gaps in achieving the best future for children with congenital obstructive uropathy.

Prostate cancer is often an indolent disease, and delays in treatment up to 6 months do not seem to affect cancer-free survival. Inadequate pre-treatment assessment and uninformed shared decision-making can lead to decision regret and disparities in receipt of treatments. Time is on our side to allocate sufficient time and resources to consider the most appropriate and individualized treatment decision

Everyone understands the tragedy of cancer; however, the severity of its effects are only known to those who have first-hand experience. Thus, not everyone understands how it feels to receive a diagnosis yourself or to support a loved one, or how colleagues and peers react at work and school. It begs the question: why are people who are dealing with a cancer diagnosis often still keeping it a secret

Large language models are gaining increasing interest in the medical community; however, an important but overlooked aspect of their capacity is their ability to integrate with tools. This integration greatly extends their potential application in health care.

A study published in Nature investigating tumour metabolism in kidney cancers provides insight into the influence of mitochondria and cellular metabolism on metastasis in this disease. In this study, a 13C-labelled nutrient, [U-13C]glucose, was administered through a peripheral intravenous line to patients with varying subtypes of renal cell carcinoma (RCC) undergoing partial or radical nephrectomy

A new phase III, randomized, controlled trial was carried out to assess the efficacy of 177Lu-PSMA-617 in patients with taxane-naive metastatic castration-resistant prostate cancer (mCRPC). A total of 468 patients with PSMA+ mCRPC who experienced disease progression after receiving an androgen receptor pathway inhibitor (ARPI) were randomly allocated to receive 177Lu-PSMA-617 or a different ARPI. Treatment

The multicentre, randomized, phase III trial TiNivo-2 was conducted to assess the efficacy of the vascular endothelial growth factor receptor inhibitor tivozanib alone versus in combination with the immune checkpoint inhibitor (ICI) nivolumab in patients with advanced renal cell carcinoma (RCC) who had progressed during or after 1–2 previous lines of therapy including one ICI. Progression-free survival

From 23 to 25 October 2024, Madrid hosted the 54th edition of the annual meeting of the International Continence Society (ICS), the leading multi-disciplinary event in the continence field, bringing together healthcare professionals in the fields of urology, gynaecology, physiotherapy and nursing with the common interest of treating incontinence. The future of continence was the central theme of the

Literature about prostate cancer in transgender women is growing, but many questions remain unanswered. Unique challenges exist in the identification of transgender women that can slow or even impair research advances in this field. Reframing our thinking about the identification of this population is imperative to help advance both research and clinical care.

When Nature Clinical Practice Urology launched in 2004, we could not have foreseen the ways in which our field has transformed. As we celebrate our 20th anniversary — traditionally, the ‘china’ anniversary — it gives us a chance to get out the special china tea service, sit back with a cup of tea and reflect on what this journal, and the editors who work on it, have achieved.

In the USA, Black men are approximately twice as likely to be diagnosed with and to die of prostate cancer than white men. In the UK, despite Black men having vastly different ancestral contexts and health-care systems from Black men in the USA, the lifetime risk of being diagnosed with prostate cancer is two-to-three times higher among Black British men than among white British men and Black British

Disulfidptosis is a programmed cell death pathway in prostate cancer. A study in Scientific Reports has investigated the roles of genes related to disulfidptosis in disease pathogenesis and progression. The team developed a risk scoring model and then examined the relationship between this score and immune characteristics, somatic mutations and responses to therapy. Two disulfidptosis subtypes were

A study in Scientific Reports has used isotransplantation to examine the effect of mouse breeding nuclei in prostate cancer development and intratumoural macrophage populations, illustrating the importance of understanding mouse models to explore the tumour immune microenviroment (TIME). TRAMP-C1 cells were implanted into C57BL/6J mice from two breeding nuclei (nA and nB) and tumour growth period and

For the past 20 years, Nature Reviews Urology has evolved alongside the field, reflecting a shift towards basic research as a tool to inform clinical practice. From the latest developments in urology to the advent of telehealth, the journal has remained committed to delivering rigorous and unbiased science, accessible to a global audience.

Over the past 20 years, Nature Reviews Urology has been at the forefront of developments in the field — from championing men’s health to explaining the intricacies of the prostate cancer tumour immune microenvironment. Going forwards the journal will continue to be a leader in the field, providing an important resource for patients and physicians alike.

Intermediate-risk and high-risk localized prostate cancer are treatable, but metastases (in ~30% of patients) often lead to death. Immunotherapy shows promise for survival, but many patients do not respond, highlighting the need for biomarkers to predict metastases and treatment response. In an article published in Scientific Reports, a novel indicator based on cell death was developed to predict metastases

Proof of concept has been demonstrated for a modern and safe immuno-nanotherapy for prostate cancer in a study published in Experimental & Molecular Medicine. These results provide the possibility of a novel, effective treatment strategy for prostate cancer. Using a microfluidic device, the investigators designed and synthesized a nonimmunogenic biocompatible cationic lipid nanocomplex coated with

Women are under-represented in surgery and are particularly subject to the intrinsically gendered practice of pimping in the clinical learning environment. The potential downstream effects of this continued practice have considerable implications on gender disparities within surgical disciplines.

The incidence of detrusor underactivity is projected to rise owing to an ageing population and the increasing prevalence of diabetes, but therapeutic options remain limited. Successful bladder contractions have been yielded in studies of bladder pacing in animals. However, anatomical incongruities highlight the need for human trials. Bladder pacing in humans through electrical stimulation has shown

New research, published in Nature, shows that gut microbiota carcinogen metabolism could contribute to chemical-induced carcinogenesis in the bladder. Chronic exposure to N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) induces bladder cancer in mouse models. Thus, the investigators used this model to examine the influence of gut microbiota on BBN-induced carcinogenesis and toxicokinetics.

In a new study published in JAMA Internal Medicine, the association between patients abandoning or reversing the pre-exposure prophylaxis (PrEP) prescription and the specialty of the prescribing clinician has been assessed. Overall, 37,003 patients who were prescribed PrEP were assessed using pharmacy claims data. The majority of patients (67%) received their prescription from primary care practitioners

Intra-tumour heterogeneity in patients with metastatic castration-resistant prostate cancer (mCRPC) poses a challenge to treatment, owing to variability in tumour growth and response to therapy. Currently available tools such as response evaluation criteria in solid tumors (RECIST) and circulating tumour DNA (ctDNA) are useful methods to measure patient response to treatment but do not enable the assessment

PIWI-interacting RNAs (piRNAs) are crucial regulators of gene expression in male germ cells. In a study published in Nature Communications, the effect of disrupting piRNA biogenesis on human spermatogenesis was assessed. Analysis of exome data from >2,000 men with infertility led to the identification of biallelic variants in 14 genes related to the piRNA pathway in these men. These variants were associated

Measuring bladder volume is essential to assess bladder function for diagnosis and monitoring of lower urinary tract dysfunction, but currently available methods such as catheterization or ultrasonography are invasive and limited to the hospital setting. In a new study published in Nature Communications, a wireless and flexible ultrasonic bladder volume monitoring (UBVM) device was developed for continuous

Artificial intelligence can be leveraged to improve the detection of prostate cancer on magnetic resonance imaging; however, before this technology is implemented in clinical practice, further research is required.

Artificial intelligence (AI) is transforming prostate cancer management from diagnosis to treatment. AI tools have been designed for the analysis of digitized histopathology and MRI scans, generation of synthetic CT scans and improvement of robotic surgical outcomes. This progress underscores the need for regulation and the development of safe, ethical and non-biased software.

Currently, no consensus biomarker exists for predicting priapism associated with sickle cell disease. Biochemical and haematological parameters have been investigated, but they are limited by a lack of specificity and the need for pre-validated thresholds. Genetic biomarkers are a potential alternative for further consideration in future efforts.

The idea that common epithelial cancers evolve from dysplasia or carcinoma in situ has been challenged by the discovery of occult disease in normal-appearing cells, known as the field effect, which interests areas that might form large plaques in the mucosal membrane. Forerunner (FR) genes, which map to genomic regions close to established tumour-suppressor genes, seem to have a role in this process

Transgender women are more likely to be diagnosed with high-grade prostate cancer than cisgender men, which might be ascribed to a delayed diagnosis. In a study published in JAMA, the authors assessed prostate-specific antigen (PSA) values in a cohort of transgender women receiving oestrogen treatment, prompted by the rationale that the levels of PSA (which are regulated by androgen) might be altered

Single-cell analysis of treatment-resistant prostate cancer demonstrated high heterogeneity between cell states across various advanced disease types, including castration-resistant and neuroendocrine prostate cancers. Expression of PSMA, STEAP1, STEAP2, TROP2, CEACAM5 and DLL3 were observed to vary within a subset of gene regulatory networks. Thus, gene regulatory networks could be used to identify