IJU this issue

Abstract

In this issue of International Journal of Urology, there are five Original Articles or Review Articles on prostatic diseases including prostate cancer and benign prostate hyperplasia. They provide us with the insight that prostate volume (PV) is important for treatment selection and/or prognosis of prostate cancer, as well as its association with severity of benign prostate hyperplasia. Shoji et al. (Tokyo, Japan) showed that intraoperative transrectal compression suppresses intraoperative increase in the PV and intraprostatic point shift during high-intensity focused ultrasound, having the potential to achieve precise whole-gland and lesion-targeted focal therapy. In a previous study, prostatic swelling and a shift toward the antero-lateral direction were confirmed during high-intensity focused ultrasound treatment, which might cause inadequate ablation of an enlarged prostate resulting in biochemical failure after high-intensity focused ultrasound. Their methods might have the potential to achieve precise whole-gland and lesion-targeted focal therapy using high-intensity focused ultrasound technology. Moschini et al. (Vienna, Austria) found that smaller prostates are associated with increased risk of biochemical recurrence (BCR) after surgery only in men with intermediate-risk disease. They assessed for the first time the impact of PV on BCR according to the D'Amico risk groups. Although several studies have shown the certain association between PV and adverse pathological features, there are conflicting observations. PV-related factors should be evaluated in the preoperative setting in order to improve the current risk stratification system, and to ensure better counseling for men with prostate cancer. In addition, the true causative link between PV and oncological outcome, whether it arises from tumor biology or not, should be thoroughly investigated. This allowed us to partially account for heterogeneity of PCa. As for the issue of heterogeneity of cancers, Antonelli et al. (Brescia, Italy) reported little impact of venous tumor thrombus (VTT) consistency (VTTC) on the prognostic role in patients with renal cell carcinoma. Their study showed that VTTC can be reliably assessed, is strongly associated with several well-established adverse prognostic factors, but does not independently predict survival in patients with renal cancer and venous thrombosis. Their study had several limitations, and a prospective study including a larger number of patients with renal cell carcinoma accompanying VTT will be required as described in the Editorial Comment. Anyway, the clinical course in patients with renal cell carcinoma accompanying VTT is comparatively heterogeneous, and the identification of reliable prognostic predictors is thus warranted. In addition, we can find an article by Kaushika et al. (Minnesota, USA) on their abundant experience with radical cystectomy for small cell carcinoma of the bladder, to compare outcomes with a cohort of patients with urothelial carcinoma, and to determine the effect of adjuvant chemotherapy and pathology re-review in this setting. Our concern is whether pure small cell carcinoma of the bladder should be discriminated from some other pathological features, such as urothelial carcinoma with neuroendocrine differentiation, which we could have increasing chances to experience. Considering heterogeneity on bladder cancer with small cell components, further studies will be required to clarify how adjuvant chemotherapy should be applied to patients who were found to have small cell carcinoma of the bladder or other features with neuroendocrine differentiation at cystectomy. None declared.