IJU this issue

Abstract

Yukio Homma md phdAssociate Editor One of the latest advances in urological oncology is the introduction of molecular targeted therapy for renal cancer. The discovery of genetic events and specific molecules in renal carcinogenesis has made the therapy plausible. However, accumulating clinical experiences have raised numerous questions, which are commented on by four experts in the editorial of this issue. The common views are: (i) targeted therapy is a clinical advance but not a universal remedy; (ii) cytokine therapy, which has been the mainstay for decades, is still an active option; (iii) combined or sequential use of available therapies would provide more favorable responses; (iv) prophylactic use to prevent development of phenotypes in hereditary renal cancer is premature; (v) better survival in Japanese patients on cytokine therapy, confounded by clinical practice, cannot be simply translated into a difference of efficacy; (vi) research on new targets and predictive markers is warranted for therapy individualization; and (vii) urologists should remain the principal players in research and clinical coordination of multiple treatments. As for other topics on renal cancer, Elsamra et al. (Rhode Island, USA) found 1–6% major complication rates in their review article on laparoscopic surgery. A uniform manner in reporting complications is strongly encouraged to facilitate comparison. An extensive review on thermal ablation therapy for small renal tumor was made by Kimura et al. (Sagamihara, Japan). Ablation therapy is to be indicated more often considering its low invasiveness and comparative oncological outcomes. Molecular targeted therapy is also applicable to castration-resistant prostate cancer, one of the hardest challenges to us. Sonpavde (Rome, Italy) reviewed the clinical efficacy of docetaxel and suggested it as the combination partner. Geldanamycin, a heat shock protein inhibitor, might be an alternative to augment androgen-responsiveness, as demonstrated by Suzuki et al. (Tokyo, Japan), in prostate cancer cell lines under hypoxic conditions. In localized prostate cancer, the clinical concern is existence of significant cancer and prediction of extra-capsular extension. A nomogram presented by Ohigashi et al. (Tokyo, Japan) predicts the existence of significant cancer before biopsy in men with serum prostate-specific antigen (PSA) less than 10 ng/mL using digital rectal examination and PSA parameters as the predictors. Sataka et al. (Tokyo, Japan) estimated probability of extra-capsular extension with laterality by the maximum percentage of cancer in the biopsy sample alone or in combination with other common predictors. The limitations of these nomogram studies, such as relatively small sample size and uncertainty in daily clinical decision-making, are mentioned in editorial comments by Tanaka (Nara, Japan) and Yamamoto (Tokyo, Japan). Unlike prostate cancer, urothelial cancer does not have good tumor markers, even in advanced stages. Okegawa et al. (Mitaka, Japan) detected circulating cancer cells in 11 of 20 cancer patients with metastases but none of 16 without metastases. Detection by the CellSearch system can work as a metastatic marker in urothelial cancer. Ozawa et al. (Okayama, Japan) summarized the role of ultrasound in the assessment of lower urinary tract function in their review article. They provided further details on elegant non-invasive urodynamic study using Doppler ultrasound for monitoring the urinary flow in the urethra to calculate flow resistance. Deng et al. (Guan Zhou, China) observed outcomes of hydronephrosis drained by nephrostomy in 14 children. The parenchyma thickness increased by 7 mm in 4 weeks most likely by shrinkage of the dilated collecting system. Tubular protein returned to the baseline level in a similar range of time. Seminalysis is usually done under light microscopy. Visco et al. (Rome, Italy) found the superiority of transmission electron microscopy in detecting anomalies in tail and midpiece of sperms. Head defects and excess residual cytoplasm were equally identified by light microscopy.