IJU this issue

Abstract

The Committee for Establishment of the Clinical Practice Guideline for the Management of Upper Tract Urothelial Carcinoma and the Japanese Urological Association determined clinical questions of the highest priority with regard to upper tract urothelial carcinoma targeted at physicians involved in its treatment. The committee members carefully selected 16 clinical questions essential for daily clinical practice and grouped them into four major categories: epidemiology, diagnosis, surgery and systemic chemotherapy/other matters. I hope this Guideline, a free article, will help standardize the diagnosis and treatment of upper tract urothelial carcinoma, and improve the treatment outcomes. One of the Review Articles is written by Shioyama et al. (Tosu, Japan) on particle RT for prostate cancer. This article summarized the latest treatment outcomes of particle RT on prostate cancer, as well as physical and radiobiological properties of this treatment for the urologist. In conclusion, proton therapy and carbon ion particle RT are considered to be effective treatment modalities for prostate cancer. Another Review Article describes lower urinary tract symptoms. Nomiya et al. (Koriyama, Japan) discuss chronic bladder ischemia associated with bladder outlet obstruction as a result of benign prostatic enlargement or atherosclerosis, animal models of bladder ischemia and the possible mechanisms for chronic ischemia-induced lower urinary tract symptoms. The authors suggest bladder ischemia and oxidative stress as therapeutic targets for drugs aimed at lower urinary tract symptoms treatment. Adjuvant instillations of bacillus Calmette–Guérin remain the standard treatment for intermediate- and high-risk non-muscle invasive bladder cancer, resulting in a significant reduction in tumor recurrence and progression. Pfister et al. (Rouen, France) carried out a prospective, randomized, multicenter study to assess a new schedule of bacillus Calmette–Guérin maintenance treatment, using one-third of the full dose (27 mg) per instillation at 3 months or 6 months, with a reduction of instillations for each cycle (2 vs 3 instillations, respectively). The authors conclude that one-third dose maintenance bacillus Calmette–Guérin is effective with no impact on tumor recurrence or muscle invasion. Among the Original Articles, six relate to prostate cancer. Using data from the Surveillance, Epidemiology and End Results database, Gandaglia et al. (Montreal, Canada) validated a risk score to select the most optimal candidates for adjuvant RT in a large cohort of prostate cancer patients treated with radical prostatectomy for pT3/4 N0/N1 disease. They were able to conclude that the presence of two or more of the pathological features, including Gleason score 8–10, pT3b/4 and lymph node invasion, might be used to identify patients who benefit from early RT. Although this study has some limitations, such as retrospective setting and absence of postoperative prostate-specific antigen data, it could contribute further evidence for the role of adjuvant RT in the postoperative setting for patients with high-risk prostate cancer. Recurrent urinary tract infections can occur in patients with dysfunctional voiding. Minardi et al. (Ancona, Italy) evaluated the therapeutic effects of α1-adrenoceptor antagonists (using tamsulosin) on recurrent urinary tract infections in women with dysfunctional voiding, with particular regard on lower urinary tract symptoms, and urodynamic and voiding parameters. This prospective randomized study suggests that in women with dysfunctional voiding and recurrent urinary tract infections, tamsulosin associated with uroflowmetry biofeedback could be an effective and safe treatment option for improving urinary symptoms and quality of life. None declared.