There is an abundance of evidence that the human microbiome plays an important and nuanced role in controlling human health, including metabolism, immunity, pain, psychological state, and cancer. The recent discovery of the human genitourinary microbiome’s existence has led to the investigation of its role in mediating the pathogenesis of urinary tract infections, urologic pain syndromes, lower urinary tract symptoms, urolithiasis, and genitourinary malignancies like bladder, kidney, and prostate cancers.
One of the major treatments for prostate cancer is androgen-deprivation therapy (ADT), and about 50% of prostate cancer patients are treated with ADT at some point in their disease. ADT is used most frequently for patients with local but advanced prostate cancer or metastatic prostate cancer. The rate of ADT use in the USA increased in the 1990s and continues to be high today.
Section Editor: Kevin T. McVary, MD
Loyola University Medical Center
In 2002, the International Continence Society (ICS) defined nocturia as “waking up at night at least once to void,” however, clinically relevant nocturia is generally accepted among urologists to indicate two or more voids that are preceded and followed by sleep. Neither definition accounts for the patient’s degree of bother from nocturia, though waking twice or more from sleep to void has been associated with impaired quality of life.
Section Editor: Seth P. Lerner, MD
Baylor College of Medicine
Upper tract urothelial carcinoma (UTUC) is cancer of the transitional urothelial cells that line the upper urothelial tract of the renal pelvis and ureter. This type of cancer accounts for between 5% and 10% of urothelial cancer cases. It’s the fourth most common cancer in men, but less common in women. In UTUC, the mean age of a patient diagnosed is 73 years. It can occur 3% of the time in both upper tracts (ureters or renal pelvis).
Cancer diagnosis and therapy is becoming more focused toward a patient-specific approach to therapy, particularly prostate cancer. The role of imaging is paramount in this evolution by providing physicians with accurate information on both the presence and extent of prostate cancers. Developments in molecular imaging are paving the way for more physicians to diagnose cancer and apply relevant therapy.
Latest prostate cancer research is turning its focus on the M0 space. M0 prostate cancer is a stage where the disease is non-metastatic but has become resistant to hormone therapy. Many therapeutic options for castration-resistant prostate cancer are approved and used for metastatic castration-resistant prostate cancer (mCRPC), but fewer options exist for those with non-metastatic (NM) CRPC.
The role of genetic testing for prostate cancer risk is a rapidly changing area. Experts debate the indications of sending a patient on to genetic counseling for further potential screening for inherited prostate cancer risk. One major issue that needs to be addressed in the urology community today is recognizing the frequency of inherited mutations that are affecting prostate cancer patients. About 1-2% of prostate cancer patients have mutations in BRCA 1 and 2, among a long list of other mutations that are quite common in metastatic prostate cancer.
Current healthcare systems are built around the traditional paradigm of patients suffering from a single acute illness, and the field of urology is not exceptional in this respect. As the population ages and becomes more sedentary, however, an increasing number of patients will suffer from underlying conditions such as frailty and/or sarcopenia, which can complicate the treatment of more acute disease such as cancer. It is therefore imperative that healthcare providers expand their awareness of how to care for these patients, as well as how to prevent these conditions in the first place.
High-intensity focused ultrasound, or HIFU, is an innovative, non-invasive treatment for a wide range of tumors and diseases and has been used for prostate cancer for over 20 years. HIFU uses an ultrasound transducer, similar to the ones used for diagnostic imaging, but with much higher energy. It is also known as MRgFUS (MRI-guided focused ultrasound) and FUS (focused ultrasound surgery). The transducer focuses sound waves to generate heat at a single point within the body and destroy the target tissue. The tissue can get as hot as 150 °F in just a few seconds. This process is repeated as many times as is necessary until the target tissue is destroyed. MRI images are used to plan the treatment and monitor the degree of heating in real time.