Receiving androgen-deprivation therapy (ADT) on an intermittent basis does not appear to be a good choice for men with metastatic hormone-sensitive prostate cancer, according to a trial published in NEJM (2013). After a median follow-up of about 10 years, the study authors found that 765 men treated with continuous therapy lived longer than 770 men treated intermittently (average survival, 5.8 vs 5.1 years). These outcomes translate to a 10% increase in the relative risk for death with the intermittent approach (hazard ratio, 1.10; 90% confidence interval, 0.99 – 1.23).

In an article published in NEJM (2013) the authors studied 1655 patients enrolled in the Prostate Cancer Outcomes Study. All has localised prostate cancer and were aged 55-64 at treatment. Two thirds had surgery and the rest radiotherapy. At 2 and 5 years those having surgery were 5-6 times more likely to have incontinence and 2-3.5 times mire likely to have erectile dysfunction, but bowel urgency was 50-60% less likely. There were no differences in these outcomes at 15 years.

In an editorial in BMJ (2013), Paul et al discuss the introduction of robotic surgery without prior evaluation. More than 360,000 robotic surgical procedures were carried out worldwide in 2011, using the only licensed robotic system; the da Vinci system developed by Intuitive Surgical. Urologists and Gynaecologists were early adopters of the technology and in 2011 more than 100,000 radical prostatectomies and 125,000 hysterectomies were performed robotically. In USA robotic surgery has become a symbol for advanced care, however it is a very expensive technology and evidence that its use improves outcomes is scarce at best.

In an article published by Bishop et al in JCU (2013), the authors discuss the results of 100 robotic radical prostatectomies (RALP). Positive margin rate was 22% overall, with 17% for T2 disease and 50% for T3 and T4 disease. 12 month continence rates were 82%. This is the first published report of results for robotic prostatectomy from a UK district general hospital.

At the Staffordshire Urology Clinic our current standard approach to surgery is laparoscopic (keyhole) rather than robotic. Our overall positive margin rate after keyhole radical prostatectomy is lower at 15%, and incontinence rates also lower than reported in this study.

At the ASCO (American Society of Clinical Oncology) Genitourinary Cancers Symposium in February 2013, Goodman and colleagues presented a paper that summarized the long-term follow-up outcomes from the Prostate Cancer Prevention Trial. The original study was conducted from 1993 to 1997 and randomly assigned men to receive either 5 mg of finasteride or placebo, with the hope of reducing the odds of developing prostate cancer. Longterm follow-up, now at 15 years, showed no significant prostate cancer survival difference between patients treated with active drug or placebo. A subset analysis of men with low risk prostate cancer that had received finasteride did, however, have a better survival, although the cause of this effect was unclear.

In an article by Ramsden and Seels published in BJUI (2011) the authors argue that there is not a literature standard for defining success in laparoscopic pyeloplasty. Studies that define success on the basis of resolution of function have success rates in excess of 95%, whereas those that use imgaing aswell have a lower rate. When success is defined strictly as resolution of pain and preserved renographic function (Derriford criteria), literature success rates range form 77-98%. The authors success rates are 85.1%

Partial nephrectomy is the standard of care for smaller renal masses. A recent review studies the different approaches of open surgery compared to laparoscopic surgery. It finds no cancer outcome differences, but supports the laparoscopic approach for reducing morbidity. However, it points out that the laparoscopic approach is a tremendously difficult technique, which limits its use to surgeons proficient in the technique.

The reference for this article is: Ranjith Ramasamy. (February 2013), Laparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long‐term oncological and functional outcomes in 340 patients. BJU International, 111: 189.

Interstitial cystitis/chronic pelvic pain syndrome is a difficult condition to treat, with few good treatments. A recent study of the scientific literature reviews the limited evidence for using intra-vesical GAG analogues and concludes that the benefits are marginal. However, in the absence of other good alternatives it remains an important treatment option.

The reference for this article is: Costin L. Chintea, Mohammed Belal. (February 2013), Is there enough evidence for the use of intravesical instillations of glycosaminoglycan analogues in interstitial cystitis?. BJU International, 111: 192 – 193.

In a study published by Loo et al published in Mayo Clinic Proceedings (2013) the authors studied 2630 patients with non visible haematuria. Only 1.9% had either bladder or renal cancer diagnosed. Age over 50 years and visible hematuria were the most reliable predictors of urothelial or renal cancer. Male sex and smoking history were also predictive of cancer.