Novel breakthroughs in advanced prostate cancer management.

INTRODUCTION: Although PSA screening has been rationalized, prostate cancer continues to have the highest incidence rate in 2021, and alone accounts for 26% of cancer diagnoses in men. A thorough review of the medical literature highlights a vast array of approved and investigational treatments for prostate cancer. Thus, selecting the best treatment option for the appropriate patient at the right time is crucial. Hence, biomarkers help in defining optimal patient stratification, revealing potential processes through which a drug might exert its impact and aid in the tailoring of treatments for efficient personalized medicine. AREAS COVERED: This article is a pragmatic review of novel prostate cancer therapies that can help guide clinicians in tackling prostate cancer with the latest treatments. EXPERT OPINION: Local radiotherapy has proven to be a game changer for low burden, de novo metastatic prostate cancer. Androgen deprivation therapy continues to be the ultimate treatment. Delaying resistance to these agents will undoubtedly be a breakthrough in the treatment of prostate cancer. When it comes to metastatic castrate-resistant disease, treatment options become narrower. PARP inhibitors and N-terminal domain inhibitors offer new hope and have a synergistic effect, with immunotherapy adding promising agents to the therapeutic arsenal.

Is pudendal nerve entrapment a potential cause for weak ejaculation?

Ejaculatory dysfunction is one of the most common complaints of patients with sexual disorders. While it encompasses several ejaculatory disorders, weak ejaculation is seldom described in the literature. Since the pudendal nerve is the main nerve of ejaculation, we aim to hypothesize that pudendal nerve entrapment could be a cause of weak ejaculation, and that pudendal nerve release could contribute to the improvement of the ejaculatory stream. We presented two cases suffering from a weak ejaculatory stream and sensation of incomplete semen emptying, accompanied with clinical features of pudendal nerve entrapment. Both cases improved after pudendal nerve block and then laparoscopic transperitoneal pudendal release, with a sustained amelioration of the ejaculatory stream after 3 weeks of surgery. Pudendal canal entrapment is therefore a potentially curable cause for weak ejaculation.

Checkpoint inhibitors in BCG-unresponsive nonmuscle invasive bladder cancer: can they help spare the bladder?

Intravesical BCG therapy has been for years, the standard of care in nonmuscle-invasive bladder cancer. But upon recurrence/relapse, radical cystectomy is imposed, due to the paucity of other therapeutic options. Immunotherapy has been revolutionizing cancer treatment, and its indications continue to broaden. It has been approved for the treatment of advanced urothelial cancer of the bladder, mainly as a second-line therapy. Its activity is being studied in nonmuscle-invasive bladder cancer that is not responsive to BCG; we herein report the trials investigating these checkpoint inhibitors (pembrolizumab, nivolumab, atezolizumab, durvalumab and avelumab) in this particular setting.

Lay abstract Administration of BCG vaccine inside the bladder has, for a long time, been the treatment of bladder cancer that has not invaded the layers of this organ, or at least has not arrived at the muscle of the bladder. However, when this cancer recurs or has not responded to this type of treatment, radical cystectomy (i.e., complete removal of the bladder) is imposed. While the latter is associated with significant decrease in quality of life, and when immunotherapy (therapy that relies on immune white blood cells combatting tumor cells) has shown promising results in metastatic bladder cancer, trials are ongoing to prove the potential benefits of this novel therapy in confined, but not responsive to BCG, bladder cancer. In this article, we report these studies, highlighting the most important ones that are, if not already, leading to approval of immunotherapy in this setting.

Acute obstructive pyelonephritis due to pelvic organ prolapse: a case-based review of the literature.

Pelvic organ prolapse (POP) can lead to acute bilateral obstructive pyelonephritis (ABOP) due to bilateral ureteral compression. When this occurs, conservative treatment through POP reduction, intravenous antibiotics and supportive care seems to provide an interesting option in the wait of definitive management of POP. The cornerstone of ABOP management, which is the emergent urinary drainage, seems to have many drawbacks in this context due to both technical and patient-related criteria, making it invasive and compromising patient safety and comfort in many settings. Here, we review the management of ABOP and provide a case of an acute obstructive pyelonephritis due to POP.