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Numerous agents have been investigated in prostate cancer prevention. Many manipulate sex steroid levels or function, some regulate response to oxidative stress and others affect tumor proliferation and/or apoptosis. Some are postulated to even affect downstream targets, such as cyclooxygenase-2, which has been shown to be elevated in prostate cancer by most investigators. The evidence for all these potential chemopreventive agents is critically reviewed. While the current information base is vast, level 1 evidence is lacking, and ongoing trials are not due to provide such evidence for many years to come. In addition, the current lack of ability to accurately differentiate clinically important prostate cancer from latent disease makes chemoprevention in this setting even more challenging. Currently, no reliable biomarkers that can act as surrogate endpoints for the development of clinically relevant prostate cancer exist, which makes performing large chemoprevention trials expensive. At present, there is little to suggest that the urologist or General Practitioner should be recommending any particular chemopreventive agent to either the general population or those deemed to be at higher risk of contracting prostate cancer.

Evaluation of: van Leeuwen PJ, Connolly D, Tammela TLJ et al. Balancing the harms and benefits of early detection of prostate cancer. Cancer 116(20), 4857-4865 (2010). Prostate cancer screening remains controversial, with different countries taking different views on its value. We review the study by van Leeuwen and colleagues, evaluating the risk-benefit ratio for screening from the European Randomized study of Screening for Prostate Cancer (ERSPC) stratified by age and serum prostate-specific antigen level at study entry. Though the overall results from the ERSPC demonstrated a 20% relative reduction in prostate cancer mortality in the screened arm, the current study demonstrated that the benefit was minimal for men aged 55-74 years with a serum prostate-specific antigen

Bladder cancer is the second most common urological malignancy with a one in 28 lifetime risk. Three-quarters of tumors are non-muscle-invasive (formerly termed superficial) at the time of presentation. Approximately half of all non-muscle-invasive bladder cancer (NMIBC) will recur and, depending on certain prognostic factors including grade, stage and presence of carcinoma in situ, a number will progress to muscle invasion. The standard of care for NMIBC is transurethral resection of bladder tumor (TURBT) to remove the mass lesion(s). Intravesical therapy of NMIBC post-TURBT therefore aims to delay/prevent recurrence and/or progression to muscle-invasive bladder cancer. While intravesical chemotherapy, such as mitomycin C, and immunotherapy, such as bacillus Calmette-Guerin are well established, there is current interest in novel therapies based on improved molecular understanding of bladder cancer. These novel therapies include gene therapy, using viral and non-viral vectors for transfer, monoclonal antibodies and direct tumoricidal viruses. While there is a sound theoretical basis for these therapies based on molecular targeting, there is little evidence in human studies that these therapies have clinical impact on NMIBC. However, it is certain that their use will be investigated further and they provide great hope for the future of NMIBC adjuvant therapy.

Localized prostate cancer is one of the success stories of modern oncology, with radical treatments offering long-term cancer-specific survival for most patients. In fact, most men with this condition die from nonprostate cancer diseases rather than from their prostate cancer. Open radical prostatectomy has been the gold standard radical treatment for localized prostate cancer, but a new dawn is emerging. Novel minimally invasive modalities are now available, and include both minimally invasive prostatectomy as well as newer energy sources such as high-intensity focused ultrasound. This review summarizes these newer technologies, in terms of technique, as well as both oncological and functional outcomes to date. The ultimate goal of such novel minimally invasive modalities is to continue to improve on the functional outcomes without compromise to the oncological results of the gold standard.

Prostate cancer is the most prevalent nondermatological malignancy affecting men in the Western world. An increase in public awareness has led to earlier detection. Accepted treatments for localized prostate cancer include active surveillance, radical prostatectomy, interstitial brachytherapy, external beam radiotherapy and watchful waiting. The authors discuss the rationale for the different approaches together with outcomes including toxicity. Novel approaches are also explored. The management of locally advanced disease has long been a challenge and the evolving evidence is reviewed.