Nature Reviews Urology最新文献

Genitourinary cancers account for 20% of cancer instances globally and pose a substantial burden. The microbiome, defined as the ecosystem of organisms that reside within and on the human body, seems to be closely related to multiple cancers. Research on the gut microbiome has yielded substantial insights into the interactions of this entity with the immune system and cancer therapeutic efficacy, whereas the urinary microbiome has been relatively less well-studied. Advances in next-generation sequencing technologies led to new discoveries in the urinary microbiome, which might aid in early detection, risk stratification and personalized treatment strategies in genitourinary cancers. Mechanistic investigations have also suggested a role for the urinary microbiome in modulating the tumour microenvironment and host immune response. For example, distinct urinary microbial signatures have been linked to bladder cancer occurrence and recurrence risk, with specific taxa associated with cytokine production and inflammation. Urinary microbiome signatures have also been explored as potential biomarkers for non-invasive cancer detection. However, challenges remain in standardizing methodologies, validating findings across studies, and establishing causative mechanisms. As investigations into the urinary microbiome continue to evolve, so does the potential for developing microbiome-modulating therapies and enhancing diagnostic capabilities to improve outcomes in patients with genitourinary cancers.

Cadmium is a heavy metal that is often found in water systems and soil owing to its release from industrial processes. Occupational exposure is seen in those who work in production and use of nickel–cadmium batteries, phosphate fertilizers, copper and nickel smelting, and waste incineration and disposal. Furthermore, exposure in the general population can occur via cigarette smoke, water and consumption of foods that accumulate cadmium. The long half-life of this metal means that it can accumulate in human tissue, leading to a variety of health concerns. The mechanisms and causes of overactive bladder (OAB) remain unclear, but the known neurotoxic and pro-inflammatory properties of cadmium mean it is considered a possible contributing factor.

Data were analysed from the 2007–2020 National Health and Nutrition Examination Survey (NHANES), and the relationship between blood cadmium levels and OAB and its components were assessed using weighted multivariate logistic regression. Prevalence of OAB in this database was 26.2% of the 15,467 respondents. Blood cadmium levels were associated with overall OAB, but this association was small and not significant after adjusting for other variables, although blood cadmium levels in the OAB group were statistically higher than in the non-OAB group. Cadmium was inversely associated with severity of nocturia (OR 0.85, 95% CI 0.74–0.98, P < 0.05) and was also linked to more severe incontinence in adults aged 50–59 years and in non-Hispanic Black patients.

Air pollution has been suggested as a potential modifiable risk factor for prostate cancer, but data remain inconsistent. Now a study of over 210,000 men from a UK biobank suggests that long-term exposure to air pollution increases prostate cancer risk.

Data from 210,722 men who were free of prostate cancer at baseline were collected from the UK Biobank. The mean age of these men was 56.6 years, and 10,841 men were diagnosed with incident prostate cancer during a total of 2,228,981 person-years of follow-up monitoring (median follow-up duration 10.9 years). This information was cross-referenced with air pollution data from the UK government Department for Environment, Food & Rural Affairs, which included ambient air pollutants, such as particulate matter with diameters ≤2.5 μm (PM_2.5) and ≤10 μm (PM₁₀), nitrogen oxides (NO₂ and NO_x), sulfur dioxide (SO₂), benzene and ozone (O₃).

Overexpression of free radicals induced by heavy metals such as aluminium (Al) and nickel (Ni) can be detrimental to male fertility. However, by-products of agriculture, such as peels, seeds and leaves, are rich in bioactive compounds and might, therefore, be useful as potential protectors of reproductive health. Cucumeropsis mannii is a melon whose seed is rich in alkaloids, flavonoids, glycosides, steroids and tannins, the husk of which is burned and becomes incorporated into the soil in Nigeria, where the study was performed. In the same area, crude oil exploration results in high levels of Ni and Al pollution.

In the study, male rats were exposed to Ni, Al or a binary mixture of the two (Ni/Al), which decreased serum gonadotrophins (LH and FSH) and testosterone (T) compared with controls. Co-administration with melon seed husk extract (MSHE) nanoparticles significantly increased FSH, LH and T compared with the metal-only exposed groups; this effect was also seen in rats receiving MSHE alone. Interestingly, prolactin was significantly increased in metal-treated animals, but co-treatment with MSHE reduced these levels and MSHE-only treatment significantly lowered prolactin below the level seen in the metal-treated groups.

Chlorination is a common method for disinfecting drinking water but can produce potentially carcinogenic by-products, such as trihalomethanes (THMs). A new systematic review and meta-analysis was conducted to assess the association between residential THM exposure and cancer risk, and the results were published in Environmental Health Perspectives.

Overall, 29 studies assessing THM concentrations in relation to cancer in 14 organs were analysed, including 8 on bladder cancer. Among all tumours, only bladder cancer and colorectal cancer were eligible for meta-analyses.

The environmental pollutant bis(2-ethylhexyl) phthalate (DEHP) induces oxidative stress, leading to impaired sperm parameters and reproductive toxicity.

In a new study published in Molecular and Cellular Endocrinology, the role of glutathione S-transferase A2 (GSTA2) — a known detoxifying agent against environmental pollutants — was assessed in counteracting DEHP-induced reproductive damage.

Radical cystectomy is a primary treatment for muscle-invasive bladder cancer but can be associated with challenges in resource-limited settings owing to limited access to specialized surgical procedures.

In a new study published in BMC Urology, Taha and colleagues present a pilot study analysing perioperative complications and mortality associated with radical cystectomy at the Gezira Hospital for Renal Disease and Surgery (GHRDS) in Sudan, reflecting outcomes from an in-country training programme established by the Society of International Urology (SIU).

Contemporary advances in prostate cancer treatments have markedly improved patient outcomes, yet concerns persist regarding the increased cardiovascular toxicity of prostate cancer treatments, which is multifaceted. Local therapies entail non-negligible cardiovascular risks. The effects of androgen deprivation therapy, which is pivotal in disease management, on cardiovascular health remains contentious, with gonadotropin-releasing hormone agonists and antagonists showing varying cardiovascular outcomes. Despite the ongoing controversy over the cardiovascular risks of gonadotropin-releasing hormone antagonists versus agonists, current evidence does not support favouring one over the other based solely on cardiovascular risk. Combination therapy with androgen receptor pathway inhibitors and androgen deprivation therapy shows additive cardiovascular risks, but robust comparative data are lacking. Chemotherapies such as docetaxel and cabazitaxel, along with emerging targeted therapies and radiopharmaceuticals, are associated with varied cardiovascular risks, necessitating personalized patient assessment. Clinicians should adhere to cardio-oncology guidelines when prescribing therapeutic agents, especially for patients with pre-existing cardiovascular conditions. Optimal monitoring and management strategies are essential to mitigate cardiovascular morbidity and mortality.