Editorial

The challenges in treating patients with advanced urologic cancers often comes from the lack of level 1 evidence in how best to manage their cancers and the complications stemming from the treatments received. In this edition of Current Opinion in Supportive and Palliative Care, I was again privileged to select topics and authors to tackle some of these difficult urologic issues. The controversies surrounding penile cancer and how to best manage this rare disease continue even today. Challenges in doing large randomized clinical trials (RCTs) to confirm the role and timing of surgery, chemotherapy and radiation therapy will likely remain for some time. This tumor is both infrequent and deadly, and the best chance at long-term control is the first intervention. This clearly requires planning and a multidisciplinary treatment plan that is optimized in large centers with an interest and experience, or else in my opinion we are doing a disservice to those who present with penile cancer. The article dealing with the surgical management of patients with castration-resistant prostate cancet is also addressing a topic that is rarely discussed, given the historically short survivals of these patients. With new systemic therapies now available, patients are living longer, and local complications of the disease sometimes become the major cause of morbidity and loss of quality of life. The thought of surgical intervention is often considered ludicrous even today, but some have pushed the envelope and have made us question these dogmas. Obviously, this is not for all patients, but in some it may be hugely beneficial. Again here, experience and a well-thought-out plan is a prerequisite. The management of patients with oligometastatic cancers has also become an area of interest in which dogmas are being challenged. Data to date are thought provoking and is helping to drive clinical trials to address the value of this approach. It is, however, almost impossible to do standard RCTs, so innovative trial designs as well as registries will help determine whether this should be part of the therapeutic options that should be offered. Technology in radiation therapy is leading to better therapeutic effectiveness and less toxicity in treating oligo metastatic disease, forcing the tumor board discussions to tread new waters. In renal cell carcinoma, but also in other tumor settings in genitourinary including prostate cancer. This brings us to one of the major challenges in oncology: imaging effectively what needs to be treated and making sure that we are not missing significant lesions. This has always been one of the major issues in prostate cancer, in which most of the distant metastases are in the bone which is the most difficult area to image precisely. In terms of treatment and research, this limits our ability to optimally determine the patient characteristics and treatment response to the existing and new drugs used in prostate cancer. Finally, there is an additional article that summarizes the treatment options and approach to patients with the troublesome complication of hemorrhagic cystitis due to radiation therapy. For those who do not deal directly with this patient population, it is hard to imagine how having blood in the urine can be so problematic; but for those who have seen these difficult cases, the article will hopefully supplement and help organize strategy. Intervening quickly and in a strategic fashion will help immensely. Given that most patients have long life-expectancies, it is critical to consider the short- and long-term quality-of-life aspects in managing hemorrhagic cystitis. It is imperative that an acute problem does not turn out to be a long-term nightmare. In the end, all these articles have an underlying theme: optimizing patient care requires that we sometimes consider options that take us out of our comfort zone. Acknowledgements None. Conflicts of interest There are no conflicts of interest.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.