This issue 31‐12

IJU this issue Currently, the management of prostate diseases is a privilege of urologists. After reading this month's issue of the IJU, I was struck by the sincere commitment of urologists to the diagnosis and treatment of prostate diseases, particularly prostate cancer. This issue includes 3 review articles, 14 original articles, and 3 urological notes, of which 7 are related to prostate cancer and 3 are related to benign prostatic hyperplasia. This indicates that approximately half of the publications pertain to prostate diseases, reflecting the daily efforts of urologists in clinical practice. In the review by Morizane et al. on pelvic lymph node dissection (PLND), it is noted that the traditional terminology for lymph node regions, incorporating insights from both surgical and gynecological disciplines regarding lymphatic flow, indicates that current PLND practices lack a clear therapeutic rationale. The article is also enriched with beautiful figures, and I anticipate that it will serve as a landmark reference for future discussions on PLND. Miura et al. reported real-world data concerning the current state of upfront combination therapy utilizing ARSI and docetaxel for metastatic prostate cancer. They found that the prevalence of upfront combination therapy is 72% and 54% among patients with high and low tumor burdens, respectively, with older age and poor performance status often leading to the choice of vintage hormonal agents. This observation closely aligns with our own experience. Even in the era of ARSI, the efficacy of estramustine remains robust. Kambe et al. assessed the safety and efficacy of neoadjuvant degarelix acetate combined with low-dose estramustine phosphate for high- and very high-risk prostate cancer. Their findings demonstrated that estramustine phosphate is a predictor of biochemical recurrence in patients with very high-risk prostate cancer undergoing robot-assisted radical prostatectomy with neoadjuvant chemohormonal therapy. Guo et al. reported that folic acid supplementation may increase the risk of developing prostate cancer in relation to certain SNPs. While folic acid intake is effective in preventing cardiovascular events and dementia and is occasionally used as a supplement for male infertility, I believe that in these patient populations, testosterone levels are generally low, potentially mitigating significant clinical concerns. Kato et al. have reported that the frequency of active surveillance (AS) is low in Japan. However, I feel that a comprehensive understanding of various biological factors related to prostate cancer development, as well as dietary habits and supplements, can enable clearer decisions regarding the eligibility for AS among patients. Artificial urinary sphincter (AUS) has long been recognized for its efficacy in treating severe urinary incontinence after radical prostatectomy. However, there is limited information on cases requiring revision surgery. In their review, Kaiho et al. provide detailed insights into the indications for AUS removal and reimplantation, as well as important considerations regarding the placement of the device during such surgeries. The long-awaited topic reported by Shirai et al. on the vacuum erection device (VED) has also appeared. Undoubtedly VED are useful not only for common ED but also for ED following radical prostatectomy and for penile rehabilitation. Now we have AUS and VED. If we add penile prosthesis to this, the management of sexual function after localized prostate cancer treatment would be perfect. In the 1990s, it was widely believed that the bladder, prostate, and testes belonged to only urologists. However, gastrointestinal surgeons and pediatric surgeons sometimes handle the bladder, and in some cases, gynecologists perform sperm retrieval from the testes. If the high-quality clinical practices, like those published in this issue, continue to be applied to prostate diseases, I humbly believe that urologists can maintain their position as the sole group of physicians who can manage the prostate diseases. None declared.