John P. Stein, MD, FACS

Drs. Henry, MacVicar, and Hussainprovide a timely reviewof the current management ofmuscle-invasive and metastaticurothelial cancer. The emerging roleof neoadjuvant chemotherapy and thepromise of novel, less toxic targetedtherapies are of particular interest inthe treatment of a disease in whichoutcomes remain poor for locally advancedand metastatic involvementdespite an aggressive multimodalityapproach.[1] We wish to briefly commenton three issues raised by theauthors: (1) the role of surgery in themanagement of invasive disease,(2) the indiscriminate use of neoadjuvantchemotherapy for clinically localizeddisease, and (3) the currentstatus of bladder-sparing approaches.

Conventional histopathologic evaluation of bladder cancer, encompassing tumor grade and stage, is inadequate to accurately predict the behavior of most bladder tumors. Intense research efforts are under way to identify and

The article by Drs. Steele and Richie is a well-written, extremely important review of the natural history, treatment options, and current role of surgery in the management of nonseminomatous germ cell tumors of the testis. The authors present their rationale for retroperitoneal lymph node dissection (RPLND) in a thoughtful and provocative way. Their philosophy mimics that practiced at the University of Southern California (USC), which is very similar to that espoused by Drs. John Donohue and Larry Einhorn, who pioneered the current management practices that have made germ cell testicular tumors the most curable solid tumor in humans.[1,2]