In the KEYNOTE-564 trial, patients with resected clear cell renal cell carcinoma at a high risk of relapse experienced disease-free survival and especially overall survival benefits following treatment with pembrolizumab, which in turn was established as the novel standard adjuvant therapy for these patients. Accurate patient selection is crucial. Managing post-pembrolizumab recurrence is challenging owing to limited evidence for guiding therapeutic decisions based on clinical features.

In this Perspective, Larcher et al. describe a dedicated treatment programme for Von Hippel–Lindau disease established at San Raffaele Hospital, which encompasses diagnosis, surveillance, treatment, research and outreach. The authors then discuss the benefits of care centralization for Von Hippel–Lindau disease and other rare diseases.

A subset of men with prostate cancer have elevated periprostatic androgens compared with levels in peripheral blood, which are associated with poor clinical outcomes after radical prostatectomy. This new paradigm for gonadal androgen physiology is termed ‘sneaky T’ phenomenon.

Antibiotic-resistant uropathogenic bacteria are becoming increasingly prevalent. In this Review, strategies for clinicians and researchers to address this challenge are delineated, including implementation of policies, stewardship practices, and the exploration of emerging therapeutic targets aimed at mitigating antibiotic resistance.