Hypogonadism affects several million men in the United States, its prevalence increases with age, and it is underdiagnosed and undertreated. Reasons for underdiagnosis and undertreatment are numerous. First, signs and symptoms of low testosterone are often subtle and nonspecific. Second, a consensus on the definition of low testosterone has not been established. Many commercially available assays for the measurement of testosterone levels have not been standardized, resulting in considerable variability among laboratories in reference values for identifying low testosterone levels.

In this issue of Grand Rounds in Urology J. Curtis Nickel presents a discussion of phytotherapy for benign prostatic hyperplasia (BPH) with an invited commentary from Paul D. Maroni. Though natural and herbal remedies have been around for centuries, it is only within the last 20 years that patients have embraced herbal remedies. It is time to stop viewing them as viable treatment options without de initive research studies. These treatments not only empower patients by allowing them to do their own research (via the Internet, by watching infomercials, through ready magazine and newspaper articles, etc.), but also allow patients to circumvent the traditional health care treatment process. Today’s patients are more interested in the concept of “prostate health” than those in the past, but unfortunately few if any clinical trials have been published that assess the long-term effects with respect to disease progression.

In this new year of Grand Rounds in Urology (GRU), we continue our tradition of providing the practicing urologist with the latest in information on genitourinary diseases. I am also pleased that we will exand our coverage from four issues to six in 2008. Our first issue, Vol- ume 7, Issue 1, focuses on Hypogonadism, and includes a thorough review by Dr. Al- varo Morales, Director of the Centre of Applied Urological Research at Kingston General Hospital and Queen’s University in Kingston, Ontario, Canada.

The Current Status of Metastatic Prostate Cancer Treatment

In May 2007, the American Urological Association published updated guidelines for the management of clinically localized prostate cancer. Despite high response rates to initial hormone therapy, treatment remains non-curative and the disease will ultimately progress in the majority of patients. To assist in understanding the contents of these updated guidelines, this supplement is a review by Dr. Nicholas Vogelzang and colleagues from the Nevada Cancer Institute designed to address the current roles of hormonal and chemotherapy in the management of metastatic prostate cancer. This supplement is supported by an unrestricted educational grant from sanofi aventis.

In this final issue of Volume 6 of Grand Rounds in Urology we are pleased to provide our readers with overviews into the treatment of two difficult to treat genitourinary issues: Peyronie’s Disease (PyD) and superficial bladder cancer. In the first article, Drs. Anthony Bella and Tom lue provide a detailed approach to surgical approaches to PyD, a physically and psychologically devastating condition for both the affected patients and their partners. More than a typical review arti- cle, this contribution offers both a review of the current literature and first-hand ex- perience from techniques developed by the authors while at the university of Califor- nia at San Francisco. It is accompanied by several detailed and valuable illustrations.