While rural residency appears to affect the choice of treatment 11 or perhaps its timing, it is unknown whether rural men do worse than urban counterparts following definitive treatment for localised PCa. We sought to identify if rural residency is a risk factor for PCa specific mortality using outcomes data from the Victorian RP register (VRPR), a whole of population series of men from both urban and rural areas of Victoria who have all undergone treatment by open RP. MethodsThe VRPR is a prospective whole of population series of all men who underwent open RP for the treatment of localised prostate adenocarcinoma between 1995 and AbstractObjective: To present long-term survival data from the Victorian Radical Prostatectomy Register (VRPR), 1995-2000, and analyse the effect of rural residence on survival. Methods:Men who underwent open radical prostatectomy (RP) in Victoria from 1995 to 2000 were recorded in a population register co-ordinated by the Victorian Cancer Registry and Cancer Council Victoria. Baseline clinical, pathological and demographic information such as location were recorded and linked to mortality and recurrence data. Men who had neoadjuvant therapy or missing data for socioeconomic status (SES), tumour grade and stage were excluded leaving 1984 patients in the analyses (92.1% of total register).Results: Follow-up concluded in 2009 with 238 deaths observed, of which 77 were prostate cancer (PCa) specific. Cox and competing risk regressions were used for analysis. Living in a rural area was associated with higher odds of PCa specific mortality after RP (trend p<0.001) and a higher hazard of PCa death, the discrepancy rising up to four-fold (SHR=4.09, p=0.004) with increasing remoteness of residence. This effect is apparent after adjustment for SES, age, private or public hospital treatment, PSA level and tumour-specific factors. Conclusion:Rural men in Victoria have a shorter time to PCa death following definitive treatment, even after adjustment for SES and adverse tumour characteristics.Implication: Rural men are faring worse than their urban counterparts following the same cancer treatment.

Background:Global DNA methylation has been reported to be associated with urothelial cell carcinoma (UCC) by studies using blood samples collected at diagnosis. Using the Illumina HumanMethylation450 assay, we derived genome-wide measures of blood DNA methylation and assessed them for their prospective association with UCC risk.Methods:We used 439 case–control pairs from the Melbourne Collaborative Cohort Study matched on age, sex, country of birth, DNA sample type, and collection period. Conditional logistic regression was used to compute odds ratios (OR) of UCC risk per s.d. of each genome-wide measure of DNA methylation and 95% confidence intervals (CIs), adjusted for potential confounders. We also investigated associations by disease subtype, sex, smoking, and time since blood collection.Results:The risk of superficial UCC was decreased for individuals with higher levels of our genome-wide DNA methylation measure (OR=0.71, 95% CI: 0.54–0.94; P=0.02). This association was particularly strong for current smokers at sample collection (OR=0.47, 95% CI: 0.27–0.83). Intermediate levels of our genome-wide measure were associated with decreased risk of invasive UCC. Some variation was observed between UCC subtypes and the location and regulatory function of the CpGs included in the genome-wide measures of methylation.Conclusions:Higher levels of our genome-wide DNA methylation measure were associated with decreased risk of superficial UCC and intermediate levels were associated with reduced risk of invasive disease. These findings require replication by other prospective studies.

The acute scrotum is a challenging condition for the treating emergency physician requiring consideration of a number of possible diagnoses including testicular torsion. Prompt recognition of torsion and exclusion of other causes may lead to organ salvage, avoiding the devastating functional and psychological issues of testicular loss and minimizing unnecessary exploratory surgeries. This review aims to familiarize the reader with the latest management strategies for the acute scrotum, discusses key points in diagnosis and management and evaluates the strengths and drawbacks of history and clinical examination from an emergency perspective. It outlines the types and mechanisms of testicular torsion, and examines the current and possible future roles of labwork and radiological imaging in diagnosis. Emergency departments should be wary of younger males presenting with the acute scrotum.

indicates that both authors contributed equally to this paper. Objective• To describe the contemporary patterns of care for renal cell carcinoma (RCC) using a whole of population series from Victoria. Patients and methods• Retrospective review of medical records of all patients diagnosed and treated for RCC in Victoria in 2009. • Patients were identified via the State-wide Victorian CancerRegistry.• Patient demographic characteristics, symptoms, stage, and first-line treatment were assessed.• Associations between case residential location (metropolitan or rural) and treatment were examined using multivariate logistic regression after adjusting for age, sex, socioeconomic status, treatment in private or public hospital and comorbidity. Results• Data were obtained for 499 of 577 eligible patients.• In all, 413 patients (83%) underwent surgery.• Laparoscopic radical nephrectomy (RN) was the most common procedure for Stage I pT1a/pT1b tumours (51.2%); partial nephrectomy (PN) was performed for 27%