Xanthogranulomatous pyelonephritis is associated with obstruction, stones and infection. CT is the mainstay of diagnosis, but appearances can mimic other conditions, including renal cell carcinoma. Nephrectomy is commonly recommended, but conservative treatment with antibiotics has been described after tissue diagnosis. We present a case of xanthogranulomatous pyelonephritis with concomitant renal cell carcinoma, which was an association that was suggested in 1988 and supported by subsequently reported cases. Conservative management of biopsy or cytology proven xanthogranulomatous pyelonephritis is unsafe, as an area of synchronous malignant tumour may be missed: we recommend it only in patients unfit for nephrectomy.
Nomograms produce useful information regarding risk of disease; however, they often have not been validated on different populations. Risk predictions need to be considered carefully and treatment decisions were made on a patient specific basis.
An 80-year-old man with history of prostate cancer successfully treated with brachytherapy was initially thought to have Fournier’s gangrene until imaging detected a rectoprostatic fistula. Although this is known to be a rare complication of prostate brachytherapy, in this case the aetiology was a new primary rectal adenocarcinoma. It was not possible to catheterise per urethra owing to the fistula, so he was fitted with suprapubic catheter, and underwent palliative loop colostomy. Brachytherapy carries a low risk of second primary cancers, although two previous cases reported such cancers as radiation induced. This is, to our knowledge, the first case of rectal adenocarcinoma following prostate brachytherapy in the literature.
Objectives: This study aimed to determine the diagnostic accuracy of bi-parametric magnetic resonance imaging (bpMRI) for clinically significant (CS) prostate cancer (PCa), and to assess the suitability of a new diagnostic pathway using bpMRI and prostate-specific antigen density (PSAd) to determine the need for biopsy. Methods: A total of 386 patients referred to one UK cancer centre with suspected PCa across 12 months from 2017 to 2018 underwent bpMRI, with a Prostate Imaging Reporting and Data System (PIRADS) score assigned. Of these, 266 (69%) were biopsied, with 150 CS-PCa (a Gleason score of 7 or a Gleason score of 3 with core length ⩾5 mm) detected: a 57% diagnostic yield. Imaging, PSAd and biopsy results were collated, and a confusion matrix was calculated. Results: Twenty-three men with PIRADS 1 were biopsied, with two CS-PCa detected: PSAd M=0.19 ( SD=0.07). Twenty-one men with PIRADS 2 lesions were biopsied, with one CS-PCa detected: PSAd was 0.28. Seventy-five men with PIRADS 3 were biopsied, with 25 CS-PCa detected: PSAd M=0.26 ( SD=0.16). Fifty-seven men with PIRADS 4 were biopsied, with 46 CS-PCa detected: PSAd M=0.26 ( SD=0.16). Ninety men with PIRADS 5 were biopsied, with 83 CS-PCa detected: PSAd M=0.55 ( SD=0.63). Among the 266 biopsied patients, a pathway offering biopsy if PIRADS is ⩾3 or PSAd ⩾0.1 spares 11 (4.2%) biopsies compared to baseline practice, with a sensitivity of 100% and a specificity of 10.1%, for biopsy-detected CS-PCa. The diagnostic yield is 61.8%. Conclusion: BpMRI is comparable to multi-parametric MRI for assessing need for biopsy in suspected PCa, albeit with lower specificity. A diagnostic pathway using bpMRI and PSAd can be safely used to avoid biopsy in men at low risk, increasing diagnostic yield of biopsy while reducing overdiagnosis and avoiding the risks and costs associated with gadolinium contrast. Level of evidence: Level 4.
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