3 5 9What ' s known on the subject? and What does the study add? Fournier ' s gangrene (FG) is a rare but life-threatening disease challenging the treating medical staff. Despite the fact that antibiotic therapy combined with surgery and intensive care surveillance are performed as standard treatment, mortality rates remain high. There have been efforts to develop a reliable tool to predict severity of the disease, not only to identify patients at highest risk of major complications or death but also to provide a target for medical teams and researchers aiming to improve outcome and to gather information for counselling patients. Laor et al . published the FG severity index (FGSI) in 1995 presenting a complex prediction score solely for patients with FG. Fifteen years later, Yilmazlar et al . suggested a new and supposedly more powerful scoring system, the Uludag FGSI (UFGSI), adding an age score and an extent of disease score to the FGSI.In the present study population we applied two scoring systems for outcome prediction that are solitarily applicable in patients with FG (FGSI, UFGSI), as well as two general scoring systems such as the established age-adjusted Charlson Comorbidity Index (ACCI) and the recently introduced surgical Apgar Score (sAPGAR) to compare them and to test whether one system might be superior to the other. In addition, we identifi ed potential prognostic factors in the study population. By contrast to many earlier studies, we performed a combined prospective and retrospective analysis and provided a 30-day follow up. In the cohort of the present study, older patients with comorbidities as well as a need for mechanical ventilation and blood transfusion are at higher risk of lethal outcome. All scores are useful to predict mortality. Despite including more variables, the UFGSI does not seem to be more powerful than the FGSI. In daily routine we suggest applying ACCI and sAPGAR, as they are more easily calculated, generally applicable and well validated. OBJECTIVE PATIENTS AND METHODS• In all, 44 patients were analysed. The scores were applied.• A Mann -Whitney U -test, Fisher ' s exact test, receiver operator characteristic (ROC) analysis and Pearson correlation analysis were performed. RESULTS• The results of the present study show a signifi cant association among FGSI ( P = 0.002), UFGSI ( P = 0.002), ACCI ( P = 0.004), sAPGAR ( P = 0.018) and death.• The differences between the area under the receiver operating characteristic curve of the scores were not signifi cant.• Non-survivors were older ( P = 0.046), had a greater incidence of acute renal failure ( P < 0.001) and coagulopathy ( P = 0.041), were treated more often with mechanical ventilation ( P = 0.001) and received more packed red blood cells (RBCs; P = 0.001). CONCLUSION• Older patients with comorbidities and need for mechanical ventilation and RBCs are at higher risk for death.• In the present cohort, scores calculated easily at the bedside, such as ACCI and sAPGAR, seemed to be as good at predicting outcome in patients with F...

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Sensitivity to visualize and detect prostate cancer improved using real-time elastography in addition to gray scale ultrasound during prostate biopsy. Overall sensitivity did not reach levels to omit a systematic biopsy approach.

Patients with neuroendocrine tumors benefit from neoadjuvant chemotherapy, as evidenced by better overall survival and lower rates of non-organ-confined disease at the time of RC. For tumors with micropapillary differentiation, sarcomatoid differentiation, or adenocarcinoma, neoadjuvant chemotherapy decreased the frequency of non-organ-confined disease at the time of RC. However, this favorable effect did not translate into a statistically significant overall survival benefit for these patients, potentially due to the aggressive tumor biology. Cancer 2017;123:4346-55. © 2017 American Cancer Society.

An OM benefit was observed among men who traveled long distances for PCa treatment, which is likely to be a reflection of centralization of care and more favorable patient-level characteristics in those travelers. Furthermore, the survival benefit mediated by long travel distances appears to be influenced by baseline socioeconomic, treatment, and facility-level factors. Cancer 2017;123:3241-52. © 2017 American Cancer Society.

Perfusion patterns of prostate cancer suspicious elastographic lesions are heterogeneous. However, the combined approach of real-time elastography and contrast enhanced ultrasound in this pilot study significantly decreased false-positive results and improved the positive predictive value of correctly identifying histopathological cancer.

Magnetic resonance imaging/transrectal ultrasound fusion enhances the likelihood of detecting clinically significant cancers in a repeat biopsy setting. Adding real-time elastography to magnetic resonance imaging supports the characterization of cancer suspicious lesions.

RESULTS• Histopathologically, PCa was confirmed in 894 out of 1374 (61.8%) evaluated sectors and ECE was identified in 47 (21%) patients.• Of these 894 sectors, RTE correctly detected 594 (66.4%) and GSU 215 (24.0%) cancer suspicious lesions.• Sensitivity was 51% and specificity 72% using RTE compared to 18% and 90% for GSU.• RTE identified the largest side specific tumour focus in 68% of patients.• ECE was identified with a sensitivity of 38% and specificity of 96% using RTE compared to 15% and 97% using GSU. CONCLUSIONS• Compared with GSU, RTE provides a statistically significant improvement in detection of PCa lesions and ECE.• RTE enhances GSU, although improvement is still needed to achieve a clinically meaningful sensitivity. KEYWORDSelastography, prostate cancer, staging, ultrasonography, extracapsular extension, index lesion What's known on the subject? and What does the study add? Current studies evaluating real-time elastography in patients prior to radical prostatectomy reported sensitivities between 57% and 100% for detection of prostate cancer. This is the first prospective study comparing the findings of real-time elastography and conventional gray-scale ultrasound with final pathology. A significant improvement for cancer detection as well as detection of extra capsular is shown by adding the attributes of tissue elasticity to current gray-scale imaging.Study Type -Diagnostic (exploratory cohort) Level of Evidence 2b OBJECTIVE• To evaluate whether transrectal real-time elastography (RTE) improves the detection of intraprostatic prostate cancer (PCa) lesions and extracapsular extension (ECE) compared with conventional grey-scale ultrasonography (GSU). PATIENTS AND METHODS• In total, 229 patients with biopsy-proven PCa were prospectively screened for cancer-suspicious areas and ECE using GSU and RTE.• The largest tumour focus detected by RTE was defined as the index lesion.• The prostate gland was stratified into six sectors on GSU and RTE, which were compared with histopathological whole mount sections after radical prostatectomy.