Background Multi-parametric MRI (mp-MRI) has the potential to serve as a non-invasive triage test for men at risk of prostate cancer. Our objective was to determine the performance characteristics of multi-parametric MRI (mpMRI) in men at risk prior to first biopsy using 5mm template prostate mapping (TPM) as the reference standard. Methods One hundred and twenty nine consecutive men with clinical suspicion of prostate cancer that had no prior biopsy, underwent mpMRI (T1/T2-weighted, diffusion-weighting, dynamic-contrast enhancement) followed by TPM. The primary analysis used: a) radiological scores of suspicion of ≥3 attributed from a 5-point ordinal scale, b) a target condition on TPM of any Gleason pattern ≥4 and/or a maximum cancer core length of ≥4mm and c) two sectors of analysis per prostate (right and left prostate halves). Secondary analyses evaluated the impact of: a) changing the mpMRI score threshold to ≥4 and b) varying the target definition for clinical significance. Results 141/258 (55%) sectors of analysis showed “Any cancer”; 77/258 (30%) had the target histological condition for the purpose of deriving the primary outcome. Median (with range) for age, PSA, gland volume and number of biopsies taken were 62 years (−41-82), 5.8ng/ml (1.2-20), 40ml (16-137) and 41 cores (20-93). For the primary outcome sensitivity, specificity, positive and negative predictive values and area under the receiver operating curve (with 95% CI) were 94% (88-99%), 23% (17-29%), 34% (28-40%), 89% (79-98%) and 0.72 (0.65-0.79), respectively. Conclusion MpMRI demonstrated encouraging diagnostic performance characteristics in detecting and ruling-out clinically significant prostate cancer in men at risk who were biopsy naive.

PurposeTo assess the performance of multiparametric magnetic resonance imaging (mp-MRI) in patients with previous negative transrectal ultrasound (TRUS) guided prostate biopsy.Materials and methodsFifty-four patients with at least 1 previous negative TRUS prostate biopsy underwent mp-MRI in the form of T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging. This was followed by transperineal template systematic prostate biopsies. Analysis was done based on 2 sectors per prostate, right and left (108 sectors out of 54 prostates). mp-MRI was scored using an ordinal scale 1 to 5 based on the suspicion of the presence of clinically significant disease. We used 6 different definitions for clinically significant disease and tested the performance of mp-MRI at each single definition.ResultsMedian age was 64 (range, 39–75), median PSA level was 10 (range, 2–23), and median number of biopsies was 45 (range, 21–137). Cancer of any volume and any grade was detected in 34 of 54 (63%) patients. mp-MRI accuracy at detection of clinically significant cancer using University College London (UCL) definition 2 (any Gleason score of 4 or maximum cancer core length of ≥4 mm or both) showed sensitivity of 76%, specificity of 42%, positive predictive value of 38%, and negative predictive value of 79%. For a different definition of significant tumor (UCL definition 1; dominant Gleason score 4 or maximum cancer core length ≥6 mm or both), the sensitivity was 90%, specificity 42%, positive predictive value 26%, and negative predictive value 95%.Conclusionsmp-MRI showed good performance at both detection and ruling out clinically significant disease, according to the definition used. mp-MRI can then be used as a triage test in the population with persistently elevated or rising PSA levels to select patients that can avoid unnecessary prostate biopsy.

Objectives: To investigate the complication rate within 30 days after transrectal ultrasound-guided biopsy of the prostate in England, and to examine associated risk factors. Methods: A population-based study was carried out using the English cancer registry linked to administrative hospital data. We included men aged 45 years and older diagnosed with prostate cancer between 2000 and 2008. A complication was considered to have occurred if men had been admitted to hospital as a result of urological causes (urinary tract infection/sepsis, hematuria and urinary retention) within 30 days of the transrectal ultrasound-guided biopsy of the prostate. Multivariable logistic regression was carried out to estimate odds ratios, reflecting the impact of risk factors on the complication rate. Results: Of the 198 361 included men, 69% were aged between 65 and 84 years. The 30-day complication rate was 3.7% (1.1% for urinary tract infection/sepsis, 1.4% for hematuria and 1.3% for urinary retention). The most important risk factors were age above 85 years (odds ratio 3.85, 95% confidence interval 3.18-4.67, compared with age below 55 years) and three or more comorbidities (odds ratio 3.50, 95% confidence interval 3.17-5.87, compared with no comorbidity). The overall complication rate increased over time (odds ratio 1.20, 95% confidence interval 1.08-1.34, 2008 compared with 2000), as did the complication rate as a result of urinary tract infection/sepsis (odds ratio 1.72, 95% confidence interval 1. 41-2.10, 2008 compared with 2000). Conclusions: There has been an increase in the complication rate after transrectal ultrasound-guided biopsy of the prostate in England between 2000 and 2008, predominantly as a result of infections. Age and comorbid conditions seem to represent the two most important risk factors for occurrence of post-biopsy complications.

Since the first partial nephrectomy was first conducted 131 years ago, the procedure has evolved into the gold standard treatment for small renal masses. Over the past decade, with the introduction of minimally invasive surgery, open partial nephrectomy still retains a valuable role in the treatment of complex tumours in challenging clinical situations (e.g. hereditary renal cancer or single kidneys), and enables surgeons to push the boundaries of nephron-sparing surgery. In this article, we consider the origin of the procedure and how it has evolved over the past century, the surgical techniques involved, and the oncological and functional outcomes.

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Posing the right research question is essential for consolidating your ideas from something that has piqued your interest into a focused, clinically relevant and achievable piece of research. This question should lead to results that can impact upon patient benefit by addressing a gap in your field, such as understanding the molecular basis of disease, developing biomarkers and diagnostics to improving established or identifying novel treatments. The question needs to be clear and precise in order to address a specific issue and to produce meaningful results. In this article we provide guidance on how to refine your initial idea to frame a research question by considering current knowledge, clinical utility and feasibility.

Objectives: The aim was to compare prostate cancer and all-cause mortality in patients diagnosed with prostate cancer following a transurethral resection of the prostate (TURP) (incidental prostate cancer, IPC), to men diagnosed with localised non-incidental prostate cancer (NIPC). Patients and methods: Men diagnosed with localised prostate cancer between 2000 and 2008 were identified from the English national cancer registry. Their records were linked to the Hospital Episode Statistics (HES) database of hospital admissions in England to identify men who had a TURP. Men were considered to have IPC if prostate cancer was diagnosed less than 60 days after TURP. Mortality rates were calculated using the Kaplan-Meier method. Mortality rate ratios (RR) comparing IPC and NIPC were calculated with multivariable Poisson regression adjusting for age group, co-morbidities, year of diagnosis and radical treatment. Results: A total of 192,960 men were included. Of these, 6666 (3.5%) had IPC and 186,294 (96.5%) NIPC. Median followup was 4.7 years (0.5-11.0). Ten-year prostate cancer mortality was 17.1% in IPC, 19.0% in NIPC. With adjustment, the prostate cancer-specific mortality in IPC was 30% lower than NIPC (RR 0.70, 95% CI 0.65-0.75, p<0.001), with no difference in all-cause mortality. Conclusion: Ten-year prostate cancer mortality in IPC was 17%. Men with IPC had lower prostate cancer-specific mortality than other prostate cancer patients.

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