Most multiple sclerosis (MS) patients experience some sexual, bladder and/or bowel dysfunction during the course of the disease--one of MS most disabling features. This study estimated the frequency of these problems among patients, two to five years after diagnosis, and investigated how these problems are associated with health-related quality of life (using the Multiple Sclerosis Quality of Life-54 questionnaire). The study population comprised a cohort of patients (n = 56), diagnosed in a three-year period, in Hordaland County, Norway. The patients were examined clinically, including scoring of the Expanded Disability Status Scale (EDSS), and completed questionnaires related to bowel and bladder dysfunction, sexual problems and health-related quality of life. More than half the patients had bladder and sexual problems. The frequency of self-reported bladder problems corresponded to the relatively high levels of residual urine found. The presence of these problems was associated with lower scores on the quality of life scales. Further, the bowel problems reported were markedly associated with the quality of life scores. Since treatments and preventive strategies can manage many of these problems, we suggest increasing the focus on these aspects of the disease when consulting patients, including at early stages.

Objective• To evaluate the performance of real-time elastography (RTE) in an initial biopsy setting. Patients and Methods• In the period from February 2011 to June 2012, 127 consecutive patients were included in the study.• We used a Hitachi Preirus with Hi-RTE module, a prostate end-fire transrectal probe was used for RTE and for targeted biopsies, and a simultaneous biplane probe was used for the standard systematic biopsies.• The peripheral zone of the prostate was divided into six regions, and each biopsy obtained was referred to a specific region.• All patients were first examined with RTE and, if cancer was suspected, targeted biopsies were taken. A standard systematic 10-core biopsy was then taken in all patients. Results• In all, 64 (50%) patients were diagnosed with prostate cancer in the initial biopsy setting. Three patients were diagnosed solely on RTE-targeted biopsies, 31 were found only in systematic biopsies, and 30 were correctly diagnosed with both methods.• In the RTE-positive group there was a significantly higher frequency of positive cores, a lower prostate volume, a higher Gleason score, and a higher fraction of cancer tissue in each core.• In a multiple regression model RTE was an independent marker for high-risk cancer.• The sensitivity of 42% for all prostate cancers increased to 60% for high-grade prostate cancers.• Similarly, the negative predictive value increased from 79% to 97%. An additional eight patients were diagnosed with prostate cancer during the study period. Conclusions• A positive RTE is an independent marker for detection of high-risk prostate cancer, and a negative RTE argues against such.• RTE with targeted biopsies cannot replace systematic biopsies, but provides valuable additional information about the tumours.

OBJECTIVETo evaluate the long-term effects, including durability, of interstitial laser coagulation (ILC) in patients with symptomatic benign prostatic hyperplasia. PATIENTS AND METHODSIn all, 49 men (median age 68 years, range 52-80) were treated with ILC; 22 men were assessed for a median (range) of 54 (46-61) months. Information on the timing and type of re-treatment were collected for the remaining patients. RESULTSThe median (quartiles) International Prostate Symptom Score decreased from 22 (19-28) at baseline to 13 (5-21), a decrease of 41%. The peak urinary flow increased by 20% to 10.2 (8.7-12.9) mL/s. Twenty-two patients were re-treated (by any type) after ILC, giving a re-treatment rate of 50%. CONCLUSIONThere were moderate effects on voiding variables and a high re-treatment rate during the long-term follow-up after ILC. It seems reasonable that the use of ILC is restricted to selected, high-risk patients.

The combination of PCA3 score and RTE detected 97% of significant prostate cancers. The combinative use of RTE and PCA3 will be further investigated in an unselected series of men with suspected prostate cancer.

BackgroundThe standard of care in patients with suspected prostate cancer (PCa) is systematic prostate biopsies. This approach leads to unnecessary biopsies in patients without PCa and also to the detection of clinical insignificant PCa. Better tools are wanted. We have evaluated the performance of real-time elastography (RTE) combined with prostate cancer gene 3 (PCA3) in an initial biopsy setting with the goal of better identifying patients in need of prostate biopsies.Methods127 patients were included in this study; three were excluded because of not measureable PCA3 score leading to 124 evaluable patients. A cut-off value of 35 was used for PCA3. All patients were examined with a Hitachi Preirus with an endfire probe for RTE, a maximum of five targeted biopsies were obtained from suspicious lesions detected by RTE. All patients then had a 10-core systematic biopsy performed by another urologist unaware of the RTE results. The study includes follow-up data for a minimum of three years; all available histopathological data are included in the analysis.ResultsThere was a significant difference in PCA3 score: 26.6 for benign disease, 73.6 for cancer patients (p < 0.001). 70 patients (56 %) were diagnosed with prostate cancer in the study period, 21 (30 %) low-risk, 32 (46 %) intermediate-risk and 17 (24 %) high-risk. RTE and PCA3 were significant markers for predicting intermediate- and high-risk PCa (p = 0.001). The combination of RTE and PCA3 had a sensitivity of 96 % and a negative predictive value (NPV) of 90 % for the group of intermediate- and high-risk PCa together and a NPV for high-risk PCa of 100 %. If both parameters are positive there is a high probability of detecting intermediate- or high-risk PCa, if both parameters are negative there is only a small chance of missing prostate cancer with documented treatment benefit.ConclusionsRTE and PCA3 may be used as pre-biopsy examinations to reduce the number of prostate biopsies.

We report on one-year results after transurethral microwave thermotherapy (TUMT) in patients with symptoms due to benign prostatic hyperplasia (BPH). The material consists of 91 cases, treated with the PRIMUS U + R device in a single, one-hour out-patient procedure. The International Prostate Symptom Score (I-PSS), S, fell from baseline 23 (17-27) to 12 (7-18.8), quality of life assessment, L, improved from 4 (3-5) to 2 (1-3) and peak urinary flow increased from 9.6 +/- 0.3 to 11.1 +/- 0.4 (ml/sec) after one year. No changes in postvoiding residuals were observed. Sixty five per cent of the patients were assessed as responders to the treatment. Complications were urinary retention and bacteriuria. Neither enlargement of prostate nor a prominent median lobe, seem to be predictors of subjective outcome. TUMT appears to be a safe and, in the majority of patients, effective measure to relieve symptoms due to BPH.

Tumour stage and a high level of serum VEGF were predictors for an increased risk of recurrence and cancer-specific death. Furthermore, the study showed that serum VEGF may be used to determine the subtype of RCC preoperatively.

The most important reason for referring patients to our specialist clinic was elevated PSA, often detected by means of opportunistic PSA screening. This study shows the effect of PSA testing in real-life practice.