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.