Objective To describe the outcome, assessed as the level of prostate specific antigen (PSA), of a mature (more than half the events recorded) prospective randomized study with a median follow-up of 82 months of neoadjuvant hormonal therapy before radical prostatectomy, as this has been suggested to decrease the rate of positive surgical margins (i.e. provide greater potential to completely excise the tumour). Patient and methods From December 1991 to March1994, 126 patients with clinically localized prostate cancer were randomized between direct radical prostatectomy or a 3-month course of a gonadotrophinreleasing hormone analogue before surgery. The patients were followed by PSA determinations and a value of > 0.5 ng/mL used to define progression. ResultsThe incidence of positive surgical margins decreased from 45.5% to 23.6% ( P = 0.016) with hormone treatment. Despite this there was no difference in PSA progression-free survival at the last follow-up; it was 51.5% for those undergoing radical prostatectomy only and 49.8% for those who received hormonal pretreatment ( P = 0.588). Conclusions Three months of neoadjuvant hormonal therapy before radical prostatectomy offers no benefit to the patient and cannot be recommended for routine clinical use.

Transrectal ultrasound scan (TRUS) of the prostate was performed on 511 patients, 391 of whom also underwent between 1 and 5 transrectal 1.2 mm core biopsies. The infection rate in the whole group was 4.1%; 32% of the patients were given antibiotic prophylaxis with norfloxacin 400 mg twice daily for 1 week and in this group the infection rate was 0.8%. In the remaining patients, who received 400 mg norfloxacin at the time of biopsy and another 400 mg the same evening, the infection rate was 5.6%. The only risk factor identified for post-biopsy infection was steroid medication. Only minor discomfort (or none at all) was reported by 95% of patients during the examination procedure. If TRUS was combined with core biopsy 92% reported either minor or no discomfort. Of 78 patients who experienced both finger-guided fine needle aspiration biopsy and TRUS-guided core biopsy 82% preferred the latter procedure. TRUS and core biopsy proved acceptable to most patients. Antibiotic treatment with 2 tablets of norfloxacin failed to prevent infection.

RALP was more effective and more costly. A way to improve the cost effectiveness may be to perform RALP at fewer high volume urology centres and utilise the full potential of each robot.

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Cystinuria continues to be one of the most challenging stone diseases. During the latest decades our knowledge of the molecular basis of cystinuria has expanded. Today 160 different mutations in the SLC3A1 gene and 116 in the SLC7A9 gene are listed. The full implications of type A, B or AB status are not yet fully understood but may have implications for prognosis, management and treatment. Despite better understanding of the molecular basis of cystinuria the principles of recurrence prevention have remained essentially the same through decades. No curative treatment of cystinuria exists, and patients will have a life long risk of stone formation, repeated surgery, impaired renal function and quality of life. Therapy to reduce stone formation is directed towards lowering urine cystine concentration and increasing cystine solubility. Different molecules that could play a role in promoting nucleation and have a modulating effect on cystine solubility may represent new targets for cystinuria research. Investigation of newer thiol-containing drugs with fewer adverse effects is also warranted. Determining cystine capacity may be an effective tool to monitor the individual patient's response. Compliance in cystinuric patients concerning both dietary and pharmacological intervention is poor. Frequent clinical follow-up visits in dedicated centres seem to improve compliance. Cystinuric patients should be managed in dedicated centres offering the complete range of minimal invasive treatment modalities, enabling a personalized treatment approach in order to reduce risk and morbidity of multiple procedures.