BackgroundEarly detection and treatment of asymptomatic men with advanced and high-risk prostate cancer (PCa) may improve survival rates.ObjectiveTo determine outcomes for men diagnosed with advanced PCa following prostate-specific antigen (PSA) testing who were excluded from the ProtecT randomised trial.Design, setting, and participantsMortality was compared for 492 men followed up for a median of 7.4 yr to a contemporaneous cohort of men from the UK Anglia Cancer Network (ACN) and with a matched subset from the ACN.Outcome measurements and statistical analysisPCa-specific and all-cause mortality were compared using Kaplan-Meier analysis and Cox's proportional hazards regression.Results and limitationsOf the 492 men excluded from the ProtecT cohort, 37 (8%) had metastases (N1, M0 = 5, M1 = 32) and 305 had locally advanced disease (62%). The median PSA was 17 μg/l. Treatments included radical prostatectomy (RP; n = 54; 11%), radiotherapy (RT; n = 245; 50%), androgen deprivation therapy (ADT; n = 122; 25%), other treatments (n = 11; 2%), and unknown (n = 60; 12%). There were 49 PCa-specific deaths (10%), of whom 14 men had received radical treatment (5%); and 129 all-cause deaths (26%). In matched ProtecT and ACN cohorts, 37 (9%) and 64 (16%), respectively, died of PCa, while 89 (22%) and 103 (26%) died of all causes. ProtecT men had a 45% lower risk of death from PCa compared to matched cases (hazard ratio 0.55, 95% confidence interval 0.38–0.83; p = 0.0037), but mortality was similar in those treated radically. The nonrandomised design is a limitation.ConclusionsMen with PSA-detected advanced PCa excluded from ProtecT and treated radically had low rates of PCa death at 7.4-yr follow-up. Among men who underwent nonradical treatment, the ProtecT group had a lower rate of PCa death. Early detection through PSA testing, leadtime bias, and group heterogeneity are possible factors in this finding.Patient summaryProstate cancer that has spread outside the prostate gland without causing symptoms can be detected via prostate-specific antigen testing and treated, leading to low rates of death from this disease.

Training on the portable Integrated Laparoscopic Simulator significantly improved core laparoscopic skills in medical students with no prior experience.

Due to increased sensitivity, the expression of circulating nucleotides is rapidly gaining popularity in cancer diagnosis. Whole blood mRNA has been used in studies on a number of cancers, most notably two separate studies that used whole blood mRNA to define non-overlapping signatures of prostate cancer that has become castration independent. Prostate cancer is known to rely on androgens for initial growth, and there is increasing evidence on the importance of the androgen axis in advanced disease. Using whole blood mRNA samples from patients with prostate cancer, we have identified the four-gene panel of FAM129A, MME, KRT7 and SOD2 in circulating mRNA that are differentially expressed in a discovery cohort of metastatic samples. Validation of these genes at the mRNA and protein level was undertaken in additional cohorts defined by risk of relapse following surgery and hormone status. All the four genes were downregulated at the mRNA level in the circulation and in primary tissue, but this was not always reflected in tissue protein expression. MME demonstrated significant differences in the hormone cohorts, whereas FAM129A is downregulated at the mRNA level but is raised at the protein level in tumours. Using published ChIP-seq data, we have demonstrated that this may be due to AR binding at the FAM129A and MME loci in multiple cell lines. These data suggest that whole blood mRNA of androgen-regulated genes has the potential to be used for diagnosis and monitoring of prostate cancer.

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Introduction The diagnostic and management pathways for patients presenting with acute flank pain are complex. Although computed tomography (CT) of the kidneys, ureters and bladder (KUB) is the gold standard investigation for urolithiasis, the multitude of differential diagnoses must also be considered in the context of long-term risk from ionising radiation. This study investigated the integrated role and diagnostic yield of non-contrast CT in cases of acute flank pain. Methods A retrospective cohort study was undertaken of 1,442 consecutive patients investigated with CT KUB between March 2013 and February 2015. The primary outcome was diagnostic yield of CT with secondary outcomes being predictors of need for urological intervention. Results A cause for acute flank pain was identified in 717 patients (50%), there was an incidental finding in 389 patients (27%) and normal imaging was reported in 336 patients (23%). A diagnosis was more commonly made in male than in female patients (70% vs 40%) and with increasing age (46% in patients aged <30 years, 56% in those aged 30–49 years and 63% in those aged ≥50 years). The overall rate for an ipsilateral urinary tract stone was 41%. Factors strongly associated with emergency intervention included stone size >10mm (odds ratio [OR]: 11.7, 95% confidence interval [CI]: 3.3–42.7), stones located at the pelviureteric junction (OR: 7.8, 95% CI: 2.6–22.9), C-reactive protein >50mg/l and ≤100mg/l (OR: 15.2, 95% CI: 5.1–45.3), and estimated glomerular filtration rate ≤30ml/min (OR: 5.8, 95% CI: 1.5–21.8). Conclusions This contemporary study identifies age and sex as independent variables affecting the diagnostic yield of CT KUB in cases of acute flank pain, and highlights factors associated with a need for emergency intervention in proven ureteric stones.

It has been a dream of the database and Web communities to reconcile the unstructured nature of the World Wide Web with the neat, structured schemas of the database paradigm. Even though databases are currently used to generate Web content in some sites, the schemas of these databases are rarely consistent across a domain. This makes the comparison and aggregation of information from different domains difficult. We aim to make an important step towards resolving this disparity by using the structural and relational information on the Web to (1) extract Web lists, (2) find entity-pages, (3) map entity-pages to a database, and (4) extract attributes of the entities. Specifically, given a Web site and an entity-page (e.g., university department and faculty member home page) we seek to find all of the entity-pages of the same type (e.g., all faculty members in the department), as well as attributes of the specific entities (e.g., their phone numbers, email addresses, office numbers). To do this, we propose a Web structure mining method which grows parallel paths through the Web graph and DOM trees and propagates relevant attribute information forward. We show that by utilizing these parallel paths we can efficiently discover entity-pages and attributes. Finally, we demonstrate the accuracy of our method with a large case study.

IntroductionWe assessed the clinical performance of a new digital single-use flexible ureteroscope (UscopePU3022).Material and methodsA prospective cohort study was carried out across 11 centers (July–Oct. 2017). The UscopePU3022 was assessed regarding ease of insertion; deflection, image quality, maneuverability and overall performance using either a visual analog* or Likert scale.ResultsA total of 56 procedures were performed in 11 centers (16 surgeons) with the indication being renal stones in 83%. The median score for ease of scope insertion was 10 (3–10). Intraoperative maneuverability was rated as ‘good’ in 38% and ‘very good’ in 52%. Visual quality was rated as ‘poor or bad’ in 18%, ‘fair’ in 37% and ‘good or very good’ in 43%. Two scopes failed intraoperatively (4%). Preoperative and postoperative median upward and downward deflection was 270 degrees. Compared to standard flexible ureteroscopy (f-URS) maneuverability was rated as ‘equivalent’ in 30% and ‘better’ in 60%; visual quality was ‘worse’ in 38% and ‘equivalent or better’ in 62%; limb fatigue scores were ‘better’ in 86%; and overall performance was ‘worse’ in 55% and ‘equivalent or better’ in 45%.ConclusionsUscopeTM3022 performed well with regards to maneuverability, deflection and limb fatigue and appears to be at least non-inferior to standard f-URS with regards to these parameters. Poor image quality is a concern for UscopePU3022 with it receiving a low overall performance rating when compared to standard f-URS. Despite this it scored highly when investigators were asked if they would use it in their practice if it was cost-effective to do so.