We aimed to evaluate the utility of prostate-specific membrane antigen (PSMA) PET/CT for the detection of local disease within the prostate. This is a retrospective review of a single-center experience evaluating intraprostatic detection rates compared with final histopathology in a radical prostatectomy (RP) population. Seventy-two patients had PSMA PET/CT scan performed as part of their primary staging. Intraprostatic PSMA PET/CT avidity was assessed. PSMA PET/CT uptake was retrospectively correlated with patient characteristics including final histopathology, MRI Prostate Imaging Reporting and Data System (PI-RADS) score, clinical tumor stage, prostate-specific antigen (PSA) level, and patient age. The sensitivity of PSMA PET/CT for the detection of RP-confirmed prostate cancer was 81.2%. Much higher sensitivity was found within certain subpopulations. The patient characteristics that most strongly correlated with focal intraprostatic PSMA PET/CT uptake were patient age (Kendall's tau coefficient τb = 0.24, p < 0.05) and clinical T stage (τb = 0.21, p < 0.05). The International Society of Urological Pathology (ISUP) grade group from final RP was predicted by standardized uptake value (SUVmax) and to a lesser extent PSA and the maximal dimension of PET-avid lesions. SUVmax monotonically increased with ISUP grade group. If SUVmax was above 10 g/mL, the final RP histopathology had a relative risk of 2.3 (95% CI 1.3–4.1) of being ISUP grade group 5. This trial provides early evidence that PSMA PET/CT assists in the grading of prostate cancer and suggests that the imaging modality is particularly accurate in subpopulations including the elderly and those with palpable disease.

Objectives: To describe the outcomes and associations of pericardial disease, with a particular focus on the outcomes of patients admitted with primary or secondary pericardial disease. Design: Retrospective observational study. Setting: All public and private hospitals in New South Wales, Australia. Participants: Hospitalised patients with pericardial disease admitted from 2004 to 2021 that was (a) a primary diagnosis or (b) a secondary diagnosis. Measures: Mortality both in-hospital and during several years of available follow-up. Results: Out of 45 446 patients diagnosed with pericardial disease, under half (46.8%) had pericardial disease as the primary reason for hospitalisation. Patients in whom pericardial disease was the primary compared with the secondary diagnosis were more commonly male (68.2% vs 59.1%), younger (median 51.2 years vs 66.0 years) and less comorbid (age-adjusted median Charlson Comorbidity Index 1 vs 4). In patients with pericardial disease, adjusted in-hospital mortality was fivefold lower if this was the primary diagnosis (OR 0.21, p<0.001). Malignancy affected 19% of the population and after adjustment was associated with a much higher in-hospital mortality for patients with a primary (OR 4.33) or secondary diagnosis of pericardial disease (OR 2.67). Other negative prognostic factors included older age, liver disease, chronic kidney disease, pulmonary hypertension, heart failure and chronic obstructive pulmonary disease. Conclusions: Patients with pericardial disease have a low in-hospital mortality of about 1% if this was the primary diagnosis. However, patients in whom it was a secondary diagnosis, especially in the presence of comorbidities such as malignancy, had a much worse prognosis.

Background: Myocarditis is a serious disease that has drawn increasing attention due to its association with COVID-19 and vaccination. This study investigates the epidemiology of myocarditis beyond the COVID-19 pandemic, including its incidence and outcomes over time. Methods: We analyzed the population-wide retrospective data from the Admitted-Patient-Data-Collection database of patients admitted to hospitals in New South Wales (NSW), Australia, with a diagnosis of myocarditis from 2001 to 2022. The incidence of myocarditis, changing classification of myocarditis over time, and complications of myocarditis over time were all calculated. Results: There were 4071 patients diagnosed with their first episode of myocarditis, with a median age of 42 years old, and 66% were male. The incidence of myocarditis in NSW has tripled over 20-years to 8.3 per-100,000-persons by 2022. Reactive myocarditis (i.e., myocarditis within 30-days of a respiratory or digestive illness) accounted for 38% of first presentations of myocarditis. Post COVID-19 myocarditis, a subset of reactive myocarditis, accounted for 42% of myocarditis admissions since the onset of the COVID-19 pandemic in Australia. Eight percent of patients had a background history of malignancy, and 6% had a history of autoimmune disease. In-hospital mortality was 4.5% during the entire study period but has been falling by 11% per year. During follow up, most readmissions for myocarditis occurred within 6-months; with 5.1% recurrence at 6-months compared to only 6.7% at 5-years. Conclusions: Myocarditis is an important condition with increasing incidence in Australia and with markedly changing characteristics in the pandemic and post pandemic era.

Constrictive pericarditis is a rare but serious complication of pericardial disease, with limited longitudinal studies assessing risk factors. We evaluated the epidemiology and predictors of constrictive pericarditis in a large population-based cohort. We conducted a retrospective cohort study of all hospitalized patients with pericardial disease from 2004-2021 using the Australian New South Wales Admitted Patient Data Collection database. Multivariable logistic regression identified risk factors for constrictive pericarditis at index admission with pericardial disease, while time-dependent Cox regression and Fine and Gray's method assessed risk factors during follow-up. Among 45445 patients with pericardial disease, 763 (1.7%) developed constrictive pericarditis (median age 64.3 years; 63.4% male). The median time from cardiac surgery to diagnosis of constriction was 6 months and from autoimmune disease diagnosis was 2 years. Of these, 530 (1.2%) had constriction at index presentation of pericardial disease and 233 (0.5%) developed constriction during follow-up. Constriction at index presentation was associated with older age, malignancy (odds ratio [OR]=1.5, 95% confidence interval [CI]=1.2-1.8), tuberculosis (OR=3.9, 95%CI=1.4-8.9), liver disease (OR=1.7, 95%CI=1.3-2.2) and heart failure (OR=2.7 95%CI=2.2-3.3). Constriction identified during follow up was more common following hospitalization for heart failure (hazard ratio [HR]=5.3, 95%CI=3.4-8.2), non-constrictive recurrent pericardial disease requiring hospitalization (HR=3.7, 95%CI=2.3-6.2) or pericardiocentesis (HR=3.6, 95%CI=2.7-4.8). In this large contemporary cohort, constrictive pericarditis was rare but occurred more commonly after a diagnosis of tuberculosis, malignancy, liver disease, heart failure, recurrent pericardial disease and pericardiocentesis. These findings highlight the importance of long-term vigilance in considering constriction in at-risk populations.