Introduction: Accurate grading at the time of diagnosis is fundamental to risk stratification and treatment decision making, particularly for men being considered for Active Surveillance (AS). With the introduction of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) there has been considerable improvement in sensitivity and specificity for the detection and staging of clinically significant prostate cancer. Our study aims to determine the role of PSMA PET/CT in men with newly diagnosed low or favourable intermediate risk prostate cancer to better select men for AS. Method: This is a retrospective single centre study performed from January 2019 and October 2022. This study includes men identified from electronic medical record system who had undergone a PSMA PET/CT following newly diagnosed low or favourable-intermediate risk prostate cancer. Primary outcome was to assess the change in management for men being considered for AS following PSMA PET/CT results on the basis of PSMA PET characteristics. Results: In total, there were 11 of 30 men (36.67%) who were assigned management by AS and 19 of 30 men (63.33%) who had definitive treatment. 15 of the 19 men that needed treatment had concerning features on PSMA PET/CT results. Of the 15 men with concerning features on PSMA PET, 9 (60%) men were found to have adverse pathological features on final prostatectomy features. Conclusion: This retrospective study suggests that PSMA PET/CT has potential to influence the management of men with newly diagnosed prostate cancer that would otherwise be appropriate for active surveillance.

This report describes a unique case of an 89-year-old-male who presented with a right psoas abscess and new erosive changes in the L3/L4 vertebral bodies. This is on a background of non muscle invasive bladder cancer (NMIBC) for which he received intravesical Bacillus Calmette-Guerin (BCG). Pott's disease is a rare complication of BCG therapy and there is paucity of data about the risk factors for systemic spread of intravesical BCG.

Jain A, et al. World J Mens Health. 2024 Aug;42:e72. https://doi.org/10.5534/wjmh.230216

Objective: Transperineal prostate (TP) biopsy is the key diagnostic tool for evaluating prostate cancer and is feasible under local anaesthetic (LA) alone. However, concerns about its tolerability encourage use of a multimodal analgesia approach. Pre-emptive over-the-counter analgesia with LA may provide a simple and low-risk option. The objective of this study was to investigate the effects of over-the-counter analgesia on TP biopsies conducted under LA. Methods: This interventional single-centre study investigated 160 participants who undertook a TP biopsy under LA, with and without pre-emptive analgesia (1 g of paracetamol and 400 mg of ibuprofen). Pain tolerability was measured using a visual analogue scale (VAS) at three procedural points (probe insertion, LA infiltration, and biopsy); an overall average VAS score was subsequently calculated. The abstracted secondary variables include patient details (age, prostate size, and PSA level), biopsy details (number of cores and volume of LA used), and preferability for LA use in future TP biopsies. An inferential statistical analysis was performed using Wilcoxon’s Rank Sum non-parametric test, Pearson’s test of correlation, and Pearson’s Chi-squared test. Results: The groups were comparable in age, prostate size, and PSA level. Median VAS scores were consistently lower in the intervention cohort, but without statistical significance. A higher volume of LA was associated with lower overall VAS (p = 0.03). LA was strongly preferred over GA for hypothetical future TP biopsies in both cohorts. Conclusions: Pre-emptive analgesia does not significantly improve tolerability of TP biopsy under LA. Our study substantiates evidence that TP biopsy is generally well tolerated under LA and preferred over GA.

Upper Tract Urothelial Carcinomas (UTUC) are generally uncommon, accounting for approximately 5% of all urinary tract tumours. This report describes a unique Case of a 52-year-old-male with no known risk factors or symptoms of UTUC, who presented with bilateral sub-massive pulmonary embolus (PE). Subsequent computed tomography (CT) demonstrated a small (<2cm) right cortical based mass a discordant venous tumour thrombus (VTT) extending in the IVC, up to the level of the hepatic vein and bilateral renal veins. The patient had surgical excision in the form of right radical nephroureterectomy, IVC resection with bovine pericardial graft reconstruction and left renal autotransplant.