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PIRADS-3 lesions and clinically significant prostate cancer – what are we missing?
The use of pre-biopsy MRI has definitely enhanced our decision making in managing patients with suspected prostate cancer (PCa). There is still uncertainty around the outcomes for patients with PIRADS-3 lesions, with a small but definite risk of missing clinically...Prostate cancer management 1 – non-metastatic disease
You are referred a 68-year-old gentleman to the rapid access prostate clinic with a serum prostate specific antigen (PSA) of 12ug/L. He is otherwise fit and well with mild voiding lower urinary tract symptoms (LUTS). He undergoes a multi parametric...
Long-term oncologic outcomes of salvage cryoablation for rrPC
Of patients undergoing radiotherapy (RT) for prostate cancer (PC), at least 15-20% will experience recurrence. Although salvage prostatectomy achieves durable oncological outcomes at 10 years, it is associated with significantly high morbidity. Thus, the majority of men with radio-recurrent prostate...
Characteristics of APC and the usefulness of MP-MRI for diagnosis
The authors evaluated the pathological and oncological characteristics of anteriorly located prostate cancer (APC) in 728 RP specimens, and the accuracy of multiparametric magnetic resonance imaging (MP-MRI) for APC evaluation. Patients were characterised as APC (70% or more of tumour...
All biochemical recurrences are equal, but some are more equal than others
Despite significant technological advancements, radical prostatectomy (RP) and radiotherapy (RT) are not always effective in curing localised prostate cancer (PCa). Many patients experience a rise in prostate-specific antigen (PSA), known as biochemical recurrence (BCR), leading to considerable anxiety and a...
Preoperative risk stratification of high-risk prostate cancer patients
High-risk prostate cancer (HRPCa) is associated with a significant risk of recurrence after radical treatment. While several classification systems exist, the D’Amico criteria – based on clinical T stage ≥T2c, prostate specific antigen (PSA) ≥20 ng/mL, or Gleason score (GS)...Focal therapy for prostate cancer – ready for prime time?
The current therapeutic ratio for radical therapy in many men with localised prostate cancer is not ideal. For a significant side-effect profile, there seems to be a small survival benefit over a 10-15 year period. A strategy that might balance...Developing a core outcome set for male fertility trials
Advances in fertility treatment since in vitro fertilisation was pioneered by Edwards and Steptoe, cumulating in the birth of Louise Brown in 1978, have been nothing short of remarkable [1]. Since then, a myriad of treatments has been developed for...The PROMIS trial – time for multi-parametric MRI before a first prostate biopsy
Whilst the relatively random process of 12 core transrectal ultrasound guided (TRUS) prostate biopsy remains by far the most widely employed approach to prostate cancer diagnosis in the UK, its flaws as a standalone diagnostic strategy are increasingly apparent. TRUS-biopsy...Use of MRI in the evaluation of prostate cancer: part 2
Diffusion weighted imaging and contrast enhanced imaging Introduction Magnetic resonance imaging (MRI) is widely used in localisation, staging and post-treatment follow-up of prostate cancer. In the previous issue, we discussed the usefulness of MRI in depicting prostate anatomy and pairing...
Adjustable Transobturator Male System® as a novel treatment for men with stress urinary incontinence
Stress urinary incontinence (SUI) in men is a debilitating condition, often occurring after prostate cancer surgery, with an incidence ranging from 4% to 40%. Key predictors of SUI post-prostatectomy include age, body mass index (BMI), comorbidity index, lower urinary tract...
