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PurposeTo systematically review currently available data on 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) used for the primary staging of high-risk prostate cancer.MethodsWe performed critical reviews of EMBASE, Web of Science (including MEDLINE) and Cochrane databases in October 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. We included studies that utilized 68Ga-PSMA PET for primary staging of prostate cancer. Quality was assessed using the Critical Appraisal Skills Programme checklist for diagnostic test studies.ResultsFollowing our systematic search strategy, 12 studies were included for assessment. These studies comprised a total of 322 patients who underwent 68Ga-PSMA PET scanning for the purpose of primary staging. Only 5 of these studies included histopathologic correlation data. High variation in methodology and outcomes such as sensitivity (range 33–99%) and specificity (> 90%) was seen across all studies. The ability of 68Ga-PSMA PET to detect malignant lesions was evident across studies, with most studies demonstrating increased detection rates with respect to conventional imaging modalities.ConclusionsIn the primary staging of prostate cancer 68Ga-PSMA PET appears to outperform traditional imaging modalities. Overall, there are few high-quality studies investigating 68Ga-PSMA PET in this sub-group highlighting the need for formal assessment of PSMA PET in the form of large-volume, prospective studies.

Socioeconomic status (SES), race and geographical factors are known to impact prostate cancer management and outcomes. We aimed to assess these factors with regard to access to novel imaging in prostate cancer. Using the Prostate Cancer Outcomes Registry of Victoria (PCOR-Vic) we identified 5256 men diagnosed with prostate cancer via biopsy. Following the introduction of government rebate, the access to MRI improved with respect to SES. Access to PET imaging remains poor with respect to SES and geographical location in the absence of Federal funding. Further improvements for men with low SES and regional areas to access PET staging.

Background Fluoroquinolone resistance is an issue of concern amongst physicians worldwide. In urology, fluoroquinolones are often used in the treatment of acute pyelonephritis and prostatitis, as well as infections caused by multidrug‐resistant pathogens. Aims We aim to highlight the importance of antimicrobial stewardship and the need for ongoing biomedical research to discover novel agents in our losing battle against resistant pathogens. Materials and methods In this review, we survey the literature and summarise fluoroquinolone resistance as it pertains to pyelonephritis and prostatitis, as well as alternative treatment strategies and prevention of multidrug resistance. Results The rise of fluoroquinolone resistance in bacteria has reduced the available treatment options, often necessitating hospital admission for intravenous antibiotics, which places an additional burden on both patients and the healthcare system. Many countries such as Australia have attempted to limit fluoroquinolone resistance by imposing strict prescribing criteria, though these efforts have not been entirely successful. Solutions to overcome resistance include prevention, combination therapy and the development of novel antimicrobial agents. Conclusions Prevention of the proliferation of resistant organisms by antimicrobial stewardship is paramount, and urologists are obliged to be aware of responsible prescribing practices such as referring to local guidelines when prescribing. By reserving fluoroquinolones for infections in which they are truly indicated and by prescribing based on both patient and local environmental factors, we can preserve this effective resource for future use.

A primary variant of social media, online support groups (OSG) extend beyond the standard definition to incorporate a dimension of advice, support and guidance for patients. OSG are complementary, yet significant adjunct to patient journeys. Machine learning and natural language processing techniques can be applied to these large volumes of unstructured text discussions accumulated in OSG for intelligent extraction of patient-reported demographics, behaviours, decisions, treatment, side effects and expressions of emotions. New insights from the fusion and synthesis of such diverse patient-reported information, as expressed throughout the patient journey from diagnosis to treatment and recovery, can contribute towards informed decision-making on personalized healthcare delivery and the development of healthcare policy guidelines. We have designed and developed an artificial intelligence based analytics framework using machine learning and natural language processing techniques for intelligent analysis and automated aggregation of patient information and interaction trajectories in online support groups. Alongside the social interactions aspect, patient behaviours, decisions, demographics, clinical factors, emotions, as subsequently expressed over time, are extracted and analysed. More specifically, we utilised this platform to investigate the impact of online social influences on the intimate decision scenario of selecting a treatment type, recovery after treatment, side effects and emotions expressed over time, using prostate cancer as a model. Results manifest the three major decision-making behaviours among patients, Paternalistic group, Autonomous group and Shared group. Furthermore, each group demonstrated diverse behaviours in post-decision discussions on clinical outcomes, advice and expressions of emotion during the twelve months following treatment. Over time, the transition of patients from information and emotional support seeking behaviours to providers of information and emotional support to other patients was also observed. Findings from this study are a rigorous indication of the expectations of social media empowered patients, their potential for individualised decision-making, clinical and emotional needs. The increasing popularity of OSG further confirms that it is timely for clinicians to consider patient voices as expressed in OSG. We have successfully demonstrated that the proposed platform can be utilised to investigate, analyse and derive actionable insights from patient-reported information on prostate cancer, in support of patient focused healthcare delivery. The platform can be extended and applied just as effectively to any other medical condition.

The South West Oncology Group’s 2000 randomised-control trial investigated the addition of maintenance intravesical bacillus Calmette-Guerin (BCG) to non-muscle invasive urothelial carcinoma (NMIUC) treatment. The results were published when the efficacy of BCG immunotherapy maintenance was unclear. Randomisation produced two arms, each containing 192 patients assessed to be at high risk of recurrence following induction BCG therapy for NMIUC. The treatment arm went on to receive three successive weekly intravesical and percutaneous BCG administrations at three months, six months and then six monthly for three years from the start of induction therapy. Recurrence free-survival (RFS), was higher in the maintenance arm with 41% (95%CI 35–49) RFS at five years in the control arm and 60% RFS (53–67 95% CI) in the maintenance arm ( p  < 0.0001). Only 16% of patients in the treatment arm received all of the scheduled maintenance courses of BCG. The study’s seminal results correlate with contemporary systematic review and have guided international guidelines.

Objective To evaluate via a review of published literature, the efficacy of endoluminal ultrasound (ELUS) and optical coherence tomography (OCT) in the following ureteric diseases: urolithiasis, upper tract urothelial carcinoma, stricture disease and pelvic‐ureteric junction obstruction (PUJO). Patients and methods Ureteric high‐frequency ELUS provides 360° imaging, to a depth of 20 mm, and has been demonstrated to assess ureteric stricture length, degree of fibrosis and aetiology. OCT produces high‐quality images with a penetration depth of 2 mm. ELUS has proven to be useful at the time of endopyelotomy for PUJO as it can identify crossing vessels, some not detectable on CT angiography, allowing the urologist to avoid these when making their incision. Ureteric ELUS may be utilised for submucosal ureteric stones as they are highly visible. Endoluminal ultrasound may be deployed in the case of known sub‐mucosal urolithiasis when the ureter appears stone‐free. It may help identify sub‐mucosal stones or stones within diverticulum. Results Endoluminal ultrasound has been analysed for its use in determining muscle‐invasive urothelial carcinoma of the ureter. The PPV for ≥pT2 was only 16.7% in one study of six patients with MIBC and 76.2% in 21 patients with

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