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Prostate cancer is the second most frequently diagnosed cancer among men worldwide, and it represents a substantial worldwide health issue, primarily impacting men as they grow older. Understanding its epidemiology and etiology is crucial for crafting efficient preventive measures and enhancing treatment results. The epidemiology of this disease provides valuable insights into its prevalence and distribution. Age is a critical factor, with the risk of prostate cancer increasing with advancing years. Incidence rates are notably higher in developed countries, suggesting a role for lifestyle and environmental factors. Furthermore, there are significant racial and geographical disparities in prostate cancer incidence, with African-American men experiencing both a higher incidence and more aggressive forms of the disease. On the other hand, hormones, especially testosterone and its conversion to dihydrotestosterone (DHT), contribute to prostate cell growth and, potentially, cancer. Genetics also plays a pivotal role, with certain gene mutations, like Breast Cancer gene 1 & 2 (BRCA1 and BRCA2), elevating risk. Dietary habits and lifestyle choices influence susceptibility, with diets low in fruits and vegetables and high in saturated fats linked to higher risk. Chronic inflammation, often tied to prostatitis, may further increase susceptibility to prostate cancer. This review article explores the complex realm of prostate cancer, providing insights into its occurrence, factors that elevate risks, and the fundamental factors that play a role in its emergence and how we can prevent it.

Background Pulmonary metastasectomy was performed in the early twentieth century and ever since, it has evolved to be one of the main treatment options for certain metastatic malignancies. The advancement of minimally invasive procedures enabled new techniques to minimize morbidity and improve patient quality of care and overall outcome. Cases presentation Herein we present three patients, aged 53, 48, and 27 years, known to have sigmoid, rectal, and non-seminomatous germ cell tumors respectively. All patients were diagnosed to have metastatic lung nodules and underwent laparotomy to excise abdominal tumors followed by trans-diaphragmatic single-port video-assisted thoracoscopic pulmonary metastasectomy. All patients achieved complete surgical tumor excision, and none had pulmonary related complications on follow-up. Conclusion Our prescribed novel trans-diaphragmatic single-port video-assisted thoracoscopic surgery (VATS) technique for synchronous pulmonary metastasectomy and intra-abdominal tumor resection is safe and can achieve complete resection with negative margins.

Durability-related deterioration in concrete is primarily an expansive mechanism which is tensile in nature. The accurate tensile strength of concrete is hence useful in the prediction of the initial and the residual periods of service of concrete structures. The splitting tensile strength test method (standard: ASTM C496) is traditionally used in the assessment of the tensile strength of concrete; however, the test method provides limited useful information on concrete durability. This research studies a newly developed pressure tensile strength test method designed to obtain quantified tensile strength values while also providing information on concrete durability.Experimental work was performed to study the effect of various durability parameters on the pressure tensile strength test method for concrete. Sensitivity analyses were performed to quantify the effect of various void ratios, moisture contents, and water-to-cement ratios (W/C) on the results of the pressure tensile strength test. In addition to destructive pressure tensile (PT) strength testing, specimens were tested nondestructively using surface resistivity (SR) and ultrasonic pulse velocity (UPV) and were tested destructively for strength in splitting tension (ST) and compression (CO) and for permeable void ratio (PVR). Relationships were evaluated between the aforementioned test results, as well as with temperature, W/C, void ratio, and moisture content.Results showed, amongst other indications, that recorded PT strength values:i) were higher for saturated concrete than air-dry or oven-dry concrete;ii) exhibited no change as void ratio increased (i.e. showed an independence) in saturated conditions;iii )decreased as void ratio increased (i.e. showed an inverse proportionality) in air-dry and oven-dry conditions.These results provided a step forward toward possible standardization of the pressure tensile strength test method which was ultimately developed for use in a durability design approach and for use as an alternative to the splitting tensile strength test method for durability evaluation purposes.Recommendations if pressure tensile strength testing is to reach standardization: Specimens should be tested for pressure tensile strength in the saturated state and a durability design standard should be created based on tensile strength.

Introduction YouTube, the world's largest video platform, hosts thousands of educational surgical videos that many trainees rely on to enhance their understanding and proficiency in various surgical procedures. Consequently, a crucial inquiry arises regarding the trustworthiness of these videos as a valuable resource for these trainees. In this article, we address this question by focusing on one of the most frequently performed surgical procedures in the field of urology and assessing the effectiveness of these videos as an educational tool for urology trainees (ST3+: Specialty Training Year 3 and above). Methodology We conducted a comprehensive search on YouTube for all videos related to 'Testicular Exploration'. After applying specific inclusion and exclusion criteria, we identified a total of nine eligible videos for analysis. These videos were assessed using the LAParoscopic Surgery Video Educational GuidelineS (LAP-VEGaS) scoring system, which categorized them into two distinct groups. The first group, known as the 'high-quality group', included videos that scored 11 points or higher according to the LAP-VEGaS scoring criteria. The second group, termed the 'low-quality group', consisted of videos that scored less than 11 points using the LAP-VEGaS scoring tool. Additionally, we collected data on various metrics, such as video view counts, duration, likes and dislikes counts, comments count, like ratio, view ratio, and power index, and performed a comparative analysis between the two aforementioned groups. Results Between April 2013 and September 2023, the selected videos exhibited an average total view count of 95,546±138,000. The videos had an average duration of 6.35±2.26 minutes. Furthermore, the mean values for both likes and dislikes were 461.55±581 and 2.89±2.86, respectively. In contrast, the mean like ratio, view ratio, and power index were 0.98±0.0112, 176,00±13,100, and 173.80±131, respectively. The mean LAP-VEGaS scores for videos related to testicular exploration were 9.94±2.05. It is noteworthy that the first group had a statistically higher number of dislikes; however, the view count, comments count, likes count, and view ratio were statistically lower in the same group. Conclusion Videos related to testicular exploration on YouTube exhibit notably low quality and do not serve as a valuable resource for urology trainees. Key factors such as video duration, total view count, and viewer interactions (including likes, dislikes, and comments) should not be relied upon as indicators of educational video quality. Consequently, it is advisable for urology trainees to refrain from using YouTube as a primary source for learning about testicular exploration. Instead, they should seek guidance and support from experienced senior colleagues, educational supervisors, or consultants to explore more reliable sources of information for this surgical procedure.Introduction YouTube, the world's largest video platform, hosts thousands of educational surgical videos that many trainees rely on to enhance their understanding and proficiency in various surgical procedures. Consequently, a crucial inquiry arises regarding the trustworthiness of these videos as a valuable resource for these trainees. In this article, we address this question by focusing on one of the most frequently performed surgical procedures in the field of urology and assessing the effectiveness of these videos as an educational tool for urology trainees (ST3+: Specialty Training Year 3 and above). Methodology We conducted a comprehensive search on YouTube for all videos related to 'Testicular Exploration'. After applying specific inclusion and exclusion criteria, we identified a total of nine eligible videos for analysis. These videos were assessed using the LAParoscopic Surgery Video Educational GuidelineS (LAP-VEGaS) scoring system, which categorized them into two distinct groups. The first group, known as the 'high-quality group', included videos that scored 11 points or higher according to the LAP-VEGaS scoring criteria. The second group, termed the 'low-quality group', consisted of videos that scored less than 11 points using the LAP-VEGaS scoring tool. Additionally, we collected data on various metrics, such as video view counts, duration, likes and dislikes counts, comments count, like ratio, view ratio, and power index, and performed a comparative analysis between the two aforementioned groups. Results Between April 2013 and September 2023, the selected videos exhibited an average total view count of 95,546±138,000. The videos had an average duration of 6.35±2.26 minutes. Furthermore, the mean values for both likes and dislikes were 461.55±581 and 2.89±2.86, respectively. In contrast, the mean like ratio, view ratio, and power index were 0.98±0.0112, 176,00±13,100, and 173.80±131, respectively. The mean LAP-VEGaS scores for videos related to testicular exploration were 9.94±2.05. It is noteworthy that the first group had a statistically higher number of dislikes; however, the view count, comments count, likes count, and view ratio were statistically lower in the same group. Conclusion Videos related to testicular exploration on YouTube exhibit notably low quality and do not serve as a valuable resource for urology trainees. Key factors such as video duration, total view count, and viewer interactions (including likes, dislikes, and comments) should not be relied upon as indicators of educational video quality. Consequently, it is advisable for urology trainees to refrain from using YouTube as a primary source for learning about testicular exploration. Instead, they should seek guidance and support from experienced senior colleagues, educational supervisors, or consultants to explore more reliable sources of information for this surgical procedure.

The objective of this retrospective study is to assess the effectiveness and safety of two beta-emitting prostate-specific membrane antigen (PSMA) radioligands, [177Lu]Lu and [161Tb]Tb, in heavily treated patients with metastatic castration-resistant prostate cancer (mCRPC). A total of 148 cycles of beta-emitting PSMA radioligand therapy were given to 53 patients at a specialized cancer care center in Amman, Jordan. This treatment was offered following the exhaustion of all prior treatment modalities. Approximately half of the cases (n = 26) demonstrated an initial partial response to PSMA radioligand therapy. Moreover, roughly one-fourth of the patients (n = 13) exhibited a sustained satisfactory biochemical response, which qualified them to receive a total of six PSMA radioligand therapy cycles and maintain continued follow-up for additional treatment cycles. This was reflected by an adequate prostate-specific antigen (PSA) decline and a concomitant partial response evident on [68Ga]Ga-PSMA positron emission tomography/computed tomography imaging. A minority of patients (n= 18; 34%) experienced side effects. Generally, these were low-grade and self-limiting toxicities. This study endorses previous research evidence about PSMA radioligand therapy’s safety and efficacy. It also provides the first clinical insight from patients of Arab ethnicity. This should facilitate and promote further evidence, both regionally and internationally.

The recent approval of [[sup.177]Lu]Lu-prostate-specific membrane antigen (PSMA) for managing metastatic castration-resistant prostate cancer (mCRPC) has catalyzed the innovation of various PSMA-targeted radiopharmaceuticals. In our retrospective study, we explored both safety and efficacy of two beta-emitting PSMA radioligands, [[sup.177]Lu]Lu and [[sup.161]Tb]Tb, for mCRPC therapy. Our study included 53 patients and reinforced prior evidence validating the clinical safety and efficacy of these radioligands. Our research suggested that these treatments are characterized by a favorable safety profile with negligible toxicity. Moreover, [[sup.161]Tb]Tb-PSMA recipients, though trialed in a smaller patient sample, yielded concordant outcomes on par with those receiving [[sup.177]Lu]Lu-PSMA, highlighting its promise as an alternative therapy and warrants additional investigation. The objective of this retrospective study is to assess the effectiveness and safety of two beta-emitting prostate-specific membrane antigen (PSMA) radioligands, [[sup.177]Lu]Lu and [161Tb]Tb, in heavily treated patients with metastatic castration-resistant prostate cancer (mCRPC). A total of 148 cycles of beta-emitting PSMA radioligand therapy were given to 53 patients at a specialized cancer care center in Amman, Jordan. This treatment was offered following the exhaustion of all prior treatment modalities. Approximately half of the cases (n = 26) demonstrated an initial partial response to PSMA radioligand therapy. Moreover, roughly one-fourth of the patients (n = 13) exhibited a sustained satisfactory biochemical response, which qualified them to receive a total of six PSMA radioligand therapy cycles and maintain continued follow-up for additional treatment cycles. This was reflected by an adequate prostate-specific antigen (PSA) decline and a concomitant partial response evident on [[sup.68]Ga]Ga-PSMA positron emission tomography/computed tomography imaging. A minority of patients (n= 18; 34%) experienced side effects. Generally, these were low-grade and self-limiting toxicities. This study endorses previous research evidence about PSMA radioligand therapy’s safety and efficacy. It also provides the first clinical insight from patients of Arab ethnicity. This should facilitate and promote further evidence, both regionally and internationally.

The objective of this retrospective study is to assess the effectiveness and safety of two beta-emitting prostate-specific membrane antigen (PSMA) radioligands, [ Lu]Lu and [161Tb]Tb, in heavily treated patients with metastatic castration-resistant prostate cancer (mCRPC). A total of 148 cycles of beta-emitting PSMA radioligand therapy were given to 53 patients at a specialized cancer care center in Amman, Jordan. This treatment was offered following the exhaustion of all prior treatment modalities. Approximately half of the cases (n = 26) demonstrated an initial partial response to PSMA radioligand therapy. Moreover, roughly one-fourth of the patients (n = 13) exhibited a sustained satisfactory biochemical response, which qualified them to receive a total of six PSMA radioligand therapy cycles and maintain continued follow-up for additional treatment cycles. This was reflected by an adequate prostate-specific antigen (PSA) decline and a concomitant partial response evident on [ Ga]Ga-PSMA positron emission tomography/computed tomography imaging. A minority of patients (n= 18; 34%) experienced side effects. Generally, these were low-grade and self-limiting toxicities. This study endorses previous research evidence about PSMA radioligand therapy's safety and efficacy. It also provides the first clinical insight from patients of Arab ethnicity. This should facilitate and promote further evidence, both regionally and internationally.

BCG-RIVM strain was used in many treatment protocols for non-muscle invasive bladder cancer only as induction courses. Cho et al. (Anticancer Res 2012) compared BCG-RIVM induction and 'standard' maintenance (Lamm et al., J Urol. 2000) to mitomycin C. They found no statistically significant differences regarding disease recurrence and progression. The purpose of our study was to determine the efficacy & tolerability of this specific BCG RIVM strain, using six-weekly, induction course and single monthly instillations as maintenance for one year, in high risk recurrent, multifocal low grade and multifocal high grade pTa/pT1, CIS transitional cell carcinoma of bladder. From 2003 - 2012, BCG-naive patients treated with intravesical BCG-RIVM for high-risk multifocal NMIBC were identified. Transurethral resection of bladder tumor (TURBT) and re-staging TURBT within six weeks, was done for accurate staging and complete elimination of disease. A six-weekly induction course, started 2-3 weeks after the last TURBT, followed by monthly maintenance protocol for one year. Recurrence, progression, cystectomy free survivals, cancer specific and over-all survival were determined. Sixty evaluable patients - median age 63, median follow-up 3.98 years. Forty-two patients (70%) completed BCG-RIVM treatment as planned. BCG termination was necessary in 18 patients (30%). Recurrence occurred in 16 patients (26.7%) at a median follow-up of 24.2 months while progression occurred in five patients (8.3%) at a median follow-up of 33 months. Recurrence-free survival and progression-free survival rates were 73% and 92% respectively. Cystectomy was performed in seven patients (12%) with a cystectomy-free survival of 88%. There were no cancer specific deaths. Two patients died of other causes (3.3%). The overall survival rate was 97%. Our study is the first to show the clinical efficacy and tolerability of BCG-RIVM strain in the management of high risk NMIBC when given in a schedule of six-weekly induction with monthly maintenance for one year. Our maintenance protocol, achieved equivalent recurrence-free, progression-free, disease specific survival and overall survival to the reported literature and the more intense three-years South West Oncology Group (SWOG) protocol.

Background BCG-RIVM strain was used in many treatment protocols for non-muscle invasive bladder cancer only as induction courses. Cho et al. (Anticancer Res 2012) compared BCG-RIVM induction and 'standard' maintenance (Lamm et al., J Urol. 2000) to mitomycin C. They found no statistically significant differences regarding disease recurrence and progression. The purpose of our study was to determine the efficacy & tolerability of this specific BCG RIVM strain, using six-weekly, induction course and single monthly instillations as maintenance for one year, in high risk recurrent, multifocal low grade and multifocal high grade pTa/pT1, CIS transitional cell carcinoma of bladder. Methods From 2003 - 2012, BCG-naive patients treated with intravesical BCG-RIVM for high-risk multifocal NMIBC were identified. Transurethral resection of bladder tumor (TURBT) and re-staging TURBT within six weeks, was done for accurate staging and complete elimination of disease. A six-weekly induction course, started 2-3 weeks after the last TURBT, followed by monthly maintenance protocol for one year. Recurrence, progression, cystectomy free survivals, cancer specific and over-all survival were determined. Results Sixty evaluable patients - median age 63, median follow-up 3.98 years. Forty-two patients (70%) completed BCG-RIVM treatment as planned. BCG termination was necessary in 18 patients (30%). Recurrence occurred in 16 patients (26.7%) at a median follow-up of 24.2 months while progression occurred in five patients (8.3%) at a median follow-up of 33 months. Recurrence-free survival and progression-free survival rates were 73% and 92% respectively. Cystectomy was performed in seven patients (12%) with a cystectomy-free survival of 88%. There were no cancer specific deaths. Two patients died of other causes (3.3%). The overall survival rate was 97%. Conclusions Our study is the first to show the clinical efficacy and tolerability of BCG-RIVM strain in the management of high risk NMIBC when given in a schedule of six-weekly induction with monthly maintenance for one year. Our maintenance protocol, achieved equivalent recurrence-free, progression-free, disease specific survival and overall survival to the reported literature and the more intense three-years South West Oncology Group (SWOG) protocol.

Background: Pulmonary metastasectomy was performed in the early twentieth century and ever since, it has evolved to be one of the main treatment options for certain metastatic malignancies. The advancement of minimally invasive procedures enabled new techniques to minimize morbidity and improve patient quality of care and overall outcome. Cases presentation: Herein we present three patients, aged 53, 48, and 27 years, known to have sigmoid, rectal, and non-seminomatous germ cell tumors respectively. All patients were diagnosed to have metastatic lung nodules and underwent laparotomy to excise abdominal tumors followed by trans-diaphragmatic single-port video-assisted thoracoscopic pulmonary metastasectomy. All patients achieved complete surgical tumor excision, and none had pulmonary related complications on follow-up. Conclusion: Our prescribed novel trans-diaphragmatic single-port video-assisted thoracoscopic surgery (VATS) technique for synchronous pulmonary metastasectomy and intra-abdominal tumor resection is safe and can achieve complete resection with negative margins.