Purpose of review: To review the role of pre-biopsy multi-parametric MRI in biopsy-naïve men for the detection of clinically significant prostate cancer.Recent findings: Recent Level 1 evidence shows that multi-parametric MRI has high sensitivity and negative predictive value for the detection of clinically significant prostate cancer in biopsy-naïve men. Concurrent developments include important work in the standardization of MRI-reporting. The low specificity and positive predictive value of MRI means that biopsy is still necessary following MRI.MRI-targeted prostate biopsy has emerged as an alternative diagnostic test to transrectal ultrasound guided prostate biopsy, though its exact role in biopsy naïve men and the optimal technique remain to be defined. Summary:There is the potential for MRI to be used as a triage test to allow a proportion of men to avoid biopsy and remain on PSA surveillance. MRI-suspicious areas can be sampled more intensively using MRI-targeted biopsy that can be carried out in a variety of ways. Future work should focus on the cost-effectiveness of introducing a pre-biopsy MRI pathway in biopsy naïve men and addressing the training needs for such a change.

One of the most common differentials for the acute scrotum is an epididymo-orchitis (EO), which can mimic the presentation of testicular torsion. We present a case of a 37-year-old man presented to the Emergency department with a 3-day history of progressive left testicular pain. A Doppler ultrasound was done which revealed increased flow to the left testicle with no evidence of testicular torsion and he was discharged. He was re-admitted with worsening pain and a repeat scan showed that the penile arterial diastolic flow had reversed, indicating testicular infarction. This was confirmed at exploration and an orchidectomy was performed. EO causing severe complications is an uncommon manifestation of a common disorder. Features suggesting a lack of response to antibiotics include sepsis, pronounced scrotal oedema, severe testicular pain and scrotal wall inflammation. The presence of a positive urine culture has also been highlighted as a poor prognostic factor.

Antigua and Barbuda is a twin-island nation within the Caribbean where the men are predominantly of African descent. The burden of prostate cancer is therefore expected to be similar to regional counterparts. There has been very little research done on prostate cancer in this nation. Few published peer-reviewed and non-peer reviewed documents exist to guide prostate cancer management and policy. A review of the available literature and the author's experience managing prostate cancer in the country was used to provide a synopsis of prostate cancer management in the country.All aspects of the prostate cancer care pathway exist in Antigua and Barbuda from public awareness and screening campaigns to external beam radiotherapy, abiraterone acetate and hospice care. There are still limitations to accessing some aspects of the care pathway such as prostate biopsies, radical prostatectomies and newer imaging modalities for staging. Data collection and analysis will help to provide objective and quantitative evidence of the nation's prostate cancer management capabilities. Other developing nations will face many of the same challenges managing prostate and other cancers and this shared experience may be particularly useful for comparing and contrasting purposes. It also provides a documented milestone on which future plans can be made to improve care and shape national policy.