Prostatic subclinical inflammation is not associated with high urinary PSA. Unless associated with glandular epithelial disruption, density of prostatic interstitial inflammatory cell infiltrate is not significantly correlated with serum PSA concentration. We believe that this issue should be considered when interpreting a prostate biopsy.

Objectives  To determine the acceptability by patients of ultrasound‐guided prostatic biopsy without anaesthesia. Patients and methods  From January 1995 to January 1996, 81 patients in our department undergoing transrectal ultrasound‐guided prostate biopsy were asked to assess the tolerability of the procedure using an immediate post‐operative questionnaire including a 10 cm linear visual analogue scale (VAS). Results  The mean VAS score was 3 (standard error 0.24) and 16% of the patients had a VAS score of ≥5. Responses to the questionnaire showed that 6% of patients judged that the procedure should have been performed under general anaesthesia, while 19% would not agree to undergo it again without some form of anaesthesia. Conclusions  Even when anaesthesia‐free, transrectal ultrasound‐guided prostatic biopsy was felt to be only mildly uncomfortable by most patients, but 19% judged that it should be accompanied by some form of anaesthesia. Consequently, local anaesthetic techniques to enhance tolerance to this type of intervention without sacrificing the advantages of the current out‐patient setting should be reassessed.

Background and objectives Cystinuria is an autosomal recessive disorder affecting renal cystine reabsorption; it causes 1% and 8% of stones in adults and children, respectively. This study aimed to determine epidemiologic and clinical characteristics as well as comorbidities among cystinuric patients, focusing on CKD and high BP.Design, setting, participants, & measurements This retrospective study was conducted in France, and involved 47 adult and pediatric nephrology and urology centers from April 2010 to January 2012. Data were collected from 442 cystinuric patients.Results Median age at onset of symptoms was 16.7 (minimum to maximum, 0.3-72.1) years and median diagnosis delay was 1.3 (0-45.7) years. Urinary alkalinization and cystine-binding thiol were prescribed for 88.8% and 52.2% of patients, respectively, and 81.8% had at least one urological procedure. Five patients (1.1%, n=4 men) had to be treated by dialysis at a median age of 35.0 years (11.8-70.7). Among the 314 patients aged $16 years, using the last available plasma creatinine, 22.5% had an eGFR$90 ml/min per 1.73 m 2 (calculated by the Modification of Diet in Renal Disease equation), whereas 50.6%, 15.6%, 7.6%, 2.9%, and 0.6% had an eGFR of 60-89, 45-59, 30-44, 15-29, and ,15, respectively. Among these 314 patients, 28.6% had high BP. In multivariate analysis, CKD was associated with age (odds ratio, 1.05 [95% confidence interval, 1.03 to 1.07]; P,0.001), hypertension (3.30 [1.54 to 7.10]; P=0.002), and severe damage of renal parenchyma defined as a past history of partial or total nephrectomy, a solitary congenital kidney, or at least one kidney with a size ,10 cm in patients aged $16 years (4.39 [2.00 to 9.62]; P,0.001), whereas hypertension was associated with age (1.06 [1.04 to 1.08]; P,0.001), male sex (2.3 [1.3 to 4.1]; P=0.003), and an eGFR,60 ml/min per 1.73 m 2 (2.7 [1.5 to 5.1]; P=0.001).Conclusions CKD and high BP occur frequently in patients with cystinuria and should be routinely screened.

Results revealed dysregulation of proteins involved in androgen pathways, and in estrogen synthesis and signaling during the development of hormone refractory prostate cancer.