The natural history of prostate cancer is remarkably heterogeneous and, at this time, not completely understood. The widespread adoption and application of prostate-specific antigen (PSA) screening has led to a dramatic shift toward the diagnosis of low-volume, nonpalpable, early-stage tumors. Autopsy and early observational studies have shown that approximately 1 in 3 men aged >50 years has histologic evidence of prostate cancer, with a significant portion of tumors being small and possibly clinically insignificant. Utilizing the power of improved contemporary risk stratification schema to better identify patients with a low risk of cancer progression, several centers are gaining considerable experience with active surveillance and delayed, selective, and curative therapy. A literature review was performed to evaluate the rationale behind active surveillance for prostate cancer and to describe the early experiences from surveillance protocols. It appears that a limited number of men on active surveillance have required treatment, with the majority of such men having good outcomes after delayed selective intervention for progressive disease. The best candidates for active surveillance are being defined, as are predictors of active treatment. The psychosocial ramifications of surveillance for prostate cancer can be profound and future needs and unmet goals will be discussed. Cancer 2008;112:1650-9.2008 American Cancer Society.KEYWORDS: prostate cancer, active surveillance, review, risk stratification. P rostate cancer is the most common form of noncutaneous malignancy among males in the U.S., and is the second leading cause of cancer mortality, accounting for more than 27,000 deaths in 2007.1 However, the natural history of this disease is remarkably heterogeneous and, at this time, not completely understood. Autopsy studies have shown that approximately 1 in 3 men aged >50 years has histologic evidence of prostate cancer, with up to 80% of these tumors measuring <0.5 cm in size and low in grade, suggesting that the majority are clinically insignificant.2 Approximately 3% of all men will die of prostate cancer, although the mortality from prostate cancer has declined by 31% over the past 13 years.1 The relative contributions of factors responsible for this decline including prostate-specific antigen (PSA) screening, improved detection strategies, and improved treatments are not known.

At almost 1 year followup stent failure due to extrinsic compression occurred in nearly half of treated patients. Analysis of data revealed a diagnosis of cancer, baseline mild renal insufficiency and metastatic disease requiring chemotherapy or radiation as predictors of stent failure. Managing extrinsic compression by retrograde stenting continues to be a practical but guarded decision and should be tailored to each patient.

Objective To characterise the use of social media among members of the American Urological Association (AUA), as the use of social media in medicine has greatly expanded in recent years. Subjects and Methods In December 2012 to January 2013, the AUA e‐mailed a survey with 34 questions on social media use to 2000 randomly selected urologists and 2047 resident/fellow members. Additional data was collected from Symplur analytics on social media use surrounding the AUA Annual Meeting in May 2013. Results In all, 382 (9.4%) surveys were completed, indicating 74% of responders had an online social media account. The most commonly used social media platforms were Facebook (93%), followed in descending order by LinkedIn (46%), Twitter (36%) and Google+ (26%). Being aged <40 years was an important predictor of social media use (83% vs 56%), with greater uptake among residents/fellows compared with attendings (86% vs 66%). Only 28% of respondents used social media partly or entirely for professional purposes. During the 2013 AUA Annual Meeting, there were >5000 tweets from >600 distinct contributors. Conclusion As of early 2013, among respondents to an e‐mail survey, most urologists and urology trainees used some form of social media, and its use in urology conferences has greatly expanded.

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keywords, lidocaine, cystoscopy, gel and pain, yielding 14 studies. Ten studies were excluded as they provided no comparison with appropriate control groups or contained insufficient data for analysis. Attempts to contact the authors of these studies yielded no additional data. A metaanalysis was conducted using a randomeffects model. RESULTSFour studies were included in the analysis, two double-blind and two single-blind, totalling 411 male patients. Three of the studies found no statistical improvement and one study found a statistically significant improvement in pain relief using lidocaine gel. Studies varied on the quantity of gel instilled and on the dwell time of gel before cystoscopy. The meta-analysis found that subjects who received anaestheticimpregnated gel were 1.7 times more likely not to experience moderate to severe pain ( < 2, 3 or 30, based on the scale used; odds ratio 1.7, 95% confidence interval 1.1-2.8) than subjects who did not have intraurethral instillation of gel. CONCLUSIONSThese data suggest that intraurethral instillation of lidocaine gel vs plain lubricating gel reduces the likelihood of moderate to severe pain during flexible cystoscopy. KEYWORDSlidocaine gel, flexible cystoscopy, pain Study Type -Therapy (systematic review) Level of Evidence 1a OBJECTIVETo consolidate previous reports and conduct a meta-analysis to draw further conclusions on the efficacy of the instillation of lidocaine gel before flexible cystoscopy, as it has had varying efficacy in several randomized controlled studies. METHODSWe reviewed previous reports cited in PubMed, Biosis and the Cochrane Library, identified by a professional librarian searching for English language-only randomized controlled studies involving the