Traditionally, men referred for investigation of raised prostate specific antigen (PSA) could expect to be investigated via blind TRUS biopsy. In recent years, the availability of pre‐biopsy imaging with multi‐parametric magnetic resonance imaging (mp‐MRI) has allowed urology centres to improve their triage and care of this patient cohort. The ability to identify discrete lesions for more accurately targeted TRUS, stream patients with anterior lesions for trans‐perineal biopsy, and of course to prevent those with no evidence of clinically significant prostate cancer from being subjected to unnecessary procedures has proved pre‐biopsy mp‐MRI a valuable tool in the assessment and diagnosis of prostate cancer. Our service recently audited the impact of the introduction of mp‐MRI on our prostate cancer assessment pathway. An analysis of the outcomes of 1558 referrals over a 2‐year period, and found that pre‐biopsy imaging has resulted in a marked reduction in unnecessary procedures and more accurate targeting of lesions, leading to improved outcomes for patients.

A 2-year follow-up of a community based prostate cancer assessment service was carried out to assess the overall prostate cancer detection rates, along with the compliance rates for annual PSA surveillance. Using data collected during the clinic, we were able to audit PSA surveillance patterns and referrals via GPs to assess the ongoing impact of the service. The majority of attendees had PSA testing at least once via their GP in the 2 years following clinic attendance. A proportion had rising PSA triggering referral to the Urology service for further investigation, resulting in further diagnoses of prostate cancer. While the ongoing surveillance levels were not as high as we would have liked, we have been able to demonstrate that attendance at the community based service has resulted in an overall increase of levels of PSA testing via GP surgeries. A limitation in GP software has been identified which may be a factor in reduced surveillance rates. This 2-year audit has demonstrated that the service was successful in achieving its dual aims of accurately assessing the detection rate of prostate cancer among attendees, and compliance with surveillance PSA testing post clinic.

Prostate cancer is a complex disease which is more prevalent among men of black and minority ethnic (BME) background than their Caucasian counterparts, with men of African-Caribbean background experiencing higher levels of incidence and mortality than any other ethnic group. The reasons behind this health inequality are poorly understood and likely to be multifactorial. Several theories have been posited, including genetic disposition, poorer access to health care, a lack of understanding of the risks posed by prostate cancer and an unwillingness to access mainstream health care. There is, however, a notable disparity between the amount of literature focusing on prostate cancer as it affects those with a BME background and on prostate cancer in general. This further compounds the difficulties encountered by BME men, who rely on health professionals being aware of the greater risk they face. More knowledge and understanding is required by both the general population and medical practitioners to address this health inequality.

We retrospectively reviewed 51 men who switched to Invicorp intracavernosal therapy following failure of treatment, or development of pain, with alprostadil intracavernosal injections. Invicorp was successful in 61% of alprostadil non-responders, with no reported penile pain. Three patients (6%) were admitted with priapism which was appropriately treated. Invicorp proved successful in two thirds of the patients who had failed to respond to intracavernosal alprostadil. Invicorp is an excellent alternative for alprostadil non-responders, proving successful in 61% of this group. Unlike alprostadil injection, Invicorp users did not experience penile pain after the injection and experienced a 50% reduction in incidence of priapism.

We designed and implemented a community‐based prostate cancer risk assessment clinic targeting men from black and minority ethnicity (BME) background. This service had the dual aims of optimizing detection of prostate cancer within a local BME population, with a secondary goal of encouraging longer‐term engagement with primary care for follow‐up prostate‐specific antigen (PSA) testing in order to facilitate early diagnosis of future disease. “Drop‐in” clinics were set up in strategic locations and, staffed by experienced urology nurses. Risk assessment was offered in the form of a PSA test, and digital rectal examination (DRE). We targeted men of BME background aged between 45 and 75 but all attending individuals were given access to counselling and assessment as appropriate. In total, 312 men attended clinics for risk assessment. We diagnosed nine prostate cancers with histological confirmation, with a further two individuals considered to have prostate cancer based on clinical/biochemical parameters. These findings were consistent with similar previously published reports. Nurse‐led, community‐based targeted risk assessment is feasible, leads to the detection of significant numbers of prostate cancers and is well received by patients.