OBJECTIVE• To assess the patient and cancer characteristics as well as outcomes of a large cohort of Australian men who chose active surveillance (AS) as initial management of their low-risk prostate cancer. PATIENTS AND METHODS• Men treated by one surgeon who had chosen AS as the primary management for prostate cancer were identifi ed from the records.• The patient and cancer data recorded included: patient age, prostate-specifi c antigen (PSA) concentration at diagnosis, mode of prostate cancer detection.• For prostate cancer diagnosed at prostate biopsy, data were collected for the number of cores taken as well as positive core number, cancer burden, and Gleason grade.• Survival analysis was used to determine the duration of AS. RESULTS• In all, 154 men with low-risk prostate cancer with a median (range) age 63.0 (36 -81) years and a mean (range) PSA concentration of 6.5 (0.3 -22) ng/mL underwent AS.• The median (range) duration of AS was 1.9 (0.1 -16.6) years. AS was ceased in 29 patients (19%) after a mean (range) of 2.4 (0.2 -7.9) years. Of these, 26 were upstaged, one chose curative treatment despite stable disease, and two died from disease not related to prostate cancer.• Actuarial analysis on the probability of still being on AS after 5 years was 61.9% (95% confi dence interval [ CI ] 46.2 -74.2%) and after 10 years was 45.0% (95% CI 21.3 -66.2%).• While the period of follow-up is short, there were no biochemical recurrences in men who underwent curative treatment and no deaths from prostate cancer. CONCLUSION• AS is an acceptable mode of initial treatment in Australian men with low-risk prostate cancer.

The inhibitory effects of five flavonoids with distinct chemical classes (flavones [luteolin], flavonols [quercetin and quercitrin], and flavanones [hesperetin and hespiridin]) on cDNA-expressed CYP2C8 were investigated. CYP2C8 was co-expressed with NADPH-cytochrome P450 reductase in Escherichia coli and used to characterise potency and mechanism of these flavonoids on the isoform. Tolbutamide 4-methylhydroxylase, a high-performance liquid chromatography-based assay, was selected as marker activity for CYP2C8. Our results indicated that the flavonoids inhibited CYP2C8 with different potency. The order of inhibitory activities was quercetin > luteolin > hesperetin > hesperidin > quercitrin. All of these compounds however exhibited mechanism-based inhibition. A number of structural factors were found to be important for inhibition; these include the molecular shape (volume to surface ratio), the number of hydroxyl groups as well as glycosylation of the hydroxyl group. Quercetin was the most potent inhibitor among the flavonoids examined in this study, and our data suggest that it should be examined for potential pharmacokinetic drug interactions pertaining to CYP2C8 substrates in vivo.

Introduction Penile strangulation can be a challenging clinical situation and usually requires prompt treatment. The clinician should be aware of the various techniques to remove such devices. Aim The aim of this article was to describe a new noninvasive technique, the “pseudo-pulley” method, to remove a penile constriction device. Methods During an episode of medication-induced hypersexuality, a 63-year-old man presented to the emergency department with a cast iron locking nut of a vehicle towbar lodged at the base of the patient’s penis. Results The utilization of the “pseudo-pulley” method to remove the constriction device negated the need for more invasive measures. We outline a step-by-step description on this new technique. The patient’s recovery was complete and uneventful. Conclusion The current case report describes a noninvasive technique for removing a penile constriction device that does not rely on specialized equipment and industrial drills that can cause iatrogenic injury.

Objectives An estimated 125 million workers are exposed to asbestos worldwide. Asbestos is classified by the International Agency for Research on Cancer as a Group 1 carcinogen. The association between occupational asbestos exposure and kidney cancer is not well established however. This study aimed to determine the mortality and incidence of kidney cancer in workers who have been exposed to asbestos. We performed a systematic review and meta-analysis to evaluate the association between occupational asbestos exposure and kidney cancer. Methods Medline, EMBASE, and Web of Science were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles on occupational asbestos exposure and kidney cancer. The studies reported the standardized mortality ratio (SMR) or standardized incidence ratio (SIR) of kidney cancer in workers exposed to asbestos. SMRs or SIRs with its 95% confidence interval (CI) were pooled using a fixed-effect model. Results Forty-nine cohort studies involving 335 492 workers were selected for analysis. These studies included 468 kidney cancer deaths and 160 incident cases. The overall pooled-SMR of kidney cancer was 0.95 (95% CI: 0.86–1.05), with no significant heterogeneity (PQ = 0.09, I2 = 24.87%). The overall pooled-SIR of kidney cancer was 0.95 (95% CI: 0.79–1.11), with no significant heterogeneity (PQ = 0.68, I2 = 0.00%). Subgroup analysis did not find any increased association with occupational asbestos exposure. There was no evidence of publication bias with Egger’s test P values of 0.08 for mortality studies and 0.99 for incidence studies. Conclusions This systematic review and meta-analysis did not show evidence of association between occupational asbestos exposure and kidney cancer mortality or incidence.