Penile fracture is a rare urological emergency that is almost always the result of an injury sustained during sexual intercourse. It has a very characteristic clinical presentation with immediate loss of erection, penile swelling and bruising, and a pop or cracking sound. Prompt surgical repair is essential to reduce the likelihood of complications including erectile dysfunction and penile curvature.

Introduction: With the recent introduction of Multiparametric MRI (MP-MRI) for suspected prostate cancer, we investigated the clinic-pathological outcome of men who were suspected to have prostate cancer but in whom initial MP-MRI was negative (Likert 2). Methods: Demographic and clinico-pathological outcomes data were analysed in men, with minimum 2 year follow up, who had undergone investigation for suspected prostate cancer with a negative (Likert 2) initial MP-MRI. The primary outcome was subsequent identification of prostate cancer in this cohort. Secondary outcome measures included correlation of prostate volume, presence of previous prostate biopsy, age, Prostate Specific Antigen (PSA) dynamics (pre and post MP-MRI scan), Digital Rectal Examination (DRE) findings and follow-up in months with the primary outcome. Results: With respect to the primary outcome of this study, prostate cancer was identified in 8.7% of men only (n=4). Of these, two cases were low risk and two were high risk. With regards the secondary outcome measures, there was a positive correlation between PSA dynamics, age at MP-MRI and follow-up in months with subsequent diagnosis of prostate cancer, although this was not statistically significant. There was no prostate cancer specific mortality or morbidity in this cohort. Conclusions: In this study, despite initial negative MP-MRI scan, prostate cancer was subsequently diagnosed in 4 men (8.7%). Reassuringly, this compares very favourably to the negative predictive value (89%) from the PROMIS trial and as such, adds an important body of work to the contemporary literature on modern diagnosis of suspected prostate cancer.

The incidence of prostate cancer continues to rise and is now the most common cancer in men in Wales and in the UK (Cancer Research UK, 2010). More men are being referred via the urgent suspected cancer (USC) pathway for further investigations than ever before. Pressure on urology departments from government targets and cancer waiting times has led to the need to find pioneering ways to meet these demands, while maintaining high standards of care. This article presents a retrospective audit that compared the practice of a nurse specialist to a urologist while undertaking transrectal ultrasound with prostatic biopsies, the definitive investigation in the detection of prostate cancer. Results have shown that the nurse‐led service is equivalent to that of the urologist in cancer detection and morbidity rates. The audit has shown that the nurse‐led prostate biopsy clinic is both effective and safe in practice. In addition, the service has reduced the waiting times for patients needing this procedure to less than a week.