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What's known on the subject? and What does the study add? A significant proportion of patients diagnosed with prostate cancer do not require immediate treatment and could be managed by active surveillance, which usually includes serial measurements of prostate‐specific antigen (PSA) levels and regular biopsies. The rate of rise in PSA levels, which could be calculated as PSA velocity or PSA doubling time, was previously suggested to be associated with the biological aggressiveness of prostate cancer. Although these parameters are obvious candidates for predicting tumour progression in active surveillance patients, earlier studies that examined this topic provided conflicting results. Our analysis showed that PSA velocity and PSA doubling time calculated at different time‐points, by different methods, over different intervals, and in different sub‐groups of active surveillance patients provide little if any prognostic information. Although we found some significant associations between PSA velocity and the risk of progression as determined by biopsy, the actual clinical significance of this association was small. Furthermore, PSA velocity did not add to the predictive accuracy of total PSA. Objective To study whether prostate‐specific antigen (PSA) velocity (PSAV) and PSA doubling time (PSADT) are associated with biopsy progression in patients managed by active surveillance. Patients and Methods Our inclusion criteria for active surveillance are biopsy Gleason sum <7, two or fewer positive biopsy cores, ≤20% tumour present in any core, and clinical stage T1–T2a. Changes in any of these parameters during the follow‐up that went beyond these limits are considered to be progression. This study included 250 patients who had at least one surveillance biopsy, an available PSA measured no earlier than 3 months before diagnosis, and at least one PSA measurement before each surveillance biopsy. We evaluated the association between PSA kinetics and progression at successive surveillance biopsies in different sub‐groups of patients by calculating the area under the curve (AUC) as well as sensitivity and specificity of different thresholds. Results Over a median follow‐up of 3.0 years, the disease of 64 (26%) patients progressed. PSADT was not associated with biopsy progression, whereas PSAV was only weakly associated with progression in certain sub‐groups. However, incorporation of PSAV in models including total PSA resulted in a moderate increase in AUC only when the entire cohort was analysed. In other sub‐groups the predictive accuracy of total PSA was not significantly improved by adding PSAV. Conclusions Our findings confirm that PSA kinetics should not be used in decision‐making in patients with low‐risk prostate cancer managed by active surveillance. Regular surveillance biopsies should remain as the principal method of monitoring cancer progression in these men.

The use of percutaneous nephrolithotomy to treat renal calculi in patients with spinal cord injury is described by authors from Melbourne. This is the first contemporary series reported for over 13 years, and the authors describe various unique features about their series and compare their results to previously reported studies. Authors from London describe the largest single series of renal transplant patients in adults and children with urolithiasis, study risk factors associated with this condition in renal transplant recipients, and report on their multimodal management by endourological and open procedures. OBJECTIVE To present our experience of percutaneous nephrolithotomy (PCNL) for treating urolithiasis in patients with spinal cord injury (SCI) using a single‐stage dilator for percutaneous access. PATIENTS AND METHODS A prospective database of patients with SCI having PCNL using the single‐stage dilator was assessed, analysing patient data, stone‐free rates, morbidity and the follow‐up outcome. RESULTS In all, 26 patients had 54 PCNLs on 32 kidneys; 20 had unilateral and six bilateral stone disease; there were many staghorn calculi (24/54). Major complications occurred in three of 54 PCNLs (6%). The complete stone‐clearance rate was 87% for PCNL alone, rising to 29 of 32 kidneys (91%) or 24 of 26 patients (92%) with adjuvant procedures. A further three kidneys required no further treatment and were monitored, having residual fragments of ≤ 2 mm. CONCLUSIONS PCNL has a high success rate and acceptable complication rate compared to extracorporeal shock‐wave lithotripsy, and remains a valid first‐line treatment option for kidney stones in patients with SCI.

Transrectal ultrasound-guided biopsy of the prostate is an integral step in the investigation of patients at risk of prostate adenocarcinoma. With an increasing number of biopsies being performed, uncommon forms of prostatic pathology will be identified more frequently. Amyloidosis of the prostate and/or the seminal vesicles may be noted on transrectal ultrasound-guided biopsy of the prostate and the implications of this histological diagnosis must be understood. We present our experience of two such cases of amyloidosis and review the literature regarding their management.