Context: MRI-targeted prostate biopsy (MRI-TB) may be an alternative to systematic biopsy for diagnosing prostate cancer.Objective: The primary aims of this systematic review and meta-analysis were to compare the detection rates of clinically significant and clinically insignificant cancer by MRI-TB to systematic biopsy in men undergoing prostate biopsy to identify prostate cancer. Evidence acquisition: A literature search was conducted using the PubMed, Embase, Web of Science, Cochrane library and Clinicaltrials.gov databases. We included prospective and retrospective paired studies where the index test was MRI-TB and the comparator test was systematic biopsy. We also included randomized controlled trials (RCTs) if one arm included MRI-TB and another arm included systematic biopsy. The risk of bias was assessed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 checklist. In addition, the Cochrane risk of bias 2.0 tool was used for RCTs.Evidence Synthesis: We included 68 studies with a paired design and 8 RCTs, comprising a total of 14709 men who received either both MRI-TB and systematic biopsy or were randomized to receive one of the tests. MRI-TB detected more men with clinically significant cancer than systematic biopsy (Detection ratio (DR) 1.16 [95% CI 1.09-1.24], p < 0.0001) and fewer men with clinically insignificant cancer than systematic biopsy (DR 0.66 [95% CI 0.57-0.76], p < 0.0001). The proportion of cores positive for cancer was greater for MRI-TB than systematic biopsy, relative risk 3.17 [95% CI 2.82-3.56], p<0.0001.Conclusions: MRI-TB is an attractive alternative diagnostic strategy to systematic biopsy. Patient summary:We evaluated the published literature, comparing two methods of diagnosing prostate cancer. We found that biopsies targeted to suspicious areas on an MRI (MRI-Targeted biopsy) were better at detecting prostate cancer that needs to be treated and at avoiding the diagnosis of disease that doesn't need treatment than the traditional systematic biopsy.

The epidemiology of scrotal cancer has changed over time away from occupational exposure to soot. The current incidence of scrotal malignancy is approximately 1 per 1 million males per year. This review summarises the current literature on the management of scrotal squamous cell carcinoma (SCC), including pathogenesis, available diagnostic tools, current treatment, and overall management strategies. The rarity of SSC cases makes it difficult to recruit patients for studies of this disease. To date, very few studies have been performed, and those that have been completed were limited by a small sample size. This review analyses all available evidence, which varies from retrospective case series to prospective multicentre trials. Psoralen ultraviolet light A treatment and human papillomavirus infection are significant risk factors for this cancer. Scrotal SCC had lower survival rates compared with other histological subtypes and the 5-year relative survival rate was 77%. Many studies also showed a positive margin, even after wide excision of the lesion. Excision of the primary lesion and a risk-stratified approach for staging and treatment of regional lymph nodes is the mainstay of current management strategies. For patients with clinically negative lymph nodes, sentinel lymph node biopsy and PET scans for patients with suspected pelvic node involvement has improved the diagnostic yield. The new neoadjuvant therapy (both chemotherapy and radiotherapy) has helped to downstage the disease for complete resection. The prognosis of scrotal SCC is determined by margin-free excision, depth of infiltration, and its histologic grade. Future trials focussing on the conjunction of SCC with penile cancer, as well as the creation of a multinational network for ‘virtual’ online multidisciplinary meetings, will help to improve the overall survival for scrotal SCC patients.

Kidney laceration following blunt trauma is responsible for up to 3% of trauma cases. The risk factors associated with renal injury are attributed to the risks of mechanical injury. However, anatomical variations that may accelerate the insult of injury are poorly documented. This case report describes a 25-year-old with degenerative lumbar scoliosis who presented with flank pain and visible haematuria following a low-impact injury. The patient had a grade IV renal injury. The curvature of the spine, shown on CT imaging, revealed a reduced retroperitoneal space around the left kidney. This case explores lumbar scoliosis as a risk factor for kidney laceration. We hypothesise that this increased risk is associated with asymmetry of the spine and reduced anatomical space in the retroperitoneum. Patients with lumbar scoliosis may be considered a high-risk category for renal injury, following low-impact trauma.

Introduction: The current trend to implement multiparametric magnetic resonance imaging (mpMRI)-guided targeted biopsy (TB) as primary biopsy for the diagnosis of suspected prostate cancer and to avoid systematic biopsy (SB) is growing. However, concern remains regarding missing clinically significant (Cs) cancer on the normal mpMRI areas of the prostate. Therefore, we compared the normal and abnormal areas from mpMRI at the same prostate biopsy, using simultaneous SB and TB technique. Methods: A prospective, comparative effectiveness study included 134 patients initially referred for primary biopsy (from October 2017 to June 2018); 100 men were selected, mean age 68 years, with a median level of prostate specific antigen of 7.6, with average prostate volume of 52 cm3 (T3 disease and prostate imaging reporting and data system (PI-RADS) score < 3 were excluded). All underwent six cores TB (median), from an average of two lesions on mpMRI and also eight cores SB (median) from normal mpMRI areas of the prostate after informed consent. Results: The combined (SB + TB) biopsy cancer detection rate was 67%, 51% having Cs disease. For Cs cancer, 35 patients were detected by both techniques. TB missed four Cs cancer (95% confidence interval (CI), p < 0.0001). Fewer men in the TB group than in the SB group were found to have clinically insignificant (Ci) cancer (95% CI, p < 0.0001). No Cs cancer diagnosis was missed on TB from PI-RADS 5 lesion. Overall, 4% Cs cancers were missed on TB and avoided over diagnosis of 9% Ci cancer. Conclusions: Cognitive TB didn’t miss any Cs cancer from PI-RADS 5 lesion found on mpMRI. Only doing Cognitive TB on PI-RADS 5 lesion would save time, reduce workload and will be cost effective both for Urology and Pathology. PI-RADS 3 and 4 lesions on mpMRI will benefit from adding systematic samples. Level of evidence: 4 Oxford Centre for Evidence-Based Medicine (CEBM).