IntroductionProstate cancer is a large clinical burden across Europe. It is, in fact, the most common cancer in males, accounting for more than 92,300 deaths annually throughout the continent. Prostate cancer is androgen-sensitive; thus an androgen deprivation therapy (ADT) is often used for treatment by reducing androgen to castrate levels. Several ADT agents have achieved benefits with effective palliation, but, unfortunately, severe adverse events are frequent. Contemporary ADT (Luteinising Hormone Releasing Hormone agonist - LHRHa injections) can result in side effects that include osteoporosis and fractures, compromising quality of life and survival.MethodsIn this review we analysed the associated bone toxicity consequent upon contemporary ADT and based on the literature and our own experience we present future perspectives that seek to mitigate this associated toxicity both by development of novel therapies and by better identification and prediction of fracture risk.ResultsPreliminary results indicate that parenteral oestrogen can mitigate associated osteoporotic risk and that CT scans could provide a more accurate indicator of overall bone quality and hence fracture risk.ConclusionsAs healthcare costs increase globally, cheap and effective alternatives that achieve ADT, but mitigate or avoid such bone toxicities, will be needed. More so, innovative techniques to improve both the measurement and the extent of this toxicity, by assessing bone health and prediction of fracture risk, are also required.

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THE case which I have the pleasure of bringing before the Academy occurred in the p~actice of the Rotunda Hospital last year, E. B, aged 23, 1-para, carne into labour on the evening of the 23rd Yeb.~ 1895. She was attended bythe pupils of the hospital during the night, who noticed nothing unusual till 10 a.m. the following m_~~rning~ when the left labium ma]us was observed to be swollen. As the swelling was increasing, the Extern-Assistant~ Dr. Murphy, was summormd~ aud he, recognisiug the case as one of hmmatoma, sent f0r me, as the Assistant on duty. On examination, I saw a large swelling, bluish in colour, occupying the L. ischio-rectal reg~on, extenting up the~ L. labium, distending the perineum, and bulging into the vagina, The co r,tour: of the tumour was very uniform~ and presented the appearance of a foetal head, greatly distending the part. The vulva was pushed over to the right side. The child's head was presenting, and about midway in the pelvis.

Tripodi has stated that the widely held and promoted notion that laboratory monitoring is not required for patients treated with non-vitamin K antagonist oral anticoagulants has been overemphasised, potentially leading clinicians to believe that laboratory testing is not needed for these patients. 4 Our data support Tripodi's viewpoint. Other potential reasons for our findings include greater familiarity with warfarin than dabigatran and uncertainty in the interpretation of coagulation test results with dabigatran. Management guidelines that utilise these tests, for both thromboembolic and haemorrhagic events, have been proposed. 5,6 Studies assessing clinical outcomes from using these guidelines will be valuable in informing practice in this area of uncertainty.

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