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Men with low-risk Gleason 3 + 3 prostate cancer on active surveillance can forgo protocol biopsies in favour of MRI and PSA monitoring with selective re-biopsy.

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Multiparametric MRI (mpMRI) of the prostate is now recommended as the initial investigation method for men with suspected prostate cancer within both UK and international guidelines. Potential benefits of this pathway include: (i) reductions in the number of men requiring biopsy; (ii) reductions in the diagnoses of indolent cancers unlikely to cause harm, minimising treatment-related complications; (iii) improved detection of clinically significant prostate cancers, particularly for patients with prior negative systematic biopsy; and (iv) improved risk-stratification of diagnosed cancers owing to greater precision in tumour grade and volume determinations.

SWL is both an efficacious and cost-effective primary treatment for patients with solitary LP stones (10-20 mm). The majority of patients can be effectively treated with primary SWL in a dedicated stone center, with the benefits of a short length of stay, low complication, and auxiliary treatment rates. The referral of such patients to high-volume lithotripsy centers with demonstrable outcomes should be given due consideration.