Study Type – Preference (prospective cohort)
Level of Evidence 1b What’s known on the subject? and What does the study add? In general the literature suggests that there is a need for improvement in aiding men diagnosed with early prostate cancer in their decision making about treatment options and that our understanding of this process is inadequate. There is limited data analyzing the reasons why these men decide between potentially curative or observational treatments and data evaluating patients’ views before and after definitive therapy are scarce. This study begins the process of understanding the reasons underlying a patient’s final treatment decision. Being a prospective study, it looks at the thought processes of these men before treatment during the time the decision is made. It also documents how satisfied patients are with their choice after their treatment and whether they would choose the same treatment again. OBJECTIVE • To identify the reasons for patients with localised prostate cancer choosing between treatments and the relationship of procedure type to patient satisfaction post‐treatment. PATIENTS AND METHODS • 768 men with prostate cancer (stage T1/2, Gleason ≤7, PSA <20 ug/L) chose between four treatments: radical prostatectomy, brachytherapy, conformal radiotherapy and active surveillance. • Prior to choosing, patients were counselled by a urological surgeon, clinical (radiation) oncologist and uro‐oncology specialist nurse. • Pre‐treatment reasons for choice were recorded. Post‐treatment satisfaction was examined via postal questionnaire. RESULTS • Of the 768 patients, 305 (40%) chose surgery, 237 (31%) conformal beam radiotherapy, 165 (21%) brachytherapy and 61 (8%) active surveillance. • Sixty percent of men who opted for radical prostatectomy were motivated by the need for physical removal of the cancer. • Conformal radiotherapy was mainly chosen by patients who feared other treatments (n = 63, 27%). Most men chose brachytherapy because it was more convenient for their lifestyle (n = 64, 39%). • Active surveillance was chosen by patients for more varied reasons. Post‐treatment satisfaction was assessed in a subgroup who took part in the QOL aspect of this study. • Of the respondents to the questionnaire, 212(87.6%) stated that they were satisfied/extremely satisfied with their choice and 171(92.9%) indicated they would choose the same treatment again. CONCLUSION • Men with early prostate cancer have clear reasons for making decisions about treatment. Overall, patients were satisfied with the treatment and indicated that despite different reasons for choosing treatment, they would make the same choice again.

Between 1996 and 2005, two of seven infants in our unit on overnight continuous-cycle peritoneal dialysis (CCPD) acquired hypothyroidism following normal thyroid function on neonatal screening. Case 1 had posterior urethral valves, commenced CCPD at day 29, and developed hypothyroidism requiring treatment at 3 months: TSH 258 micro/l (ref.: 0.3-3.8), total thyroxine 74 nmol/l (ref.: 77-159). Plasma iodine concentration was 7.44 micromol/l (ref.: 0.23-0.68). Iodine concentrations in peritoneal dialysis (PD) fluid were found to be higher at the end of the first cycle (11.4 micromol/l) than at the end of the twelfth cycle (1.55 micromol/l). Case 2 had posterior urethral valves, commenced CCPD on day 4 and was diagnosed with hypothyroidism following a prolonged jaundice screen. Thyroxine replacement was stopped 2 months after a renal transplant. A third child commenced CCPD on day 2 and had high plasma iodine concentrations at 8 weeks (5.79 micromol/l). He had borderline thyroid function, not requiring replacement. Our hypothesis is that these infants developed hypothyroidism as a consequence of iodine exposure via the Wolff-Chaikoff effect. Iodine levels were higher in the PD fluid than in plasma. This suggests that povidine-iodine 10% in the PD cap may be the source of the high plasma iodine levels.

The aim of this review was to discuss the most recent data from current trials of diethylstilboestrol (DES) to identify its present role in advanced prostate cancer treatment as new hormonal therapies emerge. The most relevant clinical studies using DES in castration-refractory prostate cancer (CRPC) were identified from the literature. The safety, efficacy, outcomes and mechanisms of action are summarized. In the age of chemotherapy this review highlights the efficacy of oestrogen therapy in CRPC. The optimal point in the therapeutic pathway at which DES should be prescribed remains to be established.

Testicular metastasis from carcinoma of the prostate is rare. We report a case of carcinoma of the prostate with bilateral testicular metastases 7 years after the initial diagnosis. The exact prognosis is not known but it usually indicates advanced disease. Although testicular metastasis is uncommon, it should be considered when a patient presents with a lump in the testis, particularly in a patient known to have another primary malignancy.

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