PCASTt/SPCG-17-a randomised trial of active surveillance in prostate cancer : rationale and design

Introduction Overtreatment of localised prostate cancer is substantial despite increased use of active surveillance. No randomised trials help define how to monitor patients or when to initiate treatment with curative intent. Methods and analysis A randomised, multicentre, intervention trial designed to evaluate the safety of an MRI-based active surveillance protocol, with standardised triggers for repeated biopsies and radical treatment. The aim is to reduce overtreatment of prostate cancer. 2000 men will be randomly allocated to either surveillance according to current practice or to standardised triggers at centres in Sweden, Norway, Finland and the UK. Men diagnosed in the past 12 months with prostate cancer, 0.2ng/mL/cc, any International Society of Urological Pathology (ISUP) grade 1 are eligible. Men with ISUP grade 2 in Ethics and dissemination Ethical approval was obtained in each participating country. Results for the primary and secondary outcome measures will be submitted for publication in peer-reviewed journals. Trial registration number NCT02914873.Peer reviewe

Finding space for flowing water in Japan's densely populated landscapes

With its rapidly flowing rivers and plentiful summer rainfall, 20th-century Japan has a history of frequent flooding. The effects on its densely populated flood plains have often been devastating. Japan also has one of the world's landscapes most heavily covered in concrete. In recent decades, however, the Japanese state has turned hesitantly to new techniques of releasing of water into the sea buttressed by a concern for ecological well-being. Its 'nature-oriented' river landscaping programme is an attempt to find a more sustainable balance between flowing water and the built terrain, allowing water to make space for itself. Our paper sets this programme in its historical context, relating it back to the premodern period and juxtaposing it to prevalent modernist 20th-century practice. Throughout this paper, we focus on the interweaving of discourse and practice, drawing attention to the 'idiom' of river landscaping as well as to the role of the state in defining this idiom. We argue that a sort of reconciliation is occurring between the contrasting discourses and practices of 'hard' and 'green' engineers