Management and outcomes of Gleason six prostate cancer detected on needle biopsy: A single-surgeon experience over 6 years

Objective: To assess the management and oncological outcomes in men diagnosed with Gleason score (GS) 6 prostate cancer on needle biopsy in a regional centre, as compared with published international data. Materials and methods: A retrospective analysis was conducted of patients who were diagnosed with GS 6 prostate cancer via transrectal ultrasound-guided or transperineal biopsy between June 2009 and September 2015 under the care of a single surgeon. Data were obtained from a prospectively collected database. Results: A total of 166 patients were diagnosed with GS 6 prostate cancer. The mean age was 61 (range 46–79) years, with mean prostate-specific antigen of 6.7 (0.91–26.8) ng/mL at diagnosis. Of 166 patients, 117 (70.5%) patients were enrolled into the active surveillance program with 82 (70%) meeting Prostate Cancer Research International Active Surveillance (PRIAS) criteria, 44 patients underwent immediate definitive treatment (88.6% radical prostatectomy and 9.1% radiotherapy) and five watchful waiting. With a median follow-up of 1.8 years, 37 (31.6%) patients on AS had definitive treatment [30 cases (81%) were attributable to disease progression, 4 cases (10.8%) to an abnormal magnetic resonance imaging result and 3 cases (8.1%) for patient preference]. In the 35 patients who underwent radical prostatectomy immediately after diagnosis, the GS was ≥7 in 29 cases (82.9%), and the final pathology was pT3a in 16 (51.6%) and pT3b in one (2.9%). In patients who underwent radical prostatectomy after being on AS, the proportion of GS ≥7 prostate cancer was 29/32 (90.6%), with pT3a in six (18.8%) and pT3b in three (9.4%) cases. Overall, 23.5% of patients had a multiparametric magnetic resonance imaging scan. Conclusion: This single-surgeon cohort of GS 6 prostate cancer patients demonstrates a high proportion of cases managed with active surveillance, with comparable rates to international literature. The majority of cases who underwent immediate definitive treatment had significant disease, indicating that patients are being appropriately selected for active surveillance

Don\u27t be fooled by the fat: A rare case of renal cell carcinoma with intratumoural fat

Angiomyolipoma (AML) is a benign renal tumour composed of fat, smooth muscle and blood vessels. Radiologic evidence of macroscopic fat within a solid renal lesion on computed tomography was historically thought to be pathognomonic for this condition. Herein, we report a case of an incidental solid renal cell mass with multiple foci of intra-tumoral fat, which was shown to be a clear cell renal cell carcinoma (RCC) at nephrectomy. Macroscopic fat within solid renal lesions does not exclude malignancy, evaluation of other radiologic features is necessary when RCC is suspected

Epidemiology of enteroviral meningoencephalitis in neonates and young infants

Aim: To describe the epidemiology of enteroviral meningoencephalitis in northern New South Wales, Australia, with a specific focus on neonatal and young infant cases. Methods: A retrospective review of PCR-confirmed enteroviral meningoencephalitis cases in the Hunter New England Local Health District of northern NSW was conducted for the period 2008-2012. Results: One hundred nine patients met the case definition. There was summer seasonality, with 50% (55/109) of cases occurring between December and February. Neonates and young infants (<3 months of age) accounted for 42% (46/109) of cases, with 20% (9/46) being premature births. Fever (83%) was the most common presentation in this age group, followed by irritability (40%), feeding difficulties (40%) and rash (17%). All received at least one antibiotic during their admission, with 26% (12/46) also treated empirically with acyclovir. There was one death. Where testing was undertaken, cerebrospinal fluid (CSF) protein levels were high in 90% (28/31) of neonates and young infants, but the CSF white cell count was variable, with 57% <10/mm³ and 21% >100/mm³. Conclusion Early diagnosis of enteroviral meningoencephalitis could alter management, potentially reducing the period of treatment with empirical antimicrobials and permitting earlier discharge