In an article in BMJ (2012), the author discusses PSA screening for prostate cancer. Several studies have shown that a small number of prostate deaths could be avoided by screening for prostate cancer. However, a significant number of men may be harmed by treatment that they may never have needed. The authors believe that by using a genetic test looking for the presence of common prostate cancer genes, followed by a personalised use of PSA screening depending on genetic risk starting at the age of 45, would reduce the cost of screening and improve the pickup of significant prostate cancer compared to insignificant disease, thus reducing over treatment.

In an article in BMJ (2012), the author discusses the increasing numbers of NHS patients treated in Private Hospitals. Individuals in the UK with private medical insurance have reduced by 1.5 million (19%) since 2009, thought to be due to the recession. This has left capacity at private hospitals, which is being increasingly filled by the treatment of NHS patients.

In an article by Patel et al published in BJUI (2012) the authors studied 234 patients with suspected renal cancer less than 4cms in size. 71 were treated by surveillance, 41 by radical nephrectomy and 90 by partial nephrectomy. After a median follow up of 34 months over 53% of masses managed by surveillance had not increased in size and only 1 (with multiple tumours) had spread. 20% went on to ablative therapy. Cancer specific survival was 99%, 93% and 97% with overall survival of 83%, 80% and 90% for surveillance, radical and partial nephrectomy groups respectively. The authors conclude that active surveillance of renal masses <4cms is as safe as surgery in the short term.

In an article by Vargas et al published in J Urol (2012), the authors showed that MRI could predict aggressive prostate cancer in patients initially thought to have low risk prostate cancer. Such upgrading is a barrier to the acceptance of active surveillance for men with prostate cancer. A total of 388 consecutive men (mean age 60.6 years, range 33 to 89) with clinically low risk prostate cancer (initial biopsy Gleason score 6 or less, prostate specific antigen less than 10 ng/ml, clinical stage T2a or less) underwent MRI before confirmatory biopsy. Three radiologists independently and retrospectively scored tumour visible on MRI using a 5-point scale (1—definitely no tumour to 5—definitely tumour). Associations between magnetic resonance imaging scores and confirmatory biopsy findings were evaluated.

On confirmatory biopsy, Gleason score was upgraded in 79 of 388 (20%) patients. Magnetic resonance imaging scores of 2 or less had a high negative predictive value (0.96–1.0) and specificity (0.95–1.0) for upgrading on confirmatory biopsy. A magnetic resonance imaging score of 5 was highly sensitive for upgrading on confirmatory biopsy (0.87–0.98).

The authors concluded that MRI was useful in the selection of patients for management with active surveillance.