In an article by Nyarangi-Dix et al published in J Urol (2012), the authors show that continence is better in patients treated by bladder neck preservation during radical prostatectomy than those without bladder neck preservation. They conducted a randomised study involving 208 men treated with radical prostatectomy at their institution. The patients did not know if they had the complete bladder neck preservation (cBNP) procedure or not. All the patients completed 12 months of follow-up. After excluding nine subjects, the analysis included 95 men who were assigned to cBNP and 104 non-BNP controls.

Surgical margin positivity rates were not significantly different between the two groups at 14.7% and 12.5%. Rates of social continence – defined as use of no more than one pad per day – were 84.2% vs 55.3% (p<0.001) at three months and 94.7% vs 81.4% (p=0.027) at 12 months, favouring cBNP. This study confirms many previous reports from retrospective data, and is similar to results from patients treated at the Staffordshire Urology Clinic.

In a news item published in BMJ (2012) by Wise, overall death from cancer is predicted to fall by 17% in UK by 2030. The predictions were based on the latest figures from the Wolfson Institute of Preventative Medicine at Barts and the London School of Medicine and Dentistry. In particular age adjusted prostate cancer deaths are predicted to fall by 16% due to earlier diagnosis and better treatment.

In an article published in BJUI (2012), the authors report that patients with blood group O have a better overall survival than other blood types, after surgery for renal cell carcinoma. This result has been observed in other cancer types.

In an article by Brigantine et al, published in Eur Urol (2012), the authors look at whether adjuvant or salvage radiotherapy is best to achieve prostate cancer cure following radical prostatectomy. This matched case control study of 890 men showed no difference in treating pT3 disease immediately post radical prostatectomy (adjuvant), or treating a rising PSA above 0.2 but below 0.5 ng/ml (salvage). At 2 and 5 years post surgery PSA recurrence free rates were about 91% and 80% in both groups with no statistical difference. Salvage treating reduces the need to treat all high risk men and reduces the morbidity of unnecessary radiotherapy. This is probably the best published evidence addressing this question to date, but the results of a randomised trial is awaited.

In an article published in BMJ, Zimmerman et al report an observational study of adults living in Alberta, Canada, between April 1997 and March 2009 who were registered with the provincial health registry. Those who developed a kidney stone during this time (n=23 706) were compared with the rest of the population (n=3 065 488) for risk of developing end stage renal disease (ESRD). They reported that one or more stone episodes during the follow-up period was associated with an increased risk of ESRD (adjusted hazard ratio 2.16 (95% CI 1.79 to 2.62)). The number of individuals who developed ESRD in the entire cohort was 5333 (0.2%) compared with 129 (0.5%) in the kidney stone cohort.

In an article published in Archives of Paediatrics and Adolescent Medicine (2012) the authors report that the rate of circumcision in newborn males had dropped from 79% in 1970s to 55% in 2010 in USA. For comparison, in UK there is a 16% circumcision rate and less than 2% in Denmark. This 20 year decline had already cost an estimated $20bn largely in the cost of treating added HIV infection, urinary tract infection in infants and adult HPV infection.

Following a German court ruling in June 2012 that described circumcision in a 4 year old Muslim boy as violating his fundamental human right to bodily integrity, an appeal to the German ethics council unanimously supported religious circumcision as long as 4 conditions were met:-
1) that both parents were in agreement
2) that the boy did not veto the procedure
3) that the procedure was performed by a suitably trained practitioner
4) that suitable pain relief was provided

In an article published in New Eng J Med (2012) the authors describe a placebo controlled trial using enzalutamide in castrate resistant prostate cancer. 1199 men were recruited; two thirds received 160 mg enzalutamide daily while the rest took placebo. The trial was stopped early, after 520 men had died, because a pre-planned analysis showed the drug’s superiority over placebo. Median survival with enzalutamide was 18.4 months, whereas with placebo this was 13.6 months. All the secondary outcomes also favoured the drug. These included the proportion of men in whom levels of prostate specific antigen (PSA) at least halved during the study (54% with enzalutamide v 2% with placebo), quality of life, and time to progression of the disease accompanied by a predefined rise in PSA (8.3 months v 3.0 months).