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Prostate artery embolisation (PAE) is a new minimally in-vasive treatment for prostate disease. Recent studies have shown, that PAE may be an alternative to transurethral resection of the prostate (TURP), and it reduces the prostate volume by 40%. The reduction in symptom score is com-parable to that of TURP, and only few major complications have been reported. The purpose of this narrative review is to provide a brief overview of the current literature on PAE.

High-quality scientific evidence may be inadequate to support real world decision-making. Assessment of applicability and generalizability of medical scientific evidence is needed for the practitioner. Often, large differences between trial participants and actual end-users of interventions exist. We present the difference between efficacy and effectiveness in connection with trial design and encourage critical evaluation of external validity. Pragmatic design of trials can be considered a preferred choice to limit the prevailing gap between current evidence and practice.

Castration-resistant prostate cancer (CRPC) is defined as tumour progression despite castrate levels of serum testosterone. During the past decade a number of new therapies, including chemotherapy and novel endocrine agents have been approved for CRPC treatment. The continued need for new effective drugs in CRPC has led to development of a novel therapeutic approach in CRPC treatment. Therapeutic vaccines activate the immune system to kill prostate cancer cells. This review describes recent pivotal phase 2 and 3 trials of CRPC vaccines and discusses the impact on future CRPC management.

Radical prostatectomy has in randomised settings failed to demonstrate a survival difference in patients with low-risk prostate cancer when tested against an observational strategy. Active surveillance has been introduced in order to reduce overtreatment by distinguishing between cancers with a biological potential, and truly indolent cancers best left untreated. Preliminary results from large prospective active surveillance cohorts are promising; however, uncertainties persist concerning optimal patient selection and follow-up, as well as the long-term safety.

Prostate cancer that progresses despite castrate levels of serum testosterone is defined as castration-resistant prostate cancer (CRPC). Molecular investigations of the disease have established that progression of CRPC remains driven by androgen receptor signalling and that CRPC continues to respond to hormonal manipulation. Recently, new endocrine treatments including an androgen receptor signalling inhibitor and a testosterone synthesis inhibitor have been approved for treatment of CRPC. We review the pivotal phase 3 trials and discuss their implications for future treatment of CRPC.

Radical prostatectomy has been offered as curative treatment for localized prostate cancer at Rigshospitalet since August 1995. We here report on postoperative complications in 719 patients operated during the 12-year-period from August 1995 to August 2007 with special emphasis on developments over time.A retrospective review.Median age at surgery was 63 years with a significant increase from 61 to 64 during the 12-year-period. We found no change in clinical preoperative T-category, whereas the median pre-treatment PSA decreased significantly. This reflects increased surgical experience and an optimized postoperative course. Significant reductions in operating time, need for blood transfusions, and length of hospitalisation were recorded. One or more complications were registered in 164 patients (22.8%); severe complications occurred in eight patients (1,1%). One patient died within 30 days after surgery.Our results demonstrate that radical prostatectomy can be performed with a minimal mortality and an acceptable morbidity.

The optimal management of prostate cancer patients with lymph node metastasis remains controversial. In this article, the outcome in a consecutive group of patients with newly diagnosed lymph node positive prostate cancer is presented.In 59 patients with histological verified lymph node positive disease but without osseous metastasis, outcome is described by time to biochemical progression, time to metastasis and survival.Median age at diagnosis was 62 years. Median pre-treatment PSA was 21 ng/ml. Endocrine treatment was initiated within median 2 weeks in 97% of the patients. Median follow-up was 3 years. Median time to biochemical progression was 1.8 years and 5-year biochemical recurrence-free survival was 14%. Median time to development of osseous metastasis was 4.4 years and 5-year metastasis-free survival was 49%. Eighteen of the 59 patients died during follow-up, 15 deaths were attributable to prostate cancer. Estimated median survival was 5.5 years.Despite early androgen deprivation therapy, patients with lymph node positive prostate cancer have a grave prognosis with a high risk of progression and disease-specific mortality.

Although prostate cancer is among the most common male cancers, little information is available on risk factors. The paper reviews trends in prostate cancer incidence, and possible risk factors are discussed. Incidence appears to have peaked and is predicted to stabilize at a higher level due to screening. Besides heredity, epidemiological studies on prostate cancer produce equivocal results. Lifestyle and environment are likely to have an important impact on prostate cancer risk, but significant and clinically relevant risk factors have yet to be identified.

Previous studies in Denmark have reported an increase in prostate cancer (PC) incidence- and mortality rates. So far, it has not been possible to establish the rising incidence as a consequence of an increase in diagnostic procedures. This study reviews the trends in PC incidence and mortality rates in Denmark during the 60-year-period from 1943 to 2002.Register-based study.The age-standardised (World Standard Population) rate of PC in Denmark increased from 11.4/100,00 in the period 1943-47 to 38.2/100,000 in the period 1998-2002. Mortality rate increased from 13.5/100,000 in 1953 to 19.1/100,000 in the period 1993-98. Within the last 10 years changes in age-distribution and clinical stage, especially among younger patients, indicate a shift towards a more active diagnostic policy.In concordance with other studies we found an increasing PC incidence. In the last 10-year-period studied from 1993 to 2002, our study found the rise in incidence most likely explained by an increase in diagnostic activity, presumably as unsystematic PSA-based "gray-zone screening". This development contrasts with the national recommendation for PSA-based screening for PC. The rising incidence will necessitate allocation of increased resources for evaluation, treatment, and follow-up of patients with PC.

Xanthogranulomatous pyelonephritis is a rare disease probably caused by long-standing obstruction and secondary infection. We report a case in a 47-year-old woman with no previous history of renal stones. Preoperative diagnostic workout included ultrasonography, CT scan, and drainage. Nephrectomy was performed, and the patient's postoperative recovery was uneventful. The difficulties of correct preoperative diagnosis are discussed.