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Purpose of review African–American men in the USA have a higher incidence of and mortality from prostate cancer (PCa), with a longstanding debate about the cause for these worse outcomes. This review examines differences in tumour biology and socioeconomics for African–American and Non-Hispanic White (NHW) men to answer the question ‘why AA men face higher risks for lethal PCa’ and draw a management consensus to redress the imbalance. Recent findings Recent evidence from over the past 2 years suggests the reasons why African–American men face a higher risk of lethal PCa are multifactorial, with contributions from differences in tumour biology as well as socioeconomic and healthcare access factors. Regarding tumour biology, genomic and transcriptome profiling suggests African–American men have upregulated expression of genes related to inflammatory pathways with downregulation of DNA repair genes. In contrast, NHW men have higher DNA repair pathways and metabolic pathways involving glycolysis and cell cycle activity. In addition, epidemiological evidence suggests equal healthcare access ensures equal PCa specific outcomes, implying African–American men's disease is not inherently more lethal. However, differences in tumour biology remain, which may explain specific differences in PCa incidence and the clinical findings of African–American men's increased response to immunotherapy and radiotherapy in recent trials. Summary Regardless of racial differences in disease outcomes and the factors causing them, African–American and NHW men seem to have diseases unique to their ancestry. This supports the exploration of personalized PCa treatment approaches, leveraging translational basic science research to uncover these differences and devise specific individualized methods therapeutic regimes to address them.

Window-of-opportunity trials, during which patients receive short-duration pre-surgical therapies, provide a platform for understanding the therapies’ mechanisms of action, but will require a paradigm shift in trial design, specimen collection and analysis.

We present a user-friendly, cloud-based facility for quantifying methane emissions with 0.25∘ × 0.3125∘ (≈ 25 km × 25 km) resolution by inverse analysis of satellite observations from the TROPOspheric Monitoring Instrument (TROPOMI). The facility is built on an Integrated Methane Inversion optimal estimation workflow (IMI 1.0) and supported for use on the Amazon Web Services (AWS) cloud. It exploits the GEOS-Chem chemical transport model and TROPOMI data already resident on AWS, thus avoiding cumbersome big-data download. Users select a region and period of interest, and the IMI returns an analytical solution for the Bayesian optimal estimate of period-average emissions on the 0.25∘ × 0.3125∘ grid including error statistics, information content, and visualization code for inspection of results. The inversion uses an advanced research-grade algorithm fully documented in the literature. An out-of-the-box inversion with rectilinear grid and default prior emission estimates can be conducted with no significant learning curve. Users can also configure their inversions to infer emissions for irregular regions of interest, swap in their own prior emission inventories, and modify inversion parameters. Inversion ensembles can be generated at minimal additional cost once the Jacobian matrix for the analytical inversion has been constructed. A preview feature allows users to determine the TROPOMI information content for their region and time period of interest before actually performing the inversion. The IMI is heavily documented and is intended to be accessible by researchers and stakeholders with no expertise in inverse modelling or high-performance computing. We demonstrate the IMI's capabilities by applying it to estimate methane emissions from the US oil-producing Permian Basin in May 2018.

There has been a significant increase in the development of data-driven safety analytics approaches in recent years. In light of these advances it has become imperative to evaluate such approaches in a principled way to determine their merits and limitations. To that end, we propose an evaluation methodology underpinned by a simulated environment that allows for a comprehensive assessment of safety analytics approaches. While assessing those approaches with historical field data is undoubtedly important, such an assessment has limited statistical power because it corresponds to only one realization. The proposed methodology enables validation over a large number of realizations, thereby circumventing the statistical limitations of evaluation on historical data. Moreover, by using a simulated environment one is able to clearly distinguish between the variability in the observed data and differences in performance between safety approaches. A simulated environment does this by comparing the approaches under controlled circumstances, resulting in a fair and systematic evaluation of the potential long-term benefits. We demonstrate the utility of the proposed methodology via a case study that compares a few candidate safety analytics approaches. These approaches differ in how they assimilate field safety data to assess safety risk and suggest mitigative actions. We show that the proposed methodology indeed reveals useful insights and quantifies the relative merits and drawbacks of the different approaches, which would be otherwise difficult to objectively determine in a real-world scenario., Comment: Accepted to Safety Science

INTRODUCTION AND OBJECTIVE:Multi parametric MRI (mpMRI) has emerged as the most common tool to evaluate the need for biopsy in men referred for suspicion of prostate cancer, however PIRADS 3 remain...

INTRODUCTION AND OBJECTIVE:mpMRI and biomarkers have emerged as helpful tools to evaluate the need for prostate biopsy, however uncertainty remains in which test to get first. We assessed the perfo...

INTRODUCTION AND OBJECTIVE:The COVID-19 pandemic exploits existing inequalities in the social determinants of health (SDOH) that influence disease burden and access to healthcare. The role of healt...

Background To compare image quality, lesion detection and patient comfort of 3T prostate MRI using a combined rigid two-channel phased-array endorectal coil and an external phased-array coil (ERC-PAC) compared to external PAC acquisition in the same patients. Methods Thirty three men (mean age 65.3y) with suspected (n = 15) or biopsy-proven prostate cancer (PCa, n = 18) were prospectively enrolled in this exploratory study. 3T prostate MRI including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) was performed using an ERC-PAC versus PAC alone, in random order. Image quality, lesion detection and characterization (biparametric PI-RADSv2.1) were evaluated by 2 independent observers. Estimated signal-to-noise ratio (eSNR) was measured in identified lesions and the peripheral zone (PZ). Patient comfort was assessed using a questionnaire. Data were compared between sequences and acquisitions. Inter/intra-observer agreement for PI-RADS scores was evaluated. Results Twenty four prostate lesions (22 PCa) were identified in 20/33 men. Superior image quality was found for ERC-PAC compared to PAC for T2WI for one observer (Obs.1, p p p-values ≥0.08). Inter−/intra-observer agreement for PI-RADS scores was moderate-to-substantial (kappa = 0.52–0.84). Higher eSNR was observed for lesions and PZ for T2WI and PZ for DWI using ERC-PAC (p Conclusion Despite improved image quality and eSNR using the rigid ERC-PAC combination, no significant improvement in lesion detection was observed, therefore not supporting the routine use of ERC for prostate MRI.

Background: It is hypothesised that simulation enhances progression along the initial phase of the surgical learning curve. Objective: To evaluate whether residents undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes. Design, setting, and participants: This international, multicentre, randomised controlled trial recruited 94 urology residents with experience of zero to ten procedures and no prior exposure to simulation in ureterorenoscopy, selected as an index procedure. Intervention: Participants were randomised to simulation or conventional operating room training, as is the current standard globally, and followed for 25 procedures or over 18 mo. Outcome measurements and statistical analysis: The number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on the Objective Structured Assessment of Technical Skill (OSATS) scale over three consecutive operations, was measured. Surgical complications were evaluated as a key secondary outcome. This trial is registered at www.isrctn.com as ISCRTN 12260261. Results and limitations: A total of 1140 cases were performed by 65 participants, with proficiency achieved by 21 simulation and 18 conventional participants over a median of eight and nine procedures, respectively (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.72–2.75). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring a lower number of procedures (HR 0.89, 95% CI 0.39–2.02). Significant differences were observed in overall comparison of OSATS scores between the groups (mean difference 1.42, 95% CI 0.91–1.92; p < 0.001), with fewer total complications (15 vs 37; p = 0.003) and ureteric injuries (3 vs 9; p < 0.001) in the simulation group. Conclusions: Although the number of procedures required to reach proficiency was similar, simulation-based training led to higher overall proficiency scores than for conventional training. Fewer procedures were required to achieve proficiency in the complex form of the index procedure, with fewer serious complications overall. Patient summary: This study investigated the effect of simulation training in junior surgeons and found that it may improve performance in real operating settings and reduce surgical complications for complex procedures.

Production surveillance is the task of monitoring oil and gas production from every well in a hydrocarbon field. A key opportunity in this domain is to improve the accuracy of flow measurements per phase (oil, water, gas) from a multi-phase flow. Multi-phase flow sensors are costly and therefore not instrumented for every production well. Instead, several low fidelity surrogate measurements are performed that capture different aspects of the flow. These measurements are then reconciled to obtain per-phase rate estimates. Current practicesmay not appropriately account for the production dynamics and the sensor issues, thus, fall far short in terms of achieving a desired surveillance accuracy. To improve surveillance accuracy, we pose rate reconciliation as a state estimation problem. We begin with hypothesizing a model that describes the dynamics of production rates and their relationship with thefield measurements. The model appropriately accounts for the uncertainties in field conditions and measurements. We then develop robust probabilistic estimators for reconciliationto yield the production estimates and the uncertainties therein. We highlight recent advancements in the area of probabilistic programming that can go a long way in improving the performance and the portability of such estimators. The exposition of our methods is accompanied by experiments in a simulation environment to illustrate improved surveillance accuracy achieved in different production scenarios.

INTRODUCTION AND OBJECTIVES:Positron emission tomography/computed tomography (PET/CT) with 18F-fluciclovine can improve the detection of recurrent prostate cancer (PCa). We assessed for factors whi...

INTRODUCTION AND OBJECTIVES:The presence of tertiary pattern 5 (TP5) on radical prostatectomy specimens has been associated with worse long-term outcomes. However, the molecular underpinnings of TP...

INTRODUCTION AND OBJECTIVES:Prostate specific antigen is a poor biomarker for prostate cancer (PCa), with a nearly 70% negative biopsy rate as well as overdiagnosis of clinically insignificant PCa....

INTRODUCTION AND OBJECTIVES:One of the major health related quality of life issues following radical prostatectomy (RP) is urinary incontinence. The detrusor apron (DA), although well described, is...

Production surveillance is the task of monitoring oil and gas production from every well in a hydrocarbon field. Accurate surveillance is a basic necessity for several reasons that include improved resource management, better equipment health monitoring, reduced operational cost, and ultimately optimal hydrocarbon production. A key challenge in this task, especially for large fields with many wells, is the measurement of multiphase fluid flow using a limited number of noisy sensors of varying characteristics. Current surveillance practices are based on fixed utilization schedules of such flow sensors, which rarely change over time. Such a passive mode of sensing is completely agnostic to surveillance performance and thus often fails to achieve a desired accuracy. Here we propose an active surveillance approach, underpinned by the concept of value of information-based sensing. Borrowing some well-known concepts from Markov decision processes, reinforcement learning and artificial neural networks, we demonstrate that a practical active surveillance strategy can be devised, which can not only improve surveillance performance significantly, but also reduce usage of flow sensors.

PURPOSE: The prospective, multicenter LOCATE ((18)F Fluciclovine [FACBC] PET/ CT in Patients with Rising PSA after Initial Prostate Cancer Treatment) trial assessed the impact of positron emission tomography/computerized tomography with (18)F-fluciclovine on treatment plans in patients with biochemical recurrence of prostate cancer after primary therapy with curative intent. MATERIALS AND METHODS: Men who had undergone curative intent treatment of histologically confirmed prostate cancer but who were suspected to have recurrence based on rising prostate specific antigen levels were enrolled prospectively. Each man had negative or equivocal findings on standard of care imaging. (18)F-fluciclovine positron emission tomography/computerized tomography was performed according to standardized protocols. Treating physicians completed a questionnaire regarding the patient treatment plan before and after scanning, recording changes to the treatment modality (eg salvage radiotherapy to systemic androgen deprivation therapy) as major and changes in a modality (eg modified radiotherapy fields) as other. RESULTS: Between June 2016 and May 2017, 213 evaluable patients with a median age of 67 years and median prostate specific antigen 1.00 ng/ml were enrolled in study. (18)F-fluciclovine avid lesions were detected in 122 of the 213 patients (57%). Overall 126 of the 213 patients (59%) had a change in management after the scan, which were major in 98 of 126 (78%) and in 88 (70%) were informed by positive positron emission tomography/computerized tomography findings. The most frequent major changes were from salvage or noncurative systemic therapy to watchful waiting (32 of 126 cases or 25%), from noncurative systemic therapy to salvage therapy (30 of 126 or 24%) and from salvage therapy to noncurative systemic therapy (11 of 126 or 9%). CONCLUSIONS: (18)F-fluciclovine positron emission tomography/computerized tomography detected 1 or more recurrence sites in the majority of men with biochemical recurrence, frequently resulting in major changes to management plans. Future studies will be planned to determine whether a management change leads to improved outcomes.

Uncertainty analysis of building energy prediction is critical to characterize the baseline performance of a building for impact assessment of energy saving schemes that include fault detection and diagnosis (FDD) systems, advanced control policies and retrofits among others. This paper presents a novel approach based on Gaussian Mixture Regression (GMR) for modeling building energy use with parameterized and locally adaptive uncertainty quantification. The choice of GMR is motivated by two key advantages (1) the number of unique operational patterns of a building can be identified using an information-theoretic criteria in a data-driven manner and (2) confidence bounds on baseline prediction are localized and their estimation is integrated with the modeling process itself. The proposed GMR approach is applied to two cases (1) one year synthetic data set generated by Department of Energy (DoE) reference model for a supermarket in Chicago climate and (2) one year field data for a retail store building located in California. The results from GMR model are compared with some prevalent multivariate regression models for baseline building energy use.

Context In 2001, Rocco et al. described a surgical technique whose aim was the reconstruction of the posterior musculofascial plate after radical prostatectomy (RP) to improve early return to urinary continence. Since then, many surgeons have applied this technique—either as it was described or with some modification—to open, laparoscopic, and robot-assisted RP. Objective To review the outcomes reported in comparative studies analysing the influence of reconstruction of the posterior aspect of the rhabdosphincter after RP. The main outcome evaluated was urinary continence at 3–7 d, 30–45 d, 90 d, 180 d, and 1 yr after catheter removal. Evidence acquisition A systematic review of the literature was performed in November 2011, searching the Medline, Embase, Scopus, and Web of Science databases. A "free-text" protocol using the terms posterior reconstruction of the rhabdosphincter, posterior rhabdosphincter , and early continence was applied. Studies published only as abstracts and reports from meetings were not included in this review. One thousand seven records were retrieved from the Medline database, 1541 from the Embase database, 1357 from the Scopus database, and 1041 from the Web of Science database. The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. Only papers evaluating use of this technique as the only technical modification among the groups were included. A cumulative analysis was conducted using Review Manager v.5.1 software (Cochrane Collaboration, Oxford, UK). Evidence synthesis Eleven studies were identified in the literature search, including two randomised controlled trials (RCTs), which were negative studies. The cumulative analysis of comparative studies showed that reconstruction of the posterior musculofascial plate improves early return of continence within the first 30 d after RP ( p =0.004), while continence rates 90 d after surgery are not affected by use of the reconstruction technique. The statistical significance of the reconstruction seems to decrease when higher continence rates are reported. Use of posterior rhabdosphincter reconstruction does not seem to be related to positive surgical margin (PSM) rates or with complications like acute urinary retention (AUR) and bladder neck stricture (BNS). Some studies suggested lower anastomotic leakage rates with the posterior musculofascial plate reconstruction technique. Conclusions The role of reconstruction of the posterior musculofascial plate in terms of earlier continence recovery is encouraging but still controversial. Methodological flaws and poor surgical standardisation seem to be the major causes. In two RCTs and one parallel (not randomised) group trial, posterior rhabdosphincter reconstruction offered no significant advantage for return of early continence after RP. No significant complications related to the posterior musculofascial plate reconstruction technique have been reported so far. A multicentre RCT is necessary to clarify the possible role of the technique in terms of earlier continence recovery.

PURPOSE OF REVIEW: Over 90% of all prostate cancer patients are diagnosed at a stage when the disease is organ-confined and potentially curable. Currently, more than 60% of all prostate cancer surgeries in the USA are performed using the robotic approach. We review the current literature evaluating the technical advances to optimize continence recovery following robotic prostatectomy. RECENT FINDINGS: Recent studies suggest that the several technical nuances during robotic prostatectomy can result in earlier continence recovery in patients without compromising the oncologic outcome. The key is in delicate handling of tissues, reducing trauma, preserving support structures, and restoring postoperative anatomy as close as possible to preoperative anatomy. There should also be standardization in assessment of continence recovery. SUMMARY: Much progress has been achieved in elucidating the anatomic, physiologic, and neural basis of the male continence mechanism, resulting in novel adaptations of the conventional approach to radical prostatectomy with the aim of preserving continence and accelerating its return. Various principles for augmenting continence return have been proposed which have been evaluated in series of open, laparoscopic, and robotic-assisted radical prostatectomy. Going forward, we foresee a paradigm shift from individual techniques toward a unified approach of interwoven principles aimed at preserving and augmenting the functional and innervative anatomy of the continence mechanism.

Background: Positive surgical margins (PSMs) are a known risk factor for biochemical recurrence in patients with prostate cancer (PCa) and are potentially affected by surgical technique and volume. Objective: To investigate whether radical prostatectomy (RP) modality and volume affect PSM rates. Design, setting, and participants: Fourteen institutions in Europe, the United States, and Australia were invited to participate in this study, all of which retrospectively provided margins data on 9778 open RP, 4918 laparoscopic RP, and 7697 robotic RP patients operated on between January 2000 and October 2011. Outcome measurements and statistical analyses: The outcome measure was PSM rate. Multivariable logistic regression analyses and propensity score methods identified odds ratios for risk of a PSM for one modality compared with another, after adjustment for age, preoperative prostate-specific antigen, postoperative Gleason score, pathologic stage, and year of surgery. Classic adjustment using standard covariates was also implemented to compare PSM rates based on center volume for each minimally invasive surgical cohort. Results and limitations: Open RP patients had higher-risk PCa at time of surgery on average and were operated on earlier in the study time period on average, compared with minimally invasive cohorts. Crude margin rates were lowest for robotic RP (13.8%), intermediate for laparoscopic RP (16.3%), and highest for open RP (22.8%); significant differences persisted, although were ameliorated, after statistical adjustments. Lower-volume centers had increased risks of PSM compared with the highest-volume center for both laparoscopic RP and robotic RP. The study is limited by its nonrandomized nature; missing data across covariates, especially year of surgery in many of the open cohort cases; lack of standardized histologic processing and central pathology review; and lack of information regarding potential confounders such as patient comorbidity, nerve-sparing status, lymph node status, tumor volume, and individual surgeon caseload. Conclusions: This multinational, multi-institutional study of 22 393 patients after RP suggests that PSM rates might be lower after minimally invasive techniques than after open RP and that PSM rates are affected by center volume in laparoscopic and robotic cases. Patient summary: In this study, we compared the effectiveness of different types of surgery for prostate cancer by looking at the rates of cancer cells left at the margins of what was removed in the operations. We compared open, keyhole, and robotic surgery from many centers across the globe and found that robotic and keyhole operations appeared to have lower margin rates than open surgeries. How many cases a center and surgeon do seems to affect this rate for both robotic and keyhole procedures. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.

Following recently published EAU Policy on Live Surgical Events (LSE's) it is assured that live surgery will be ongoing at conferences in the immediate future. However, the panel reached >80% consensus view that performing at a home institution may be safer. The committee also identified issues with a ‘travelling surgeon’ performing complex surgery in an unfamiliar environment with a surgical team that is not experienced with the intricacies of surgeons techniques. LSE's from home institutions remove or minimize these negative aspects.

PURPOSE OF REVIEW: Much of the progress in improving potency outcomes after radical prostatectomy has been achieved due to a better visualization of the neurovascular bundle responsible for erectile function. We review the current literature evaluating the existing imaging modalities to image the neurovascular bundle around the prostate pre, intra, and postoperatively, thereby enabling development of surgical techniques for better preservation of nerve function. RECENT FINDINGS: Imaging modalities like multiphoton microscopy, optical coherence tomography, Coherent anti-Raman spectroscopy, exogenous fluoroscopy using prostate-specific membrane antigen, and so on have led to a better appreciation of the neurovascular bundle, thus encouraging novel techniques in nerve preservation during radical prostatectomy. SUMMARY: In an age of heightened patient expectations and increasing life expectancy, better visualization of the neurovascular bundle around the prostate using novel imaging modalities may provide breakthroughs in improving potency outcomes after radical prostatectomy.