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There are inconsistent findings concerning the association between the serum concentrations of lipid parameters and prostate cancer (PCa), particularly in Caucasian men. There is limited data on men of African ancestry. The study examined the relationship between serum total cholesterol (TC) levels and its fractions and PCa in a hospital-based case-control study in Jamaica. The serum levels of TC, triglycerides (TG), HDL-cholesterol (HDL-C), and LDL-cholesterol (LDL-C) in 46 male patients (cases) who underwent prostate biopsy were measured over an eighteen month period. There were 32 patients without PCa who served as controls. The serum lipid concentrations between cases and controls were compared using an independent samples t-test. Multiple linear regression and binary logistic regression were used to assess the relationship between lipids and overall PCa, as well as disease severity. Based on the results, there were no significant differences between the concentrations of lipids for the cases and controls. The results of the regression analysis revealed that the serum lipid levels were not significant predicators of overall PCa. The outcomes of the binary regression analysis showed the same for PCa severity. The study concluded that there was no association between serum levels of lipids and overall PCa as well as disease severity at the time of diagnosis in the sample of Jamaican men.

Several studies suggest race-based health disparities in men with low-risk prostate cancer (PCa), with African American males having poorer oncological outcomes. We sought to determine the prevalence and predictors of pathological upgrading and upstaging in Jamaican men with low-risk PCa treated with radical prostatectomy (RP). Data on 141 men who met the National Comprehensive Cancer Network criteria for low-risk PCa and underwent RP at a single institution were reviewed. All men had a transrectal ultrasound-guided biopsy. Pre-operative clinical and final pathological data were obtained. Data were summarised as means and standard deviations or percentages as appropriate. Bivariate analyses such as independent samples t-tests and chi-square tables were conducted and logistic regression models were estimated to predict upgrading (>Gleason 6) and upstaging (p ≥ T3). The mean age was 59.5 ± 7.8 years with mean prostate specific antigen (PSA) of 6.6 ± 2 ng/mL. A total of 48.3% of men were upgraded and 11.4% were upstaged. Bivariate analyses indicated that PSA (p = 0.008) and percentage positive cores (p = 0.002) were associated with upgrading. PSA (p = 0.042) and percentage positive cores (p = 0.003) were significantly associated with upstaging. The odds of upgrading increased with increased PSA levels (OR 1.40, 95% CI 1.05-1.87, p = 0.021) or increased percentage positive cores (OR 8.27, 95% CI 2.19-31.16, p = 0.002). The odds of upstaging increased with increased PSA levels (OR 1.4, 95% CI 1.01-1.96, p = 0.046) and with increased percentages positive cores (OR 11.4; 95% CI 2.06-63.09, p = 0.005). Jamaican men with low-risk PCa are at high risk of pathological upgrading and upstaging at RP. These findings should be taken into consideration when discussing treatment options with these patients.

Screening is the only effective method of reducing prostate cancer mortality. Several reports have documented poor prostate cancer awareness and screening practices in Jamaican men. The Jamaica Cancer Society provides the most organized and largest form of screening in Jamaica and hosts an annual mass screening clinic on Prostate Cancer Awareness Day in September. We sought to determine the knowledge and attitudes towards screening and risks and prevention of prostate cancer. The study represented a cross-sectional analysis of 55 men presenting for screening on Prostate Cancer Awareness Day, September 2014 in Kingston, Jamaica. Information on prostate cancer knowledge and attitudes towards screening was obtained using interviewer-administered questionnaires (The Integrative Model of Prostate Cancer Disparity (PIPCaD). Prostate specific antigen (PSA) and digital rectal examination (DRE) were obtained from all patients. Mean PSA of participating men was 1.5 ± 1.48 ng/ml. Fifteen percent of men surveyed had a family history of prostate cancer. Prostate cancer knowledge was moderate, with at least 84 % of men responding correctly to 5 of 10 questions referring to prostate cancer risk and prevention. Most men had a favorable attitude towards screening. Starch formed the major portion of the diet in 68 % of men and 35 % of men engaged in no physical activity. Jamaican men surveyed have moderate prostate cancer knowledge and a positive attitude towards screening and prostate cancer prevention activities. However, the application of activities for potential prevention of modifiable risk factors is poor.

Applied researchers (eg, academic researchers, PhD students) strive to undertake research that can inform practice in sport, and evidence ‘ impact.’ Conversely, practitioners (eg, coaches, physiotherapists, clinicians, sports scientists) strive to apply relevant up-to-date research findings to develop or optimise practice, adopting ‘ evidence based practice. ’ Despite the researcher and practitioner within a discipline having similar overall aims (eg, improve athletic performance, reduce injury risk, optimise return to play practices), their primary roles appear different due to various contextual factors.1 2 Researchers are able to work slowly, dedicating time to solving complex problems, whereas practitioners working in the field are required to work fast, to provide day-to-day support to coaches and athletes.1 The differences in how the researcher and practitioner work can be problematic and challenge the alignment of their respective priorities within their roles (eg, timescales required to deliver outcomes, specific expertise and experience, resources). Here we share a model demonstrating how the ‘working fast1 on-field brain3’, ‘working slow1 off-field brain3’ and ‘research-practitioner2’ can work together to undertake and integrate research into practice and solve the above problems. The alignment of (applied) research questions, expectations and usability of outcomes into practice …

What's known on the subject? and What does the study add? It is known that men of African descent in the USA and Jamaica have both a higher incidence of prostate cancer and higher mortality than Caucasian men, but it is unclear whether they have worse pathological and biochemical recurrence (BCR) outcome than their Caucasian counterparts after radical prostatectomy (RP) for prostate cancer. We found that African-American (AA) men present at a younger age and have a higher mean PSA level than Caucasian-American (CA) men and that Afro-Caribbean (AC; Jamaican) men present with the highest mean PSA level, Gleason score and tumour stage of the three groups. In addition, we showed that AA and AC men have a higher likelihood of 5-year BCR than CA men and that AA and AC race are both independent predictors of BCR after RP. OBJECTIVE • To compare pathological and biochemical outcomes of radical prostatectomy (RP) among African-American (AA), Afro-Caribbean (AC; Jamaican) and Caucasian-American (CA) men using an international cohort of patients who underwent RP in the USA and Jamaica. MATERIALS AND METHODS • A retrospective review was performed of men who underwent RP for clinically organ-confined (OC) prostate cancer between 2000 and 2011 at Columbia University Medical Center (New York, USA) and the University Hospital of the West Indies (Kingston, Jamaica) between 2000 and 2007. • Men who had received neoadjuvant or adjuvant (within 3 months) therapy were excluded. • Clinicopathological variables were compared among the three groups, focusing on age, stage, PSA level, Gleason sum (GS) and margin status. • Multivariate analysis was performed to determine the predictors of biochemical recurrence (BCR; PSA >0.2 ng/mL), and Kaplan–Meier analysis was performed to determine BCR-free survival rates in AA, AC and CA men. RESULTS • A total of 483 men underwent RP for clinically OC disease (CM, n= 309, AA, n= 93 and AC, n= 81). • The mean patient age was 59 years, with AA men being younger than CA men (58 vs 60 years, P< 0.05). The mean (range) follow-up was 49 (13–133) months with no significant difference among the groups. • The men in the AC cohort had a higher mean PSA level than AA and CA men (8.8 vs 6.2 and 5.0 ng/mL, respectively, P< 0.05) and more clinical GS ≥7 (44%) tumours than AA (8%) and CA men (0%; P< 0.01). • On multivariate analysis, controlling for stage, grade, PSA level and margins, AA and AC race were independent predictors of BCR. • AA and AC men had significantly lower 5-year BCR-free survival (76 and 74%, respectively) than CA men (98% [P< 0.001]). CONCLUSIONS • This international comparison of clinicopathological outcomes in AA, AC and CA men undergoing RP shows that AA and AC men present similarly with more aggressive disease features than CA men and have lower 5-year BCR-free survival. • Both AA and AC race are significant predictors of BCR, independently of stage, grade, PSA level and margin status. Further research is needed to elucidate and correct the mechanisms behind the observed difference in outcome among these populations.

Highlights • First report of complete ureteral duplication with stones obstructing both limbs. • Ureters are smaller and contained terminally within common adventitial sheath. • Small and unyielding ureters make ureteroscopic intubation and passage difficult. • Pre-stenting improves ureteral compliance and causes passive dilation of ureter. • Recommend routine pre-stenting in this scenario to improve ureteroscopic access., INTRODUCTION A woman with bilateral complete ureteral duplication with stones simultaneously obstructing both limbs of the left double ureter is presented. A search of the English medical literature suggests that this is the first reported case. Based on the initial difficulty accessing the stones via ureteroscopy we make recommendations regarding how this rare problem should be approached if encountered. PRESENTATION OF CASE A 37-year old woman with left-sided flank pain was discovered on CT scan to have bilateral complete ureteral duplication and three stones obstructing both limbs of the left double ureter. Ureteroscopy was initially unsuccessful due to the very small calibre and unyielding nature of the ureters and both ureteral limbs were stented. Repeat ureteroscopy was easily achieved after pre-stenting and the impacted stones were completely cleared with intracorporeal laser lithotripsy. DISCUSSION The smaller calibre of both double ureters and their presence in a common adventitial sheath distally, made initial attempts at ureteroscopy difficult. Stenting both limbs increased ureteral compliance, passively dilated both ureters and allowed for improved manoeuvrability and retrograde passage of the ureteroscope. Based on the experience with this first reported case it is recommended that pre-stenting should be routinely performed prior to any attempt at ureteroscopy in cases of stones complicating completely duplicated ureters. CONCLUSION We report the first recorded case of bilateral complete ureteral duplication with stones simultaneously obstructing both limbs of the double ureter and recommend that routine pre-stenting be done prior to ureteroscopy to allow easy uncomplicated retrograde passage of the ureteroscope.

A case of a 45-year old woman with an ovarian dermoid cyst causing ureteric colic secondary to distal ureteral obstruction is reported. The dermoid cyst was observed on computed tomography to be adjacent to and compressing the distal left ureter and this was confirmed at surgical exploration. Following oophorectomy, the patient's symptoms completely resolved and the excised ovarian cyst was confirmed on pathological evaluation to be a dermoid cyst. This appears to be the first reported case of ureteral obstruction caused by an ovarian dermoid cyst in the English medical literature.

Prostate cancer is the commonest cancer in Jamaica as well as the leading cause of cancer-related deaths. One report suggested that Jamaica has the highest incidence rate of prostate cancer in the world, with an age-standardised rate of 304/100,000 per year. The Caribbean region is reported to have the highest mortality rate of prostate cancer worldwide. Prostate cancer accounts for a large portion of the clinical practice for health-care practitioners in Jamaica. The Jamaica Urological Society is a professional body comprising 19 urologists in Jamaica who provide most of the care for men with prostate cancer in collaboration with medical oncologists, radiation oncologists, and a palliative care physician. The health-care system is structured in two tiers in Jamaica: public and private. The urologist-to-patient ratio is high, and this limits adequate urological care. Screening for prostate cancer is not a national policy in Jamaica. However, the Jamaica Urological Society and the Jamaica Cancer Society work synergistically to promote screening as well as to provide patient education for prostate cancer. Adequate treatment for localised prostate cancer is available in Jamaica in the forms of active surveillance, nerve-sparing radical retropubic prostatectomy, external beam radiation, and brachytherapy. However, there is a geographic maldistribution of centres that provide prostate cancer treatment, which leads to treatment delays. Also, there is difficulty in affording some treatment options in the private health-care sectors. Androgen deprivation therapy is available for treatment of locally advanced and metastatic prostate cancer and is subsidised through a programme called the National Health Fund. Second-line hormonal agents and chemotherapeutic agents are available but are costly to most of the population. The infrastructure for treatment of prostate cancer in Jamaica is good, but it requires additional technological advances as well as additional specialist services.

Patient Male, 59. Final diagnosis Neuroendocrine carcinoma of urinary bladder. Symptoms Dysuria • hematuria. Medication - Clinical procedure MRI • cystoscopy. Specialty Urology • oncology. Objective Rare disease. Background Neuroendocrine carcinomas of the genitourinary tract are rare but distinct and important entities because they are very aggressive tumors and are usually advanced or metastatic at the time of diagnosis. A high index of suspicion must be held by the pathologist viewing the specimen, as it can easily be misdiagnosed as a high grade urothelial carcinoma. Specific, proven treatment algorithms have been formulated over the years for the latter, whilst neuroendocrine carcinomas of the genitourinary tract are rare and treatment regimes have not yet been proven to show a significant improvement in survival in the majority of cases, so accurate diagnosis is important. Case report We report the case of a 59-year-old man who presented with a short history of dysuria and frank hematuria. Imaging and cystoscopy revealed a large exophytic mass in the base of the urinary bladder, which extended into the bladder neck. Metastatic deposits were already present in his liver and vertebrae. Histology revealed a neuroendocrine carcinoma. Conclusions A comprehensive review of the existing literature regarding this rare but aggressive tumor is presented, including advances in classification, pathogenesis, and treatment.

Highlights • Suitable for uncircumcised men with a penile fracture without urethral injury. • An intentional delay of seven days is made before reassessment of the patient. • In true penile fractures a “rolling sign” at the fracture site is felt at day seven. • Focal incision over the fracture site under local anaesthesia is possible. • The delayed approach mitigates against negative surgical exploration., Introduction The traditional surgical approach to penile fracture is to perform a circumferential subcoronal degloving incision emergently to repair the injury. This approach necessitates circumcision to avoid foreskin complications. We present four men who had a delayed foreskin-sparing approach and discuss its advantages. Presentation of case Four of five uncircumcised patients who had suspected penile fractures secondary to coital injury, and without suspicion of concomitant urethral injury, had a delayed exploration, seven days after injury, utilizing an incision directly over the palpable haematoma, at the location of the tunical defect, thereby resulting in foreskin preservation. Two of 5 patients had repair under general anaesthesia, one under local anaesthesia and surgery was cancelled in another because upon reassessment at seven days he had normal erections and a normal penile examination. At follow up, all men had good functional and cosmetic outcomes. Discussion Uncircumcised patients with penile fractures, without suspicion of urethral injury, may undergo a delayed repair without prophylactic circumcision since there is minimal risk of foreskin complications. Delayed repair decreases the incidence of negative explorations by fostering a conservative approach in mimicking conditions such as superficial vein lacerations. It also enables the use of local anaesthesia in an elective ambulatory setting. Conclusion Delayed repair of penile fractures results in foreskin preservation, facilitates elective ambulatory care under local anaesthesia and decreases the incidence of negative surgical explorations.