The impact of multidisciplinary cancer meetings in guiding treatment intent in patients with upper tract urothelial carcinoma.

INTRODUCTION: Patient presentation at multidisciplinary cancer meetings (MDMs) is a key quality indicator in cancer care and may have particular utility in rare malignancies, such as upper tract urothelial carcinoma (UTUC). This study aims to investigate what proportion of patients diagnosed with UTUC had treatment intent changed at MDM, the nature of these changes, and what patient factors may correlate with a suggested change. METHODS: This study analyzed patients diagnosed with UTUC between 2015 and 2020 at an Australian tertiary referral center. MDM discussion rate and suggested treatment intent changes were analyzed. Patient factors that may prompt change, including age, estimated glomerular filtration rate (eGFR), Charlson Comorbidity Index (CCI), and Eastern Cooperation Oncology Group performance status (ECOG PS), were assessed. RESULTS: Seventy-five patients were diagnosed with UTUC of whom 71 (94.6%) were discussed at an MDM upon diagnosis. Change to palliative intent was suggested in 8/71 (11%) patients. Patients for whom change to palliative treatment was suggested had a higher age (median 85 vs. 78 years, p<.01), CCI (median 7 vs. 4, p<.005), ECOG PS (median 2 vs. 0, p<.002), and lower eGFR (mean 31 vs. 66 mL/min/1.73 m2, p< .0001), compared to those who underwent radical treatment. No patient had an MDM recommendation to change from palliative to curative treatment. CONCLUSION: MDM discussion resulted in clinically important changes of treatment intent in a substantial proportion of patients with UTUC, potentially sparing futile treatments. Several patient factors were associated with suggested changes, highlighting the requirement for accurate, in-depth patient information at MDM discussion.

Acute epididymo-orchitis from brucellosis melitensis in Australia.

Brucellosis epididymo-orchitis (BEO) is extremely rare in non-endemic areas such as Australia. While epididymo-orchitis is relatively common in adolescent men, when presented with a significant travel history, consideration should be given to rare causes such as this. Here, we present a case of BEO in a young 18-year-old man who recently migrated from Greece, with symptoms of acute scrotal pain, swelling and persistent fever. Brucella melitensis was isolated in the blood culture and confirmed with PCR. We suspect transmission was related to ingestion of unpasteurised goat dairy products. He made a full recovery after 7 days of intravenous gentamicin and 6 weeks of oral doxycycline. BEO should be considered in those who present with acute scrotal pain and fever after a recent history of travel to or from a brucellosis- endemic area.

Hormonal implications in the development and treatment of prostate cancer.

In this article, the conflicting data concerning the androgen axis and prostate cancer development are reviewed in addition to how this pathway may be exploited to prevent the development of prostate cancer. The expanding role of hormone ablative therapy alone or in conjunction with standard therapies, the controversies of timing of therapy, and the completeness of ablation and its use on an intermittent basis are reviewed.