Staging practice for prostate cancer varies and is not in line with clinical guidelines.

INTRODUCTION: The objective was to describe regional variations in M-staging in patients with newly diagnosed prostate cancer within a Danish county and to compare clinical practice with guideline recommendations. METHODS: Data were as captured from 1) a prospective, non-interventional study counting 635 consecutive patients referred for M-staging in the 2008-2009 period at three regional hospitals within one county, and 2) a questionnaire on M-staging practice completed by the five sites performing M-staging in the same county in 2015. RESULTS: All three sites referred patients for M-staging in 2008, irrespective of their risk factors. Two of the three sites maintained this practice in 2015. Furthermore, in 2015, three of five sites performed M-staging in intermediate and high-risk patients only. Planar whole-body bone scans were standard in all sites in 2008 with single photon emission computed tomography/computed tomography (SPECT/CT) being performed if required and if available. In 2015, two sites used choline positron emission tomography/CT for primary staging of high-risk patients against guideline recommendations. The use of SPECT/CT showed wide variations from "if required" to "mandatory" head-to-thigh imaging. There were notable variations between clinical practice and guidelines in 2008, and this was even more evident in 2015. CONCLUSION: Considerable variations existed with respect to the M-staging imaging practices in prostate cancer within a single Danish county. The variation was more pronounced in 2015 than in 2008. Clinical practice conflicted in part with European and national Danish guidelines. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Cowper's syringocele as cause of low urinary tract symptoms in a young man].

Cowper's syringocele (CS) is a very rare deformity of male urethra causing obstructive voiding symptoms. This case presents a 39-year-old man suffering from classical low urinary tract symptoms for five years, though without nocturia. The work-up showed normal prostate-specific antigen level, benign conditions by digital rectal examination, and normal-sized prostate on ultrasound. An urodynamic study showed outlet resistance and a supplementary ultrasound of prostate indicated a cyst structure around it. The magnetic resonance imaging confirmed a CS. Marsupialisation is the treatment of choice and was implemented.