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Background: Prognostic stratification is the cornerstone of management in nonmetastatic prostate cancer (PCa). However, existing prognostic models are inadequate-often using treatment outcomes rather than survival, stratifying by broad heterogeneous groups and using heavily treated cohorts. To address this unmet need, we developed an individualised prognostic model that contextualises PCa-specific mortality (PCSM) against other cause mortality, and estimates the impact of treatment on survival.Methods and Findings: Using records from the United Kingdom National Cancer Registration and Analysis Service (NCRAS), data were collated for 10,089 men diagnosed with nonmetastatic PCa between 2000 and 2010 in Eastern England. Median follow-up was 9.8 years with 3,829 deaths (1,202 PCa specific). Totals of 19.8%, 14.1%, 34.6%, and 31.5% of men underwent conservative management, prostatectomy, radiotherapy (RT), and androgen deprivation monotherapy, respectively. A total of 2,546 men diagnosed in Singapore over a similar time period represented an external validation cohort. Data were randomly split 70:30 into model development and validation cohorts. Fifteen-year PCSM and non-PCa mortality (NPCM) were explored using separate multivariable Cox models within a competing risks framework. Fractional polynomials (FPs) were utilised to fit continuous variables and baseline hazards. Model accuracy was assessed by discrimination and calibration using the Harrell C-index and chi-squared goodness of fit, respectively, within both validation cohorts. A multivariable model estimating individualised 10- and 15-year survival outcomes was constructed combining age, prostate-specific antigen (PSA), histological grade, biopsy core involvement, stage, and primary treatment, which were each independent prognostic factors for PCSM, and age and comorbidity, which were prognostic for NPCM. The model demonstrated good discrimination, with a C-index of 0.84 (95% CI: 0.82-0.86) and 0.84 (95% CI: 0.80-0.87) for 15-year PCSM in the UK and Singapore validation cohorts, respectively, comparing favourably to international risk-stratification criteria. Discrimination was maintained for overall mortality, with C-index 0.77 (95% CI: 0.75-0.78) and 0.76 (95% CI: 0.73-0.78). The model was well calibrated with no significant difference between predicted and observed PCa-specific (p = 0.19) or overall deaths (p = 0.43) in the UK cohort. Key study limitations were a relatively small external validation cohort, an inability to account for delayed changes to treatment beyond 12 months, and an absence of tumour-stage subclassifications.Conclusions: 'PREDICT Prostate' is an individualised multivariable PCa prognostic model built from baseline diagnostic information and the first to our knowledge that models potential treatment benefits on overall survival. Prognostic power is high despite using only routinely collected clinicopathological information. [ABSTRACT FROM AUTHOR]

Purpose: Cancer and cardiovascular disease (CVD) are common causes of morbidity and mortality, and measurement and interpretation of their co-occurrence rate have important implications for public health and patient care. Here, we present the raw and adjusted co-occurrence rates of cancer and CVD in the overall population by using a visually intuitive network approach. Methods: By using baseline survey and linked health outcome data from 490,842 individuals age 40 to 69 years from the UK Biobank, we recorded diagnoses between 1997 and 2014 of specific cancers and specific CVDs ascertained through hospital claims. We measured raw and adjusted rates of CVD for the following groups: individuals with Hodgkin or non-Hodgkin lymphoma, lung and trachea cancer, uterus cancer, colorectal cancer, prostate cancer, breast cancer, or no recorded diagnosed cancer during this time period. Analysis accounted for age, sex, and behavioral risk factors, without regard to the order of occurrence of cancer and CVD. Results: A significantly increased rate of CVD was found in patients with multiple types of cancers, including Hodgkin and non-Hodgkin lymphoma and lung and trachea, uterus, colorectal, and breast cancer, compared with patients without cancer by using age and sex-adjusted models. Increased co-occurrence for many CVD categories remained after correction for behavioral risk factors. Construction of co-occurrence networks highlighted heart failure as a shared CVD diagnosis across multiple cancer types, including breast cancer, lung cancer, non-Hodgkin lymphoma, and colorectal cancer. Smoking, physical activity, and other lifestyle factors accounted for some but not all of the increased co-occurrence for many of the CVD diagnoses. Conclusion: Increased co-occurrence of several common CVD conditions is seen widely across multiple malignancies, and shared diagnoses, such as heart failure, were highlighted by using network methods. [ABSTRACT FROM AUTHOR]

The article offers information on low-risk localized prostate cancer. It states that almost 32,000 men are diagnosed with prostate cancer annually in Great Britain. It also mentions that while active surveillance (AS) is gaining popularity in this country concerning this disease, there are relatively few published studies on this topic. Related studies on this medical topic are also mentioned.

The Prostate Imaging Reporting and Data System (PI-RADS) guidelines set out the minimal technical requirements for the acquisition of multiparametric MRI (mpMRI) of the prostate. However, the rapid diffusion of this technique has inevitably led to variability in scan quality among centres across the UK and the world. Suboptimal image acquisition reduces the sensitivity and specificity of this technique for the detection of clinically significant prostate cancer and results in clinicians losing confidence in the technique. Two expert panels, one from the UK and one from the European Society of Urogenital Radiology (ESUR)/EAU Section of Urologic Imaging (ESUI), have stressed the importance to establish quality criteria for the acquisition of mpMRI of the prostate. A first attempt to address this issue has been the publication of the Prostate Imaging Quality (PI-QUAL) score, which assesses the mpMRI quality against a set of objective criteria (PI-RADS guidelines) together with criteria obtained from the image. PI-QUAL represents the first step towards the standardisation of a scoring system to assess the quality of prostate mpMRI prior to reporting and allows clinicians to have more confidence in using the scan to determine patient care. Further refinements after robust consensus among experts at an international level need to be agreed before its widespread adoption in the clinical setting. [ABSTRACT FROM AUTHOR]

The diagnosis of prostate cancer has changed. Improved magnetic resonance imaging (MRI) technology with diffusion-weighted imaging has led to the use of multiparametric MRI (mpMRI) before biopsy in patients suspected of having prostate cancer. This has the advantage that patients with a negative mpMRI may not need biopsy, therefore avoiding the risk of complications. Those in whom mpMRI is positive can have targeted biopsies with a higher probability of diagnosing clinically significant cancer. Prostate Cancer UK (PCUK) and the British Society of Urogenital Radiology submitted a Freedom of Information (FOI) request in 2016 to UK health areas in order to assess the use of mpMRI before biopsy as part of the initial diagnosis pathway. Another request was submitted by PCUK in 2018 to assess the progress made in the UK between these two dates. Both requests had the secondary aim of identifying barriers to the implementation of mpMRI. The FOI requests showed an increase in the use of mpMRI before biopsy with 59% of areas reporting improvement between the two requests. There has been a reduction in the percentage of areas not providing any form of pre-biopsy MRI from 25% in 2016 to 13% in 2018. There remains, however, geographical variation in implementation across the UK nations. Imaging practice also shows variation with some areas performing scans without dynamic contrast enhancement (DCE) and using the findings to guide referral decisions for biopsy. Eligibility criteria for pre-biopsy MRI also vary leading to some restrictive practices. Reported barriers to implementation included scanner capacity and staffing levels. Recent guidelines and recommendations by the National Institute for Health and Care Excellence (NICE) and NHS England for men aged 50-69 years with a prostate-specific antigen (PSA) level between >3 and <30 ng/ml to receive mpMRI before biopsy put further pressure on already understaffed and under-resourced radiology departments. [ABSTRACT FROM AUTHOR]

Background Dacryoadenitis is an inflammatory enlargement of the lacrimal gland and can be idiopathic or associated with infections, malignant or inflammatory diseases like Sjögren's disease (SSj) or granulomatosis with polyangiitis (GPA). It remains the most common orbital inflammatory condition in children. This study purposes to describe a paediatric cohort of non-infectious dacryoadenitis. Methods Identification of children who underwent lacrimal gland biopsy at our centre between 2000 and 2018 was done by searching the database using two key-words: "lacrimal" and "dacryoadenitis". Patients with infectious or malignant dacryoadenitis were excluded. Medical notes were reviewed to collect data. Results Twenty-six patients underwent lacrimal gland biopsy at our centre between 2000 and 2018 and had inflammatory dacryoadenitis. 17 patients (65.4%) had non-specific chronic inflammation (NSCI) and 9 patients (34.6%) had an inflammatory systemic condition (Table 1). P53 Table 1 Patients' characteristics.   NSCI  GPA  Sarcoidosis  SSjogren  IgG4  Number of patients  17 (65.4%)  4 (15.4%)  3 (11.5%)  1 (3.9%)  1 (3.9%)  Female, n (%)  6 (35.3%)  4 (100%)  3 (100%)  1 (100%)  1 (100%)  Median age (Y) (IQ)  10.5 (4.9- 14.4)  9.72 (8.7- 13.0)  13.2 (11.45- 15.7)  11.9  11.2  Lacrimal gland involvement  Unilateral  13 (74.5%)  3 (75.0%)  2 (66.7%)  0  0  Bilateral  4 (23.5%)  1 (25.0%)  1 (33.3%)  1 (100%)  1 (100%)  Orbital symptoms            Ptosis  4 (23.5%)  1 (25.0%)  0  0  0  Erythema  3 (17.5%)  1 (25.0%)  1 (33.3%)  0  0  Pain  2 (11.8%)  1 (25.0%)  0  0  0  Extra-orbital involvement  Exocrine glands  0  0  1 (33.3%)  0  0  ENT  0  3 (75.0%)  0  0  0  Renal  1 (14.3%)  2 (50.0%)  0  1 (100%)  1 (100%)  Pulmonary  1 (14.3%)  1 (25.0%)  1 (33.3%)  0  1 (100%)  Myositis  1 (14.3%)  0  0  0  0  Arthralgia  1 (14.3%)  0  1 (33.3%)  0  0  Thyroiditis  1 (14.3%)  0  0  0  0  CNS  0  0  0  1 (100%)  0  Lymphadenopaties  0  0  0  0  1 (100%)    NSCI  GPA  Sarcoidosis  SSjogren  IgG4  Number of patients  17 (65.4%)  4 (15.4%)  3 (11.5%)  1 (3.9%)  1 (3.9%)  Female, n (%)  6 (35.3%)  4 (100%)  3 (100%)  1 (100%)  1 (100%)  Median age (Y) (IQ)  10.5 (4.9- 14.4)  9.72 (8.7- 13.0)  13.2 (11.45- 15.7)  11.9  11.2  Lacrimal gland involvement  Unilateral  13 (74.5%)  3 (75.0%)  2 (66.7%)  0  0  Bilateral  4 (23.5%)  1 (25.0%)  1 (33.3%)  1 (100%)  1 (100%)  Orbital symptoms            Ptosis  4 (23.5%)  1 (25.0%)  0  0  0  Erythema  3 (17.5%)  1 (25.0%)  1 (33.3%)  0  0  Pain  2 (11.8%)  1 (25.0%)  0  0  0  Extra-orbital involvement  Exocrine glands  0  0  1 (33.3%)  0  0  ENT  0  3 (75.0%)  0  0  0  Renal  1 (14.3%)  2 (50.0%)  0  1 (100%)  1 (100%)  Pulmonary  1 (14.3%)  1 (25.0%)  1 (33.3%)  0  1 (100%)  Myositis  1 (14.3%)  0  0  0  0  Arthralgia  1 (14.3%)  0  1 (33.3%)  0  0  Thyroiditis  1 (14.3%)  0  0  0  0  CNS  0  0  0  1 (100%)  0  Lymphadenopaties  0  0  0  0  1 (100%)  P53 Table 1 Patients' characteristics.   NSCI  GPA  Sarcoidosis  SSjogren  IgG4  Number of patients  17 (65.4%)  4 (15.4%)  3 (11.5%)  1 (3.9%)  1 (3.9%)  Female, n (%)  6 (35.3%)  4 (100%)  3 (100%)  1 (100%)  1 (100%)  Median age (Y) (IQ)  10.5 (4.9- 14.4)  9.72 (8.7- 13.0)  13.2 (11.45- 15.7)  11.9  11.2  Lacrimal gland involvement  Unilateral  13 (74.5%)  3 (75.0%)  2 (66.7%)  0  0  Bilateral  4 (23.5%)  1 (25.0%)  1 (33.3%)  1 (100%)  1 (100%)  Orbital symptoms            Ptosis  4 (23.5%)  1 (25.0%)  0  0  0  Erythema  3 (17.5%)  1 (25.0%)  1 (33.3%)  0  0  Pain  2 (11.8%)  1 (25.0%)  0  0  0  Extra-orbital involvement  Exocrine glands  0  0  1 (33.3%)  0  0  ENT  0  3 (75.0%)  0  0  0  Renal  1 (14.3%)  2 (50.0%)  0  1 (100%)  1 (100%)  Pulmonary  1 (14.3%)  1 (25.0%)  1 (33.3%)  0  1 (100%)  Myositis  1 (14.3%)  0  0  0  0  Arthralgia  1 (14.3%)  0  1 (33.3%)  0  0  Thyroiditis  1 (14.3%)  0  0  0  0  CNS  0  0  0  1 (100%)  0  Lymphadenopaties  0  0  0  0  1 (100%)    NSCI  GPA  Sarcoidosis  SSjogren  IgG4  Number of patients  17 (65.4%)  4 (15.4%)  3 (11.5%)  1 (3.9%)  1 (3.9%)  Female, n (%)  6 (35.3%)  4 (100%)  3 (100%)  1 (100%)  1 (100%)  Median age (Y) (IQ)  10.5 (4.9- 14.4)  9.72 (8.7- 13.0)  13.2 (11.45- 15.7)  11.9  11.2  Lacrimal gland involvement  Unilateral  13 (74.5%)  3 (75.0%)  2 (66.7%)  0  0  Bilateral  4 (23.5%)  1 (25.0%)  1 (33.3%)  1 (100%)  1 (100%)  Orbital symptoms            Ptosis  4 (23.5%)  1 (25.0%)  0  0  0  Erythema  3 (17.5%)  1 (25.0%)  1 (33.3%)  0  0  Pain  2 (11.8%)  1 (25.0%)  0  0  0  Extra-orbital involvement  Exocrine glands  0  0  1 (33.3%)  0  0  ENT  0  3 (75.0%)  0  0  0  Renal  1 (14.3%)  2 (50.0%)  0  1 (100%)  1 (100%)  Pulmonary  1 (14.3%)  1 (25.0%)  1 (33.3%)  0  1 (100%)  Myositis  1 (14.3%)  0  0  0  0  Arthralgia  1 (14.3%)  0  1 (33.3%)  0  0  Thyroiditis  1 (14.3%)  0  0  0  0  CNS  0  0  0  1 (100%)  0  Lymphadenopaties  0  0  0  0  1 (100%)  4/13 children tested had raised ACE (2 sarcoidosis and 2 NSCI). 7/17 had raised amylase (2 sarcoidosis,1 SSj, 4 NSCI). 3/16 had raised IgG (IgG4 disease, GPA and NSCI). ANA was positive in 4/19 patients (NSCI, GPA, Sarcoidose, SSj) and ANCA was positive in 4/19 patients (GPA). Thirteen patients received steroids (oral or IV) and elevan received DMARDS (MMF, methotrexate, azathioprine and hydroxychloroquine). Four patients received biologic (rituximab, adalimumab or infliximab). Six patients underwent orbitotomy. Patients still on follow-up had good response to treatment. One patient with NSCI presented with dacryoadenitis and later developed auto-immune thyroiditis and polymyositis, with positive ANA and anti-SRP antibodies. He was treated with steroids, methotrexate, MMF and IVIG. Conclusion Paediatric rheumatic inflammatory disorders have a diverse presentation and dacryoadenitis may be the initial manifestation. Biopsy is mandatory to exclude infection and malignancy. A full diagnostic workup is essential, especially if patients have positive ANA or ANCA. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

Poster presentation Tuesday 8 October Background Sjögren's syndrome, a chronic multisystem autoimmune disease is characterised by inflammation of the exocrine glands, principally the salivary and lacrimal glands resulting in xerostomia and xerophthalmia. It can also present with more extensive exocrinopathy as well as extra-glandular, systemic features. Defined as primary SS (pSS) when there is no association with other autoimmune disease, reported incidence and prevalence rates vary. Juvenile-onset pSS is believed to be rare; however it is likely that it is under-recognised and therefore under-diagnosed. To date there have been no studies reporting accurate incidence or prevalence of paediatric pSS (PpSS). Diagnosing pSS can be challenging. Many of the cardinal symptoms are non-specific and no gold standard biomarker of disease exists. Between 1965–2002 eleven diagnostic criteria sets were developed, none of which have gained universal acceptance or been validated for use in a paediatric population. Until recently, the most widely used criteria were those developed by the American-European Consensus Group. It remains well-recognised that international consensus on classification is important for standardisation, particularly in relation to research and monitoring treatment outcomes. With this in mind, the 2016 ACR/EULAR criteria were developed. However, there still remains a paucity of validated classification criteria for diagnosis of juvenile-onset pSS. Paediatric-focused criteria are required as features of pSS in children differ from those observed in adults. Children experience less dryness and more frequently experience systemic symptoms and parotid enlargement. Hence, simply applying adult criteria to a paediatric population may lead to mis- and/or under-diagnosis. The overarching aim of this study is to identify epidemiological, clinical and laboratory characteristics of PpSS in a multi-centre cohort of patients. Using this data our goal is to develop universally accepted classification criteria validated for use in a paediatric population. Going forward, this would enable standardisation of PpSS classification allowing for robust studies into disease pathogenesis, management and prognosis. Methods Inclusion criterion for entry into the UK/Ireland PpSS cohort study and repository is diagnosis of pSS before 18 years. A data collection pack will be sent to authors willing to participate. Information collected will include demographic, clinical and laboratory/histological data at diagnosis and subsequent follow-up appointments. Biological samples including blood, tears, saliva, urine, and glandular and extra-glandular (e.g. renal) tissue will be collected prospectively if available. Outcome measures related to disease activity and damage, as well as patient reported outcomes will also be collected at set time-points. Results No results to report. Conclusion The UK/Ireland PpSS cohort study and repository will capture data on a significant cohort of children with pSS providing a powerful resource to help improve our understanding of this rare disease. Prospective data collection will allow a fuller analysis of poor prognostic features, impact of therapy, damage accrual and variable outcome of PpSS. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]