Université de Bretagne Occidentale

Currently, there are no established guidelines for follow-up (FU) after negative prostate biopsies (PBx) despite the presence of a target on MRI. We aimed to evaluate the risk of clinically significant prostate cancer (csPCa) within 2 years (2y) and at final FU in such cases.

We analyzed 105 patients with negative systematic and targeted PBx despite positive mpMRI (PI-RADS ≥ 3) (median FU: 66.5 months [IQR: 40-83]). All patients underwent FU with serial PSA measurements, digital rectal examinations and, when indicated, FU-MRI and/or FU-PBx. Outcomes assessed csPCa occurrence (GGG /ISUP ≥ 2) at 2y and at final FU, and predictive factors for csPCa.

At 2y, the csPCa detection rate (Det-R) was 7.6%, increasing to 15.2% at final FU. No significant differences were observed at 2y based on baseline PI-RADS status. The mean initial PSAD was significantly higher in patients with csPCa at 2y versus without: 0.20 ng/mL² (SD: 0.11) versus 0.13 ng/mL² (SD: 0.12) (P = .008). Patients with baseline PSAD > 0.15 had a significantly higher 2y csPCa Det-R versus with PSAD < 0.15: 18.2% (4/22) versus 3.7% (3/81) (P = .036). The combination of PSAD < 0.15 and PI-RADS 3 at baseline was associated with a very low 2y csPCa Det-R (3%, 1/34), compared to PSAD > 0.15 and PI-RADS ≥ 4 (23%, 3/13). At final follow-up: 53% of patients with csPCa had an increasing PSAD (vs. 14% without, P = .003). A total of 41% (43/105) of patients underwent FU-MRI. Patients with csPCa were significantly more likely to have upgraded MRI findings (56% vs. 2.2%, P < .001).

Following negative PBx despite a positive mpMRI, the risk of csPCa was low. However, careful monitoring is essential, particularly in cases of PSAD > 0.15, and/or PI-RADS ≥ 4 at baseline. FU-PSAD and FU-MRI emerged as the most significant predictive factors, aiding to stratify the need for FU-PBx.

Chemsex defines the practice of sexual activity under the influence of psychoactive substances, mainly by Men who have Sex with Men (MSM). This activity can be associated with negative health consequences, yet there are no recommendations to guide management of individuals who engage in chemsex. The aim of this scoping review was to identify and describe the existing treatments (pharmacological or not) and risk/harm reduction strategies for MSM who engage in chemsex. This scoping review was performed using PubMed and Embase databases and according to the PRISMA Extension for Scoping Review criteria. Overall, 19 studies were included in the review. Among these studies, four main themes were identified: management and harm reduction strategies, key actors involved in managing MSM who engage in chemsex, perceived barriers to care and the role of pre-exposure prophylaxis, and medical information sought by MSM who engage in chemsex. This scoping review concludes with the need to develop multidisciplinary approaches to improve communication about chemsex, and to design interventional studies that target MSM who engage in chemsex.

Paracas Bay, located in the Humboldt Current system, is a highly variable coastal environment where hypoxia (dissolved oxygen concentrations <2 mg L^-1) has been reported as a persistent feature of bottom conditions. In addition to hypoxia, milky water events have been reported in the bay, most likely associated with the presence of sulfides (i.e. sulfidic events), including toxic hydrogen sulfide (H₂S). This study is the first report of sulfide concentrations in the water column of Paracas Bay, with concentrations up to 6.79 μmol L^-1 measured in the bottom water layer using Diffusive Gradient in Thin film (DGT) passive samplers. Sulfides showed a marked seasonal pattern, while ENSO phases did not seem to affect their occurrence. The presence of sulfides in the water column is closely linked to hypoxic conditions. Indeed, the analysis of the relationship between the duration of severe bottom hypoxia (dissolved oxygen ≤0.15 mg L^-1) and sulfides concentrations revealed a threshold of 18 h for sulfides accumulation in the overlying waters. Also, a gradient in sulfides concentration was observed from the sediment to the upper water layer. This gradient coupled with the variability of environmental variables (temperature, dissolved oxygen and currents velocity) highlights the complexity of this system, and suggests that a combination of advective and local physical and biogeochemical processes are responsible for the sulfidic events to occur in Paracas Bay. This study provides a baseline for assessing the potential toxicity of sulfides to cultured Peruvian scallops in upwelling bays.