Donie's Ireland daily news BLOG update

Employment in IDA Irish backed firms reaches a record high

ALMOST 200,000 EMPLOYED IN MULTINATIONALS BUT IDA WARNS OF POLITICAL UNCERTAINTY

     

Martin Shanahan, chief executive of IDA Ireland, with Minister for Jobs, Enterprise and Innovation, Mary Mitchell O’Connor: “That companies have continued to invest in Ireland is testament to the quality of the offering we have here,” he said.

IDA Ireland says the flow of foreign direct investment (FDI) into Ireland will remain strong in coming months after a record 2016, although the State enterprise agency warned against “complacency” over cost-competitiveness and potential threats in the global economy.

Employment in foreign multinationals backed by IDA reached a record high of almost 200,000 in 2016, with 244 investments during the year. This is up from a previous high of 213 in 2016.

At the publication of its annual statement on Tuesday, IDA said the number of investments from companies new to the Irish market went to 99 from 94 in 2016, with 11,842 additional jobs (net) created. Job losses were at their lowest level in 19 years.

In 2016, more than half (52%) of all jobs created by IDA clients were based outside Dublin. The mid-west experienced the fastest growth rate, of 10%, with some 1,500 jobs created during the year. The midlands fared the worst, with just 58 jobs created during the year.

Martin Shanahan, chief executive of the IDA, said he expected some US companies to delay investment announcements until details emerged of US president-elect Donald Trump’s trade policies.

He also said some London-based banks were close to choosing alternative locations, as Dublin fights to pick up business amid post-Brexit vote uncertainty.

SUCCESS

Mr Shanahan said: “That companies have continued to invest in Ireland is testament to the quality of the offering we have here. That being said – we absolutely cannot be complacent about this success. We have to keep an eye on our competitiveness including costs.

“The contribution of the FDI sector has always been important to Ireland, but the 2016 results show that the contribution has never been greater. It is particularly welcome to see such a broad-based performance and all regions growing. International services, pharmaceuticals and medical devices and financial services all showed significant employment increases in 2016.”

On Brexit, the IDA said the UK’s planned departure from the European Union has led to “a significant volume of specific queries” to IDA offices from across the world, with Ireland among a small number of locations in Europe being considered. However the IDA also noted that Brexit brings with it some “adverse impacts”.

ACCESS.

“FDI companies that depend heavily on the UK market have already been impacted by exchange rates and they may also need to consider their future access to the UK market in a post-Brexit environment.”

Looking ahead, Mr Shanahan said that “ongoing global political and economic uncertainty will continue to affect investor confidence in 2017”, while competition from other jurisdictions for FDI has “never been as strong”.

However, the outlook is still “promising”. “While there is significant uncertainty, the jobs pipeline for the first quarter of 2017 looks promising. In 2016, job losses within IDA client companies were at their lowest level since 1997. Given market turmoil, Brexit impacts and cost-competitiveness pressure, IDA does not expect this trend to continue,” Mr Shanahan said.

Irish property prices to rise by at least 8% this year 2017

HELP-TO-BUY SCHEME WILL ADD ‘FUEL TO THE FIRE’ AND DRIVE PRICE RISES, MYHOME.IE REPORTS

    

IRISH PROPERTY PRICES ARE SET TO RISE BY AT LEAST 8% IN 2017, WITH DOUBLE-DIGIT GROWTH A ‘DISTINCT POSSIBILITY’.

Property prices are set to rise by at least 8% in 2017, with double-digit growth a “distinct possibility”, as today’s launch of the new help-to-buy scheme, plus looser mortgage lending rules and constrained supply drive price growth across the country.

The prediction comes in a report from myhome.ie, the property website, and Davy, the stockbroking firm, which says the help-to-buy scheme will add “fuel to the fire” in driving price growth.

The scheme, which opens for applications today (January 3rd), will give first-time buyers of new homes 5 per cent back on the cost of their property.

According to the Central Statistics Office, property prices rose by 7.1% in the year to October, while full-year calculations from estate agent Sherry FitzGerald, also published today, estimate that prices rose by 5.2% for 2016 as a whole, a moderate increase on the 4% recorded in 2015.

Prices in Dublin increased by 3.7% in 2016, compared to 1.4% in 2015, according to Sherry FitzGerald with growth of 7.4%, 10.1% and 6.9% respectively in Cork, Galway and Limerick.

Despite recent price growth, however, average values are still about 40% off peak 2006 levels.

Big fall in supply?

Predictions of an acceleration in house-price growth next year comes as the number of properties for sale across the country has fallen to a 10-year low.

New figures from Daft.ie, also published today, show just 21,700 properties for sale nationwide on the property portal in December 2016, the lowest since January 2007.

Myhome.ie reports a similar picture, with just 20,875 properties listed for sale on the site, down 7.7% from last year.

This suggests that just 1% of the Irish housing stock is currently listed for sale – a normally functioning market would typically boast turnover levels of 4%.

“The lack of liquidity is particularly acute in Dublin where there are just 3,619 properties listed for sale.

“This is down 20% on last year and means just 0.7% of Dublin’s housing stock of 535,000 properties is currently listed for sale,” says Angela Keegan, managing director of myhome.ie.

Trinity College Dublin economist and author of the Daft.ie report Ronan Lyons warns that demographic trends, housing obsolescence and migration means that close to 50,000 new properties are needed each year but just about 14,000 were built in 2016.

“Without this kind of supply, we will all have to spend more and more of our income just to have a home,” he warns.

With fewer homes for sale, transaction levels are also slumping. While the full figures for Q4 are not yet available from the property register, early returns suggest a sharp fall in transactions in the final quarter of 2016, with sales down by 12% on the year, according to Daft.ie.

But the decline may also be due to the imminent arrival of the new help-to-buy scheme, as prospective purchasers postponed their decisions.

Asking prices rise.

The latest survey from Daft.ie for the fourth quarter of 2016 shows that asking prices across the country rose by 8% in the year, with prices continuing to rise at a faster rate outside the capital.

Asking prices in Dublin were 5% higher than in 2015, but in Cork, Galway and Kilkenny, inflation exceeded 10%, although the rate of growth has fallen since 2014.

The figures mean that the average national asking price has risen 34.3% or just over € 56,000 – since the property market reached its nadir in the third quarter of 2013.

In Dublin, however, the bottom was reached in the second quarter of 2012 and prices have risen by an average of 46.2% or €101,850 since that time.

In Limerick, prices have risen by 39% in the city (and by 19% in the county) since its low in 2014.

According to myhome.ie, while asking prices on new instructions fell by more than 2% in the fourth quarter, bringing the mix adjusted asking price for new sales nationally to €227,000 – prices on their site are still up 5.5% year on year.

In Dublin, the average asking prices for a newly listed property remained unchanged at €328,000, but this is still up 4.9% year on year, according to myhome.ie.

Flu, respiratory illness, and the winter vomiting bug on the rise in Ireland

IRELAND IS UNDER THE WEATHER AT THE MOMENT

  

HSE Hospitals across IRELAND have reported a significant increase in the number of cases of winter-related illnesses, including influenza, respiratory illness and the winter vomiting bug.

The Health Protection Surveillance Centre (HSPC), which monitors the spread of infectious diseases, says that there has been a tripling in the numbers of people with norovirus (winter vomiting bug) over the past five weeks.

The HSPC also warned that this escalation is expected to continue until at least the end of February.

Minister for Health Simon Harris has described the outbreak of the infections as “a very challenging period of time” for Ireland’s health service.

The HSE has asked people with symptoms of the winter vomiting bug not to visit or attend hospitals or GP surgeries.

“This bug, while often unpleasant, rarely causes serious problems for otherwise healthy children and adults,” the HSE said in a statement.

It can, however, “be a serious problem in hospitals and residential facilities where it can lead to ward closures, postponed operations, and worryingly, can result in very serious illness for patients in hospital who are already weakened by other medical conditions.”

The comments were echoed by Minister Harris, who warned against spreading the flu:

We all as citizens have a role to play in terms of doing everything we possibly can to minimise the spread of what is a very significant outbreak of flu.

The HSE confirmed that there have been 21 outbreaks of flu and respiratory infections in healthcare settings such as hospitals, residential centres and nursing homes so far, this season, and a significant increase in people aged 75 and older seeking treatment.

All hospitals around the country have put in place contingency measures to manage the increased number of patients coming to Emergency Departments, with the HSE saying that the spike in demand is expected to continue over the coming weeks.

The HSE has urged at-risk people to get the flu vaccination as soon as possible.

“The winter tends to be a difficult period for the health service, and that is why we have put significant resources [into dealing with it] but the particular challenges we’re experiencing now are not just the challenges of a normal winter,”Minister Harris said at a press conference this afternoon.

The minister said that there has been almost a 20% increase in the number of people over the age of 75 attending Emergency Departments over this Christmas period compared to last year.

The HSPC said the increase in the winter vomiting bug has been due to new strains of the infection being reported in Ireland, which the population is not immune to.

The HSE’s ‘Winter Initiative’ has seen at least €15 million spent in recent months to deal with the increased demand for the health service, particularly in ensuring that people are discharged from beds once they have recovered from their illness.

Irish Scientists identify a new organ in Humans & it’s official

  

DR. J. CALVIN COFFEY ABOVE RIGHT PIC, A PROFESSOR OF SURGERY AT THE UNIVERSITY OF LIMERICK IN IRELAND, HAS CONCLUDED THAT THE MESENTERY, WHICH IS A MEMBRANE FOUND IN THE GUT, IS IN ITS OWN AN ORGAN.

A mighty membrane that twists and turns through the gut is starting the new year with a new classification: the structure, called the mesentery, has been upgraded to an organ.

Scientists have known about the structure, which connects a person’s small and large intestines to the abdominal wall and anchors them in place, according to the Mayo Clinic. However, until now, it was thought of as a number of distinct membranes by most scientists. Interestingly, in one of its earliest descriptions, none other than Leonardo da Vinci identified the membranes as a single structure, according to a recent review.

In the review, lead author Dr. Calvin Coffey, a professor of surgery at the University of Limerick’s Graduate Entry Medical School in Ireland, and colleagues looked at past studies and literature on the mesentery. Coffey noted that throughout the 20th century, anatomy books have described the mesentery as a series of fragmented membranes; in other words, different mesenteries were associated with different parts of the intestines. [6 Strange Things the Government Knows About Your Body]

More recent studies looking at the mesentery in patients undergoing colorectal surgery and in cadavers led Coffey’s team to conclude that the membrane is its own, continuous organ, according to the review, which was published in November in the journal The Lancet Gastroenterology and Hepatology.

What’s in a name?

The reclassification of the mesentery as an organ “is relevant universally as it affects all of us,” Coffey said in a statement.

By recognizing the anatomy and the structure of the mesentery, scientists can now focus on learning more about how the organ functions, Coffey said. In addition, they can also learn about diseases associated with the mesentery, he added.

“If you understand the function, you can identify abnormal function, and then you have disease,” Coffey said.

The continuous nature of the mesentery, for example, may serve as a means for disease to spread from one part of the abdomen to another, according to the review.

In addition to studying disease, researchers may also look to the mesentery for new approaches to surgery, the authors said in the review.

More questions need answers

The authors noted in the review that many anatomical and other features of the mesentery still need to be described.

For instance, what body system should the mesentery be classified in? “Whether the mesentery should be viewed as part of the intestinal, vascular, endocrine, cardiovascular or immunological systems is so far unclear, as it has important roles in all of them,” the authors wrote.

While many organs have distinct functions in the body, the mesentery’s distinct function is still unknown, according to the review.

Venus is looking stunningly bright next to the moon right now and here’s why

  

THE SECOND ROCK FROM THE SUN HAS BEEN EVEN BRIGHTER THAN NORMAL AND IT’S NOT TOO LATE TO CATCH A GLIMPSE.

Those with their eyes on the skies have been noticing that Venus, the second rock from the sun, has been even more stunning than normal recently.

Venus is always one of the brightest lights in our night skies but in recent days it has been especially luminous.

All over the country, people have been posting pictures on social media of Venus below the crescent moon. Particularly sharp-eyed observers could also see a ruddy red Mars close to the moon.

We answer some questions that people have been asking.

Have I missed it?

Not necessarily. Like yesterday, Venus will remain very bright tonight but unfortunately it could be obscured by cloud cover.

If there is a break in the cloud, the best time to see it will be in the hours just after sunset as Venus sets about four hours after the Sun this month.

Early January 2017 is a great time to see Venus. According to the Beckstrom Observatory, it will reach its peak height above the horizon this month.

It will also see the distance between Venus and Mars get smaller as Venus gets higher each night.

Why is Venus so bright?

Venus is the brightest of all the planets visible in the skies above Earth due to a highly reflective acidic atmosphere.

Over the last billion years Venus’ atmosphere has become incredibly thick. Scientists believe that this is because of a runaway greenhouse effect.

And with the atmosphere being so dense, it reflects 70 per cent of the sunlight that reaches it.

In comparison, the moon only reflects 10 per cent of the light that hits it. However, due to its close proximity to earth, the moon appears brighter than Venus to us.

Can I see Mars?

Yes! Mars was bright red in the sky in May and June last year but is no longer as bright. However, you can still see it with the naked eye, with it appearing a ruddy red colour.

As the Red Planet is not as bright as Venus you need to wait until total nightfall to see it. Bear in mind it won’t be visible immediately after sunset.    

Donie's Ireland daily news BLOG.

IDA set to negotiate with UK companies to relocate to Ireland after Brexit vote

THE AGENCY IS TO BEGIN NEGOTIATIONS WITH COMPANIES LOCATED IN UK THAT MAY WANT TO RELOCATE TO IRELAND.

   

MARTIN SHANAHAN (picture left), THE CHIEF EXECUTIVE OF IDA IRELAND, SAYS THE STATE AGENCY WILL SOON BEGIN NEGOTIATIONS WITH BANKS AND OTHER COMPANIES LOCATED IN THE UK THAT MAY WANT TO RELOCATE TO IRELAND FOLLOWING THE BREXIT VOTE.

Martin Shanahan, the chief executive of IDA Ireland, says the State agency will soon begin negotiations with banks and other companies located in the UK that may want to relocate to Ireland following the Brexit vote.

Mr Shanahan stressed his first preference was for Britain to remain within the European Union (EU), but he said the IDA has “done its homework” on how to maximise foreign investment for Ireland now that the UK has voted to leave.

“We have been in discussion with potential clients [who may choose to relocate to Ireland from the UK] for months. They approached us,” said Mr Shanahan. “We have a good view on the potential for Ireland.

He said discussions with potential foreign investors could begin as soon as “next week, or the week after”.

IDA’s existing 1,200 client companies are “still digesting the news”, he said. Mr Shanahan yesterday wrote to the 1,200 to say Ireland remains committed to the EU and is effectively still open for business.

He said Ireland’s “stability” would be an attractive feature when attracting new investment in the midst of the uncertainty created for the UK by the vote. Mr Shanahan also agreed that financial services and technology were two sectors where Ireland would be particularly well placed to pick up fresh foreign investment that might otherwise locate in the UK.

“But we intend to push for investment right across the portfolio, including life sciences and engineering,” he said. “Our mandate prior to Brexit was to maximise investment for Ireland, and nothing has changed in that regard.”

TERMS OF EXIT?

Fergal O’Brien, chief economist at the employers’ lobby Ibec, said the UK is now likely to “become more aggressive” in securing foreign investment to protect its economy, which could increase competition faced by the IDA.

He said a lot depends on the terms of the exit deal given to the UK, including its level of access to the EU’s internal market: “It is in Ireland’s interests to get as much stability as possible for the UK.”

Mr O’Brien suggested that while other EU states might want to impose tough measures on the UK to discourage other countries from exiting, Ireland “needs to establish at EU level that we have skin in the game” and push for leniency.

Enterprise Ireland, meanwhile, warned against the effects of exchange rate volatility for Irish exporters into the UK. It said it would also support Irish exporters to devise medium-term diversification plans.

“In addition to our team in the UK, we have put in place a dedicated email address, phone-line and team for Enterprise Ireland clients to respond to their immediate concerns and issues,” said the agency.

Ryanair and Aer Lingus could be hit by fall in passengers

INTERNATIONAL AIR TRANSPORT ASSOCIATION SAYS WEAKER STERLING MAY CUT NUMBER OF UK TRAVELLERS

   

IAG SAID IT NO LONGER EXPECTS TO GENERATE AN ABSOLUTE OPERATING PROFIT INCREASE SIMILAR TO 2015.

Ryanair and Aer Lingus parent, International Airlines’ Group (IAG), could be hit by a fall in UK passenger numbers following the Brexit vote, according to a leading industry body.

The International Air Transport Association (IATA) predicts that a weakened sterling and shrinking economy could cut UK airline passenger numbers, which hit 250 million last year, by 3 to 5% by 2020.

A report the association published yesterday shows that Ryanair and IAG, owner of Aer Lingus, are amongst the airlines that are most exposed to a fall in air travel.

The UK is one of Ryanair’s biggest markets, accounting for more than 30 million of the 100-plus million passengers that it flies every year.

This gave it a large share of the 117 million people that flew between the UK and the rest of the EU last year. It also employs 4,000 people there.

IAG’s other airlines include British Airways, which carried more than 43 million people last year. The group warned in a statement following the vote that it does not expect this year’s growth in operating profits to match that of 2015.

Ryanair’s chief marketing officer, Kenny Jacobs, said that the Irish company would campaign to have the UK remains in the EU’s Open Skies regime, which allows airlines to fly freely between member states.

However, he indicated that Ryanair is more likely to spend money on countries within the EU, such as the Republic, Germany, Spain and Italy. “It’s going to mean that when we are looking at investing, we will look outside the UK,” he said.

The vote sent travel stocks tumbling. IAG fell 22.54% to 409 pence sterling in London. Ryanair shares were down 11.77% at €12.07 in Dublin.

Shaun Quinn, chief executive of State body, Fáilte Ireland, responsible for promoting tourism to the Republic, said it was too early to speculate on the likely impact of the vote on the industry.

“Fáilte Ireland will be monitoring any short term impacts of a devalued sterling on tourist numbers to Ireland and working with businesses in the sector to develop strategies to address any arising competitiveness challenges,” he said.

The Irish Hotels Federation warned that there was a risk a risk that economic uncertainty and a weaker sterling would hit visitor numbers from the UK.

Republic attracts three million tourists from Britain every year. The hospitality industry fears that this number could decline as the Brexit fallout continues.

Sligo seeking funding as European Volunteer Capital

     

CONCERN HAS BEEN EXPRESSED THAT NO FUNDING HAS YET BEEN ARRANGED FOR SLIGO’S DESIGNATION AS EUROPEAN VOLUNTEERING CAPITAL 2017.

The manager of Sligo Volunteer Centre Ciara Herity told councillors last week that while the supports from the Municipality were in place, no concrete funding was secured.

“We are the first non-country capital winner. It’s very exciting, for Sligo and for Ireland. The uniqueness of Sligo winning is that we are a small rural county on the periphery of Europe. It’s a privilege to have it,” she said.

Cathaoirleach of the County Council Cllr Rosaleen O’Grady said she was “concerned that they’ve no funding” but added that they had “the right woman in Marian Harkin in Europe” to help them source funding.

The MEP is Patron of Sligo Volunteer Centre and attended the presentation in person last week.

Sligo beat seven other cities in the running for the 2017 designation and previous winners include London, Lisbon and Barcelona.

Sligo Volunteer Centre celebrates its 10 year anniversary in 2017 and the designation will give due recognition to that.

M/s Herity said the designation would bring more European visitors here along with an economic boost to the town and county.

It’s hoped Sligo will host some national events: Volunteer Ireland, Special Olympics, Foroige and the Irish Girl Guides have been approached about hosting events here next year.

Cllr Sean MacManus said it was “a fantastic achievement for a small county on the periphery of Europe”. He said it was going to be difficult to match London and Lisbon “especially in view of the fact that we’ve no funding.”

“Even given Sligo County Council’s straitened financial situation to include some forming of funding to back them up,” he said.

Cllr Sinead Maguire also congratulated Sligo Volunteer Centre and said “It does reflect the spirit of volunteering that we have here in Sligo. We’re worthy winners.”

Council Chief Executive Ciarán Hayes is now tasked with designing a programme of events, actively pursuing sponsorship and raising awareness.

Marked reduction in PSA testing

    

A US TASK FORCE RECOMMENDATION AGAINST PSA-BASED SCREENING HAD A MAJOR EFFECT, GARY CULLITON HEARD AT THE JOHN FITZPATRICK IRISH PROSTATE CANCER CONFERENCE. SINCE THIS POLICY DECISION WAS MADE, THERE HAS BEEN A CONSIDERABLE IMPACT ON RATES OF DETECTION

Policy decisions are rapidly influencing primary care practice in the US. There has been a decrease in prostate-specific antigen (PSA) screening, and the urology response has been an increase in the use of active surveillance in men with low-risk disease. Recent years have also seen the advent of surgical cohorts with more intermediate and high-risk disease.

A recommendation against PSA screening may be leading to later stage disease at diagnosis, a meeting in Dublin has heard.

There has been a shift toward more advanced disease at diagnosis, and decreased use of PSA-based screening may worsen this trend.

The rapid decrease in PSA use was concerning, said Prof Michael Blute, Chief of Urology at Boston’s Massachusetts General Hospital and Professor of Surgery at Harvard. This would continue until there was a change at policy level, he said, in a talk on policy decisions and the changing face of prostate cancer at the John Fitzpatrick Irish Prostate Cancer Conference in Dublin recently. His talk dealt in particular with diagnosis and management in the US.

More surgical patients are seen with advanced or adverse pathology. “My hope is that smarter prostate cancer screening methods will be introduced,” said Prof Blute. One of his concerns centres on “reaching primary care practices.”

In 2012, the US Preventive Services Task Force (USPSTF) recommended against PSA-based screening for prostate cancer. There was moderate or high certainty that the service had no net benefit or that the harms outweighed the benefits, said the Task Force, which discouraged use of the service.

Since this policy decision was made, there has been a major impact on rates of detection. Urologists order between 7 and 10 per cent of the PSA tests in the country. The vast majority of PSA tests are ordered by primary care practices.

Dramatic reduction

A dramatic reduction was seen in the utilisation of PSA testing in primary care practices (Ahmedin Jemal, 2015). There were then conflicting results from the PLCO and ERSPC trials and the case against screening appeared to strengthen.

Following the 2012 USPSTF recommendation, there has been a 20 per cent reduction in the use of PSA testing in the United States and rates would continue to fall, said Prof Blute. “The argument about PSA screening became an ‘all or none’ debate. The ‘none’ side won out. This is having a significant impact for men diagnosed with prostate cancer at our practice.”

Overall incidence among the cohort of men aged 50 and older in the US dropped off in 2012. However, the presentation stage — for localised disease or metastatic disease — has not changed; it lags behind. For the first time in two decades, the incidence of metastatic disease among men aged 75 years or older is starting to creep up.

“My fear is that primary care practices are not listening to American Urological Association (AUA) guidelines. They are not listening to National Comprehensive Cancer Network (NCCN) guidelines. They are listening to the USPSTF,” Prof Blute said.

Since the 2012 USPSTF recommendation, there has been a 28 per cent reduction in the diagnosis of prostate cancer in the US (Barocas DA, J Urol, 2015). Equal reductions have been seen in the diagnosis of men with low-, intermediate- and high-risk cancers. “This is an extremely rapid change and it is a real concern for men with intermediate- or high-risk disease who will experience delay in diagnosis,” said Prof Blute. Delayed diagnoses would be a feature and an increase in the incidence of men with metastatic disease at diagnosis was sure to follow, he said.

The recommendation has been associated with decreased PSA screening in all age groups, decreased rates of prostate biopsies and decreased incidence of prostate cancer. There has been no change in the distribution of low-, intermediate- and high-grade disease. There have been no changes thus far among men aged between 50 and 74. Increases in men presenting with metastatic disease 75 years and older are now seen (Ahmedin Jemal, 2015). Men in the 50-to-70 years bracket would have a similar response if there was continued reduction in the utilisation of PSA, Prof Blute predicted. An increase in absolute and relative amounts of late stage prostate cancer would be seen, he predicted.

Increased numbers.

A hugely increased number of men with low-risk disease were identified following the introduction of PSA testing.

Seventy-to-80 per cent of the diagnoses were low-risk. Now, almost 40 per cent of men with newly diagnosed prostate cancer are placed — appropriately — in active surveillance protocols (National Cancer Database, 2004 to 2013).

Between 2004 and 2012, intermediate- and high-risk men were increasingly seen among surgical cohorts. Low-risk men may not benefit from aggressive therapy, but because of progression or repeat sampling biopsies that reveal higher grade disease in 20 per cent of cases, men may be upstaged to intermediate risk disease.

Data covering private practice urology in the US showed a drastic reduction in use of ADT monotherapy for patients with the highest risk on Cancer of the Prostate Risk Assessment (CAPRA) score after 2004 (Cooperberg, JAMA, 2009). Use of radical prostatectomy more than doubled. There was a continued reduction in primary androgen deprivation therapy as monotherapy among men aged 75 and older. There was also an increase in the utilisation of more aggressive therapy for patients who had higher-risk disease.

Pathologically, there has been a reverse stage shift: operations have been performed on more men with higher-risk disease. From 2000 to 2010, the number of men who underwent radical prostatectomies for low-risk disease, dropped drastically — from 50 to 30 per cent (Silberstein, Cancer, 2011). By contrast, the number of men with high- and intermediate-risk disease increased. More and more men with adverse pathology results would be seen following radical prostatectomy, said Prof Blute.

The number of men operated on with organ-confined disease was falling, but more men with extra-prostatic disease were seen.

However, there was a reduction in operations on men with primary pathologic Gleason Score Six disease.

Low-risk tumours are more frequently treated with active surveillance in the US, while high-risk tumours are more frequently treated with surgery. The recommendation against PSA screening is leading to a reverse Stage migration.

Prof Blute spoke about the role of MRI in surgical management of prostate cancer. There would be an increased tendency to operate on more aggressive tumours. Some cancer cells may be left behind (increased positive surgical margin rates) and there would probably be less favourable cancer control outcomes locally — particularly where surgery was used as single-modality treatment. Use of adjuvant therapies and pelvic lymph node dissection would also increasingly be considered.

Men in the high-risk cate-gory are a heterogenous group. Those with high-risk disease who have a single adverse variable do better than men with multiple adverse variables. In terms of management, surgery is included in guidelines by the National Comprehensive Cancer Network (NCCN) for cases of resectable disease, but unlike breast or colorectal cancer, algorithm surgery has not been tested in a multimodal fashion with radiation and hormone therapy.

Where surgery is used for initial management in high-risk disease, overall 10-year cancer-specific survival is 80-to-90 per cent (Stewart, 2015). Many men do well, where their high-risk disease is managed using surgery. Fifteen-year outcomes were published on a series of men with clinical T3 disease who had operations. The complication rate among these men — who underwent wide local excision of their cancers — was studied. They had good outcomes — equivalent to T2 disease. In terms of urinary control, 80 per cent of these men were completely dry (Ward, 2005, BJUI).

MRI is used to stage these patients prior to surgery. The same techniques used in low-risk men cannot be used to operate on men with high-risk disease. Extended pelvic lymph node dissections are recommended as the node positive rate for high risk disease will be 10 to 15 per cent. There would be risk associated with dividing the lateral pelvic fascia and releasing the neurovascular bundle and not achieving negative surgical margins. Therefore, an extrafascial approach is favoured for men with high-risk disease.

An objective was to elevate the rectoprostatic fascia so there was a wide surgical margin in the patient, said Prof Blute.

Using wide local excision surgery as an initial treatment among 1,800 men with high risk disease, 57 per cent of men ultimately had pathologically organ-confined disease and did well (Boorijian, J Urol, 2008). Ten-year local recurrence-free survival was 90 per cent. Local recurrence-free survival in these men (who often had at least T3 disease) was equivalent to that in men with T2 disease.

Profiling

Increasingly, a biomarker has been used. The Decipher test is a genomic classifier. Some 545 Mayo Clinic patients with high-risk disease were selected following radical prostatectomies (Erho, Crisan, PLOS One, 2013). These men had biochemical recurrence and a test was sought that would predict metastases.

Some 192 cases developed metastases. Transcriptome-wide expression profiling was carried out to identify signalling pathways associated with metastases.

If the Deci¬p¬her score indicated a low risk, only 2.4 per cent of men ultimately demonstr-ated metastases. The genomic classifier was judged to yield independent prognostic information in a multivariable analysis. The Decipher test was found to be the only significant variable for detecting rapid metastases and it performed well, compared to the CAPRA-S and Stephenson nomograms (Klein, Euro Urology 2015).

The Decipher test provided additional stratification in terms of risk (Ashley Ross, Johns Hopkins). Molecular stratification has been needed to classify men with high-risk disease better. There is a concern about additional toxicities in these men (who have undetectable PSA, are responding well to their surgery and have good quality of life).

Multivariable analysis demonstrated that genomic high-risk men, who received ART, had higher metastases-free survival, compared to salvage radiation treatment. An 80 per cent reduction in risk of metastases was demonstrated, among the Decipher high-risk group getting ART — rather than salvage — therapy.

Metastates

This would hopefully inform the debate about the timing of radiation treatment in the post-op setting, said Prof Blute. The genomic classifier would be very helpful in men who had high risk disease. Data showed that significant numbers of men with adverse pathologies did not develop clinical metastases. They do well and do not need adjuvant therapies.

Introducing a genomic classifier for this group of men would be very valuable in stratifying who needed the therapies and when. In patients with adverse pathology and a low-risk genomic classifier result, a careful eye should be kept on the PSA results, data indicate. More prospective studies were required, said Prof Blute.

In the current era, aggressive treatment of localised prostate cancer was increasingly being reserved for those men who needed it the most, and active surveillance for men with low-risk disease.

In the future, surgical cohorts would be increasingly intermediate- and high-risk patients, and focus must be on managing adverse pathology after surgery to achieve long-term local control of prostate cancer, added Prof Blute.

Crops grown on Mars soil are safe to eat

   

ECOLOGIST WIEGER WAMELINK INSPECTING THE PLANTS GROWN ON SOIL SIMILAR TO THAT ON MARS AT THE WAGENINGEN UNIVERSITY.

Results from trials using soil like that on Mars hold promise for future settlements on planet

Dutch scientists said crops of four vegetables and cereals grown on soil similar to that on Mars have been found safe to eat, amid plans for the first manned mission to the planet.

Abundant harvests of radishes, peas, rye and tomatoes all grown on the soil were found to contain “no dangerous levels” of heavy metals, said the team from Wageningen University on Thursday.

“These remarkable results are very promising,” said senior ecologist Wieger Wamelink. “We can actually eat the radishes, peas, rye and tomatoes, and I am very curious what they will taste like.”

Future Mars settlers will have to take food supplies with them and then plant crops in order to survive.

So using soil developed by Nasa to resemble that of the Red Planet, the university in the Netherlands has been experimenting since 2013 and has managed to raise 10 crops.

There is uncertainty still about their absorbing the high levels of heavy metals such as cadmium, copper and lead present in Mars soil. Further tests are needed on the other six crops, including potatoes, in research being backed by a crowd-funding campaign.

Nasa plans a manned trip to Mars within the next 10 to 15 years or so, and similar projects are being pursued by US billionaire Elon Musk and Dutch company Mars One, tentatively aiming to set up human colonies on the Red Planet.

The Mars One project has backed the Wageningen work and is deciding on the final 40 out of 100 candidates hoping to be its astronauts.

But unlike any Nasa mission, Mars One is a one-way trip: Whoever joins this journey to the foreign world is never, ever coming back to Earth, Fox 5 News reported.

Mars One CEO Bas Landsdorp estimates the project will cost US$7 billion (S$9.5 billion). He plans to pay for it in part by turning the mission into a reality show.

But space expert Neil deGrasse Tyson is sceptical.

“I try not to get in anybody’s way who is dreaming big,” he told Business Insider after Mars One announced the project in February last year. “But I’m sceptical it can be accomplished on the timescale” given.