A. Brassetti

Prostate-specific Antigen Density Is a Good Predictor of Upstaging and Upgrading, According to the New Grading System: The Keys We Are Seeking May Be Already in Our Pocket

OBJECTIVE To analyze the performance of prostate-specific antigen density (PSAD) as a predictor of upstaging and prognostic grade group (PGG) upgrading. MATERIALS AND METHODS We retrospectively evaluated data on men with prostate cancer (PCa) treated with robot-assisted laparoscopic radical prostatectomy (RALP) at our center in 2014-2015. Preoperative PSAD was calculated. Bioptic and pathologic PGGs were also considered in the analysis. We defined upgrading as any increase in PGG after RALP; upstaging was the pathologic diagnosis of a clinically unsuspected stage ≥3a PCa. RESULTS Data on 379 patients were analyzed. Upgrading was found in 41.4% of the patients; 29% of the patients were upstaged. On multivariable analysis, core involvement and PSAD were found to be predictors of upgrading (odds ratio [OR] 1.017, 95% confidence interval [CI] 1.001-1.034, P = .039; and OR 3.638, 95% CI 1.084-12.207, P = .001, respectively). Furthermore, core involvement and PSAD were predictors of upstaging (OR 1.020, 95% CI 1.020-1.034, P = .003; and OR 5.656, 95% CI 1.285-24.894, P = .022, respectively). PSAD showed areas under the curve of 0.712 (95% CI 0.645-0.780, P = .000) and 0.628 (95% CI 0.566-0.689, P = .000) for the prediction of upgrading and upstaging, respectively. In a subpopulation of 90 patients theoretically eligible for active surveillance, 14% were found upstaged and 17% were upgraded. PSAD showed areas under the curve of 0.894 (95% CI 0.808-0.97, P = .000) and 0.689 (95% CI 0.539-0.840, P = .021) for the prediction of upgrading and upstaging, respectively. CONCLUSION PSAD is a valuable predictor of upgrading and upstaging in men with PCa who were candidates for surgery and is accurate in selecting patients for AS.

Metabolic syndrome and smoking are associated with an increased risk of nocturia in male patients with benign prostatic enlargement

BackgroundTo evaluate the relationship between cigarette smoking, metabolic syndrome (MetS) and nocturia in patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE).MethodsFrom 2009 onward, a consecutive series of patients with LUTS/BPE were enrolled. Symptoms were assessed using the International Prostate Symptom Score (IPSS). Age, body mass index (BMI), smoker status, prostate volume (PV), prostate-specific antigen (PSA) levels, fasting glucose levels, triglyceride levels, and high-density lipoprotein levels were recorded. MetS was defined according to Adult Treatment Panel III criteria. Moderate/severe nocturia was defined as nocturnal micturition episodes ≥2.ResultsOverall 492 patients were enrolled with median age and BMI of 68 years (IQR 61/74) and 26.5 kg/m2 (IQR: 24/29), respectively. Moderate/severe nocturia was reported in 212 (43.1%) patients. MetS was diagnosed in 147 (29.9%) patients and out of them 89 (60.5%) complained moderate/severe nocturia (p = 0.001). Overall 187 (38%) patients were current smokers and out of them 99 (52%) presented moderate/severe nocturia(p = 0.034). Patients with moderate/severe nocturia were older (p = 0.001) and with larger prostate volume (p = 0.003). On multivariate analysis, age (OR: 1.067 per year, 95% CI: 1.036–1.098; p = 0.001), PV (OR: 1.011 per ml, 95% CI: 1.003–1.019; p = 0.006), MetS (OR: 2.509, 95% CI: 1.571–4.007; p = 0.001) and smoking (OR: 1.690, 95% CI: 1.061–2.693; p = 0.027) were associated with nocturia severity.ConclusionsMetS and smoking doubled the risk of moderate/severe nocturia in patients with LUTS and BPE. Assessing smoking and metabolic status in LUTS/ BPE patients is suggested.

Dutasteride add-on therapy reduces detrusor mass in patients with benign prostatic enlargement not satisfied with alpha-adrenergic antagonist monotherapy: A single center prospective study

The ultrasound assessment of bladder wall thickness (BWT) and intravesical prostatic protrusion (IPP) have emerged as a non‐invasive, inexpensive, time‐saving alternatives to pressure‐flow studies to assess benign prostatic obstruction (BPO). Aim of our study was to evaluate the effect on detrusor mass of dutasteride add‐on therapy in men with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE).

Primary penile leiomyosarcoma: case report and review of the literature

Primary leiomyosarcoma of the penis is very rare. Since 1930, only 53 cases have been re-ported in the international literature. We describe a case of primary leiomyosarcoma of the penis diagnosed in 2008 in a 63-year-oldman, presented to our department with a firm-fibrous mass involving the ventrolateral side of the shaft, treated with local excision and 3 times locally recurred. We also attempt a review of the literature regarding evolution, progression, differential diagnosis and possible treatment of this disease.

Radical Prostatectomy in Locally Advanced Prostate Cancer

Although in the prostate-specific antigen (PSA) era most of patients are diagnosed with a low-risk localized prostate cancer (PCa), still 10–30% of the screened men will have a locally advanced disease (clinical stage (cT) ≥3a) at presentation (Lowrance et al., BJU Int 109:1309–1314, 2012; Gozen et al., BJU Int 116:102–108, 2015). Considering the well-documented high risk of recurrence, these patients were historically ideal candidates for systemic therapies (Lowrance et al., BJU Int 109:1309–1314, 2012). Although a consensus regarding the best treatment option for these patients is still missing, most of them will undergo radiation combined with androgen deprivation therapy (ADT) (Widmark et al., Lancet 373:301–308, 2009; Roach et al., J Clin Oncol 26:585–591, 2008; Bolla et al., Lancet 360:103–106, 2002). However, it has been proven that patients harboring high-risk/locally-advanced PCa are those who will more likely benefit from active treatment. Their risk of recurrence and cancer-specific mortality (CSM), in fact, is the highest immediately after surgery but it substantially decreases over time, highlighting the curative efficacy of local treatment (Briganti et al., Urol Oncol 33:163.e7–e13, 2015).

Re: Robot-assisted Salvage Lymph Node Dissection for Clinically Recurrent Prostate Cancer

Experts’ summary: The authors retrospectively evaluated outcomes for 16 patients with nodal recurrence after radical prostatectomy (RP) treated with robot-assisted salvage lymph node dissection (SLND) and adjuvant androgen deprivation therapy (ADT) in 50% of the cases. Overall, 33.3% patients experienced a biochemical response (BR). Ureteral and vascular injuries occurred in one and three patients, respectively. Postoperative complications were mild (31.2% Clavien 1–2).

Monopolar Transurethral Enucleation of Prostatic Adenoma: Preliminary Report

OBJECTIVE To describe preliminary results of our monopolar transurethral enucleation of prostatic adenoma (mTUEPA). MATERIALS AND METHODS A consecutive series of male patients treated with mTUEPA, a retrograde enucleation of the prostatic adenoma performed by means of a standard monopolar resectoscope, were prospectively enrolled. Symptoms, uroflowmetry parameters, and post-voiding residual were assessed at baseline and at 1, 6, and 12 months postoperatively. Prostate volume was evaluated at baseline by means of transrectal ultrasound. Antiplatelet and anticoagulant drugs were stopped at least 1 week before the operation. RESULTS Forty-seven patients were enrolled. Mean preoperative prostate volume was 64.9 ± 28.5 g. When assessed at baseline, the mean total International Prostatic Symptoms Score was 15.2 ± 3.9, peak flow rate (Qmax) was 8.4 ± 2.9 mL/s and the post-voiding residual was 103.2 ± 90.6 mL. Four weeks after surgery, patients reported a mean International Prostatic Symptoms Score of 5.3 ± 3. This lower urinary tract symptoms relief was further maintained at 6 and 12 months after surgery. A significant postoperative improvement in uroflowmetry parameters was described, being the 6 and 12 months mean Qmax of 23.4 ± 10.6 mL/s and 18.8 ± 9.2 mL/s, respectively (P < .001). Overall, 14 postoperative complications were reported by 13 of 47 (27.6%) patients: most of them were minor complications (Clavien-Dindo Grade I-II), whereas 1 patient reported capsule perforation during surgery, requiring interruption of the procedure and its further completion (Clavien-Dindo IIIb). CONCLUSION mTUEPA is a safe and effective technique, merging the principles of laser enucleation and the advantages of mechanical enucleation with standard monopolar transurethral resection of the prostate equipment.

MP02-16 EFFECTS OF 5?-REDUCTASE INHIBITION ON BENIGN PROSTATIC HYPERPLASIA TREATED BY PHOTOSELECTIVE VAPORIZATION PROSTATECTOMY WITH THE 180 WATT GREENLIGHT XPS LASER SYSTEM: RESULTS FROM THE GOLIATH POPULATION

METHODS: Our study included 141 patients who underwent HoLEP. Enrolled patients were divided into two groups according to the presence of UI. Independent t test was used to compare between two groups. Logistic regression was performed to analyze a correlation between de novo UI and other factors such as age, prostate volume, retrieved tissue weight, operative time, and the first post-void residual (PVR) urine volume immediately after removing postoperative urethral catheter. Urethral catheter was removed after bladder instillation with a 200 ml normal saline via urethral catheter, and PVR urine volume was estimated immediately after the first postoperative self-voiding. All definitions of UI corresponded to recommendations of the International Continence Society. RESULTS: After HoLEP, 44 patients (31.2%) had de novo UI, most of which resolved within 1-6 months; 34 had stress UI, 6 had urgency UI, and 4 had mixed UI. Age and PVR urine volume were significantly higher in UI group than non-UI group (75.09 6.82 vs 72.01 8.04 years; P 1⁄4 0.029, 81.88 67.13 vs 30.15 23.56 ml, P < 0.001). In a logistic linear regression analysis, only PVR urine volume was an independent predictor of de novo UI after HoLEP. The most optimal cut-off value of PVR urine volume for predicting de novo UI was defined as 39.5 ml in the receiver operating characteristics curve analysis (sensitivity, 75.0%; specificity, 74.2%; AUC, 0.815; P < 0.001). CONCLUSIONS: About one-third of patients might undergo de novo UI following HoLEP, and most of them might have been resolved within 1-6 months. High PVR urine volume after removal of postoperative urethral catheter is associated with de novo UI after HoLEP, and could be used as a practical tool to predict postoperative de novo UI.

PD21-12 YOUNG ACADEMIC UROLOGIST BENIGN PROSTATIC OBSTRUCTION NOMOGRAM PREDICTS CLINICAL OUTCOME IN PATIENTS TREATED WITH TRANSURETHRAL PROSTATIC RESECTION

evidence, to assess, classify and treat LUTS. The algorythm was allocated in “Men’s Sexual Medicine ” App. From october 2013 to october 2015, the app was downloaded to 21.883 devices. Data from users epidemiological and baseline characteristics were prospectively collected. Software development was compatible with iPod, iPhone, iPad (from iOS 6 on) and Android devices (from OS v2.3.3 on). App programming used Cordova framework. Server was programmed with PHP/Yii and Angular JS for back and front-end. Retrieved data was stored in a high security server using a MySQL database. Users’ data was used in compliance with users rights from european regulations. Multivariable analysis was performed analyzing variables related to PE subtype (primary, secondary, natural variable and pseudo PE). Two-sided p value P 40cc (18,33 7,85 vs 2,59 6,75; p 40cc (48,42 13,62 years vs 33,69 11,72 years; p1⁄40,002). CONCLUSIONS: Digital online-based strategies such as apps can help physicians in data recruitment in men’s health. IPSS was related to nocturia and urge/incontinence, while age and IPSS were both related to prostate size >40cc.