Anna Palazzetti

Prostate Cancer Detection Rate with Koelis Fusion Biopsies versus Cognitive Biopsies: A Comparative Study

Objective: Targeted fusion biopsies have led to an improved prostate cancer (PCa) detection rate (CDR). Our aim was to assess if device-assisted fusion biopsies are superior to cognitive ones in terms of CDR. The association between multiparametric MRI parameters and PCa was also evaluated. Methods: We retrospectively enrolled 50 patients who underwent transrectal biopsy with elastic fusion (Koelis; group KB, n = 25) or cognitive approach (group CB, n = 25). Targeted biopsies were done on targets, while a variable number of random biopsies were performed depending on the clinical case. Results: The groups did not significantly differ in terms of age, prostate-specific antigen, prostate volume and previous biopsies. Mean number of random cores was significantly inferior in KB group (8.4 vs. 12.1) and mean number of targeted biopsies was significantly higher (3.6 vs. 2.6). CDR was higher in fusion biopsies (64 vs. 40%), with the gap becoming significant when considering CDR of MRI targets only (59 vs. 27%). The difference was marked for lesions ≤10 mm, where CDR was 52% in KB against 21% in CB group. Conclusions: According to our study, elastic fusion biopsies performed with Koelis achieve an increased per-patient and per-lesion CDR as compared to cognitive biopsies, especially in the case of lesions ≤10 mm.

Batson’s paravertebral venous plexus and single vertebral metastases from renal cell carcinoma

OBJECTIVES The presence of a single site bone metastasis in patients with renal cell carcinoma (RCC) is a rare clinical event. We report a single case of RCC with solitary vertebral metastasis and review of literature about renal tumor spreading in order to understand the anatomic explanation for this peculiar clinical case. METHODS We have considered the single case and reviewed current and past literature to describe the anatomic and functional background of this clinical situation. RESULTS There are rare cases of single vertebral metastasis from RCC and these are characterized from a contemporary neoplastic thrombus. The neoplastic thrombus could justify the tumoral back-flow into the paravertebral anasthomoses and so into vertebral venous sinusoids. The rich anasthomotic system that surrounds kidneys and the experimental evidence of anasthomotic links among perirenal Lejars venous system and paravertebral Batsons venous system could explain these clinical evidences. CONCLUSION Enrolment of para-vertebral Batsons venous system could have a major role in the RCC vertebral metastatic diffusion.

Urological consequences following renal transplantation: a review of the literature.

Renal transplant (RT) represents the treatment of choice for end-stage renal disease (ESRD) but harbours a wide range of possible complications and therapeutic challenges of urological competence. Dialysis years and clinical medical background of these patients are risk factors for sexual dysfunction and lower urinary tract symptoms (LUTS). On the contrary, RT itself may have a number of possible surgical complications such as ureteral stenosis and urinary leakage, while immunosuppressive treatment is a known risk factor for de-novo malignancies. The present review describes the main urologic problems of RT patients and their up-to-date treatment options according to the most recently available literature evidences.

De Novo Bladder Urothelial Neoplasm in Renal Transplant Recipients: A Retrospective, Multicentered Study

Background and Objectives: Renal transplant recipients (RTRs) have a 2- to 7-fold risk of developing a neoplasm compared to general population. Bladder urothelial neoplasms in this cohort has an incidence of 0.4–2%. Many reports describe a more aggressive behavior. The objective of this study is to describe oncologic characteristics of bladder urothelial neoplasms in RTRs and to evaluate its recurrence, progression, and survival rates. Methods: A retrospective multicentered study was performed evaluating all de novo bladder urothelial neoplasms cases in RTRs from 1988 to 2014. Descriptive statistical analysis and evaluation of recurrence, progression, and survival rates were performed. Results: A total of 28 de novo bladder transitional cell carcinomas (TCCs) were identified (incidence rate 0.64%). Cancer-specific survival rates were 100, 75, and 70% after 1, 5, and 10 years, respectively. Age at diagnosis superior to 60 years was found to be a statistically significant variable for recurrence risk. Progression rate was 14%. Presence of CIS was significantly associated with progression. All cancer-specific deaths were in the high-risk group and all were progressions from non-muscle invasive to muscle invasive bladder cancer. Conclusions: Bladder urothelial neoplasms following renal transplant is associated with a trend toward worst prognosis. Early aggressive treatments, such as early radical cystectomy, might be advisable to reduce cancer-specific deaths.

MP93-02 COMPARISON OF ONCOLOGICAL OUTCOMES BETWEEN OPEN VERSUS ROBOT-ASSISTED SALVAGE RADICAL PROSTATECTOMY: A RETROSPECTIVE MULTICENTRE SERIES

INTRODUCTION AND OBJECTIVES: To report our new vesicourethral anastomosis technique during robot assisted radical prostatectomy and test its impact on the immediate and early continence rates. METHODS: Between January-June 2016, 60 patients were enrolled in the study and data collected prospectively. Modified vesicourethral anastomosis was performed by a single surgeon. The new technique was based on stabilizing the posterior urethra with anastomosis sutures before transecting the prostatic urethra. Two 3/ 0 barbed sutures were passed from the urethra at 5 o clock and 7 o clock positions and then used for vesicourethral anastomosis. This cohort of patients (Group I, 60 pts) was compared with the most recent consecutive patients in whom standard continuous running anastomosis technique was used prior to initiating the new technique (Group II, 60 pts). Post catheter removal 1st week and 1st month continence status were compared with the standard technique using ICIQ-SF form and 1st month overactive bladder questionnaire form. Preoperative ICIQ-SF scores were aslo obtained for both groups but there were no statistical significant distance between groups. RESULTS: Groups were compared in terms of Prostate specific antigen (EBL), age, body mass index (BMI), American society of anesthesiology score (ASA), prostate volume, final gleason score, operation and anastomosis time, and estimated blood loss (EBL). Also surgical margin positivity, bladder neck reconstruction rate, lymph node invasion rate were compared. Only statistically significant difference was encountered in modified anastomosis group in terms of age; group II was younger compared to group I. (61+7.5 vs. 64+7.6, p<0.05). For the 1st week of post catheter removal, mean ICIQ-SF scores for group I and -group II were 4.1+5.7 vs. 12.1+4.1 respectively (p<0.001). Recatheterization was needed in ;4 of 60 patients in Group 1 and 1 of 60 patients in Group 2; (p>0.05). Similarly; 1st month ICIQ-SF scores for group II and group I were 10.8+4.4 vs. 2.6 +4.3, respectively (p<0.001). Overactive bladder questionnaire scores were also compared. There was a statistically significant difference between two groups in favor of group I (18+7.7 vs. 5.3+6.2) (p<0.001). CONCLUSIONS: Modified anastomosis technique seems to have better early continence rates compared to the standard technique. Moreover, overactive bladder symptoms were significantly less common with the novel anastomosis technique. Further randomized studies are needed to better evaluate the effect and reproducibility of this new technique.

MP64-02 ONCOLOGICAL OUTCOMES OF SALVAGE RADICAL PROSTATECTOMY: A MULTICENTRE SERIES OF 243 PATIENTS

INTRODUCTION AND OBJECTIVES: The CAPRA-S score uses pathologic data from radical prostatectomy to predict biochemical recurrence and mortality. Recently, external validation was performed using the American and European cohorts, however, it has not previously been validated in a large, multi-institutional Asian cohort. Thus, we independently validated CAPRA-S score in an independent multiinstitutional Korean (K-CaP) database. METHODS: The study cohort comprised 3,274 patients treated with radical prostatectomy between March 2005 and December 2014. Prediction of biochemical recurrence was assessed by Kaplan-Meier analysis and the concordance index (c-index). Performance of CAPRAS in predicting biochemical recurrence was assessed by calibration plots, and decision curve analysis. RESULTS: During the median follow-up duration of 43.0 months, biochemical recurrence developed in 697 patients (21.3%). When stratifying patients with a CAPRA-S of 0-2, 3-5, and 6-12 (defining low, intermediate and high risk group), 39.4%, 35.9%, and 24.7% of patients were in a CAPRA-S low, intermediate and high risk group, respectively. Also, estimated 5-year biochemical recurrence-free survival was 91.2%, 71.3% and 30.7%, respectively. The c-index of the CAPRA-S to predict biochemical recurrence was 0.782 (Fig. 1). The calibration plot at 5-year generally showed a good fit. Decision curve analysis revealed a greater net benefit (net increase in the proportion of patients appropriately identified for adjuvant treatment) of the CAPRA-S score for the threshold probabilities of treating all men or no men with adjuvant therapy (Fig. 2). CONCLUSIONS: The CAPRA-S score was accurate when applied in a multi-institutional Korean database. It predicted biochemical recurrence after radical prostatectomy with a c-index of 0.782. The CAPRA-S score can be valuable that may aid in determining the need for adjuvant therapy. Source of Funding: None

MP50-03 SALVAGE RADICAL PROSTATECTOMY COMPLICATIONS AND FUNCTIONAL OUTCOMES: OPEN VERSUS ROBOTIC PROCEDURES.

Paolo Gontero*, Giancarlo Marra, Paolo Alessio, Marco Oderda, Anna Palazzetti, Francesca Pisano, Antonino Battaglia, Stefania Munegato, Claudia Filippini, Bruno Frea, Turin, Italy; Fernando Munoz, Aosta, Italy; Estefania Linares, Raphael Sanchez Salas, Paris, France; Sanchia Goonewardene, Prokar Dasgupta, Declan Cahill, Ben Challacombe, London, United Kingdom; David Gillatt, Raj Persad, Bristol, United Kingdom; Juan Palou, Barcelona, Spain; Steven Joniau, Leuven, Belgium; Salvatore Smelzo, Thierry Piechaud, Bordeaux, France; Alexandre De La Taille, Cr eteil, France; Morgan Roupret, Paris, France; Derya Tilki, Hamburg, Germany; Rick Popert, London, United Kingdom

Osteoclast-Like Giant Cell Carcinoma Hidden by a Bladder Stone in a Patient with Neurogenic Bladder

Patients with neurogenic bladder are at increased risk of the development of lower urinary tract infection, bladder stones resulting from emptying disorders, and bladder neoplasms resulting from chronic stimulation after clean intermittent catheterization (CIC). In the present case report, a patient with neurogenic bladder who was initially diagnosed with a bladder stone was finally found to be affected by an osteoclast-like giant cell carcinoma of the bladder. This neoplasm has the unique characteristic of mimicking stones because of calcium deposits in the surface of the mass. In our opinion, it is advisable to perform an endoscopic diagnostic confirmation to rule out any oncologic disease before considering open surgery in patients with a similar clinical presentation.

Is 11C-choline Positron Emission Tomography/Computed Tomography Accurate to Detect Nodal Relapses of Prostate Cancer After Biochemical Recurrence? A Multicentric Study Based on Pathologic Confirmation from Salvage Lymphadenectomy

BACKGROUND A 11C-choline positron emission tomography/computed tomography (PET/CT) scan is used for restaging prostate cancer (PCa) patients with biochemical recurrence (BCR). Only a few reports have focused on the correlation between PET/CT and nodal relapse location at pathologic examination. OBJECTIVE To assess the accuracy of PET/CT in predicting the site of nodal relapses in patients undergoing pelvic and/or retroperitoneal salvage lymph node dissection (sLND). DESIGN, SETTING, AND PARTICIPANTS Multicentric retrospective study including 106 patients with BCR of PCa after radical treatment; all patients but six had a PET/CT showing at least one nodal recurrence and received sLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PET/CT results were compared with histologic findings and analyzed in terms of sensitivity, specificity, and accuracy. Multivariable regression analyses were performed. RESULTS AND LIMITATIONS Overall sensitivity, specificity, negative and positive predictive value, and accuracy of PET/CT for disease location were 61.6%, 79.3%, 66.3%, 75.7%, and 70.2%, respectively. Sensitivity was 75.5% in the lower pelvis with 69.8% specificity. The retroperitoneal region had high specificity (94.7%) but a relatively low sensitivity (58.3%). The sLNDs did not find any positive nodes in 16 patients (15%). According to regression analyses, discriminative accuracy of PET/CT was 70.4% and improved with an increased number of dissected nodes and prostate-specific antigen doubling time <12 mo. Limitations include retrospective design and lack of a standardized sLND template followed for all patients. CONCLUSIONS The ability of PET/CT to detect nodal relapses is limited by a high false-positive rate, particularly in the iliac-obturator region and, more alarmingly, a high false-negative rate in the common iliac, sacral, and retroperitoneal regions. An extended template including pelvic and retroperitoneal regions should be adopted when sLND is planned for curative intent. PATIENT SUMMARY The 11C-choline positron emission tomography/computed tomography scan is a commonly used tool to restage prostate cancer patients with biochemical recurrence, showing an overall per patient accuracy >80%; however, its ability to detect the site of nodal relapses remains suboptimal.

The role of non-invasive urodynamics in bladder outlet obstruction diagnosis in male patients

PURPOSE Many methods have been suggested to assess bladder outlet obstruction, as defined by the gold standard of pressure flow studies. A comprehensive review of the literature on the different methods used to diagnose bladder outlet obstruction by non-invasive means was performed in order to compare those methods to invasive urodynamics in terms of sensitivity and specificity. MATERIALS AND METHODS A MEDLINE search was done of the published literature covering from December 2003 on non-invasive methods, including only single measures to diagnose bladder outlet obstruction. We performed a comparison between all methods in terms of sensitivity and specificity for each test. For many techniques these values were calculated directly from the data presented in the article. RESULTS There has been applied many methods to diagnose bladder outlet obstruction. Those methods were divided into uroflowmetry, condom-catheter method, penile cuff method and Doppler ultrasonography urodynamics. Each method has been described and discussed in terms of its role in adding information to the diagnostic work-up for bladder outlet obstruction. CONCLUSIONS Pressure flow studies still remain the gold standard for assessing bladder outlet obstruction. However non-invasive urodynamics is a promising branch. Probably the most reliable information is given by the association of numerous methods together.