Arnav Srivastava

Combining Prostate Health Index density, magnetic resonance imaging and prior negative biopsy status to improve the detection of clinically significant prostate cancer

To determine the performance of Prostate Health Index (PHI) density (PHID) combined with MRI and prior negative biopsy (PNB) status for the diagnosis of clinically significant prostate cancer (PCa).

Radiotherapy for stage I and II testicular seminomas: Secondary malignancies and survival

INTRODUCTION Testicular seminoma affects relatively young men with excellent survival outcomes. There has been increasing concern that radiotherapy (RT) leads to secondary malignant neoplasms (SMNs) and subsequent mortality. We evaluated the effect of RT on incidence of SMNs and quantified cancer-related mortality and other causes of death for patients with stage I and II testicular seminoma. MATERIAL AND METHODS A national sample of men (1988-2013) diagnosed with stage IA/IB/IS/IIA/IIB/IIC testicular seminomas from Surveillance, Epidemiology, and End Results were evaluated. Use of RT over time and survival curves (5/10/15-year) was stratified by stage. Log-binomial regression determined relative risk of developing SMNs. Incidence rate ratios (IRR) and age-adjusted Cox proportional hazards models compared overall, cancer-specific survival (CSS), and other cancer-specific survival. Competing-risks regression generated cumulative incidence functions. Prevalence ratios explored excess deaths owing to specific causes. RESULTS A total of 16,463 men were included with 9,126 (55.4%) undergoing RT with markedly decreased use for stage I seminoma in recent years (<20%) and ~50% for stage IIA. RT increased risk of SMNs (relative risk = 1.84 [95% CI: 1.61-2.10, P<0.01]). Survival rates were excellent (15-year CSS for stage I [≥99%], stage IIA [98.1%], stage IIB-C [96%-97%]). RT was associated with improved CSS for stage IB and IIA, but demonstrated less benefit for stage IA (IRR = 0.63 [95% CI: 0.35-1.14, P = 0.10]) with worse other cancer-specific survival (IRR = 1.80 [95% CI: 0.97-3.59, P = 0.05]). Gastrointestinal, respiratory, urinary, and hematologic malignances accounted for 84% of SMN deaths. CONCLUSIONS RT offers excellent CSS for men with stage I/II seminoma and an increased risk of SMN later in life. Future studies should better evaluate risk-stratification for stage IB patients.

Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study

To explore the comparative effectiveness of partial nephrectomy (PN), radical nephrectomy (RN), ablative therapies (ablation) and active surveillance (AS) for small renal masses (SRMs; tumour diameter ≤4.0 cm) in the domains of survival, renal function and quality of life (QoL) using the prospectively maintained Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry.

A Prospective Cohort Study of Postdischarge Opioid Practices After Radical Prostatectomy: The ORIOLES Initiative

Opioid pain medications are overprescribed, but few data are available to help in appropriate tailoring of postdischarge opioid prescriptions after surgery. Prior studies are retrospective and based on incomplete responses (<50%) to questionnaires, with small sample sizes for any particular surgery. The ORIOLES initiative was a prospective cohort study (2017-2018) designed to measure postdischarge opioid prescribing and use and clinical predictors of use for consecutive patients after radical prostatectomy. The objectives were to establish a postdischarge opioid reference value to meet the needs of >80% of patients and compare open and robotic surgery. A total of 205 adult patients were enrolled, with 100% completing follow-up. In units of oral morphine equivalents (OMEQ), a median of 225mg was prescribed and 22.5mg used. There was no difference by surgical approach or among patients with a history of pain-related diagnoses. Overall, 77% of postdischarge opioid medication was unused, with 84% of patients requiring ≤112.5mg OMEQ. Only 9% of patients appropriately disposed of leftover medication. Approximately 5% reported continued incisional pain due to surgery at 30d, but none required continued opioid medication use. Prescribing more opioids was independently associated with greater opioid use in adjusted models. PATIENT SUMMARY: In this report, we looked at opioid medication use following discharge after radical prostatectomy. We found that 77% of opioid pain medication prescribed was unused, with 84% of patients using less than half of their prescription. Prescribing more opioids was associated with greater use; only 9% of patients appropriately disposed of leftover medication.

PD53-05 RISK OF SECONDARY MALIGNANCY AND CAUSES OF DEATH AFTER RADIATION THERAPY FOR TESTICULAR SEMINOMAS

RESULTS: A total of 645 patients underwent PC-RPLND for Stage III NSGCT. Patients with > 40 LN, were more likely to have private insurance than those with 21-40 or 20 (77% vs 74% vs 64%, p 1⁄4 0.014), pure embryonal (18% vs 15% vs 15%) or teratoma (13.7% vs 12.5% vs 5.8%) histology. On univariate analysis, insurance status (p 1⁄4 0.015), M1b stage (p 1⁄4 0.006), positive LN status (p 1⁄4 0.018), LN metastasis size (<2cm, p 1⁄4 0.017 & 2e5cm, p 1⁄4 0.021) and LN count, both as a continuous (p 1⁄4 <0.001) and categorical (p 1⁄4 0.015) variable, predicted OS (Table 1). Five-year OS was 96% for the > 40 LN group, compared to 91% and 77% for the 2140 and 20 LN groups (Figure 1). Risk-adjusted multivariable Cox model showed an 83% reduction in hazard of death for patients with > 40 LN examined (hazard ratio [HR] 0.17; 95% CI, 0.040.71) (Table 1). CONCLUSIONS: The results from our study demonstrate LN yield appears to be an independent predictor of OS in patients undergoing PC-RPLND. These results suggest that the removal and review of more than 40 LN improves the therapeutic efficacy of PC-RPLND for NSGCT.

MP80-15 RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR SEMINOMAS: POPULATION-BASED STAGE-BY-STAGE SURVIVAL OUTCOMES

INTRODUCTION AND OBJECTIVES: There is limited data to define an appropriate threshold for lymph node yield (LNY) following regional lymphadenectomy (rND) for penile squamous cell carcinoma (pSCC) and, whether that specific threshold impacts overall survival (OS). We sought to determine whether a specific LNY affects OS following rND for pSCC and, to define the minimum beneficial number of lymph nodes (LN) to retrieve. METHODS: Using the National Cancer Database (NCDB), we identified men diagnosed with pSCC, who underwent rND, from 2004 to 2013. We excluded men diagnosed on autopsy or at the time of death, with preoperative chemotherapy or radiotherapy, M+ disease, and with < 3 months of follow up. We assessed the statistical distribution of LNY following rND. A multivariable logistic regression model was developed to assess predictors of OS including: age, comorbidity, race, stage, grade, nodal status, and LNY. Kaplan-Meier (KM) survival analysis was performed to compare OS by varying thresholds of LNY. RESULTS: 938 men with pSCC underwent rND. Of these 452 met inclusion criteria. Median follow up was 29.9 months. The median number of regional LN retrieved was 16. Based on the statistical distribution of LNY and, sensitivity analysis, a threshold of 15 LNs appeared to be clinically and statistically relevant. There was no significant difference in race, stage, grade for men with LNY 15 vs >15. However, men with LNY 15 were older than those with LNY >15 (64 vs 58 years, p<0.01). On multivariable analysis, significant independent predictors of worse OS were: age (HR: 1.02; CI [1-1.03], p<0.05), N+ disease (HR: 3.06; CI [2.12-4.42], p<0.001), and LNY 15 (HR: 1.62; CI [1.17-2.24], p<0.01). Men with a LNY 15 demonstrated a significantly decreased 5-year OS compared to those with LNY > 15 (50% VS 73%, p<0.05). On subgroup analysis of men with T2, N0, LNY >15 trended toward better 5-year OS vs LNY 15 (90% VS 71%, p1⁄40.06) (Figure) CONCLUSIONS: LNY following rND for pSCC appears to have an impact on OS independent of age, stage, nodal status and grade. A minimum LNY >15 following rND may have a beneficial impact on OS and may serve as the quantitative threshold for defining an adequate rND.