Chad Ritch

Effect of statin use on biochemical outcome following radical prostatectomy: EFFECT OF STATIN USE ON BIOCHEMICAL OUTCOME FOLLOWING RADICAL PROSTATECTOMY

Study Type – Prognosis (retrospective cohort)

Relationship of erythrocyte membrane polyunsaturated fatty acids and prostate-specific antigen levels in Jamaican men

To investigate the relationship between erythrocyte membrane polyunsaturated fatty acid (PUFA) and serum prostate‐ specific antigen (PSA) levels in Jamaican men, as there may be an association between prostate cancer incidence and dietary fatty acids, and prostate cancer incidence in Jamaica is among the highest in the world.

Cutaneous Vesicostomy for Palliative Management of Hemorrhagic Cystitis and Urinary Clot Retention

We present the case of a 9 year old boy with hemorrhagic cystitis and urinary clot retention in the setting of chemotherapy refractory pre-B cell acute lymphocytic leukemia. The patient was undergoing palliative care which was complicated by severe discomfort from urinary clot retention. The decision was made to perform a cutaneous vesicostomy for clot removal and urinary drainage given the goals of care. The patient tolerated the procedure well and was comfortable with no further urinary tract symptoms until he expired. Cutaneous vesicostomy should be considered as an effective surgical option for severe clot retention in children.

Optimizing patient's selection for prostate biopsy: A single institution experience with multi-parametric MRI and the 4Kscore test for the detection of aggressive prostate cancer

Objectives To evaluate the performance of mpMRI and the 4Kscore test together for the detection of significant prostate cancer. Material and methods We selected a consecutive series of men who were referred for evaluation of prostate cancer at an academic institution and underwent mpMRI and the 4Kscore test. The primary outcome was the presence of Gleason 7 or higher cancer on biopsy of the prostate. We used logistic regression and Decision Curve Analysis to report the discrimination and clinical utility of using mpMRI and the 4Kscore test for prostate cancer detection. We modeled the probability of harboring a Gleason 7 or higher prostate cancer based on the 4Kscore test and mpMRI findings. Finally, we examined various combinations and sequences of mpMRI and the 4Kscore test and assessed the impact on biopsies avoided and cancers missed. Results Among 300 men who underwent a 4Kscore test and mpMRI, 149 (49%) underwent a biopsy. Among those, 73 (49%) had cancer, and 49 (33%) had Gleason 7 cancer. The area under the curve (AUC) for using the 4Kscore test and mpMRI together 0.82 (0.75–0.89) was superior to using the 4Kscore 0.70 (0.62–0.79) or mpMRI 0.74 (0.66–0.81) individually (p = 0.001). Similarly, decision analysis revealed the highest net benefit was achieved using both tests. Conclusions The 4Kscore test and mpMRI results provide independent, but complementary, information that enhances the prediction of higher-grade prostate cancer and improves patient’s selection for a prostate biopsy. Prospective trials are required to confirm these findings.

Malakoplakia of the prostate diagnosed on multiparametric-MRI ultrasound fusion guided biopsy: A case report and review of the literature

Malakoplakia is an unusual chronic inflammatory condition described by Michaelis and Gutmann in 1902 and further characterized by von Hansemann in 1903.1 Microscopically, there are sheets of macrophages containing round concentrically basophilic intracytoplasmic inclusions (targetoid appearance) named Michaelis-Gutmann bodies; which contain calcium salts, iron, intact and degenerating bacteria within phagolysosomal bodies. A strong association with infectious process is well known, and a defective intraphagolysosomal digestive activity of macrophages and monocytes leading to inadequate killing of ingested bacteria is hypothesized. Gram-negative bacteria such as Escherichia coli and Klebsiella pneumonia are often isolated from malakoplakia lesions. However, association with immunosuppression has been linked too.1, 2 Being first described from a bladder biopsy specimen, this is still the most common site of involvement. Yet, in recent years, cases of the disease affecting extravesical sites such as prostate, skin, bone, uterus and lungs, have been reported with increasing frequency.2 Malakoplakia involvement of the prostate was initially described by Carruthers in 1959, and up to date, this location is considered extremely rare.3, 4 We describe a case of prostatic malakoplakia, diagnosed on multiparametric MRI (mpMRI) ultrasound fusion guided biopsy in a patient with clinically suspected prostate cancer (PCa).

MP38-04 IS AN UPGRADED PIRADS 4 EQUIVALENT TO A TRUE PIRADS 4? A VALIDATION OF PIRADS VERSION 2 IN A PROSPECTIVE COHORT OF MEN UNDERGOING MRI-US FUSION BIOPSY OF THE PROSTATE

the outcome of 12-core transrectal ultrasound (TRUS) guided prostate biopsy. Herein, we aim to decipher the predictive value of mp-MRI in detection and exclusion of prostate cancer using TRUS prostate biopsy. METHODS: UK multicentre study. Data from 592 patients scheduled to undergo mp-MRI and/or 12-core TRUS-guided prostate biopsy from January till September 2016 was reviewed retrospectively from a prospective database. Mp-MRIs were reported using the Prostate Imaging Reporting and Data System (PI-RADS). Only patients who had pre biopsy mp-MRIs followed by prostate biopsy were included in the study. 108 patient were excluded as they did not have mp-MRI or biopsy due to contraindications. RESULTS: Prebiopsy mp-MRIs followed by a 12-core TRUSguided prostate biopsy were completed in 484 patients. The sensitivity and specificity of mp-MRI for prostate cancer detected on prostate biopsy were 92.6% and 74.4%, respectively. The negative predictive and positive predictive values of mp-MRI for prostate cancer detected on biopsy were 89.7% and 80.8%, respectively. 129 patients had a PIRADS score of 5 on mp-MRI, with prostate cancer detected in 92%(n1⁄4119) of patients on biopsy. The incidence of Gleason scores 6,7,8 and 9 in patients with PI-RADS 5 were 15.9%(n1⁄419), 51.2%(n1⁄461), 6.7%(n1⁄48) and 26%(n1⁄431), respectively. 117 patients had a PI-RADS score of 4 on mp-MRI, with prostate cancer detected in 53.8%(n1⁄463) of patients on biopsy. The incidence of Gleason scores 6,7,8 and 9 in patients with PI-RADS 4 were 60%(n1⁄436), 33.3% (n1⁄421), 4.7% (n1⁄43) and 1.5% (n1⁄41), respectively. 153 patients had a PI-RADS score of 3 on mp-MRI, with prostate cancer detected in 29% (n1⁄445) of patients on biopsy. The incidence of Gleason scores 6,7 and 9 cancers in patients with PI-RADS score of 3 were 68% (n1⁄431), 26.6% (n1⁄412) and 4.4% (n1⁄42), respectively. Overall there was a statistically significant association between patients with PIRADS scores 3 and cancer positive biopsies (p1⁄40.001). CONCLUSIONS: Mp-MRI has a high predictive value for both diagnosing and excluding prostate cancer. Patients with PI-RADS scores 3 had a significant association with detection of prostate cancer on biopsy. These findings could aid in guiding follow-up protocols in men suspected of prostate cancer.

MP54-11 COMPARISON OF READMISSION AND SHORT-TERM MORTALITY RATES BETWEEN DIFFERENT TYPES OF URINARY DIVERSION IN PATIENTS UNDERGOING RADICAL CYSTECTOMY

between 2008 and 2013 using the National Cancer Database. Quality indicators were defined as 1) surgical margin status, 2) lymph node yield, and 3) receipt of neoadjuvant chemotherapy. Univariate analysis and multivariate analysis was used to assess the relationship between academic facility type and annual cystectomy volume and quality indicators while controlling for demographic and pathologic characteristics. RESULTS: A total of 12,083 patients met our inclusion criteria. On multivariate analysis, while controlling for demographic and pathologic characteristics, treatment at academic facilities was associated with higher rates of negative margins (OR: 0.80; 95%CI: [0.67-0.95], p1⁄40.01), greater lymph node yields (OR: 0.49; [0.44-0.55], p<0.001), and higher rates of neoadjuvant chemotherapy(OR: 0.73; [0.64-0.55], p<0.001). High volume facilities (>24 cystectomies/year) were associated with greater lymph node yields (OR: 2.69; [2.08-3.47], p<0.001), but not significantly associated with increased neoadjuvant chemotherapy use. Intermediate volume centers (12-24 cystectomies/year) were associated with increased neoadjuvant chemotherapy use (OR: 1.60; [1.36-1.88], p<0.001). CONCLUSIONS: At a national level, high quality indicators of cystectomy (negative surgical margin, adequate lymph node yields, and receipt of neoadjuvant chemotherapy) were more likely to occur at academic facilities. High volume centers were associated with higher lymph node yields. Such data support the regionalization of cystectomy care to these centers.

MP53-15 LOCAL THERAPY IN METASTATIC PROSTATE CANCER: DOES THE BURDEN OF DISEASE MATTER? RESULTS FROM A NATIONAL POPULATION-BASED CANCER REGISTRY

any urinary leak) after RP and post IMRT was achieved in 29 (69%) and 27 (64.3%), respectively. After a median follow up of 3.4 years, a PSA recurrence and clinical recurrence were observed in 7 (16.7%) and 4 (9.5%) patients. A 5-year biochemical and clinical recurrencefree survival rate were 70.7% and 84.0%, respectively. 5-year overall free survival was 93.6%. None of patients died for prostate cancer during follow up. CONCLUSIONS: This phase II trial test a novel multimodal treatment paradigm for high-risk prostate cancer. Toxicity was acceptably low and long term oncological outcomes were good. Further studies are needed to compare this novel treatment paradigm to the standard of care.

MP80-14 LYMPH NODE YIELD AS A PREDICTOR OF OVERALL SURVIVAL FOLLOWING REGIONAL LYMPHADENECTOMY FOR PENILE CANCER

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.

PD66-09 UTILIZATION OF ROBOTIC VERSUS OPEN PARTIAL NEPHRECTOMY FOR MANAGEMENT OF CT1 AND CT2 RENAL MASSES

INTRODUCTION AND OBJECTIVES: Partial nephrectomy is widely utilized for surgical management of small renal masses. Robotic partial nephrectomy (RPN) has demonstrated improved postoperative morbidity and comparable oncologic outcomes compared to open partial nephrectomy (OPN). However, there is limited data regarding the utilization of RPN across different socio-economic strata and racial groups in the United States. We investigated trends and disparities in utilization of RPN for management of cT1 and cT2 renal masses. METHODS: Patients who underwent RPN and OPN for clinical stage T1 and T2, N0, M0 renal masses from 2010 to 2013 were identified in the National Cancer Data Base (NCDB). Univariate and multivariable logistic regression analyses were performed to evaluate differences in receiving RPN across various patient groups. RESULTS: A total of 23,681 patients fulfilled inclusion criteria. Utilization of RPN for management of cT1/cT2 renal masses significantly increased from 2010 to 2013 compared to OPN (Figure.1). Black (aOR1⁄40.91, 95%CI: 0.84-0.99) and Hispanic (aOR1⁄40.85, 95% CI: 0.76-0.94) patients were less likely to undergo RPN in favor of OPN. RPN was less likely to be performed in rural counties (aOR1⁄4 0.81, 95% CI: 0.66-0.98) and in patients with no insurance (aOR1⁄40.52, 95% CI: 0.45-0.61) or patients covered by Medicaid (aOR1⁄40.81, CI: 0.73-0.89). No significant difference was seen with respect to utilization of RPN between academic and non-academic facilities. Patients with higher clinical stage and co-morbidities were also less likely to undergo RPN (aOR1⁄40.23, 95% CI: 0.150.36 and 0.79, 95% CI: 0.71-0.87 respectively). CONCLUSIONS: Utilization of RPN continues to increase over time; however, there is significant disparity in utilization of RPN based on socio-economic status and race. Black or Hispanic patients and patients in rural communities and with limited insurance were more likely to be treated with OPN instead of RPN.