Christopher D. Kosarek

Discerning the survival advantage among patients with prostate cancer who undergo radical prostatectomy or radiotherapy: The limitations of cancer registry data

The objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results.

Cancer and All-cause Mortality in Bladder Cancer Patients Undergoing Radical Cystectomy: Development and Validation of a Nomogram for Treatment Decision-making

OBJECTIVE To develop and validate a nomogram assessing cancer and all-cause mortality following radical cystectomy. Given concerns regarding the morbidity associated with surgery, there is a need for incorporation of cancer-specific and competing risks into patient counseling and recommendations. MATERIALS AND METHODS A total of 5325 and 1257 diagnosed with clinical stage T2-T4a muscle-invasive bladder cancer from January 1, 2006 to December 31, 2011 from Surveillance, Epidemiology, and End Results-Medicare and Texas Cancer Registry-Medicare linked data, respectively. Cox proportional hazards models were used and a nomogram was developed to predict 3- and 5-year overall and cancer-specific survival with external validation. RESULTS Patients who underwent radical cystectomy were mostly younger, male, married, non-Hispanic white and had fewer comorbidities than those who did not undergo radical cystectomy (P < .001). Married patients, in comparison with their unmarried counterparts, had both improved overall (hazard ratio 0.76; 95% confidence interval 0.70-0.83, P < .001) and cancer-specific (hazard ratio 0.76; 95% confidence interval 0.68-0.85, P < .001) survival. A nomogram developed using Surveillance, Epidemiology, and End Results-Medicare data, predicted 3- and 5-year overall and cancer-specific survival rates with concordance indices of 0.65 and 0.66 in the validated Texas Cancer Registry-Medicare cohort, respectively. CONCLUSION Older, unmarried patients with increased comorbidities are less likely to undergo radical cystectomy. We developed and validated a generalizable instrument that has been converted into an online tool (Radical Cystectomy Survival Calculator), to provide a benefit-risk assessment for patients considering radical cystectomy.

A peripelvic renal cyst resulting in clinically symptomatic ureteropelvic junction obstruction

Simple renal cysts are commonly observed and asymptomatic in the majority of patients. These cysts are usually located peripherally and are unnoticed unless they grow large enough to cause pain by impinging on the kidney.1 In contrast to the simple cyst, the peripelvic renal cyst is contiguous to the renal pelvis and infrequently observed.1 Often peripelvic cysts either stem from an embryologic vestige or result from a lymphatic obstruction.2 Rarely do peripelvic cysts cause ureteropelvic junction obstruction (UPJO). UPJO most commonly occurs in childhood and adolescence. Most common causes include intrinsic stenosis, an abnormal insertion point of the ureter, or compression of the ureter by a crossing vessel.3 In the case presented, a peripelvic cyst was found to be compressing the UPJ, causing an obstruction. Due to the unusual nature of the peripelvic cyst and the resultant obstruction, we chose to report this case.

Urethral Steinstrasse following Laser Lithotripsy of Prostatic Urethral Calculi

Symptomatic prostatic calculi are rare occurrences with several management options, the most popular of which is currently transurethral laser lithotripsy. This is a generally well-tolerated procedure with minimal complications. To date, no reported episodes of steinstrasse at the urethral level following prostatic calculi lithotripsy have been documented to our knowledge. We report a unique case of acute urinary retention secondary to obstructive calculi fragments following a transurethral laser lithotripsy of large prostatic calculi, further complicated by stricture at the fossa navicularis.

A Rare Case of Multifocal Prostatic Blue Nevus

Prostatic blue nevus is a rare benign pathologic diagnosis most commonly diagnosed incidentally on many different types of prostate specimens. Blue nevus is the deposition of stromal melanin characterized by spindle cells within the fibromuscular stroma which stains positive for melanin-specific stains Fontana-Masson and S100 and stains negative for CD68, HMB45, and iron stains. We report the case of a multifocal and bilateral blue nevus in a 52-year-old Hispanic male who presented with an elevated prostate-specific antigen of 4.3 and mild obstructive lower urinary tract symptoms, found by transrectal ultrasound-guided prostate needle biopsy. The biopsy also revealed benign prostatic tissue with postatrophic hyperplasia and chronic inflammation. This is the 35th reported case of prostatic blue nevus and the third to show multifocal blue nevus.

Initial series of magnetic resonance imaging (MRI)-fusion targeted prostate biopsy using the first transperineal targeted platform available in the USA

To describe a step‐by‐step guide for using the first transperineal targeted prostate biopsy platform available in the USA.

MP21-11 INCREASED UTILIZATION OF ADVANCED IMAGING TECHNOLOGY AND ITS ECONOMIC IMPACT FOR PATIENTS DIAGNOSED WITH BLADDER CANCER IN THE UNITED STATES

vs 8.4 4.8 days no readmission, p1⁄40.003), there was no significant relationship after adjusting for other factors (20.6% 0-6 days vs 19.5% 10+ days, adjusted OR 1.03, 95% 0.79-1.35, Figure). A subset analysis examining only surgery-related readmissions demonstrated similar findings. CONCLUSIONS: If no in-hospital complications occur following radical cystectomy, applying arbitrary minimum thresholds for length of stay may not decrease the risk of hospital readmission.