D. Garrou

Perioperative and renal functional outcomes of elective robot-assisted partial nephrectomy (RAPN) for renal tumours with high surgical complexity.

To evaluate the perioperative, postoperative and functional outcomes of robot‐assisted partial nephrectomy (RAPN) for renal tumours with high surgical complexity at a large volume centre.

Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow‐up

To report the first clinical experience with a temporary implantable nitinol device (TIND; Medi‐Tate®) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).

Multiparametric Magnetic Resonance/Ultrasound Fusion Prostate Biopsy: Number and Spatial Distribution of Cores for Better Index Tumor Detection and Characterization

Purpose: We evaluated the minimum core number for better index tumor detection to determine the best core site as well as biopsy Gleason score heterogeneity in the same index lesion. The aim was to optimize the highest Gleason score detection. Materials and Methods: A total of 327 patients with negative digital rectal examination underwent magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy for elevated/rising prostate specific antigen and/or 1 or more detectable lesions on multiparametric magnetic resonance imaging after a previous negative standard biopsy. Depending on the diameter of each index lesion (8 or less, or greater than 8 mm) 4 or 6 cores, respectively, were taken according to a well determined sequence. Results: Of the patients 166 (50.7%) had prostate cancer, including 79 (47.6%) with an 8 mm or less index lesion and 87 (52.4%) with a greater than 8 mm index lesion. Of patients with an index tumor 8 mm or less 7 (8.9%) had 1, 31 (39.2%) had 2, 27 (34.2%) had 3 and 14 (17.7%) had 4 positive cores. Similarly, of patients with a lesion greater than 8 mm 8 (9.2%) had 1, 30 (34.5%) had 2, 13 (14.9%) had 3, 14 (16.1%) had 4, 12 (13.8%) had 5 and 10 (11.5%) had 6 positive cores. The major prevalence of positive cores was observed in the center of the target. Gleason score heterogeneity was found in 12.6% of those with an 8 mm or less target vs 26.4% with a target greater than 8 mm. In the center of the target there was a slight prevalence of Gleason pattern 4 or greater, or a lesser pattern. Conclusions: Approaching magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy with a single core might be inadequate. Rather, taking 2 cores in the center of the index lesion may provide more accurate cancer detection and optimize the chances of finding the highest Gleason pattern.

3-Year follow-up of temporary implantable nitinol device implantation for the treatment of benign prostatic obstruction

To report 3‐year follow‐up results of the first implantations with a temporary implantable nitinol device (TIND®; Medi‐Tate Ltd., Or Akiva, Israel) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Multiparametric prostate MRI: Technical conduct, standardized report and clinical use

Multiparametric prostate MRI (mp-MRI) is an emerging imaging modality for diagnosis, characterization, staging, and treatment planning of prostate cancer (PCa). The technique, results reporting, and its role in clinical practice have been the subject of significant development over the last decade. Although mp-MRI is not yet routinely used in the diagnostic pathway, almost all urological guidelines have emphasized the potential role of mp-MRI in several aspects of PCa management. Moreover, new MRI sequences and scanning techniques are currently under evaluation to improve the diagnostic accuracy of mp-MRI. This review presents an overview of mp-MRI, summarizing the technical applications, the standardized reporting systems used, and their current roles in various stages of PCa management. Finally, this critical review also reports the main limitations and future perspectives of the technique.

Use of chitosan membranes after nerve-sparing radical prostatectomy improves early recovery of sexual potency: results of a comparative study

To evaluate the 1‐year efficacy of chitosan membrane (ChiMe) application on the neurovascular bundles (NVBs) after nerve‐sparing (NS) robot‐assisted radical prostatectomy (RARP) in potency recovery rate. To compare the results with those of a contemporary cohort of patients who did not benefit from chitosan use.

PD18-06 5 YEARS FOLLOW-UP OF A PROSPECTIVE RANDOMISED CONTROLLED TRIAL COMPARING LAPAROSCOPIC VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY: ONCOLOGICAL AND FUNCTIONAL OUTCOMES

evaluated the association of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) with sociodemographic characteristics, family history of PC, global health score/quality of life (EORTC quality of life questionnaire-C30 subscale), depression/anxiety (Patient Health Questionnaire 4), latest PSA-level >1⁄4 0.2 ng/ml, time since RP and current therapy using hierarchical multiple regression analysis. RESULTS: Mean age at survey was 75.2 years with a median follow-up of 11.5 years. The final regression model showed younger age, lower global health status/quality of life, higher depression/anxiety scores, higher latest PSA-level and shorter time since RP predicting a higher level of PSAand PC Anxiety, respectively. Familial PC predicted only for PSA-Anxiety (all p < 0.05). The final regression model explained 12% of the variance for PSA-Anxiety and 24% for PCAnxiety. CONCLUSIONS: PC-specific anxiety is still relevant even many years after surgery. Besides depression and anxiety, younger age, shorter time since RP and a rising PSA-level play an important role during follow-up. Survivors who fulfill these characteristics are at higher risk to develop PC-specific anxiety which have need to be kept in mind by the treating physician regarding to a successful follow-up.

The role of chitosan membranes application on the neurovascular bundles during robot-assisted radical prostatectomy: Preliminary results of a phase II study

INTRODUCTION & OBJECTIVES: Erectile dysfunction and urinary incontinence are the main postoperative sequelae in patients undergoing radical prostatectomy. The introduction of robotics in surgery for prostate cancer has helped the improvement of the oncological and functional results with more precise nerve-sparing tecnique. In parallel to this, in recent years, studies in bio-medical field proposed the application of bio-materials aimed to support nerves regeneration. The aim of the study was to evaluate the eventual improvement of functional results after nerve-sparing robot-assisted radical prostatectomy (RARP) after the application of chitosan membranes on the neurovascular bundles. MATERIAL & METHODS: From July 2015 to June 2016 98 patients who underwent nerve-sparing RARP with a pre-operative IIEF> 20 were enrolled; the chitosan membrane (CM) was applied intraoperatively. Preoperative, intraoperative, postoperative, pathological and functional variables and oncological results were analyzed. Patients were defined as continent if 0 pad or 1 Safety pad was used; they were defined as potent with a score > 2 to Question 2 of the EPIC-Sexual Assessment Questionnaire (valid erections for intercourse or masturbation). The functional results were evaluated at 1 ,2 and 3 months after catheter removal. Specifically for the purpose of the study, a cohort of consecutive patients to whom CM was not applied was matched-paired after propensity score analysis to be the control group (nCM). RESULTS: The protocol did not result in an increase in operative time, intraoperative blood loss, rate of peri- and postoperative complications and worsening of the oncological results. Nerve sparing technique was bilateral interfascial in 58, interfascial/intrafascial unilateral in 24 and in bilateral intrafascial in 16 patients. In the CM group 36 (36.34%), 47 (47.93%) and 54 (54.08%) patients were potent at 1, 2 and 3 months after surgery, respectively. In the nCM group potent patients were found to be 31 (31,63%), 41 (41.81%) and 45 (45.91%), respectively (p-value: ns). Considering only patients who could benefit from a complete preservation of neurovascular bundles (intrafascial bilateral nerve-sparing), 7 (43.75%), 11 (68.75%) and 12 (75.00%) had an early recovery of potency in the CM group at 1, 2 and 3 months after surgery, respectively; in the nCM group 6 (37,50%), 9 (56.25%) and 10 (62.50%) achieved a recovery of potency (p-value:ns). Concerning the recovery of urinary continence, no differences were found. CONCLUSIONS: The application of chitosan membranes on the neurovascular bundles during RARP is safe and feasible. Functional results showed a trend towards a faster recovery of sexual potency in patients who received CM, without substantial differences in the recovery of continence. Larger sample size are needed to eventually found a statistically significant difference in potency recovery rate derived from chitosan application.

Abstract 379: Circulating tumor cells (CTCs) in clinically localized prostate cancer (PCa): searching a prognostic tool

Proceedings: AACR 106th Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA Background If PCa screening has reduced advanced disease and disease-specific mortality, the tradeoff is an over-diagnosis of cases that would not have caused clinical consequences during a mans lifetime if left untreated. Conversely, a vast numbers of men, which harbor occult extra-prostatic extension, develop recurrence after surgery. Despite it looks like an addressable question by quantifying Circulating Tumor Cells (CTCs), unlike breast cancer, in which prognostic and predictive impact of tumor cells in peripheral blood or bone marrow (Disseminated Tumor Cells, DTCs) was largely provided, their role in localized PCa is far from clear. Methods From July 2011 to August 2013, we quantify the tumor burden at diagnosis in peripheral blood of 153 PCa patients stage T2a-T3b, enrolled at three clinical sites (Roma, Orbassano and Padova). All the patients were candidate to undergo radical prostatectomy because of positive biopsy for cancer. Two labs (Orbassano and Padova) performed the CellSearch assay. In patients enrolled in Roma (Janus trial, a phase II study for the use of zoledronic acid as neoadjuvant treatment of invasive PCa), we evaluated in parallel the DTCs. Results We used data obtained in patients enrolled in Orbassano (n = 50) and Roma (n = 15) as training set, meanwhile we used patients of Padova (n = 88) as validation set. Consistently with previous reports (Kraan, Sleijfer et al. 2011) reporting low inter-test and inter-lab variability, the baseline CTC count in the two sets did not significantly differ (Mann-Whitney Rank Sum Test, p = 0.170), so that they were further analyzed altogether. Overall, we found that 74 out of 153 PC patients (48,4%) had at least 1 CTC per 7.5 ml of peripheral blood; 45 PC (29,4%) patients had > 2 cells and 21 PC patients (13,7%) had > 3 cells. Interestingly, 8 out of 153 PC patients (5,2%) had > 5 cells at the first blood draw, before surgery. When we synchronously detected CTCs and DTCs, we found consistent results in 64% of patients (Wilcoxon signed Rank Test, p = 0.339). Conclusions Even when the PCa is pathologically organ confined at surgery, it was reported 5% to 20% of these patients harbor foci of micro-metastatic disease that will later manifest itself as recurrent disease. Here we show CTCs by CellSearch assay in close to 50% of biopsy-confirmed PCa patients, obtaining evidence of a systemic disease. Prospective studies will be required to investigate whether CTC-status is associated with worst outcome in the M0 setting of PCa, as already provided in early breast cancer patients (Lucci, Hall et al. 2012). Citation Format: Elisabetta Rossi, Antonella Facchinetti, Vittorio Aneloni, Emanuel Zilio, Massimo Dal Bianco, Alice Zoccoli, Daniele Santini, Diletta Garrou, Francesco Porpiglia, Rita Zamarchi. Circulating tumor cells (CTCs) in clinically localized prostate cancer (PCa): searching a prognostic tool. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 379. doi:10.1158/1538-7445.AM2015-379

Ureteroscopy: is it the best?:

Over the last 40 years the treatment of urolithiasis passed from open surgical therapies to minimally invasive approaches. From the introduction of the first ureteroscopes in ‘80s many technological improvements allowed to reduce endourological instruments’ size, ensuring in the meanwhile an increasingly high success rate in the resolution of the urolithiasis. The purpose of the study is to review the current role of the ureteroscopy(URS) in the treatment of urinary stones. A non-systematic review was performed considering the most recent Guidelines and results from Literature. The results confirm that, considering ureteral calculi, the stone-free rate (SFR) for URS is significantly higher than for ESWL in the treatment of distal ureteral stones <10 mm and >10 mm. Endoscopy has a first-line role also in the treatment of proximal ureteral stones >10 mm, together with ESWL. Retreatment rate and ancillary procedures are also lower in patients treated with URS, despite it is more invasive if compared with ESWL. Recent data are available in Literature about the treatment of nephrolithiasis with Retrograde Intra-Renal Surgery (RIRS). RIRS is the first-line treatment, together with ESWL, for stones <20 mm, and second choice for stones >20 mm. However, for large renal stones the role of RIRS is still being discussed. In conclusion, the majority of urinary stones can be treated by rigid or flexible URS. Further studies are required to clarify the role of endoscopy in the treatment of large stones, especially if compared to percutaneous approaches.