G. Tema

External validation of Chun, PCPT, ERSPC, Kawakami, and Karakiewicz nomograms in the prediction of prostate cancer: A single center cohort-study

OBJECTIVES The aim of our study was to analyze the performance of 5 different risk calculators for prostate cancer diagnosis: Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC), European Randomized Study of Screening for Prostate Cancer Risk Calculator (ERSP-RC), Karakiewicz nomogram, Chun nomogram, and Kawakami Nomogram. METHODS From 2008 onwards, we consecutively enrolled, at a single institution in Italy, men undergoing 12-core transrectal ultrasound-guided prostate needle biopsy. Demographic, clinical, and pathological data were collected. The risk of prostate cancer (PCa) was calculated according to the PCPT-RC, ERSPC-RC, Karakiewicz, Kawakami, and Chun nomograms. Calibration and discrimination were assessed using calibration plots and receiver operator characteristic analysis. Additionally, decision curve analyses (DCA) were used to assess the net benefit associated with the adoption of each model. RESULTS Overall, 1,100 patients were evaluated, 39% presented PCa and out of them 26% presented high-grade PCa (defined as Gleason ≥ 4 + 3). All the models showed good discrimination capacities for PCa on receiver operator characteristic analysis (area under the curve: 0.59-0.72) On calibration curves the ERSCP, the PCPT and the Chun nomogram underestimated the risk of PC while the Kawakami overestimated it. At DCA, the net benefit associated with the use of the models in the prediction of cancer was observed when the threshold probability was between 40% and 60%. CONCLUSION In a cohort of Italian men undergoing prostate biopsy, the performance accuracy of these calculators for the prediction prostate cancer is suboptimal. According to our experience the use of these calculator in clinical practice should be encouraged. Although integration with new serum/urine markers or magnetic resonance imaging results is warranted.

Bipolar plasma enucleation of the prostate vs. open prostatectomy in large benign prostatic hyperplasia: a single centre 3-year comparison

BackroundAim of our study is to compare the surgery outcomes and safety of button bipolar enucleation of the prostate vs. open prostatectomy in patients with large prostates (> 80 g) in a single-centre cohort study.Materials and methodsAll patients with lower urinary tract symptoms due to benign prostatic enlargement undergoing button bipolar enucleation of the prostate (B-TUEP) or open prostatectomy (OP) between May 2012 and December 2013 were enroled in our study. Data on clinical history, physical examination, urinary symptoms, erectile function, uroflowmetry and prostate volume were collected at 0, 1, 3, 6, 12, 24 and 36 months. Early and long-term complications were recorded.ResultsOverall, 240 patients were enroled. Out of them 111 patients (46%) performed an OP and 129 patients (54%) performed a B-TUEP. In terms of efficacy, both procedures showed durable results at three years with a reintervention rate of 7.5% in the OP group and 5% in the B-TUEP group. In terms of safety, B-TUEP presented less high-grade complications when compared with OP.ConclusionsIn our single-centre study, B-TUEP represents a valid alternative to OP with excellent outcomes at three years. Further multicentre studies should confirm our results.

Narrow Band Imaging reduces persistence of cancer in patients with pT1 high grade bladder cancer

PURPOSE To evaluate persistence rate on repeated transurethral resection of the bladder (re-TURB) 6 weeks after the first TURB in patients with pT1HG disease undergoing resection of the margins and bed on Narrow Band Imaging. MATERIALS AND METHODS A consecutive series of patients undergoing TURB and a diagnosis of pT1 high grade disease were prospectively enrolled. On initial TURB patients underwent classic white light resection of the tumour followed by narrow band image (NBI) resection of margins and bed. After 6 weeks from the initial TURB, patients underwent a re-TURB under white light. Persistence rates on re-TURB were recorded. RESULTS Overall 797 patients underwent TURB, out of them 126 patients with pT1 high grade disease were included in the study. The total number of lesions was 226 meaning 1.79 lesions per patient. On re-TURB 24/126 (19%) of the patients presented residual disease with a total of 28/226 (12%) lesions identified. All these patients presented a pTa residual disease. Out of them 8/21 (38%) presented bladder cancer on the resection bed and 13/21 (62%) presented bladder cancer on margins. CONCLUSION Narrow Band Imaging trans-urethral resection of the bladder is an oncological effective procedure in the treatment of pT1HG disease. The procedure has a 19% of persistence rate which is inferior when compared to the available evidence on white light TURB. Further multicenter studies are needed in order to validate our results.

Erectile Dysfunction and Lower Urinary Tract Symptoms

Purpose of ReviewIn the past years, the relationship between lower urinary tract symptoms and erectile dysfunction has been widely explored. The aim of our systematic review is to summarize the published evidence over the past year on lower urinary tract symptoms (LUTS) and erectile dysfunction (ED).Recent FindingsRecent data support the relationship between LUTS and ED in Eastern Europe and in Asia. The role of phosphodiesterase inhibitors alone or in combination with alpha blockers to treat LUTS and ED, especially in younger patients, is strongly supported by high level of evidence.SummaryLUTS and ED are prevalent conditions in men over 50; epidemiologically, the relationship between both conditions has been confirmed all over the world. PDE5i alone or in combination with alpha blockers can be considered the gold standard for the treatment of young patients with storage symptoms and concomitant ED. In clinical research, a better understanding of the molecular pathways behind this association may also help to identify new possible targets and develop novel therapeutic approaches to manage both disorders; the identification of new biomarkers of both disorders is also compulsory in this area.

Repeat prostate‐specific antigen (PSA) test before prostate biopsy: a 20% decrease in PSA values is associated with a reduced risk of cancer and particularly of high‐grade cancer

To analyse the impact of repeating a prostate‐specific antigen (PSA) level assessment on prostate biopsy decision in a cohort of men undergoing prostate biopsy.

PD49-06 THE ADHERENCE TO THE EAU GUIDELINES ON PENILE CANCER TREATMENT COULD INFLUENCE THE SURVIVAL: MULTICENTER, RETROSPECTIVE, EUROPEAN STUDY.

METHODS: Invasive penile cancer cases from 2010-2012 were identified from the NCDB. Pathologic tumor stage was recorded including spongiosal versus carvernosal involvement. Differences in demographic (age, race, comorbid status) and pathologic features (size of tumor, grade, nodal status, LVI, histology, and extranodal extension) between T2 and T3 tumors were compared using c and t-tests. Univariate and multivariate logistic regression was performed to determine the odds of positive lymph nodes (pN+) at inguinal lymph node dissection (ILND) relative to T-stage. RESULTS: There were 367 T2 and 507 T3 patients with penile cancer. The proportion of cases with pN+ disease was 15%, 32%, 46% and 58% for T1, T2, T3 and T4 cases, respectively. Compared to T2 tumors, T3 tumors were larger (mean size 5.8 cm vs. 4.3 cm), more often treated with radical penectomy (36% vs 17%), had higher positive surgical margin rates (12% vs 9%), more aggressive pathology (32% vs 27% poorly differentiated), and were more likely to have lymphovascular invasion (42% vs 31%) (all p < 0.05). In univariate analysis, compared to T1 tumors, T2 (OR 2.8, 95% CI 1.9-4.2) and T3 (OR 4.7, 95% CI 3.3-6.8) were both associated with an increased risk of positive lymph nodes. Although in multivariate analysis, both T2 (OR 2.0, 95% CI 1.2-3.3) and T3 (OR 2.3, 95% CI 1.4-3.6) remained significantly associated with risk of positive lymph nodes compared to T1 disease, there was no increase in risk between T2 and T3 disease (OR 1.1, 95% CI 0.7-1.8, p 1⁄4 0.56). CONCLUSIONS: The proposed new AJCC staging system for the penile cancer distinguishes spongiosal (T2) from cavernosal (T3) involvement and identifies significant differences in pathologic features of the tumors (grade, LVI and size). There does not appear to be a difference in positive lymph node status between the two grades when other clinical and pathological variables are considered. Further study is required to confirm these findings and the prognostic implications of the proposed new staging system.

Analysis of the relationship between benign prostatic hyperplasia/lower urinary tract symptoms and total serum testosterone level

Study design, materials and methods From 2009 onwards, a consecutive series of patients with LUTS related to BPE were prospectively enrolled. Patients were evaluated using the International prostatic symptom score (IPSS), ultrasound prostate volume assessment. Body mass index (BMI) as well as waist circumferences were measured. Blood samples were collected and tested for: PSA levels, testosterone, Sex Hormone Binding Globuline (SHBG), 17-Beta estradiol. We evaluated the association between hormone serum levels and LUTS/BPE using logistic regression analyses and Spearman correlation test.

PD21-12 YOUNG ACADEMIC UROLOGIST BENIGN PROSTATIC OBSTRUCTION NOMOGRAM PREDICTS CLINICAL OUTCOME IN PATIENTS TREATED WITH TRANSURETHRAL PROSTATIC RESECTION

evidence, to assess, classify and treat LUTS. The algorythm was allocated in “Men’s Sexual Medicine ” App. From october 2013 to october 2015, the app was downloaded to 21.883 devices. Data from users epidemiological and baseline characteristics were prospectively collected. Software development was compatible with iPod, iPhone, iPad (from iOS 6 on) and Android devices (from OS v2.3.3 on). App programming used Cordova framework. Server was programmed with PHP/Yii and Angular JS for back and front-end. Retrieved data was stored in a high security server using a MySQL database. Users’ data was used in compliance with users rights from european regulations. Multivariable analysis was performed analyzing variables related to PE subtype (primary, secondary, natural variable and pseudo PE). Two-sided p value P 40cc (18,33 7,85 vs 2,59 6,75; p 40cc (48,42 13,62 years vs 33,69 11,72 years; p1⁄40,002). CONCLUSIONS: Digital online-based strategies such as apps can help physicians in data recruitment in men’s health. IPSS was related to nocturia and urge/incontinence, while age and IPSS were both related to prostate size >40cc.