Lluís Fumadó

Association of ERG and TMPRSS2‐ERG with grade, stage, and prognosis of prostate cancer is dependent on their expression levels

There is controversy in the literature on the role of the fusion TMPRSS2‐ERG in the pathogenesis and progression of prostate cancer. The quantitative differences in TMPRSS2‐ERG fusion expression have received very limited attention in the literature.

Concurrent TMPRSS2‐ERG and SLC45A3‐ERG rearrangements plus PTEN loss are not found in low grade prostate cancer and define an aggressive tumor subset

SLC45A3 is the second most common ERG partner in prostate cancer (PrCa). Coexisting TMPRSS2 and SLC45A3 rearrangements are found in a subset of cases, but the meaning is still unknown.

Twelve Core Template Prostate Biopsy is an Unreliable Tool to Select Patients Eligible for Focal Therapy.

Introduction: To determine whether unilateral prostate cancer diagnosed at 12-core prostate biopsy harbours relevant prostate cancer foci in contralateral lobe in cases eligible for hemiablative focal therapy. Material and Methods: We analysed 112 radical prostatectomies of unilateral Gleason 6/7 prostate cancer based on prostate biopsy information. The presence of significant prostate cancer foci and/or the index lesion in the contralateral lobe is described. A subanalysis is performed in cases of Gleason score 6 and in cases of very-low-risk prostate cancer. Results: Contralateral prostate cancer was present in 69.6% of cases, fulfilling significant prostate cancer criteria in 33% and being the index lesion in 32%. No significant differences were found when analysing the Gleason 6 group (73% contralateral prostate cancer, 34% significant prostate cancer and 35% index lesion) or the very-low-risk prostate cancer group (80% contralateral prostate cancer, 29% significant prostate cancer and 45% index lesion). Conclusions: The assumption of unilateral prostate cancer based on 12-core template prostate biopsy information is unreliable. In about one third of the cases, there will be focus of significant prostate cancer or the index lesion in the contralateral lobe. This information should be taken into account when hemiablative focal therapies are considered.

ERG overexpression plus SLC45A3 (prostein) and PTEN expression loss: Strong association of the triple hit phenotype with an aggressive pathway of prostate cancer progression

TMPRSS2 and SLC45A3 rearrangements may coexist in the same tumor. ERG rearrangements and PTEN loss are concomitant events in prostate cancer (PrCa), and can cooperate in progression. We have reported that mRNA expression of TMPRSS2-ERG and SLC45A3-ERG rearrangements plus PTEN loss define an aggressive tumor subset. The aim of this study has been to validate these results by immunohistochemistry in a large cohort of tumors. ERG, SLC45A3 and PTEN immunostaining and their association with pathological features and PSA progression-free survival were analyzed in 220 PrCa (PSMAR-Biobank, Barcelona, Spain). ERG protein expression was found in 46.8% and SLC45A3 and PTEN loss in 30% and 34% tumors, respectively. Single ERG positive immunostaining was associated with GS = 6 tumors (p = 0.016), double ERG+/PTEN loss with GS = 7 (p = 0.008) and Grade Group 2 (GG) or GG3 cases (p = 0.042), ERG+/SLC45A3 loss/PTEN loss (“triple hit”) with GS ≥ 8 (p < 0.0001) and GG4 or GG5 tumors (p = 0.0003). None of GS = 6 nor = GG1 cases showed this combination. In the GS ≥ 8 group, ERG+ (p = 0.002), PTEN loss (p = 0.009) and “triple hit” (p = 0.003) were associated with Gleason pattern 3 component, and single SLC45A3 loss (p = 0.036) with GS ≥ 8 without pattern 3. The number of aberrant events and the triple hit were strongly associated with shorter PSA progression-free survival. In GS = 6 PrCa, single ERG+ was also associated with progression. ERG+ identifies a distinct pathway of PrCa. Additional assessment of PTEN and SLC45A3 adds relevant prognostic information. The triple hit phenotype (ERG+/SLC45A3 loss/PTEN loss) is associated with progression and could be used for patient stratification, treatment and follow-up.

MP86-13 HEALTH RELATED QUALITY OF LIFE OF PATIENTS UNDERGOING ACTIVE SURVEILLANCE – COMPARISON WITH PROSTATE CANCER ACTIVE TREATMENTS

INTRODUCTION AND OBJECTIVES: Interest in disease-specific psychological well-being of patients with cancer has increased, and it has been estimated that less than half of all cancer patients are properly identified and treated for anxiety or depression. The aim of this study was to evaluate psychological health assessment in oncological patients admitted for surgery. METHODS: We performed a cross-sectional study in consecutively enrolled patients with bladder, kidney or prostate cancer, scheduled for surgery. Demographic data, socioeconomic status, education level and diagnoses were recorded. We evaluated the level of clinically meaningful depression and anxiety assessed by two tools: the Hospital Anxiety and Depression Scale and the State-Trait Anxiety Inventory (STAI). In order to determine variables related to depression and anxiety among the demographic variables, logistic regression analyses were conducted, with p<0.05 considered as statistically significant. RESULTS: 207 patients completed the questionnaires and were included in the study. The most frequent procedures were performed for bladder tumours (60.4%), being transurethral resection the most common type of surgery (52.7%) followed by radical prostatectomy (24.6%). The mean STAI-state score was 19.3 ( 10.3), and the mean STAI-trait score was 18.4 ( 11.9) points. Patients showed HADs depression and anxiety scores of 3.3 ( 3) and 5.6 ( 3.3) points, respectively. Female patients showed a higher level of anxiety and STAI-trait compared to males. CONCLUSIONS: Gender, tumour type and surgical approach were significantly related to psychological distress in patients undergoing surgery for urological cancer. Females and patients with kidney tumour undergoing radical nephrectomy presented higher levels of anxiety.

The management of active surveillance in prostate cancer: validation of the Canary Prostate Active Surveillance Study risk calculator with the Spanish Urological Association Registry

The follow up of patients on active surveillance requires to repeat prostate biopsies. Predictive models that identify patients at low risk of progression or reclassification are essential to reduce the number of unnecessary biopsies. The aim of this study is to validate the Prostate Active Surveillance Study risk calculator (PASS-RC) in the multicentric Spanish Urological Association Registry of patients on active surveillance (AS), from common clinical practice. Results We find significant differences in age, PSA and clinical stage between our validation cohort and the PASS-RC generation cohort (p < .0001), with a reclassification rate of 10–22% on the follow-up Bx, no cancer was found in 43% of the first follow-up Bx. The calibration curve shows underestimation of real appearance of reclassification. The AUC is 0.65 (C.I.95%: 0.60–0.71). PDF and CUC do not suggest a specific cut-off point of clinical use. Methods We select 498 patients on AS with a minimum of one follow-up biopsy (Bx) from the 1,024 males registered by 36 Spanish centers recruiting patients on the Spanish Urological Association Registry on AS. PASS-RC external validation is carried by means of calibration curve and area under de ROC-curve (AUC), identifying cut-offs of clinical utility by probability density functions (PDF) and clinical utility curves (CUC). Conclusions In our first external validation of the PASS-RC we have obtained a moderate discrimination ability, although we cannot recommend cut-off points of clinical use. We suggest the exploration of new biomarkers and/or morpho-functional parameters from multiparametric magnetic resonance image, to improve those necessary tools on AS.

Complex vesico-vaginal fistula repair with posterosuperior bladder flap

Introduction: Vesicovaginal fistulae (VVF) remain one of the most challenging problems in modern female urology. VVF are classified as simple and complex. Complex fistulae are fistulae of large size (greater than or equal to 3 cm in diameter); those recurring after prior attempts at closure; those associated with a history of prior radiation therapy or with malignancy; those occurring in a compromised operative field owing to poor healing or host characteristics and those involving the trigone, bladder neck and/or urethra. Materials and Methods: From November 1985 to September 2010, 58 cases of VVF were repaired at our institution with the Gil-Vernet technique, without the necessity of interposition of any autologous or heterologous material. We present the case of a 44-year old woman with a previous history of cesarean, who presented with vaginal urine leakage after bladder injury with an initial attempt of primary closure during laparoscopic hysterectomy for uterine myoma. This video describes the VVF repair using a autoplasty closure with posterosuperior vesical flap “The GilVernet technique. Results: In 99.41% cases closure of the fistula was achieved at the first sur gical attempt. Conclusion: In our experience, the Gil-Vernet technique has been successful in most cases and we recommend this technique for repair of complex VVF.