Marian S. Wettstein

Prostate cancer risk prediction using the novel versions of the European Randomised Study for Screening of Prostate Cancer (ERSPC) and Prostate Cancer Prevention Trial (PCPT) risk calculators: Independent validation and comparison in a contemporary European cohort

To externally validate and compare the two novel versions of the European Randomised Study for Screening of Prostate Cancer (ERSPC)‐prostate cancer risk calculator (RC) and Prostate Cancer Prevention Trial (PCPT)‐RC.

Identification of the best complete blood count-based predictors for bladder cancer outcomes in patients undergoing radical cystectomy.

Background:We sought to determine which parsimonious combination of complete blood count (CBC)-based biomarkers most efficiently predicts oncologic outcomes in patients undergoing radical cystectomy (RC) for bladder cancer (BC).Methods:Using our institutional RC database (1992–2012), nine CBC-based markers (including both absolute cell counts and ratios) were evaluated based on pre-treatment measurements. The outcome measures were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Time-dependent receiver-operating characteristics curves were used to characterise each biomarker. The CBC-based biomarkers, along with several clinical predictors, were then considered for inclusion in predictive multivariable Cox models based on the Akaike Information Criterion.Results:Our cohort included 418 patients. Neutrophil–lymphocyte ratio (NLR) was the only biomarker satisfying criteria for inclusion into all models, independently predicting RFS (HR per 1-log unit=1.52, 95% CI=1.17–1.98, P=0.002), CSS (HR=1.47, 95% CI=1.20–1.80, P<0.001), and OS (HR=1.56, 95% CI=1.16–2.10, P=0.004). Haemoglobin was also independently predictive of CSS (HR per 1 g/dl=0.91, 95% CI=0.86–0.95, P<0.001) and OS (HR=0.90, 95% CI=0.88–0.93, P<0.001), but not RFS.Conclusions:Among CBC biomarkers studied, NLR was the most efficient marker for predicting RFS, whereas NLR and haemoglobin were most efficient in predicting CSS and OS. NLR and haemoglobin are promising, cost-effective, independent biomarkers for predicting oncologic BC outcomes following RC.Condensed abstract:Various CBC-based biomarkers have separately been shown to be predictive of oncologic outcomes in patients undergoing cystectomy for BC. Our study evaluated these biomarkers, and determined that NLR is the best CBC-based biomarker for predicting RFS, whereas NLR and haemoglobin are most efficient for predicting CSS and OS.

Absorption of Irrigation Fluid Occurs Frequently during High Power 532 nm Laser Vaporization of the Prostate

PURPOSE Absorption of irrigation fluid was not detected during GreenLight™ laser vaporization of the prostate using the first generation 80 W laser. However, data are lacking on intraoperative irrigation fluid absorption using the second generation 120 W high power laser. We assessed whether fluid absorption occurs during high power laser vaporization of the prostate. MATERIALS AND METHODS We performed this prospective investigation at a tertiary referral center in patients undergoing 120 W laser vaporization for prostatic bladder outlet obstruction. Normal saline containing 1% ethanol was used for intraoperative irrigation. The expired breath ethanol concentration was measured periodically during the operation using an alcometer. The volume of saline absorption was calculated from these concentrations. Intraoperative changes in hematological and biochemical blood parameters were also recorded. RESULTS Of 50 investigated patients 22 (44%) had a positive breath ethanol test. Median absorption volume in the absorber group was 725 ml (range 138 to 3,452). Ten patients absorbed more than 1,000 ml. Absorbers had a smaller prostate, more capsular perforation, higher bleeding intensity and more laser energy applied during the operation. Three patients (13%) had symptoms potentially related to fluid absorption. Hemoglobin, hematocrit and serum chloride were the only blood parameters that changed significantly in the absorber group. The changes were significantly different than those in nonabsorbers. CONCLUSIONS Fluid absorption occurs frequently during high power laser vaporization of the prostate. This should be considered in patients who present with cardiopulmonary or neurological symptoms during or after the procedure.

CD73 Predicts Favorable Prognosis in Patients with Nonmuscle-Invasive Urothelial Bladder Cancer

Aims. CD73 is a membrane associated 5′-ectonucleotidase that has been proposed as prognostic biomarker in various solid tumors. The aim of this study is to evaluate CD73 expression in a cohort of patients with primary bladder cancer in regard to its association with clinicopathological features and disease course. Methods. Tissue samples from 174 patients with a primary urothelial carcinoma were immunohistochemically assessed on a tissue microarray. Associations between CD73 expression and retrospectively obtained clinicopathological data were evaluated by contingency analysis. Survival analysis was performed to investigate the predictive value of CD73 within the subgroup of pTa and pT1 tumors in regard to progression-free survival (PFS). Results. High CD73 expression was found in 46 (26.4%) patients and was significantly associated with lower stage, lower grade, less adjacent carcinoma in situ and with lower Ki-67 proliferation index. High CD73 immunoreactivity in the subgroup of pTa and pT1 tumors (n = 158) was significantly associated with longer PFS (HR: 0.228; p = 0.047) in univariable Cox regression analysis. Conclusion. High CD73 immunoreactivity was associated with favorable clinicopathological features. Furthermore, it predicts better outcome in the subgroup of pTa and pT1 tumors and may thus serve as additional tool for the selection of patients with favorable prognosis.

Prognostic Role of Preoperative Serum Lipid Levels in Patients Undergoing Radical Prostatectomy for Clinically Localized Prostate Cancer

BACKGROUND. The prognostic role of preoperative serum lipid levels in patients undergoing radical prostatectomy (RP) for clinically localized prostate cancer (PCa) is unclear. The aim of the present study was to investigate preoperative serum lipid levels in patients with clinically localized PCa undergoing RP and their association with clinicopathological features and oncological outcome.

Pure bipolar plasma vaporization of the prostate: the Zürich experience.

INTRODUCTION AND OBJECTIVES Bipolar plasma vaporization (BPV) has been introduced as an alternative to transurethral resection of the prostate (TURP). Promising short-term results, but inferior mid-term results compared to TURP have been reported following first-generation bipolar electrovaporization. Outcome data following second-generation BPV are still scarce. The aim of this investigation was to evaluate the intra- and postoperative outcomes of contemporary BPV in a center with long-standing expertise on laser vaporization of the prostate. METHODS A consecutive series of 83 patients undergoing BPV in a tertiary referral center was prospectively evaluated. The investigated outcome parameters included the maximum flow rate (Qmax), postvoid residual volume, International Prostate Symptom Score (IPSS)/quality of life (Qol), and prostate-specific antigen (PSA) tests. Follow-up investigations took place after 6 weeks, 6 months, and 12 months. The Wilcoxon signed-rank test was used to compare pre- and post-treatment parameters. RESULTS The median (range) preoperative prostate volume was 41 mL (17-111 mL). The preoperative IPSS, Qol, Qmax, and residual volume were 16 (2-35), 4 (0-6), 10.1 mL/s (3-29.3 mL/s), and 87 mL (0-1000 mL), respectively. One third of the patients were undergoing platelet aggregation inhibition (PAI). No intraoperative complications occurred. Postoperatively, 13 patients (15.7%) had to be recatheterized. Three patients (3.6%) had clot retention and 28 patients (34%) reported any grade of dysuria. After 6 weeks, all outcome parameters improved significantly and remained improved over the 12-month observation period [IPSS: 3 (0-2); Qol: 1 (0-4); Qmax: 17.2 mL/s (3.2-56 mL/s); residual volume 11 mL (0-190 mL)]. The PSA reduction was 60% at study conclusion. Three patients (3.6%) developed a urethral stricture and four patients (4.8%) bladder neck sclerosis. Re-resections were not necessary. CONCLUSIONS Contemporary BPV is a safe and efficacious treatment option even for patients undergoing PAI. Early urinary retention and temporary dysuria seem to be specific side effects of the treatment. Bleeding complications are rare. Long-term follow-up is needed to confirm these promising short-term results.

External Evaluation of a Novel Prostate Cancer Risk Calculator (ProstateCheck) Based on Data from the Swiss Arm of the ERSPC

PURPOSE We externally validated a novel prostate cancer risk calculator based on data from the Swiss arm of the ERSPC and assessed whether the risk calculator (ProstateCheck) is superior to the PCPT-RC and SWOP-RC in an independent Swiss cohort. MATERIALS AND METHODS Data from all men who underwent prostate biopsy at an academic tertiary care center between 2004 and 2012 were retrospectively analyzed. The probability of having any prostate cancer or high grade prostate cancer (Gleason score 7 or greater) on prostate biopsy was calculated using the ProstateCheck. Risk calculator performance was assessed using calibration and discrimination, and additionally compared with the PCPT-RC and SWOP-RC by decision curve analyses. RESULTS Of 1,615 men 401 (25%) were diagnosed with any prostate cancer and 196 (12%) with high grade prostate cancer. Our analyses of the ProstateCheck-RC revealed good calibration in the low risk range (0 to 0.4) and moderate overestimation in the higher risk range (0.4 to 1) for any and high grade prostate cancer. The AUC for the discrimination of any prostate cancer and high grade prostate cancer was 0.69 and 0.72, respectively, which was slightly but significantly higher compared to the PCPT-RC (0.66 and 0.69, respectively) and SWOP-RC (0.64 and 0.70, respectively). Decision analysis, taking into account the harms of transrectal ultrasound measurement of prostate volume, showed little benefit for ProstateCheck-RC, with properties inferior to those of the PCPT-RC and SWOP-RC. CONCLUSIONS Our independent external evaluation revealed moderate performance of the ProstateCheck-RC. Its clinical benefit is limited, and inferior to that of the PCPT-RC and SWOP-RC.

MP38-10 COMPLICATIONS FOLLOWING EXTENDED TRANSPERINEAL TEMPLATE MAPPING MRI/TRUS FUSION BIOPSY OF THE PROSTATE – INITIAL EXPERIENCE FROM 421 PROCEDURES

INTRODUCTION AND OBJECTIVES: Transperineal template mapping MRI/TRUS fusion biopsy (TMBx) offers superior accuracy and allows optimal risk stratification for patients detected with prostate cancer. However, limited data is available regarding complications and morbidity following TMBx. The goal of this retrospective analysis was to obtain the complication rate follwing TMBx in a large series. METHODS: The records of 402 consecutive patients undergoing TMBx between June 2013 and August 2016 were reviewed. All patients received a single shot antibiotic prophylaxis with 80 mg gentamicin. All underwent transperineal fusion targeted biopsy of MRIsuspicious lesions (median 3 cores per lesion) and transperineal extended template biopsy (median 41 cores). The complications were reported according to the modified Clavien-Dindo classification system. RESULTS: Of the 421 biopsies, 371 (88.1%) had an uneventful biopsywithout complications. Twenty patients (4.8%) showedpost-biopsy complications requiring an outpatient consultation or hospital admission within 30 days of the procedure. According to the Clavien-Dindo classification there were 25 patients (5.9%) with grade I complications, 24 (5.7%) with grade II and one patient (0.2%) with a grade IIIb complication (TUR-P within 30 days as a patients desire). Eleven patients (2.6%) developed an urosepsis (fever >38.5 C), 38 (9%) had an urinary retention requiring urethral catheterization and two (0.5%) had an acute bacterial prostatitis. Of the eleven patients with urosepsis, seven carried Escherichia coli, the other four cases were ESBL, Enterococcus faecalis, Serratia marcenscens and Enterobacter cloacae complex with Staphyloccocus aureus. Those patients had to be hospitalised for 2.5 days on average (range 1-7 days). 37 patients (8.8%) mentioned haematospermia while 93 (22.1%) noticed haematuria within 30 days of the procedure. A binomial logistic regressionshowed that an increasedprostate volumewasassociatedwith an increased likelihood of exhibiting urinary retention (p 1⁄4 0.006). CONCLUSIONS: In this analysis we demonstrated a low morbidity following TMBx. The procedure is very well tolerated and safe for patients. Especially the rate of major infections and urosepsis are low. Haematuria and haematospermia were very common but selflimiting in most of the cases. However, urinary retention is a major complication with 9% of all cases and is associated with increased prostate volume. Therefore we now leave the catheter for two days in patients with larger prostate glands.

MP02-02 PURE BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE: 5-YEAR FOLLOW-UP FROM A PROSPECTIVE 3D ULTRASOUND VOLUMETRY STUDY

INTRODUCTION AND OBJECTIVES: Pure bipolar plasma vaporization (BPV) has been established as low-morbidity alternative to conventional transurethral resection of the prostate (TURP). Low intraand postoperative morbidity as well as excellent functional short-term results have been reported. However, long-term outcome is still lacking. The extent of prostate tissue removal, which impacts the durability of postoperative functional improvements, is also unknown after BPV. The aim of the present study was to investigate the long-term functional outcome and associated prostate volume changes following pure BPV of the prostate. METHODS: A consecutive series of 75 patients treated by pure BPV in a tertiary care academic center was prospectively investigated. Prostate volume was assessed using planimetric volumetry following transrectal 3D-ultrasound of the prostate. Prostate volume and clinical parameters were recorded preoperatively and regularly after BPV (after catheter removal, 6W, 6M, 1, 3 and 5Y). RESULTS: Median (interquartile range; IQR) preoperative prostate volume was 41 ml (26.8ml), IPSS 16 (10), QoL 4 (2), Qmax 10.1ml/s (8ml/s), PVR 91ml (140ml) and PSA 2.57ng/ml (3.5ng/ml). A significant relative prostate volume reduction (RVR) of 33.3% (IQR: 22.3%; p<0.001) was already detectable at the time of catheter removal. Relative volume reduction increased significantly up to 12M (6W: 45.9% (17.4%; p<0.001), 6M: 50.5% (16.1%; p<0.001) and 12M 52.2% (17.4%; p1⁄40.014). After 12M the RVR remained stable with 50.6% (14.3%; p1⁄40.58) after 3Y and 52.6% (14.1%; p1⁄40.59) after 5Y. Postoperatively, all investigated clinical parameters improved significantly and remained stable during the 5Y follow-up [5Y results (IQR): IPSS: 3 (8), QoL: 1 (1), Qmax: 16.3ml/s (13.7ml/s), PVR 20ml (46.5ml)]. Median PSA reduction after 5Y was 55% (36.2%). During the observation period 9 urethral strictures (12%) were detected of which 7 were de novo strictures. Bladder neck incisions for postoperative bladder neck stenosis were performed in 6 patients (8%). Median prostate volume in these patients was 30.6ml (18.2ml). Re-resections for regrown adenoma were not necessary. CONCLUSIONS: Low intraand postoperative morbidity in combination with excellent functional outcome and durable prostate volume reduction confirm the role of contemporary BPV as a minimally invasive alternative to conventional TURP. However, postoperative bladder neck stenoses appeared rather frequent after BPV and might be a procedure-specific drawback.

MP71-19 LOSS OF POWER OUTPUT IS FREQUENTLY DETECTABLE DURING LASER VAPORIZATION OF THE PROSTATE USING THE 180-WATT 532 NM LASER IN COMBINATION WITH MOXYTM LASER FIBERS

INTRODUCTION AND OBJECTIVES: The objective was to measure the penetration depth after PhotoVaporization of the Prostate (PVP) by Enhanced Contrat UltraSonography (ECUS). METHODS: It is a forward-looking study about twelve patients operated by a PVP performed by the GREENLIGHT XPS laser. Ethical committee gave its aproval (EUDRACT N : 2012-001451-39). ECUS was performed (B-mode then contrast mode after injection of 2,4mL of suphur hexafluoride micro bubbles) preoperatively and immediately after the PVP and at 1 month. With ultrasound were measured: width, prostatic volume and diameter of the cavity of vaporization (DC) with the B-mode; then in contrast mode MicroFlow Imaging (MFI): the prostatic width and the NonVascularized cavity diameter (DD). The necrotic depth was measured using the formula: NC 1⁄4 (DD-DC)/2) (Figure 1). RESULTS: The characteristics of the patients were : a median age of 70 years old [57-81], median prostatic volume of 65 cc [40-110], median maximal urinary flow of 7,2 mL/s [2, 9-15,2], median post mictional residual volume of 90 cc [0-213], median IPSS score of 19 [8-24] and a median PSA rate of 4 ng/mL [1,6-7,9]. The results found with ultrasound performed pre and post operatively are summarized in table 1. All the patients had their bladder catheter removed and then discharged the hospital at day 1, except one patient who had an acute retention treated at day 8 by an indwelling catheter. CONCLUSIONS: The use of ECUS showed an unexpected necrotic depth up to 16,5 mm in the immediate post-operative ultrasound. This necrotic depth persisted at 1 month and was measured up to 13 mm. At one month we measured a 26% decrease of the prostatic volume and a 23% of the necrotic depth. These results are to be considered to performe securely PVP without any rectal complication. The continuing follow-up at 6 and 12 months will probably precize the necrotic depth evolution and the potential correlation with the occurrence of irritative voiding dysfunction. Table 1 : Ultrasonography results