Richard Hindley

The index lesion and focal therapy: an analysis of the pathological characteristics of prostate cancer

To determine the pathological characteristics of radical prostatectomy specimens with respect to index and secondary lesions.

Laparoscopic management of complicated urachal remnants

To report our experience with a laparoscopic approach to managing symptomatic urachal anomalies.

Laparoscopic Cytoreductive Nephrectomy: A Three-Center Retrospective Analysis

INTRODUCTION Metastatic renal cell carcinoma is associated with a poor prognosis. Given the current lack of effective systemic therapies and data suggesting a survival benefit from cytoreductive nephrectomy (CRN) before systemic therapy, we have retrospectively analyzed the experience of laparoscopic cytoreductive nephrectomy (LCRN) in three U.K. centers. The focus of this study was to assess the peri- and postoperative safety and hence feasibility of LCRN in the United Kingdom. PATIENTS AND METHODS Twenty-five patients with metastatic renal cell carcinoma deemed suitable for systemic therapy underwent LCRN in three U.K. centers over a 4-year period. RESULTS The tumors ranged from 3.4 cm in diameter to 12 cm. Operating times ranged from 89 (minimum) to 310 minutes (maximum), median 175 minutes. The median amount of blood loss was 150 mL, and hence the transfusion rate was low with only one patient requiring on-table transfusion and two patients requiring additional blood before discharge. Hospital stay ranged between 2.5 and 11 days; median postoperative stay was 3 days. CONCLUSIONS In our initial experience, LCRN seems safe and feasible with low morbidity and a good perioperative outcome.

Case Report: Baskets in the Kidney: An Old Problem in a New Situation

A potential complication of using a zero-tip basket to remove stones from a lower-lower pole calix of the kidney is impaction in this position. We report an endourologic technique involving a hydrogel-coated ureteral dilator to facilitate closure of the wires and removal of the basket following lithotripsy to fragment the stone.

PD56-08 THE PART TRIAL - A PHASE III STUDY COMPARING PARTIAL PROSTATE ABLATION VERSUS RADICAL PROSTATECTOMY (PART) IN INTERMEDIATE RISK PROSTATE CANCER – EARLY DATA FROM THE FEASIBILITY STUDY

INTRODUCTION AND OBJECTIVES: Salvage surgery is an option for recurrent prostate cancer(PCa) after focal therapy(FT). This is the first study to assess the impact of FT on surgical outcomes comparing salvage robotic-assisted radical prostatectomy(S-RARP) versus primary-RARP(P-RARP). We aimed to compare the impact of FT on perioperative, oncological and functional outcomes in men underwent S-RARP versus P-RARP. METHODS: Prospective data of 2775 men underwent RARP for localized PCa from 2000 to 2016 were reviewed. Twenty-five men underwent S-RARP after FT failure(S-RARP group). Total 2750 underwent RARP as primary treatment. Matched-pair 1:2 selection of 44 out of 2750 patients by age, IPSS and IIEF5 defined P-RARP group. Primary endpoint was between-groups differences on functional outcomes. Secondary endpoint was oncological data. p<0.05 was significant. RESULTS: Surgical time, transfusion and complication rates were comparable(p 0.05). Rates of continence probability[49.5%(SE 0.13) versus 62.4%(SE 0.08), p1⁄40.8 and 73%(SE 0.14) versus 76.5%(SE 0.07), p1⁄40.8, at 1 and 2 years, respectively] and the chance for achieving continence[HR 1.062, 95%CI 0.54-2.08, p1⁄40.861] were comparable between-groups. Potency recovery was significant lower on S-RARP at 1 year follow-up[3 2 versus 9.22 6.55, p1⁄40.008]. S-RARP showed significant lower rates of cumulative BCR-free survival probability[67.6%(SE 0.12) versus 95.1%(SE 0.03), p1⁄40.001 and 56,3%(SE 0.15) versus 92,4%(SE 0.04), p1⁄40.001, at 1 and 2 years, respectively]. S-RARP presented significant increased risk of BCR[HR 4.8, 95%CI 1.67-13.76, p1⁄40.004]. Upstaging was an independent predictor factor for BCR on S-RARP[HR 14.65, 95%CI 1.46-146.37, p1⁄40.022]. CONCLUSIONS: Salvage-RARP following FT failure is feasible and safe with acceptable complications rates. Patients assigned to FT should be previously advised about lower erectile recovery rates in case of a salvage surgery. Urologists may be warned about the risk of undertreatment in patients presenting failure along FT follow-up. Source of Funding: None

MP70-11 MEDIUM TERM OUTCOMES FOLLOWING FOCAL HIFU FOR THE TREATMENT OF LOCALISED PROSTATE CANCER: A SINGLE CENTRE EXPERIENCE.

HIFU; in eight patients (19,5%) the catheter was maintained until day 15. Nine men (21,9%) had self-resolving, mild to moderate, dysuria (median duration 7 days). Urinary tract infection was noted in 5 men (12,2%). Mean 6-months PSA was 2,4 ng/ml (0,2-9). Forthy patients (97,6%) had normal mpMRI findings 6-months after HIFU. One patient showed focal abnormal signal at mpMRI around the treated area: fusion biopsies confirmed the persistence of microfocal PCa with Gleason score 3+3 (treatment failure); in this patients a retreatment was performed. No major complication was observed. IPSS score showed no significant difference before and 6-months after HIFU. At 6 months, all patients were completely continent, and potency was maintained in 30 of 31 preoperatively potent patients. CONCLUSIONS: The integration between fusion biopsy and Focal One device allows to date the most accurate detection and treatment of index focus of PCa. This preliminary experience with 6-months follow-up time indicates that HIFU focal ablation of prostate cancer leads to 00Trifecta00 outcomes (cancer control, continence, sexual potency) in 91,5% of 41 men. The integration of new technologies enables the accurate and early diagnosis of recurrence after focal ablative treatment, leaving the possibility of a precise HIFU retreatment.

The ability of free to total prostate-specific antigen and prostate-specific antigen density to detect clinically significant prostate cancer in men undergoing transperineal template biopsy

Objective: The purpose of this study was to determine the ability of the ratio of free to total prostate-specific antigen and prostate-specific antigen density to predict the presence of clinically significant prostate cancer on template biopsies. The value of these tests may be underestimated as they were previously validated against sextant transrectal biopsy of the prostate, which has been proved to miss a large proportion of significant prostate cancers. The ability of these tests to specifically detect clinically significant cancers has not previously been studied. Patients and methods: A retrospective analysis was performed of patients undergoing transperineal template biopsy who also had free to total prostate-specific antigen and prostate-specific antigen density. Receiver-operating characteristic analysis was performed to determine the comparative utility of each test in the detection of all cancers as well as clinically significant cancers, by means of the area under the curve. Results: Data from 293 patients were analysed. Prostate cancer was detected in 72% of patients, of which 62% of this group had clinically significant disease. Receiver-operating characteristic analysis demonstrated the superiority of prostate-specific antigen density and free to total prostate-specific antigen over standard prostate-specific antigen in the overall detection of cancer (area under the curve 0.662 and 0.674 vs 0.534, p=0.003 and 0.02 respectively). Both tests were even more effective in the detection of clinically significant cancers (area under the curve 0.755 and 0.715 vs 0.572, p<0.0001 and 0.009 respectively). Conclusion: The free to total prostate-specific antigen and prostate-specific antigen density both appear to perform well at detecting clinically significant prostate cancer in our population of men undergoing template biopsy. The potential role of these inexpensive tests should not be overlooked as they may be of value when deciding which patients require biopsy following an initial magnetic resonance imaging scan and also for those on surveillance protocols.

Lymph node parameters and complications following laparoscopic extended pelvic lymphadenectomy for prostate cancer in 1000 consecutive patients

Objective: The purpose of this study was to investigate the short-term results of extended pelvic lymphadenectomy (ePLND) during laparoscopic radical prostatectomy (LRP). Patients and methods: Of 1330 consecutive patients undergoing LRP during a 90-month period 1000 (75%) had an ePLND for d’Amico intermediate- or high-risk prostate cancer. Results: Operating time, blood loss, conversion and transfusion rates and hospital stay were similar in patients having standard pelvic lymphadenectomy (sPLND) and ePLND. Median lymph node count was significantly greater following ePLND vs sPLND (17 vs 6; p⩽0.0001). Complication rates were also similar but trended (p=0.06) towards a greater rate after ePLND vs sPLND: 9.0% and 5.5%. Lymph node involvement (LNI) was detected more frequently following ePLND in patients with: prostate specific antigen (PSA)=0–9.9 (p=0.01) and PSA=10–19.9 (p⩽0.0001); biopsy Gleason sum ⩽8 (p⩽0.0001 to 0.03); intermediate- (p⩽0.0001) and high-risk (p⩽0.0001) cancer; pathological Gleason grade 7 (p⩽0.0001) and pathological stage T3 (p=0.0009 for pT3a and p⩽0.0001 for pT3b). Conclusion: ePLND is a more effective tool than sPLND in detecting LNI for patients in all prognostic clinical groups. This can be achieved without significant penalty with respect to operating time or complication rates.

PD5-10 TRANSURETHRAL RESECTION OF THE PROSTATE (GL-XPS OR TURP) DOES NOT RESULT IN SIGNIFICANT IMPAIRMENT OF ERECTILE FUNCTION

James Andrew Thomas*, Bridgend, Wales, United Kingdom; Andrea Tubaro, Rome, Italy; Neil Barber, Frimley, Camberley Surrey, United Kingdom; Frank d’ Ancona, Nijmegen, Netherlands; Gordon Muir, London, United Kingdom; Ulrich Witzsch, Frankfurt, Germany; Marc-Oliver Grimm, Jena, Germany; Joan Benejam, Manacor, Spain; Jens-Uwe Stolzenburg, Leipzig, Germany; Antony Riddick, Edinburgh, Scotland, United Kingdom; Sascha Pahernik, Heidelberg, Germany; Johannes Roelink, Almelo/Hengelo, Netherlands; Filip Ameye, Gent, Belgium; Christian Saussine, Strasbourg, France; Frank Bruyere, Tours, France; Wolfgang Loidl, Linz, Austria; Tim Larner, Brighton, United Kingdom; Nirjan Gogoi, Wakefield, United Kingdom; Richard Hindley, Hampshire, United Kingdom; Rolf Muschter, Rotenburg, Germany; Andrew Thorpe, Newcastle upon Tyne, United Kingdom; Nitin Shrotri, Kent, United Kingdom; Stuart Graham, London, United Kingdom; Moritz Hamann, Kiel, Germany; Kurt Miller, Berlin, Germany; Martin Schostak, Magdeburg, Germany; Carlos Capitan, Madrid, Spain; Helmut Knispel, Berlin, Germany; Alexander Bachmann, Basel, Switzerland

Reply from Authors re: Giorgio Gandaglia, Alberto Briganti, Andrea Salonia, Francesco Montorsi. Excellent Erectile Function Recovery after Focal Therapy: Is This Enough? Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2015.11.014: Focal Therapy Preserves Erectile Function in Men with Prostate Cancer

erectile function among patients treated with these approaches, for which there were significant differences in the amount of healthy prostatic tissue spared [3]. The similar functional outcomes observed in patients receiving ablation of different amounts of prostatic tissue suggest that sparing at least one NVB might be sufficient to obtain satisfactory erectile function after treatment. Again, this can be safely obtained using other well-established treatment modalities. In particular, a meticulous surgical approach allows preservation of anatomic structures responsible for erections and continence [5,7], even in patients with more aggressive disease characteristics [8]. Finally, these excellent functional results are presented in the absence of solid oncologic data at long-term followup [1]. The introduction of novel treatment approaches will substantially improve our ability to manage patients with clinically localized PCa and reduce the risk of treatmentrelated side effects. Nonetheless, efficacy data on oncologic endpoints are needed before these therapies can be routinely implemented in the clinical setting. Although the study by Yap et al [3] demonstrates that focal therapy is associated with excellent recovery of erectile function, longterm results from ongoing trials evaluating the outcomes of this technique are needed to clarify its role in the management of PCa patients. Meanwhile, we should remember that other well-established treatment approaches can provide optimal long-term recovery of erectile function in selected patients without compromising oncologic outcomes [5–10].