Sami-Ramzi Leyh-Bannurah

Initial Experience of 68Ga-PSMA PET/CT Imaging in High-risk Prostate Cancer Patients Prior to Radical Prostatectomy

UNLABELLED Prostate-specific membrane antigen (PSMA) overexpression theoretically enables targeting of prostate cancer (PCa) metastases using gallium Ga 68 ((68)Ga)-labeled PSMA ligands for positron emission tomography/computed tomography (PET/CT) imaging. Promising detection rates have been reported when using this approach for functional imaging of recurrent PCa; however, until now, the diagnostic accuracy of (68)Ga-PSMA PET/CT for preoperatively identifying lymph node metastases (LNMs) had not been assessed. We retrospectively compared preoperative (68)Ga-PSMA PET/CT lymph node (LN) findings with histologic work-up after radical prostatectomy (RP). Overall, 608 LNs containing 53 LNMs were detected during RP. LNMs were present in 12 of 30 patients (40%). The (68)Ga-PSMA PET/CT scans identified 4 patients (33.3%) as LN true positive and 8 patients (66.7%) as false negative. Median size of (68)Ga-PSMA-PET/CT-detected versus undetected LNMs was 13.6 versus 4.3 mm (p<0.05). Overall sensitivity, specificity, positive predictive value, and negative predictive value of (68)Ga-PSMA PET/CT for LNM detection were 33.3%, 100%, 100%, and 69.2%, respectively. Per-side analyses revealed corresponding values of 27.3%, 100%, 100%, and 52.9%. Conversely, (68)Ga-PSMA PET/CT enabled tumor visualization in the prostate. In 92.9% of patients, the intraprostatic tumor foci were correctly predicted. Overall, (68)Ga-PSMA PET/CT is a promising tool for functional imaging; however, our initial experience revealed substantial influence of LNM size on the diagnostic accuracy of (68)Ga-PSMA PET/CT. PATIENT SUMMARY We assessed the diagnostic accuracy of (68)Ga-PSMA PET/CT in high-risk prostate cancer patients prior to radical prostatectomy. We found that lymph node metastasis detection rates were substantially influenced by lymph node metastasis size.

Open and robot-assisted radical retropubic prostatectomy in men receiving ongoing low-dose aspirin medication: revisiting an old paradigm?

To assess blood loss, transfusion rates and 90‐day complication rates in patients receiving ongoing 100 mg/day aspirin medication and undergoing open radical prostatectomy (RP) or robot‐assisted RP (RARP).

Contemporary Incidence and Cancer Control Outcomes of Primary Neuroendocrine Prostate Cancer: A SEER Database Analysis

Micro‐Abstract Reports on neuroendocrine prostate cancer (NEPC) are scarce and mostly based on historical series or case reports. Importantly, incidence rates and survival figures of NEPC in contemporary patients are unknown. A retrospective analysis from a large administrative database was used to answer this question. NEPC is rare and mostly diagnosed at metastatic stage. Prognosis is poor regardless of histologic subtype. Introduction: Neuroendocrine carcinoma of the prostate (NEPC) is a rare entity. We aimed at providing contemporary data on incidence and survival figures of de‐novo NEPC. Materials and Methods: Within the Surveillance, Epidemiology, and End Results (SEER) database, we identified 309 individuals with de‐novo NEPC diagnosed between 2004 and 2013. We evaluated age‐adjusted incidence rates over the study. Kaplan‐Meier analyses assessed overall survival (OS) after stratification according to histologic subtype, metastatic status, and treatment. Cox regression analyses tested the predictors of overall mortality, after adjusting for confounders. Results: A total of 309 cases of NEPC were identified from 510,913 cases of prostate cancer. Metastatic disease was identified in 198 (64.1%) cases. The most common histologic subtype (n = 186; 60.2%) was small‐cell carcinoma (SCC). The age‐adjusted incidence of NEPC significantly increased over the study span. However, this increase only affected SCC (from 0.13/1,000,000 person‐years in 2004 to 0.30/1,000,000 person‐years in 2013; P = .001). Median survival for NEPC was 10 months. After stratification by metastatic status, no difference was observed according to SCC versus non‐SCC. Treatment with radical prostatectomy improved OS only among individuals with non‐metastatic disease, whereas radiation therapy did not affect OS rates. In multivariable Cox regression analyses predicting overall mortality, metastatic stage (hazard ratio, 1.52; 95% confidence interval, 1.12‐2.06; P < .01) and radical prostatectomy (hazard ratio, 0.38; 95% confidence interval, 0.20‐0.74; P < .01) achieved independent predictor status. Conclusion: De‐novo NEPC is extremely rare and will be encountered in clinical practice by few urologists. Most cases are metastatic at diagnosis. Prognosis is poor regardless of histologic type, especially in metastatic stage.

Anterior Localization of Prostate Cancer Suspicious Lesions in 1,161 Patients Undergoing Magnetic Resonance Imaging/Ultrasound Fusion Guided Targeted Biopsies

Purpose Based on findings in transrectal ultrasound guided biopsy series standard sampling of the prostate targets the posterior/peripheral zone. However, a substantial proportion of lesions that are prostate cancer suspicious and PI‐RADS™ (Prostate Imaging Reporting and Data System) 3 or greater on magnetic resonance imaging is located in the anterior segment of the prostate, requiring deeper placement and targeting of the biopsy needle. Materials and Methods Overall 1,161 patients underwent magnetic resonance imaging/ultrasound fusion guided targeted biopsy. Prostate cancer suspicious lesions on magnetic resonance imaging were dichotomized into anterior vs posterior prostate segments. Patients were stratified by the number of prior negative systematic biopsy sessions. Descriptive statistics included the frequency and proportion of multiparametric magnetic resonance imaging findings and corresponding histological results. Results Targeted biopsy was performed in 513 patients (44%) who were systematic biopsy naïve, 396 (34%) with 1 prior negative systematic biopsy and 252 (22%) with 2 or more prior negative systematic biopsies. When patients were stratified by the number of prior systematic biopsy sessions, the proportion with exclusively anterior, PI‐RADS 3 or greater lesions on magnetic resonance imaging increased from 3.5% to 9.1% (p = 0.006). Unfavorable 3 + 4 and 4 + 3 or greater primary Gleason patterns were identified in exclusively anterior vs posterior lesions in 31% vs 21% of the 448 patients, of whom 64 had exclusively anterior and 384 had posterior PI‐RADS 3 or greater lesions, respectively, on magnetic resonance imaging. Multivariable logistic regression analyses confirmed these findings. Conclusions After multiple previous negative systematic biopsy sessions the proportion of anterior lesions on magnetic resonance imaging increased. Such lesions harbored a greater amount of unfavorable prostate cancer. Therefore, image guidance for precise targeting should be considered, especially after initially negative transrectal ultrasound guided systematic biopsy.

Effect of Hospital and Surgeon Case Volume on Perioperative Quality of Care and Short-term Outcomes After Radical Cystectomy for Muscle-invasive Bladder Cancer: Results From a European Tertiary Care Center Cohort

Micro‐Abstract This prospective multicenter study analyzed the effect of hospital and surgeon case volume on perioperative quality of care and short‐term complications and mortality in 479 patients undergoing radical cystectomy for bladder cancer. We found that hospital volume might represent an at least equally important factor regarding postoperative complications as the surgeon case volume itself at European tertiary care centers. Background: Case volume has been suggested to affect surgical outcomes in different arrays of procedures. We aimed to delineate the relationship between case volume and surgical outcomes and quality of care criteria of radical cystectomy (RC) in a prospectively collected multicenter cohort. Patients and Methods: This was a retrospective analysis of a prospectively collected European cohort of patients with bladder cancer treated with RC in 2011. We relied on 479 and 459 eligible patients with available information on hospital case volume and surgeon case volume, respectively. Hospital case volume was divided into tertiles, and surgeon volume was dichotomized according to the median annual number of surgeries performed. Binomial generalized estimating equations controlling for potential known confounders and inter‐hospital clustering assessed the independent association of case volume with short‐term complications and mortality, as well as the fulfillment of quality of care criteria. Results: The high‐volume threshold for hospitals was 45 RCs and, for high‐volume surgeons, was > 15 cases annually. In adjusted analyses, high hospital volume remained an independent predictor of fewer 30‐day (odds ratio, 0.34; P = .002) and 60‐ to 90‐day (odds ratio, 0.41; P = .03) major complications but not of fulfilling quality of care criteria or mortality. No difference between surgeon volume groups was noted for complications, quality of care criteria, or mortality after adjustments. Conclusion: The coordination of care at high‐volume hospitals might confer a similar important factor in postoperative outcomes as surgeon case volume in RC. This points to organizational elements in high‐volume hospitals that enable them to react more appropriately to adverse events after surgery.

Impact of preoperative risk on metastatic progression and cancer-specific mortality in patients with adverse pathology at radical prostatectomy

To evaluate the impact of preoperative risk category on metastatic disease and prostate cancer‐specific mortality (CSM) in patients with prostate cancer (PCa) with adverse pathology at radical prostatectomy (RP).

MP70-01 STATE-OF-THE-ART AUTOMATED EXTRACTION OF DETAILED PATHOLOGICAL DATA FROM NARRATIVELY WRITTEN ELECTRONIC HEALTH RECORDS

INTRODUCTION AND OBJECTIVES: Often, high-volume databases (eg. SEER) contain insufficient detail about underlying diseases and results drawn from such datasets represent weak evidence. Detailed information is present in narrative clinical documentation, but it is costly/ time-consuming to make it computable for analyses. With advent of machine learning and natural language processing(NLP), an automated approach is viable to generate detailed high-volume research data. To introduce a NLP pipeline for clinical named entity recognition(NER) with machine learning classification to extract detailed information from narratively written pathological radical prostatectomy(RP) electronic health records(EHR). METHODS: Prospectively recorded institutional RP pathological database served as gold-standard. Overall, 3,679 RP EHR were randomly split into 70% trainingand 30% test-datasets. First, all training EHR were automatically annotated by utilizing regular expressions, engineered for the task of extracting name entities. These expressions were parameterized with gold-standard encoding values. This approach enabled to provide a semi-automatically annotated corpus of narratively written pathological reports containing the initially context-free gold-standard encodings. Following pathological variables were identified: Primary/secondary Gleason pattern, corresponding percentages, tumor and nodal stage, total and tumor volume, maximum diameter and surgical margin. Second, state-of-the-art NLP techniques (spaCy NLP framework, v2.0.0a16; GloVe word vectors; convolutional neural network;, TIGER Corpus) were utilized to train an industrystandard German language model for pathological EHRs by transfer learning. Finally, accuracy of the named entity extractors was compared to gold-standard encodings. RESULTS: Agreement rates(95% CI) were: Primary/secondary Gleason pattern each 91.3%(89.4-93.0), corresponding percentages 70.5%(67.6-73.3)/80.9%(78.4-83.3), tumor stage 99.3%(98.6-99.7), nodal stage 98.7%(97.8-99.3), total volume 98.3%(97.3-99.0), tumor volume 93.3%(91.6-94.8), maximum diameter 96.3%(94.9-97.3) and surgical margin 98.7%(97.8-99.3). Cumulative agreement was 91.3%. CONCLUSIONS: Semi-automatic data extraction is precise and efficient. Moreover, this approach is scalable and based on an established state-of-the art NLP software library, where most recent technical NLP advancements can be utilized easily. In consequence, our approach is generalizable to other genitourinary EHRs and tumor entities.

MP34-20 CAN RADICAL CYSTECTOMY BE PERFORMED SAFELY IN THE METASTATIC SETTING? LOCATION OF METASTATIC BLADDER CANCER AS A DETERMINANT OF IN-HOSPITAL MORTALITY

weighting (IPW)-adjusted and facility-clustered Cox and logistic regressions were used to assess the impact of histological variants vs. UCB on OS and histopathological outcomes. RESULTS: Overall, 475 (4.4%), 224 (2.1%), 155 (1.4%), and 10,033 (92.2%) patients underwent RC for MIBC with pure squamous cell, adenocarcinoma, neuroendocrine carcinoma, and UCB, respectively. In IPW-adjusted analyses, squamous cell (HR1⁄41.26; 95%CI1⁄4 [1.07-1.49]; P1⁄40.006) and neuroendocrine (HR1⁄41.53; 95%CI1⁄4[1.211.95]; P<0.001) were associated with worse OS relative to UCB (Figure 1). Squamous cell (OR1⁄41.58; 95%CI1⁄4[1.23-2.04]; P<0.001), adenocarcinoma (OR1⁄41.49; 95%CI1⁄4[1.04-2.14]; P1⁄40.030), and neuroendocrine carcinoma (OR1⁄42.37; 95%CI1⁄4[1.58-3.55]; P<0.001) at diagnosis were associated with greater odds of pT3 disease. Squamous and neuroendocrine variants were associated with decreased (OR1⁄40.66; 95%CI1⁄4[0.48-0.91]; P1⁄40.012) and increased (OR1⁄41.58; 95%CI1⁄4[1.062.37]; P1⁄40.026) odds of pN+ disease, respectively, while adenocarcinoma was associated with greater odds of positive margins (OR1⁄42.14; 95%CI1⁄4[1.39-3.30]; P1⁄40.001). CONCLUSIONS: Pure squamous cell and neuroendocrine carcinoma is associated with worse OS relative to UCB, whereas no difference was found between adenocarcinoma and UCB. All histological variants were associated with higher pT stage at surgery compared to UCB.

PD51-04 THE IMPACT OF ANXIETY AND DEPRESSION ON FUNCTIONAL OUTCOME IN PATIENTS WHO UNDERWENT RADICAL PROSTATECTOMY

risk patients, where an early SRT was associated with better cancer control (all p<0.01). Conversely, this effect was not evident in the very lowand very high-risk patients, where PSA level at SRT was not significantly associated with the risk of metastasis (all p>0.05) CONCLUSIONS: We developed a risk stratification tool that identified five prognostic risk groups. The early SRT administration provides better cancer control in low-, intermediate-, and high-risk patients. On the other hand, very low(undetectable PSA after RP, Gleason score 7, and pT3a) and very high-risk patients (PSA persistence after RP and Gleason score 8) do not benefit from an early treatment administration.

MP97-09 VENOUS THROMBOEMBOLIC EVENTS IN PATIENTS UNDERGOING OPEN AND MINIMALLY INVASIVE RADICAL PROSTATECTOMY: POPULATION-BASED TIME TREND ANALYSIS

removed (from 13.4 in 1998 to 20.5 in 2013; p1⁄40.003), associated with an increased rate of patients with 3 positive lymph nodes (from 5.6% in 1998 to 30.9% in 2013; p1⁄40.002). Pathological stage remained stable over time (all p?0.8). Conversely, the rate of pathological Gleason 4+3 and 8 increased significantly (from 17.6 to 43.1% and from 13.6 to 45.2% in 1998 and 2013, respectively; all p<0.001). The rate of PSM increased between 1998 and 2007, and remained stable thereafter. There was a trend towards lower use of adjuvant therapies (hormonal therapy-HT and radiotherapy with or without HT from 2004 to 2013; p<0.001), with increasing rates of men conservatively managed after RP (p<0.001). At MVA, year of surgery was associated with higher risk of BCR (HR: 1.08; p<0.001) and CR (HR: 1.09; p<0.001) CONCLUSIONS: A trend towards more aggressive disease and worse cancer control was observed in more contemporary N+ PCa patients treated with RP which paralleled a lower rate of utilization of adjuvant therapies. These data should be taken into account when selecting the proper post-operative management of N+ PCa patients