Seyed Behzad Jazayeri

Clinicopathological, functional, and immediate oncologic outcome assessment in men aged≤50 years with prostate cancer after robotic prostatectomy.

BACKGROUND To define the pathologic and functional outcomes of men 50 years of age and younger with prostate cancer in a contemporary robotic cohort, this study was designed. METHODS Patients undergoing robotic-assisted laparoscopic prostatectomy from April 2002 to April 2012 (n = 2,495) formed the base population for the current analyses. The patients were dichotomized according to their age≤50 (n = 271) and>50-year-old (n = 2,224). Clinicopathological and health-related quality-of-life outcomes were recorded and analyzed for differences. Propensity score matching was used when assessing urinary and sexual function outcome. RESULTS Baseline prostate-specific antigen and clinical stage were similar between men older than 50 years and those younger. Younger patients had less severe disease (D׳Amico risk and Gleason scores) and smaller prostates. Young men had higher rates of erectile function at all time points, including baseline (94% vs. 83% at 12mo, P <0.01). Continence was similar at all time points except for 6 months, where younger patients experienced a faster return than older patients and then remained constant, while older patients continued to improve (96% vs. 89%, P<0.01). After matching process, the difference in erectile function at 6-month follow-up was lost. CONCLUSION Most men aged 50 years and younger who received robotic-assisted laparoscopic prostatectomy had clinically significant prostate cancer. Although histopathologic and short-term oncologic outcomes were nearly identical when compared to older patients, younger men had a more rapid and superior return of erectile function.

Are magnetic resonance imaging undetectable prostate tumours clinically significant? Results of histopathological analyses

Abstract Objective To investigate whether tumours at threshold values for detection on magnetic resonance imaging (MRI) represent clinically significant tumours or not, and therefore the utility of MRI in active surveillance (AS) protocols. Patients and methods A retrospective analysis of a single institution database was performed after Institutional Review Board approval. Between 2010 and 2013, 1633 patients underwent robot-assisted laparoscopic prostatectomy (RALP) at a single institution by a single surgeon. Of these, 1361 had complete clinical data and were included in analysis. Multivariate logistic regression was used to assess histopathological grade compared to tumour size whilst controlling for biopsy Gleason score, prostate-specific antigen level, body mass index, race, and age. Results Of 120 tumours <5 mm in size, four were Gleason score 4 + 3. Of 276 tumours of 5–10 mm, 22 (8.1%) were Gleason score 4 + 3 and one (0.2%) was Gleason score 8. On multivariate regression analyses, tumours of <5 mm were much less likely to be high grade (Gleason score >3 + 4) at RALP compared to larger tumours (3.3% vs 25.1%, P < 0.001), or Gleason score ⩾8 (0.0% vs 7.6%, P < 0.001). Size was further shown to significantly correlate with grade on multivariate regression (P < 0.001). Conclusions Prostate tumours below the detection threshold for MRI (5 mm) most probably represent clinically insignificant tumours, which alone would not necessitate leaving AS in favour of more aggressive therapy. These findings point to a possible role of MRI in modern AS protocols.

MP77-14 DIABETES MELLITUS, METFORMIN AND PROSTATE CANCER: RESULTS OF A PROSTATE CANCER DATABASE ANALYSIS

INTRODUCTION AND OBJECTIVES: Chemoprevention of prostate cancer has long been an interesting topic. Data have shown that Metformin is associated with lower prostate specific antigen levels. A recent study showed that Metformin can modify gene expression in prostate cancer cells. Literature is controversial on the role of metformin in prostate cancer prevention. This study was designed to assess relationship of diabetes mellitus and metformin with prostate cancer. METHODS: A database of patients with prostate cancer was searched for patients with diabetes mellitus taking medications. Patients with diabetes mellitus prior to prostate cancer detection were detected. Data were imported into SPSS v. 21 for analysis. After primary analysis, patients taking metformin were compared to diabetic patients not taking metformin and non-diabetic patients. RESULTS: Between March 2003 and October 2016, there were 3,645 patients in the database of which 228 (6.2%) were diagnosed with diabetes mellitus prior to the time of prostate cancer detection. In diabetic group, 139 patients were using metformin products prior to surgery. There were additional 35 patients who were taking metformin for other conditions rather than diabetes mellitus. A general comparison of characteristics of diabetic and non-diabetic patients in the study is shown in table 1. Diabetic patients were more commonly black, had higher BMI, Higher D’Amico risk and higher American Society of Anesthesiologist risk classification (all p<0.05). There was no significant difference between diabetic patients taking metformin and diabetic patients on other treatment plans. Analysis of patients taking metformin with other patients (diabetic and non-diabetic) showed no significant difference in terms of prostate cancer characteristics. CONCLUSIONS: Diabetes mellitus might impact the course of prostate cancer development. The results of the study does not support the protective effect of metformin on prostate cancers in diabetic or nondiabetic.

Improvement of severe baseline lower urinary tract symptoms following robotic-assisted laparoscopic prostatectomy.

This study was designed to assess lower urinary tract symptoms (LUTS) following robotic‐assisted laparoscopic prostatectomy.

Abdominal Mass After Robotic Assisted Laparoscopic Prostatectomy: Spigelian Type Trocar Hernia

Prostate cancer is the most common cancer in men. Men are diagnosed at early stages of prostate cancer with the use of prostate specific antigen. Surgical removal of the prostate is the standard treatment in localized prostate cancer. Complications after surgical procedures are inevitable. Although robotic prostatectomy has resulted in decreased complications compared to open surgery, complications occur. After an uneventful robotic assisted laparoscopic prostatectomy in a 71-year-old gentleman, with history of chronic cough and continued low dose glucocorticoid use, the patient returned to hospital with complain of a tender abdominal mass in right lower quadrant. After performing a computed tomography of the contrast, a Spigelian type trocar hernia was noted. The patient underwent a laparoscopic diagnostic surgery followed by small bowel resection and abdominal wall defect repair. The patient was discharged home with no other complains.

The Modulating Effects of Benign Prostate Enlargement Medications on Upgrading Predictors in Patients with Gleason 6 at Biopsy

Background: Upgrading following prostate biopsy is very common in clinical practice. This study investigated whether the use of 5-alpha reductase inhibitors (ARI) and alpha blockers affect known clinical predictors of Gleason score upgrading or not. Materials and Methods: A retrospective study on 998 patients treated with robotic assisted laparoscopic prostatectomy for clinically localized biopsy Gleason score 6 prostate cancer were studied. The logarithm of prostate specific antigen concentration, prostate size and tumor volume were compared on the basis of the medication history of 5-ARIs and alpha blockers in the cohort of biopsy Gleason 6 patients with benign prostatic hyperplasia history, and patients whose prostate sizes fall in the top quartile. We compared known clinical and pathologic characteristics associated with upgrading in regression models with and without the addition of medications. Results: Alpha blockers, but not 5-ARI were associated with a bigger prostate. Upgrading was associated with older age (OR 1.03, 95% CI 1.01-1.06), higher BMI (OR 1.00 CI 1.01-1.08), higher log prostate specific antigen (OR 7.32, CI 3.546-15.52), smaller prostate size (OR 0.97, CI 0.96-0.98), fewer biopsy cores (OR 0.96 CI 0.92-0.99), more positive cores (OR 1.20, CI 1.08-1.34), and higher percentage of tumor at biopsy (OR 1.02, CI 1.01-1.03). Neither of the two medication classes were a significant predictor of upgrading. Medications made minimal changes in the multivariate predictive models. Conclusion: Although, alpha blockers were associate with bigger prostate size, the modulating effects of alpha blockers and 5-ARIs on common predictors of Gleason score upgrading was not significant.

Robotic Assisted Laparoscopic Prostatectomy Performed after Previous Suprapubic Prostatectomy

Operative management of prostate cancer in a patient who has undergone previous open suprapubic simple prostatectomy poses a unique surgical challenge. Herein, we describe a case of intermediate risk prostate cancer in a man who had undergone simple prostatectomy ten years prior to presentation. The patient was found to have Gleason 7 prostate cancer on MRI fusion biopsy of the prostate for elevated PSA and underwent an uncomplicated robot assisted laparoscopic radical prostatectomy.