Tatenda Nzenza

A prospective randomized multicentre study of the impact of gallium-68 prostate-specific membrane antigen (PSMA) PET/CT imaging for staging high-risk prostate cancer prior to curative-intent surgery or radiotherapy (proPSMA study): clinical trial protocol.

Accurate staging of patients with prostate cancer (PCa) is important for therapeutic decision‐making. Relapse after surgery or radiotherapy of curative intent is not uncommon and, in part, represents a failure of staging with current diagnostic imaging techniques to detect disease spread. Prostate‐specific membrane antigen (PSMA) positron‐emission tomography (PET)/computed tomography (CT) is a new whole‐body scanning technique that enables visualization of PCa with high contrast. The hypotheses of this study are that: (i) PSMA‐PET/CT has improved diagnostic performance compared with conventional imaging; (ii) PSMA‐PET/CT should be used as a first‐line diagnostic test for staging; (iii) the improved diagnostic performance of PSMA‐PET/CT will result in significant management impact; and (iv) there are economic benefits if PSMA‐PET/CT is incorporated into the management algorithm.

Advances in Urologic Imaging: Prostate-Specific Membrane Antigen Ligand PET Imaging

Radiolabeled prostate-specific membrane antigen PET (PSMA PET) is emerging as an important modality for imaging prostate cancer (PCa). Promising clinical experience has led to increasing number of studies exploring the role of PSMA PET in different aspects of PCa including primary detection, risk stratification, targeted biopsy, initial staging, restaging at biochemical recurrence, biologic characterization, treatment response assessment and prognostication. PSMA PET may prove an important disease biomarker, expand our understanding of the pathogenesis and pave the way for personalized management of PCa.

PD65-07 THE IMPACT OF ANDROGEN DEPRIVATION THERAPY ON T CELL CHARACTERISTICS IN PROSTATE CANCER PATIENTS

INTRODUCTION AND OBJECTIVES: Over 70-85% of men with advanced prostate cancer (PCa) develop bone metastases that are characterized by severe bone pain. Bone fractures and refractory bone pain are associated with metastatic skeletal pathologies such as osteolytic lesions and abnormal osteoblastic activity. These processes give rise to decreased quality of life and predict higher mortality rates. Studies examining bone pain in prostate cancer are limited and those doing so in immunocompetent models are rare. In this study we sought to examine the contribution of the immune system to bone pain and have created a novel model to study underlying mechanisms. METHODS: We established a murine prostate cancer bone metastasis pain model in C57BL/6 mice. This was performed by transplanting a HiMyC mouse prostate cancer cell line, into the femur of immunocompetent mice. Behavioral assays were utilized to measure pain development as well as the impact on gait as well as measures of depression and anxiety. Mechanical allodynia was tested using Von Frey fiber testing at 5 day intervals. At 2 months post-injection, behavior changes on Zero maze and digiGait tests were collected. Animal tissues including femurs, dorsal root ganglion and spinal cord were collected at sacrifice and micro-CT and histology/immunohistochemistry were performed. RESULTS: Mice receiving either 5x104 prostate cancer cells or saline injection into the right femur showed lower threshold for the paw withdrawal response induced by mechanical stimulation. After 3 weeks, the difference on the withdrawal threshold for mechanical allodynia was greater between two groups. At 8 weeks, analysis of the Zero maze and Digigait tests indicated reduced movement capacity and aberrant movement associated emotional activity compared with sham control. Bone samples were scanned with micro-CT and showed typical osteolytic and osteoblastic changes. Furthermore, the trabecular volumes showed ae50% reduction in the prostate cancer group. In examining neural mechanisms, increased CGRP immunoreactivity on the ipsilateral side of tumor-bearing mice at L2-L4 level dorsal root ganglion (DRG) and the corresponding area of the dorsal horn of spinal cord was observed. Differential intracellular trafficking of PGP9.5 was observed which might play an important role in the regulation of nociception input or primary integration in peripheral sensory pathway. CONCLUSIONS: Our studies describe a novel immunocompetent bone metastasis model that may be utilized to understand prostate cancer metastatic bone pain and the contribution of the immune system to pain development and progression.

Transurethral Resection of Bladder Tumours

Transurethral resection of bladder tumour (TURBT) is performed for diagnosis and treatment of bladder cancer. The objective when performing TURBT is to ascertain accurate histological diagnosis of the tumour (type, grade and stage), and to completely resect non-muscle invasive tumours. It may also be used to debulk large tumours prior to radiotherapy and as a palliative measure for symptom control (e.g. bleeding).

PRECISION delivers on the PROMIS of mpMRI in early detection

Use of multiparametric MRI for detection of prostate cancer has been increasing and two recent studies have provided high-quality evidence advocating its integration into the diagnostic protocol. A new paradigm for detection of prostate cancer in the era of PROMIS and PRECISION should be adopted globally.

Towards gender diversity in urological leadership.

Is gender parity in urology possible? Although the number of female urologists is increasing, a disparity remains in the gender composition of the editorial boards of the top urology journals and in urological societies.

Urodynamic findings in Susac syndrome: first reported filling cystometrogram

Susac syndrome is a rare neurological disease, with only 300 cases reported in the literature. Lower urinary symptoms are not an uncommon feature of the disease, yet there is no information on specific dysfunction typical urodynamic findings associated with the disease. We present what we believe to be the first reported filling cystometrogram study of Susac syndrome for the evaluation of voiding dysfunction.

Quality of handwritten surgical operative notes from surgical trainees: a noteworthy issue

Surgical operation notes are crucial for medical record keeping and information flow in continued patient care. In addition to inherent medical implications, the quality of operative notes also has important economic and medico‐legal ramifications. Further, well‐documented records can also be useful for audit purposes and propagation of research, facilitating the improvement of delivery of care to patients. We aimed to assess the quality of surgical operation notes written by junior doctors and trainees against a set standard, to ascertain whether these standards were met.

Spontaneous renal calyceal and ureteric rupture secondary to intravenous contrast during computed tomography intravenous pyelogram.

Upper urinary tract rupture in the absence of trauma is typically related to ureteric calculi causing obstructive nephropathy. Spontaneous extravasation of contrast during CT intravenous pyelography (CT IVP) is infrequently reported. Two cases, who underwent CT IVP to further investigate positive urine cytology and microscopic haematuria, respectively, are described here. In both cases, there was spontaneous extravasation of contrast seen in the postcontrast scans in the absence of ureteric calculi or hydronephrosis which is very unusual.