Vito Palumbo

Multimodal treatment for high-risk prostate cancer with high-dose intensity-modulated radiation therapy preceded or not by radical prostatectomy, concurrent intensified-dose docetaxel and long-term androgen deprivation therapy: results of a prospective phase II trial

BackgroundThe optimal management of high-risk prostate cancer remains uncertain. In this study we assessed the safety and efficacy of a novel multimodal treatment paradigm for high-risk prostate cancer.MethodsThis was a prospective phase II trial including 35 patients with newly diagnosed high-risk localized or locally advanced prostate cancer treated with high-dose intensity-modulated radiation therapy preceded or not by radical prostatectomy, concurrent intensified-dose docetaxel-based chemotherapy and long-term androgen deprivation therapy. Primary endpoint was acute and late toxicity evaluated with the Common Terminology Criteria for Adverse Events version 3.0. Secondary endpoint was biochemical and clinical recurrence-free survival explored with the Kaplan-Meier method.ResultsAcute gastro-intestinal and genito-urinary toxicity was grade 2 in 23% and 20% of patients, and grade 3 in 9% and 3% of patients, respectively. Acute blood/bone marrow toxicity was grade 2 in 20% of patients. No acute grade ≥4 toxicity was observed. Late gastro-intestinal and genito-urinary toxicity was grade 2 in 9% of patients each. No late grade ≥3 toxicity was observed. Median follow-up was 63 months (interquartile range 31–79). Actuarial 5-year biochemical and clinical recurrence-free survival rate was 55% (95% confidence interval, 35-75%) and 70% (95% confidence interval, 52-88%), respectively.ConclusionsIn our phase II trial testing a novel multimodal treatment paradigm for high-risk prostate cancer, toxicity was acceptably low and mid-term oncological outcome was good. This treatment paradigm, thus, may warrant further evaluation in phase III randomized trials.

Re: Andrea Minervini, Marco Carini, Robert G. Uzzo, Riccardo Campi, Marc C. Smaldone, Alexander Kutikov. Standardized Reporting of Resection Technique During Nephron-sparing Surgery: The Surface–Intermediate–Base Margin Score. Eur Urol 2014;66:803–5

We read with great interest the Platinum Opinion written by Minervini et al [1], who proposed a novel scoring system to standardize reporting of the excision status of specimens after partial nephrectomy (PN). The authors propose macroscopic quantification of the margins of healthy parenchyma visible at the level of the superficial and intermediate surfaces and base of the excised renal tumour. In detail, for each portion of the tumour the surgeon should be able to identify (1) cases in which only the tumour pseudocapsule without additional overlying tissue is visible (simple enucleation, SE), (2) cases in which a minimal margin ( 1 mm) of renal parenchyma is present around the tumour (enucleoresection), and (3) cases in which the tumour contour cannot be appreciated through resected parenchyma (resection). The score sum, ranging from 0 to 5, should allow five different techniques to be distinguished: pure enucleation (score sum 0–1), hybrid enucleation (score sum 2), pure enucleoresection (score sum 3), hybrid enucleoresection (score sum 4), and resection (score sum 5). The authors conclude that this new reporting system should improve the interpretation of PN outcomes and their reliable comparison across surgical series [1]. We have several concerns regarding this proposal.

Urethral-fixation technique improves early urinary continence recovery in patients who undergo retropubic radical prostatectomy

To describe step‐by‐step an original urethrovesical anastomosis technique (urethral fixation) in patients undergoing retropubic radical prostatectomy (RRP), to compare their early urinary continence recovery with those in a control group receiving a standard anastomosis technique and to identify the predictors of early urinary continence recovery.

Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer

Objective: To evaluate perioperative outcomes and early survival in a series of octogenarians who underwent radical cystectomy (RC) and urinary diversion for bladder cancer. Patients and Methods: We retrospectively evaluated the clinical records of 44 patients aged ≥80 years who underwent open RC and urinary diversion at 2 high-volume centers between July 2013 and December 2015. Estimated blood loss (EBL), transfusion rate, and length of hospital stay (LOS) were evaluated. Ninety-day postoperative complications were stratified according to the type of urinary diversion. Univariable analysis was performed to identify predictors of overall and major complications. Overall survival (OS) was estimated using the Kaplan-Meier method. Results: Median age was 83 years (interquartile range [IQR] 81-85). Age-adjusted Charlson score was ≥4 in 37 (84%) patients, and American Society of Anesthesiologists score was ≥3 in 34 (77%) patients. Ileal conduit (IC) was performed in 21/44 (48%) cases, cutaneous ureterostomy (CU) in 20/44 (45%), and no urinary diversion was required for 3 (7%) dialytic patients. Median EBL was 700 mL (IQR 500-1,000) and 23 (52%) patients required blood transfusion. Median LOS was 13 days (IQR 10-18). Overall complications were recorded in 29 (66%) patients, with major complications observed in 12 (27%), with death occurring in 1. No differences in complications were observed between IC and CU. The 2-year OS estimate was 62.5%. Conclusions: Open RC in octogenarians has an acceptable rate of major complications and mortality. IC should be considered a good urinary diversion in these patients.

Surgical Treatment of Eosinophilic Cystitis in Adults: A Report of Two Cases and a Literature Review

Eosinophilic cystitis is a rare disease that presents with either urinary frequency, hematuria, suprapubic pain or urinary retention. Although benign, this entity may progress to diffuse bladder involvement with the need for surgical treatment. We report on 2 cases of advanced disease that required cystectomy with very complex lower urinary tract reconstruction, and review the literature of surgically treated cases.

MP20-19 A PROSPECTIVE DIAGNOSTIC ACCURACY STUDY OF PROSTATE IMAGING REPORTING AND DATA SYSTEM VERSION 2 ON 3 TESLA MULTIPARAMETRIC MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING IN DETECTING PROSTATE CANCER WITH WHOLE-MOUNT PATHOLOGY

CONCLUSIONS PATIENTS & METHODS • A single uropathologist with 10-year experience processed all RP specimens. Whole-mount sections were analyzed (Figure 2). Clinically significant PCa was defined as any tumour with diameter ≥1 cm (as surrogate for volume ≥0.5 cc) or International Society of Urological Pathology grade ≥2 or extraprostatic extension/seminal vesicle invasion. An independent radiologist together with the uropathologist analyzed the two maps per patient to match each lesion identified on mpMRI to the corresponding findings on definitive histology.

PD36-03 PERIOPERATIVE OUTCOMES OF OPEN RADICAL CYSTECTOMY IN OCTOGENARIANS: RESULTS FROM TWO HIGH-VOLUME CENTRES

INTRODUCTION AND OBJECTIVES: Following the global trend of population aging, researchers and clinicians are increasingly facing the challenges of surgical management of malignancies in elderly patients. Although RC is a long-established treatment of muscle-invasive bladder cancer, little data are available on the postoperative outcomes of this intervention in the octogenarians. Contemporary representative open RC series report an overall complication rate ranging between 30% and 70% for any age category. Complication rate for our octogenarians lie within this range. The aim of our study was to evaluate the safety of open radical cystectomy (RC) in octogenarians, considering the potentially higher risk for postoperative complications due to the generally unfavourable comorbidity profile in this patient category. METHODS: We retrospectively evaluated a cohort of 44 patients aged 80 years treated with open RC and urinary diversion at two high-volume urology units between July 2013 and December 2015. Median age was 83 years. Charlson score was 3 in 41 (93%) patients, and ASA score was 3 in 34 (77%) patients. RC was performed in 42 (95%) patients for muscle-invasive bladder cancer and in 2 (5%) patients for benign disease. Orthotopic ileal neobladder (V.I.P. technique), ileal conduit and cutaneous ureterostomies were performed in 1 (2%), 20(45%) and 20 (45%) patients, respectively. In 3 (8%) patients no urinary diversion was performed since they were already on dialysis for chronic kidney disease. Primary outcome was rate of 90-day complications graded according to Dindo-Clavien classification. Secondary outcomes were: operative time,estimated blood loss, recovery of bowel activity measured as timing of stool passage, and length of hospital stay. RESULTS: Overall 90-day complications were recorded in 23(52%) pts. Complications were grade II in 11 (25%) patients (blood transfusions), grade IIIa in 5 (11%) (1 wound dehiscence,1uretero-ileal leakage, 1 uretero-ileal stricture, 1 urinary fistula and 1 unilateral hydroureteronephrosis treat with nephrostomy), grade IIIb in 5 (11%) (3 wound dehiscence, 1 bowel obstruction, 1 pelvic bleeding), grade IV in 1 (2%) (myocardial infarction) and grade V in 1 (2%). Median operative time was 258 min (interquartile range [IQR]190-305). Median estimated blood losswas 700 ml (IQR 550-840). Stool passage was observed in 2 (5%) patients on POD 1, in 2 (5%) on POD 2, in 4 (9%) on POD 3, in 6 (14%) on POD 4 and in 30 (68%) on POD 5. Median length of hospital stay was 13 days (IQR 8-17). CONCLUSIONS: Open RC in octogenarians appears feasible with an acceptable complication rate. Thus, ages hould not be considered as an absolute exclusion criterion for RC, particularly when this operationis performed in high-volume referral centres.