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You have accessJournal of UrologyProstate Cancer: Detection & Screening V (MP36)1 Apr 2019MP36-17 DEFINING BIOCHEMICAL RECURRENCE IN PROSTATE CANCER WITH HYBRID PSMA PET MRI Paria Saadat, Georges Mehawed*, Michelle Ong, Andre Joshi, Matthew Roberts, Marlon Perera, Handoo Rhee, Yeates Alexander, Ian McKenzie, Janelle Munns, Greg Malone, Eric Chung, Peter Heathcote, John Preston, Lawson Malcolm, Simon Wood, David Pryor, Margot Lehman, Gustafson Sonja, Kenneth Miles, Stanley Ngai, and Ian Vela Paria SaadatParia Saadat More articles by this author , Georges Mehawed*Georges Mehawed* More articles by this author , Michelle OngMichelle Ong More articles by this author , Andre JoshiAndre Joshi More articles by this author , Matthew RobertsMatthew Roberts More articles by this author , Marlon PereraMarlon Perera More articles by this author , Handoo RheeHandoo Rhee More articles by this author , Yeates AlexanderYeates Alexander More articles by this author , Ian McKenzieIan McKenzie More articles by this author , Janelle MunnsJanelle Munns More articles by this author , Greg MaloneGreg Malone More articles by this author , Eric ChungEric Chung More articles by this author , Peter HeathcotePeter Heathcote More articles by this author , John PrestonJohn Preston More articles by this author , Lawson MalcolmLawson Malcolm More articles by this author , Simon WoodSimon Wood More articles by this author , David PryorDavid Pryor More articles by this author , Margot LehmanMargot Lehman More articles by this author , Gustafson SonjaGustafson Sonja More articles by this author , Kenneth MilesKenneth Miles More articles by this author , Stanley NgaiStanley Ngai More articles by this author , and Ian VelaIan Vela More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556027.16655.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Biochemical recurrence (BCR) can occur in in up to 50% or more of men with high risk prostate cancer previously treated with surgery of curative intent. Detection of locally recurrent or metastatic disease in the presence of BCR after treatment of localised disease at low prostate specific antigen (PSA) may be improved by use of hybrid Prostate Specific Membrane Antigen (PSMA), Positron Emission Tomography (PET) with magnetic resonance imaging (MRI). The clinical utility of this approach has been minimally reported. We sought to report on a large series of hybrid PSMA PET MRI in defining BCR. METHODS: Following Institutional Research Board approval, a retrospective review of all PSMA PET MRI studies between April 2015 and April 2017 within a tertiary referral institution was conducted. Clinical variables, including patient demographics, PSA, previous treatment and histology prior to scan, indication for scan, imaging results, and outcome post imaging were collected prior to statistical analysis. RESULTS: A total of 300 PSMA PET MRI scans were performed, of which 135 were to investigate BCR. Sixty-four patients had undergone radical prostatectomy with a median PSA of 0.43 ng/ml (Interquartile Range (IQR) = 0.21 - 1.35), in whom 15 received postoperative external beam radiation therapy (EBRT) while 71 patients had received EBRT alone. From the surgical cohort, 31 patients (48.5%) had a positive scan (median PSA level 1.3 ng/ml, IQR = 0.26 – 4; Gleason score 4 + 4 in 17 patients) involving the prostatic bed (n = 6), lymph nodes (n = 18), bone (n = 6), and soft tissue (n = 11), for median serum PSAs of 1.8, 1.35, 1.6 and 0.4 ng/mL, respectively. Median PSA for those with a negative scan was 0.28 ng/mL (IQR = 0.17 – 0.57), despite 10 patients (30%) with a Gleason score 4 + 4. CONCLUSIONS: PSMA PET MRI imaging may play an important role in detecting recurrent disease in men with BCR post radical prostatectomy. The average PSA for detection of metastatic lesions are substantially less than previously quoted figures using the standard of care imaging in the setting of biochemical recurrence. Source of Funding: None. South Brisbane, Australia; Brisbane, Australia© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e520-e521 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paria Saadat More articles by this author Georges Mehawed* More articles by this author Michelle Ong More articles by this author Andre Joshi More articles by this author Matthew Roberts More articles by this author Marlon Perera More articles by this author Handoo Rhee More articles by this author Yeates Alexander More articles by this author Ian McKenzie More articles by this author Janelle Munns More articles by this author Greg Malone More articles by this author Eric Chung More articles by this author Peter Heathcote More articles by this author John Preston More articles by this author Lawson Malcolm More articles by this author Simon Wood More articles by this author David Pryor More articles by this author Margot Lehman More articles by this author Gustafson Sonja More articles by this author Kenneth Miles More articles by this author Stanley Ngai More articles by this author Ian Vela More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction and Objectives: Renal cell carcinoma (RCC) accounts for 2–3% of all cancers. With increasing use of Computer Tomography, a large proportion are detected earlier and amenable to focal therapies such as Radiofrequency Ablation (RFA). Our institution is unable to offer image‐guided percutaneous ablation (PA) through the public service due to lack of Interventional Radiology (IR) resources. Currently, patients with a small renal mass (SRM) are either actively observed, undergo radical nephrectomy (RN), partial nephrectomy (PN) or referred to another tertiary institution for focal therapy. Recent studies have demonstrated no difference in long‐term efficacy between RN, PN and PA treatment of SRMs in selected patients; but with significantly higher rates of morbidity in the surgical treatment groups. Our Urology Multidisciplinary Team (MDT) is supported by an interventional radiologist with Uroradiology specialisation who provides PA for our patients through a private facility and we assessed the cost‐effectiveness of our institution outsourcing PA . The aim of the study was to compare the costs associated with performing nephrectomies (RN, PN) in a public hospital with the costs of performing minimally invasive PA in a private hospital; and to assess the financial impact on the public system of the different treatment options for SRMs. Methods: The cost of performing PA at a large tertiary private hospital for patients with a SRM (<4 cm) between October 2017‐October 2018 was calculated and compared to the cost of RN or PN for patients with a SRM between January 2015 to June 2018 at a tertiary public hospital. Results: Twelve patients underwent PA (radiofrequency ablation or microwave ablation); 10 were performed under conscious sedation. A total of 56 RN and PN were performed during the studied period, including 19 patients with a SRM (RN = 15; PN = 4 with the majority (n = 17) performed laparoscopically. Mean size of lesions was similar (surgery = 29.8 mm; RFA = 27.2 mm). The average procedural time was significantly longer with surgery (219.66 min vs 54.75 min). Length of stay was longer with surgery. Cost per admission for surgery was $19 302.66 which was higher than PA costs of $4513 at a private institution. The cost of performing equivalent PA in a public hospital was calculated to be $2784.35, however this would not include staffing costs (doctors, nurses, radiographers etc).Outsourcing of PA was associated with additional Urology and Radiology appointments, MDT meetings, travel for patients and logistical challenges for the treating teams. Conclusion: The cost of outsourcing focal treatment of SRMs with PA to a private hospital appears to be similar to the same service provided in a public hospital. PA is more cost‐effective than surgery in carefully selected patients. The additional benefits of providing PA in a public hospital would include more streamlined management and continuity of care for patients. Greater funding for interventional radiology services to provide PA procedures in public hospitals should be considered by health authorities to improve access to less‐invasive treatments for SRMs and result in considerable cost‐savings for health budgets.

PURPOSE:Vesicourethal anastomosis (VUA) during radical prostatectomy can be achieved using various suture plication techniques. Traditionally, an indwelling urinary catheter remains in-situ to facilitate the healing process of the reconstructed VUA. Compromise or rupture of this anastomosis may lead to acute urinary leak and subsequent urinoma or stricture formation. This ex-vivo porcine model aims to evaluate VUA tensile strength using different suture techniques and catheter types. METHODS:Male porcine bladders were obtained and prostatectomy was performed. The specimens were randomized and VUA were created using 3-point interrupted, 6-point interrupted or 6 point continuous 3-0 monocryl suture. 20Fr catheters were utilized, specifically varying manufacturers (A and B) and catheter balloon shapes (round versus oval). The VUA model was placed within a reproducible pulley system and graduated weights were applied until failure of the catheter balloon or the model VUA. Model failure was defined as either 'VUA rupture', 'Catheter passage through VUA' or 'catheter failure'. RESULTS:Twenty consecutive porcine bladders were prepared, tested and utilized for analysis. VUA reconstructed with 3-point fixation was more likely to suffer VUA rupture (p=0.025) compared to 6-point interrupted or 6-point continuous VUA. Higher tensile pressure causing catheter balloon rupture (p=0.009) was observed for Manufacturer A. Catheters with oval-balloon shape were more likely to dislodge past the VUA without disruption of the anastomosis (p=0.002). CONCLUSIONS:During prostatectomy, anastomotic technique and catheter selection can significantly alter the tensile properties of the VUA. Further research is required to validate our findings in clinical models.

You have accessJournal of UrologyKidney Cancer: Basic Research & Pathophysiology I1 Apr 2016MP71-18 A PATIENT-DERIVED ORTHOTOPIC XENOGRAFT MODEL FOR TARGETING RCC METASTASIS: IDENTIFYING PERSONALIZED THERAPEUTIC STRATEGIES Stephen Bardot, Jessie Gills, Ravan Moret, Xin Zhang, Ashley Richman, John Nelson, Christudas Morais, Glenda Gobe, Marc Matrana, Li Li, Grace Maresh, Sunil Talwar, and Maria Latsis Stephen BardotStephen Bardot More articles by this author , Jessie GillsJessie Gills More articles by this author , Ravan MoretRavan Moret More articles by this author , Xin ZhangXin Zhang More articles by this author , Ashley RichmanAshley Richman More articles by this author , John NelsonJohn Nelson More articles by this author , Christudas MoraisChristudas Morais More articles by this author , Glenda GobeGlenda Gobe More articles by this author , Marc MatranaMarc Matrana More articles by this author , Li LiLi Li More articles by this author , Grace MareshGrace Maresh More articles by this author , Sunil TalwarSunil Talwar More articles by this author , and Maria LatsisMaria Latsis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1464AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal cell carcinoma (RCC) is the most common solid tumor of the kidney, with a mortality of 30 to 40%. RCC is highly metastatic and potentially lethal. The 5-year survival for metastatic RCC patients is less than 10%. The challenge of managing RCC patients often involves administering drugs sequentially until response is achieved. Individualized therapy could change the current approach to metastatic disease. Our objective was to establish a patient-derived orthotopic xenograft (PDOX) intra-renal sub-capsular injection NOD/SCID mouse model that recapitulates metastatic RCC for personalized therapeutic strategies. METHODS Two luciferase-tagged RCC cell lines (A498-Luc, 769P-Luc) were used to determine the IC50 of sunitinib, pazopanib, and everolimus using bioluminescent imaging (BLI) of in vitro cell viability assay at 48 hrs. A consented human RCC specimen (KiCa-Pt58) was obtained via radical nephrectomy and tumor cells tagged with luciferase. KiCa-Pt58-Luc cells (0.01 million) were then injected sub-capsularly into the left kidneys of NOD/SCID mice. Mice bearing kidney tumors were split into 1 control and 4 sequential treatment groups receiving 40mg/kg sunitinib, 40mg/kg pazopanib, or 5mg/kg everolimus (Table 1) three times per week via gavage. Tumor growth was monitored weekly by BLI. Drug responses were evaluated based on BLI data and decision made for whether to switch to the next sequence drug. At necropsy, primary tumors and mouse lungs were collected for BLI, weights, and histology. RESULTS The IC50 was 6µM for sunitinib and 3.6µg/ml for pazopanib. In our PDOX model, patient tumors successfully produced primary tumor and spontaneous lung metastasis as seen in RCC patients (45/45). Selected drug dosages delivered by gavage were safe, effective and without adverse effects. Drug sequence of sunitinib switch to everolimus was the most effective among 4 combinations tested for primary tumor progress and lung metastasis for patient tumor KiCa-Pt58 CONCLUSIONS Our unique PDOX model provides a platform for testing RCC drugs simultaneously for responses in primary tumor progression and metastasis. It could lead to the development of realistic, durable, and individualized treatments for RCC patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e922 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Stephen Bardot More articles by this author Jessie Gills More articles by this author Ravan Moret More articles by this author Xin Zhang More articles by this author Ashley Richman More articles by this author John Nelson More articles by this author Christudas Morais More articles by this author Glenda Gobe More articles by this author Marc Matrana More articles by this author Li Li More articles by this author Grace Maresh More articles by this author Sunil Talwar More articles by this author Maria Latsis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment III1 Apr 2015PD19-09 INTERNATIONAL UROLOGY JOURNAL CLUB ON TWITTER- A GROWING EDUCATIONAL FORUM Isaac Thangasamy, Michael Leveridge, Benjamin Davies, Brian Stork, Stacy Loeb, and Henry Woo Isaac ThangasamyIsaac Thangasamy More articles by this author , Michael LeveridgeMichael Leveridge More articles by this author , Benjamin DaviesBenjamin Davies More articles by this author , Brian StorkBrian Stork More articles by this author , Stacy LoebStacy Loeb More articles by this author , and Henry WooHenry Woo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.708AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 2012, we pioneered the first ever international twitter-based journal club (#urojc) to discuss urology articles on a monthly basis with diverse global participation. Since that time, this model of an international twitter-based journal club has been adopted by several other medical specialties including general surgery, respiratory medicine and nephrology. The objective of this study is to examine the development of the urology journal club into an innovative and thriving forum for exchange of ideas, information and opinions since its conception two years ago. METHODS Monthly twitter analyses such as number of users, tweets and impressions for the journal club were obtained via a third-party service called Symplur using the hashtag #urojc. Qualitative analysis was also performed of each individual tweet to assess for relevance to the discussion. Comparisons were made between data from the first and second year of operation of the journal club, including the number and geographic location of participants, as well as the quantity and quality of tweets. RESULTS See Table 1 for summary statistics. The total number of unique users of #urojc almost doubled from year one to year two. The mean number of total participants increased by seven per month, and mean number of total countries represented increased by three per month. While the number of tweets per month also increased from year one to year two, the proportion of content-relevant tweets remained stably high at approximately 60%. Meanwhile, there was a greater degree of participation from authors of the study being discussed over time. CONCLUSIONS It is clear that the International Urology Journal Club continues to draw robust participation from a global audience, and serves as a benchmark for twitter-based journal clubs in other specialties. The majority of tweets are relevant to the content of the article, providing a novel forum to discuss new research findings with a global audience. Table 1. Summary statistics comparing first and second year∗ Year One Year Two Total Unique users 189 184 373 Mean no. of participants 39 46 44 Mean no. of countries (continents) represented 7(3) 10(4) 9(4) Mean no. of new participants 14 15 15 Mean no. of tweet 195 209 202 Mean no. of impressions 130832 242557 184265 Author participation (%) 7/12 (58) 9/12 (75) 16/24 (67) Original tweets related to topic (%) 62 58 60 Origial tweets related to #urojc (%) 10 5 8 Irrelevant tweets (%) 6 7 6 Re-tweets (%) 22 30 26 ∗ All figures are per month © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e395 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Isaac Thangasamy More articles by this author Michael Leveridge More articles by this author Benjamin Davies More articles by this author Brian Stork More articles by this author Stacy Loeb More articles by this author Henry Woo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Göteborg randomised population-based prostate cancer screening trial demonstrated that prostate-specific antigen (PSA)-based screening reduces prostate cancer deaths compared with an age-matched control group. Utilising the prostate cancer detection rates from this study, we investigated the clinical and cost effectiveness of a similar PSA-based screening strategy for an Australian population of men aged 50–69 years.

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2015MP65-11 GENDER DISPARITY IN SURVIVAL FROM BLADDER CANCER CAN NOT BE EXPLAINED BY LATE PRESENTATION OR DIFFERENCES IN TREATMENT Manish Patel, Albert Bang, David Gillett, and David Smith Manish PatelManish Patel More articles by this author , Albert BangAlbert Bang More articles by this author , David GillettDavid Gillett More articles by this author , and David SmithDavid Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2301AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although men are diagnosed with bladder cancer (BC) with a rate three times higher than women, women experience poorer survival. The cause of this gender difference is not clear. The aim of this study was to investigate the discrepancy in survival from BC by gender and explore potential explanations for the difference using a population-wide linkage study. METHODS Using the New South Wales (NSW) central cancer registry we identified all invasive BC cases diagnosed between 2001 and 2009. Records were linked to the NSW Admitted Patient Data collection (APDC), to retrieve all inpatient treatment details and to the Registry of Births Deaths and Marriages and Australian Bureau of Statistics to obtain death details. Kaplan Meir survival curves and cox proportional hazards model were used to determine survival estimates and associations. RESULTS 5377 new cases of BC were identified. No differences in the proportions of patients presenting at different stages between genders was identified. Disease specific survival (DSS) however was worse for females compared to males with localised and regional disease (p<0.05). This difference was only seen in individuals aged 70 years or more and no difference was identified in those younger. Multivariable cox-regression analysis of the cohort of individuals aged 70 years or more, revealed that stage, age and sex remained independent variables (p<0.05) predicting DSS. Treatment differences did not impact these survival differences. In this cohort,age, stage and private hospital treatment influenced overall survival. CONCLUSIONS In a population wide analysis, females aged 70 years or more, suffer worse DSS compared to males. The differences are not accounted for by worse disease presentation and are independent of age suggesting BC in post-menopausal females may be biologically more aggressive. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e811 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manish Patel More articles by this author Albert Bang More articles by this author David Gillett More articles by this author David Smith More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...