You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP13)1 Apr 2019MP13-19 COMPARISON OF CANCER DETECTION RATES IN MICRO-ULTRASOUND BIOPSIES VERSUS ROBOTIC ULTRASOUND-MAGNETIC RESONANCE IMAGING FUSION BIOPSIES FOR PROSTATE CANCER Oliver R. Claros*, Fabio Muttin, Rafael R. Tourinho-Barbosa, Anna C. Gallardo, Eric Barret, François Rozet, Nathalie Cathala, Dominique Prapotnich, Annick Mombet, Rafael Sanchez-Salas, and Xavier Cathelineau Oliver R. Claros*Oliver R. Claros* More articles by this author , Fabio MuttinFabio Muttin More articles by this author , Rafael R. Tourinho-BarbosaRafael R. Tourinho-Barbosa More articles by this author , Anna C. GallardoAnna C. Gallardo More articles by this author , Eric BarretEric Barret More articles by this author , François RozetFrançois Rozet More articles by this author , Nathalie CathalaNathalie Cathala More articles by this author , Dominique PrapotnichDominique Prapotnich More articles by this author , Annick MombetAnnick Mombet More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , and Xavier CathelineauXavier Cathelineau More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555295.45193.66AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: We aimed to compare the cancer detection rates in patients who underwent micro-ultrasound biopsy (MB) versus Robotic ultrasound-magnetic resonance imaging fusion biopsies (RFB) for prostate cancer. METHODS: Between February 2017 and September 2018, 451 biopsies were performed at our institution. We performed a matched pair analysis based on prostate volume and PSA. We selected 271 patients that underwent target biopsy that composed the population of the study. In total 223 men underwent RFB, and 48 underwent MB. The study cohort was divided into two groups: robotic ultrasound-magnetic resonance imaging fusion biopsy (Group A) and micro-ultrasound biopsy (Group B). Micro-ultrasound imaging was performed using the high resolution ExactVu system (29 MHz, Exact Imaging, Markham, Canada). RFB was performed using Artemis Device (Eigen, Grass Valley, CA). Biopsy samples were taken from targets in each modality, plus systematic samples. RESULTS: There were no differences according cancer detection rates except for target detection rates of clinically significant tumors. The prostate cancer detection rate was 67.7% (151) in group A and 62.5% (30) in group B (p=0.48) The detection of clinically significant cancer defined as patients with Gleason score greater or equal to 3+ 4 was 31.8%(71) in group A and 39.5% (19) in group B (p=0.31). The cancer detection rate of random biopsies were similar in group A and group B (21.5% vs. 22.91% respectively ; p=0.83). Patients from Group B had higher clinically significant tumours detection in target biopsies (37.5% vs. 22.86%; p=0.035). CONCLUSIONS: Our study suggests that micro-ultrasound biopsy may be comparable to RFB according to prostate cancer detection. Micro-ultrasound might play a role in cognitive fusion biopsies. Source of Funding: none Paris, France© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e184-e185 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oliver R. Claros* More articles by this author Fabio Muttin More articles by this author Rafael R. Tourinho-Barbosa More articles by this author Anna C. Gallardo More articles by this author Eric Barret More articles by this author François Rozet More articles by this author Nathalie Cathala More articles by this author Dominique Prapotnich More articles by this author Annick Mombet More articles by this author Rafael Sanchez-Salas More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement PDF downloadLoading ...

IntroducciónLa importancia de la sobrestadificación de tumores renales cT1 a pT3a no está clara. Evaluamos la incidencia de la sobrestadificación, identificamos factores predictivos y analizamos los resultados oncológicos de estos pacientes frente a aquellos que no sobrestadificaron. También comparamos los resultados oncológicos de la sobrestadificación de cT1 a pT3a con tumores renales pT3a de novo.MétodosDe una base de datos de 1.021 tumores renales con datos de seguimiento completos disponibles, 517 pacientes tenían cT1. Los pacientes que sobrestadificaron a pT3a se compararon con aquellos que no lo hicieron. Se analizaron los resultados de las características clínicas, perioperatorias, histopatológicas y oncológicas iniciales.ResultadosDe 517 pacientes con cT1, 105 (20,3%) sobrestadificaron a pT3a y 412 (79,7%) no lo hicieron. La proporción de pacientes en cada grupo tratados mediante nefrectomía parcial y radical, el tamaño del tumor postoperatorio, la histología, el estado de los márgenes, y la afectación de ganglios linfáticos fueron similares. Entre los que sobrestadificaron, 9 pacientes (8,6%) desarrollaron la primera recurrencia en comparación con solo 3 (0,7%) en aquellos que no sobrestadificaron (p<0,001). La mediana del tiempo hasta la recurrencia (57 frente a 107 meses; p <0,001) fue menor en los tumores renales pT3a de novo.ConclusionesLa sobrestadificación patológica de cT1 a pT3a y la necrosis en la histopatología se asociaron con la recurrencia. La edad avanzada, el tabaquismo, la necrosis en la histopatología, la histología de células claras y grados más altos de Fuhrman contribuyeron a la sobrestadificación patológica de los tumores cT1. El CCR pT3a de novo tuvo una supervivencia peor cuando se comparó con los pacientes con cT1 que sobrestadificaron a CCR pT3a.

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy (MP78)1 Apr 2019MP78-16 SALVAGE POSSIBILITIES AFTER FOCAL THERAPY FAILURE: REDO FOCAL TREATMENT VERSUS ROBOTIC RADICAL PROSTATECTOMY ANALYSIS Rafael R. Tourinho-Barbosa*, Caio PD. Santos, Oliver R. Claros, Arnas Bakavicius, Eric Barret, Francois Rozet, Arie Carneiro, São Paulo, Nathalie Cathala, Dominique Prapotnich, Annick Mombet, Rafael Sanchez-Salas, and Xavier Cathelineau Rafael R. Tourinho-Barbosa*Rafael R. Tourinho-Barbosa* More articles by this author , Caio PD. SantosCaio PD. Santos More articles by this author , Oliver R. ClarosOliver R. Claros More articles by this author , Arnas BakaviciusArnas Bakavicius More articles by this author , Eric BarretEric Barret More articles by this author , Francois RozetFrancois Rozet More articles by this author , Arie CarneiroArie Carneiro More articles by this author , São PauloSão Paulo More articles by this author , Nathalie CathalaNathalie Cathala More articles by this author , Dominique PrapotnichDominique Prapotnich More articles by this author , Annick MombetAnnick Mombet More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , and Xavier CathelineauXavier Cathelineau More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557348.39951.f2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Focal therapy (FT) for prostate cancer (PCa) presents non-negligible rates of disease recurrence. We aim to assess the outcomes of redoing FT (s-FT) after FT failure as an alternative to radical salvage procedures METHODS: From 2010 to 2018, 37 patients underwent s-FT and 28 patients salvage robotic radical prostatectomy (s-RRP) after focal high-intensity focused ultrasound, cryotherapy or vascular targeted photodynamic therapy. Patients with less than 3 months of follow-up or whole-gland energy salvage treatment were excluded. We also excluded Gleason score (GS) ≥ 7 (4+3) and PSA ≥ 20ng/ml patients aiming to reduce selection bias. Functional outcomes were reported at 3 and 12 months. Urinary incontinence was defined as ≥ 1 daily pads. Complications were registered according to Clavien-Dindo classification. Failure was defined as positive biopsy GS ≥ 7 in s-FT group, PSA ≥ 0.2ng/ml in s-RRP group, need of retreatment, metastasis or PCa-specific death RESULTS: Forty-eight (s-FT: 30 and s-RRP:18) patients were enrolled in the analysis with a median follow-up of 36mo (interquartile range [IQR] 17-53) and 22mo (IQR 6-37); p=0.06 in s-FT and s-RRP groups, respectively. There were no significant differences between the groups regarding age, prostate-specific antigen (PSA), sexual activity or urinary function at baseline. In s-FT and s-RRP groups, GS 6 (3+3) was found in 65.5% and 27.8% and GS 7 (3+4) in 34.5% and 72.2% of patients, respectively (p=0.02). There was no significant difference in complications grade 2 or greater between the groups. Only a patient in s-RRP group presented a grade 3 complication. Failure-free survival in s-FT and s-RRP groups were 96.4% (95% CI 3.5-77.2) and 79.5% (95% CI 10.7-48.3) at 1-yr and 54.2% (95% CI 10.9-31.2) and 47.7% (95% CI 13.9-20.2) at 3-yr, respectively (p=0.27). Only one patient presented PCa-metastasis in s-RRP group. No PCa-specific death was seen in this study. Median ICSmale score was 1 (IQR 0-2) and 9 (IQR 3-12), p<0.001 and median IIEF-5 score was 9 (IQR 3-18) and 1 (IQR 1-9), p=0.007, at 3 months after s-FT and s-RRP, respectively. Enough erection for sexual activity was found in 15 (57.7%) and 0 patients at 3mo, and 13 (72.2%) and 1 (7.1%) at 12mo, p<0.001, respectively. While no patient presented urinary incontinence in s-FT group, it was present in 12 patients (66.6%, p<0.001) at 3mo and in 4 (26.7%, p=0.07) at 12mo (p=0.07) in s-RRP group CONCLUSIONS: A second FT provide acceptable complications and oncological outcomes in short-term, and better functional outcomes in comparison with radical treatment after FT failure Source of Funding: None Paris, France; Brazil; Paris, France© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1149-e1149 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael R. Tourinho-Barbosa* More articles by this author Caio PD. Santos More articles by this author Oliver R. Claros More articles by this author Arnas Bakavicius More articles by this author Eric Barret More articles by this author Francois Rozet More articles by this author Arie Carneiro More articles by this author São Paulo More articles by this author Nathalie Cathala More articles by this author Dominique Prapotnich More articles by this author Annick Mombet More articles by this author Rafael Sanchez-Salas More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVEHigh-intensity focused ultrasound (HIFU) Focal therapy appears to have encouraging oncologic outcomes and urinary and erectile function. The control of the treated area can be done using contrast enhanced ultrasound with sulfur hexafluoride (Sonovue®) at the end of the procedure. We report oncological and functional outcomes in HIFU focal therapy (FT) for prostate cancer (PCa) management using sonovue.METHODSA total of 274 HIFU procedures were found in our registry in the period between June 2014 and July 2018. Prospective data of 59 consecutive patients after focal high-intensity focused ultrasound (HIFU) using Sonovue were collected. FT failure was defined as positive biopsy Gleason score (GS) ≥ 7 in- or out-field, local or systemic salvage treatment, PCa-metastasis or PCa-specific death.RESULTSA total of 59 patients submitted to HIFU with median follow-up of 18 months were included in the analysis. Median age was 66.7 yr (IQR 59.1-74.3). Median preoperative prostate-specific antigen (PSA) was 7.6 ng/ml (IQR 5-10.2) and preoperative biopsies GS 6, 7(3+4), 7(4+3) were found in 26 (44%), 30 (50.8%) and 3 (5%), respectively. Failure was found in 16 (27.1%) patients. Failure-free survival (FFS) in 2 and 4yr was 83% and 74% respectively (Figure 1). No PCa-specific death was registered in the period of study. Median nadir PSA after FT was 2.67 ng/ml. Sexual potency was achieved in 75% of previous potent patients and urinary continence in 93.4% of patients at 3 months. Fourteen (23%) patients presented with complications. Four (6.7%) patients have presented complications grade 1 and 10 (16.9%) patients have presented complications grade 2. Six (10.1%) patients have presented acute urinary retention.CONCLUSIONSOur study shows that the use of Sonovue after HIFU FT was safe. Patients present a significant proportion of failure after HIFU FT but with good functional outcomes and without incidence of severe complications.

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy (MP78)1 Apr 2019MP78-08 PREDICTIVE FACTORS OF FAILURE FOLLOWING FOCAL THERAPY FOR PROSTATE CANCER Rafael R Tourinho-Barbosa*, Rafael Sanchez-Salas, Sylvain Collura-Merlier, Fabio Muttin, Arnas Bakavicius, Eric Barret, Francois Rozet, Arie Carneiro, São Paulo, Nathalie Cathala, Dominique Prapotnich, Annick Mombet, Marcos Tobias-Machado, Santo Andre, and Xavier Cathelineau Rafael R Tourinho-Barbosa*Rafael R Tourinho-Barbosa* More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , Sylvain Collura-MerlierSylvain Collura-Merlier More articles by this author , Fabio MuttinFabio Muttin More articles by this author , Arnas BakaviciusArnas Bakavicius More articles by this author , Eric BarretEric Barret More articles by this author , Francois RozetFrancois Rozet More articles by this author , Arie CarneiroArie Carneiro More articles by this author , São PauloSão Paulo More articles by this author , Nathalie CathalaNathalie Cathala More articles by this author , Dominique PrapotnichDominique Prapotnich More articles by this author , Annick MombetAnnick Mombet More articles by this author , Marcos Tobias-MachadoMarcos Tobias-Machado More articles by this author , Santo AndreSanto Andre More articles by this author , and Xavier CathelineauXavier Cathelineau More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557340.24703.deAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Failure and need of retreatment after focal therapy (FT) for prostate cancer (PCa) has been seen in more than one third of patients in mid-term follow-up. In this study, we assess the perioperative factors associated with PCa recurrence following FT. METHODS: Ten covariates potentially associated to recurrence were collected from 193 post-focal high-intensity focused ultrasound (HIFU) and 121 post-focal cryotherapy patients. FT failure was defined as post-treatment biopsy Gleason score (GS) ≥ 7 in- or out-of-field, needs of local or systemic salvage treatment, PCa-metastasis or PCa-specific death. Preoperative variables included were biopsy GS, preoperative prostate-specific antigen (PSA), prostate volume, biopsy cores length, biopsy and magnetic resonance imaging (MRI) multifocality and target lesion size. Nadir PSA, PSA drop rates and nadir time were also included as postoperative variables. Three multivariate models for overall, HIFU and cryotherapy patients were built based on the coefficients of Cox survival function. RESULTS: Median age was 68yr (interquartile range [IQR] 62-73) and 66yr (IQR 62-71) in HIFU and cryotherapy groups, respectively. Biopsy GS 6 (3+3) was present in 68% and 30% and GS 7 (3+4) in 76% and 24% of HIFU and cryotherapy patients, respectively. Only 4 (2.1%) patients in group HIFU had biopsy GS 7 (4+3) and 1 (0.5%) patient had a biopsy GS 8 (4+4). Median preoperative PSA and post-FT nadir PSA were respectively 7.1ng/ml (IQR 5.5-8.9) and 2.6ng/ml (IQR 1.4-4.5) in HIFU group and 6.5ng/ml (IQR 5.0-8.3) and 2.7ng/ml (IQR 1.6-4.1) in cryotherapy group. According to coefficients of Cox survival function, pre-FT biopsy GS, preoperative PSA, biopsy cores length proportion, nadir PSA and nadir time were included in the overall patients multivariate model. Only pre-FT biopsy GS ≥ 7 (3+4) (hazard ratio [HR] 2.14 [95% confidence interval [CI] 1.22-3.75]; p=0.008), and nadir PSA (HR 2.55 [95% CI 1.50-4.35]; p=0.001) were consistently associated to FT failure. In HIFU and cryotherapy models, pre-FT biopsy GS ≥ 7 (3+4) (HR 2.51 [95% CI 1.48-4.28]; p=0.001 and HR 2.10 [95% CI 1.12-3.95]; p=0.02, respectively) and nadir PSA (HR 2.37 [95% CI 1.37-4.09]; p=0.002 and HR 2.14 [95% CI 1.21-3.80]; p=0.009, respectively) were also the only factors associated to FT failure. CONCLUSIONS: Preoperative biopsy GS and nadir PSA after treatment were the only factors consistently associated to FT failure in both HIFU and cryotherapy groups. Clinicians should take those factors in account to advise patients preoperatively and during follow-up decisions. Source of Funding: None Paris, France; Brazil; Paris, France; Brazil; Paris, France© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1144-e1145 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael R Tourinho-Barbosa* More articles by this author Rafael Sanchez-Salas More articles by this author Sylvain Collura-Merlier More articles by this author Fabio Muttin More articles by this author Arnas Bakavicius More articles by this author Eric Barret More articles by this author Francois Rozet More articles by this author Arie Carneiro More articles by this author São Paulo More articles by this author Nathalie Cathala More articles by this author Dominique Prapotnich More articles by this author Annick Mombet More articles by this author Marcos Tobias-Machado More articles by this author Santo Andre More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To estimate the conditional biochemical recurrence-free probability and to develop a predictive model according to the disease-free interval for men with clinically localized prostate cancer treated with minimally invasive radical prostatectomy.METHODS:The study population consisted of 3576 consecutive patients who underwent laparoscopic radical prostatectomy and 2619 men treated with robotic radical prostatectomy in the past 15 years at Institute Mutualiste Montsouris, Paris, France. Biochemical recurrence was defined as serum prostate-specific antigen ≥0.2 ng/dL. Univariable and multivariable survival analyses were carried out to identify the prognostic factors for overall free-of-biochemical recurrence probability and conditional survival with respect to the years from surgery without recurrence. A detailed nomogram for the static and dynamic prognosis of biochemical recurrence was developed and internally validated.RESULTS:The median follow-up period was 8.49 years (interquartile range 4.01-12.97), and 1148 (19%) patients experienced biochemical recurrence. Significant variables associated with biochemical recurrence in the multivariable model included preoperative prostate-specific antigen, positive surgical margins, extracapsular extension, pathological Gleason ≥4 + 3 and laparoscopic surgery (all P < 0.001). Conditional survival probability decreased with increasing time without biochemical recurrence from surgery. When stratified by prognosis factors, the 5- and 10-year conditional survival improved in all cases, especially in men with worse prognosis factors. The concordance index of the nomogram was 0.705.CONCLUSIONS:Conditional survival provides relevant information on how prognosis evolves over time. The risk of recurrence decreases with increasing number of years without disease. An easy-to-use nomogram for conditional survival estimates can be useful for patient counseling and also to optimize postoperative follow-up strategies.

Introduction: Oncological outcomes of radical prostatectomy (RP) in patients progressing on active surveillance (AS) are debated. We compared outcomes of AS eligible patients undergoing RP immediately after diagnosis with those doing so after delay or disease progression on AS. Methods: Between 2000 and 2014, 961 patients were AS eligible as per EAU criteria. RP within 6 months of diagnosis (IRP) or beyond (DRP), RP without AS (DRPa) and AS patients progressing to RP (DRPb) were compared. Baseline PSA, clinical and biopsy characteristics were noted. Oncological outcomes included adverse pathology in RP specimen and biochemical recurrence (BCR). Matched pair analysis was done between DRPb and G57 patients undergoing immediate RP (GS7IRP). Results: IRP, DRP, DRPa and DRPb had 820 (85%), 141 (15%), 118 (12.24%) and 23 (2.7%) patients respectively. IRP, DRPa and DRPb underwent RP at a median of 3, 9 and 19 months after diagnosis respectively. Baseline characteristics were comparable. DRP vs. IRP had earlier median time (31 vs. 43 months; p < .001) and higher rate of progression to BCR (7.6 vs. 3.9%; p = .045). DRPb showed higher BCR (19 vs. 5%; p = .021) with earlier median time to BCR, compared to IRP and DRPa (p = .038). There was no difference in adverse pathology and BCR rates, but time to BCR was significantly lesser in DRPb (49 vs. 6 months;p < .001), compared to GS7IRP. Conclusions: Patients progressing on AS had worst oncological outcomes. RP for GS7 progression and matched pair of GS7 patients had similar outcomes. Worse oncological outcomes in AS progressors cannot be explained by a mere delay in RP. (C) 2018 Published by Elsevier Espana, S.L.U. on behalf of AEU.

ObjectivesTo evaluate the technical feasibility, oncological and functional outcomes of nerve sparing cystoprostatectomy (NSCP) and prostate capsule‐sparing cystectomy (PCSC) for the treatment of organ‐confined bladder cancer at a single referral centre.Patients and MethodsFrom April 2001 to June 2012, 60 patients underwent PCSC and 47 were treated with NSCP. Inclusion criteria for PCSC were: fully informed consent for the well‐motivated patient; negative transurethral resection of the bladder neck; normal prostatic specific antigen (PSA) level (defined as <4 ng/dL during the first year of the study, which was later lowered to 2.5 ng/dL); and normal transrectal ultrasonography, with biopsy for any suspicious nodule. Patients received a complete oncological and functional follow‐up. The Kaplan–Meier method was used to depict survival outcomes after surgery.ResultsAfter a median follow‐up of 73 and 62 months for PCSC and NSCP, respectively, the 5‐year cancer‐specific survival was 90% for the PCSC group and 78% for the NSCP group (P = 0.055). Considering complications within 30 days after surgery, 13% and 21% patients had Clavien ≥III complications in the PCSC and NSCP groups, respectively (P = 0.2). For functional outcomes, at 3 months after surgery, 54 (90%) and 24 (51%) patients reported full recovery of daytime urinary continence in the PCSC and NSCP groups, respectively (P < 0.001); and for erectile function recovery, 32 (53%) and four (9%) patients in the PCSC group and in the NSCP group were respectively potent without any treatment (P < 0.001).ConclusionsNSCP and PCSC are appropriate for a subset of patients with bladder cancer, with excellent oncological and functional results. These surgical procedures should be proposed to well‐motivated patients.

Introducción Se debaten los resultados oncológicos de la prostatectomía radical (PR) en pacientes que progresan en vigilancia activa (VA). Comparamos los resultados de los pacientes elegibles para VA sometidos a PR inmediatamente después del diagnóstico con aquellos que lo hacían después de un retraso o progresión de la enfermedad en VA. Métodos Entre 2000 y 2014, 961 pacientes fueron elegibles para VA según los criterios de la EAU. Se comparó la PR a los 6 meses del diagnóstico (PRI) o más allá (PRT), PR sin VA (PRTa) y pacientes en VA que progresan a PR (PRTb). Se registró PSA inicial, características clínicas y de biopsia. Los resultados oncológicos incluyeron patología adversa (PA) en la muestra de PR y recurrencia bioquímica (RBQ). Se realizó un análisis de pares emparejados entre los pacientes con PRTb y GS7 sometidos a PR inmediata (GS7PRI). Resultados PRI, PRT, PRTa y PRTb tuvieron 820 (85%), 141 (15%), 118 (12,24%) y 23 (2,7%) pacientes respectivamente. PRI, PRTa y PRTb se sometieron a PR a una mediana de 3, 9 y 19 meses después del diagnóstico, respectivamente. Las características basales fueron comparables. PRT vs. PRI tuvieron una mediana de tiempo más temprana (31 vs. 43 meses; p<0,001) y una mayor tasa de progresión a RBQ (7,6 vs. 3,9%; p=0,045). PRTb mostró RBQ más alta (19 frente a 5%; p=0,021) con una mediana de tiempo más temprana a RBQ, en comparación con PRI y PRTa (p=0,038). No hubo diferencias en las tasas de PA y RBQ, pero el tiempo hasta RBQ fue significativamente menor en PRTb (49 frente a 6 meses; p <0,001), en comparación con GS7PRI. Conclusiones Los pacientes que progresaron en VA tuvieron los peores resultados oncológicos. PR para progresión de GS7 y par coincidente de pacientes con GS7 tuvieron resultados similares. Peores resultados oncológicos en los progresores de VA no pueden explicarse por una mera demora en PR.

Purpose: Today, up to one-third of newly diagnosed prostate cancer (PCa) cases may be suitable for focal treatment. The lack of data about the toxicity profiles of lesion-targeting therapies, however, has made it difficult to compare treatment modalities. The aim of the present study was to evaluate comprehensively the incidence, severity, and timing of onset of complications for PCa patients undergoing focal high-intensity focused ultrasound (HIFU) and focal cryosurgical ablation of the prostate (CSAP). Materials and Methods: A total of 336 patients were included who underwent focal HIFU or focal CSAP as a primary treatment for PCa between January 2009 and December 2017. Mean follow-up was 11 months (standard deviation: 3.0). All complications were captured and graded according to severity, and classified by timing of onset. Univariate and multivariate analysis was performed to identify predictors of the most common side effects. Results: There were 98 complications in 79/210 patients (38%) undergoing focal HIFU and 34 complications in 27/126 patients (21%) undergoing focal CSAP. In terms of severity, 95% of the complications of focal HIFU and 91% of the complications of focal CSAP were minor. Most complications presented in the early postoperative period. On multivariate analysis, subtotal HIFU was associated with acute urinary retention (AUR), while a smaller prostate size and longer catheterization time with dysuria. In CSAP patients, longer catheterization time was associated with AUR and urethral sloughing. The main limitation is the nonrandomized and retrospective nature. Conclusions: Focal HIFU and focal CSAP provide a tolerable toxicity, with primarily minor complications presenting in the early postoperative period.

Introduction: The significance of upstaging of cT1 renal tumors to pT3a is not clear. We evaluate the incidence of upstaging, identify predictors and analyze oncological outcomes of these patients versus those who did not upstage. We also compared the oncological outcomes of cT1 upstaging to pT3a with de novo pT3a renal tumors. Methods: From a database of 1021 renal tumors with complete available follow-up data, 517 patients had cT1. Patients upstaging to pT3a were compared to those who did not. Baseline clinical, perioperative, histopathologic features and oncological outcomes were analysed. Results: Out of 517 cT1 patients, 105 (20.3%) upstaged to pT3a and 412 (79.7%) did not. Proportion of patients in each group undergoing partial and radical nephrectomy, postoperative tumor size, histology, margin status and lymph node involvement were similar. Among upstaged, 9 patients (8.6%) developed first recurrence as compared to only 3 (0.7%) in those not upstaging (P < 0.001). The median time to recurrence (57 vs. 107 months; P < 0.001) was lesser in de novo pT3a renal tumors. Conclusions: Pathological upstaging from cT1 to pT3a and necrosis on histopathology were associated with recurrence. Advanced age, smoking, necrosis on histopathology, clear cell histology and higher Fuhrman grades contributed to pathological upstaging of cT1 tumors. De novo pT3a RCC had worse survival when compared to cT1 patients upstaging to pT3a RCC. (C) 2018 Published by Elsevier Espana, S.L.U. on behalf of AEU.

OBJECTIVE:To evaluate the effects of switching from prednisone (P) to dexamethasone (D) at asymptomatic prostate-specific antigen (PSA) progression in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate (AA). MATERIALS AND METHODS:Among 93 patients treated with AA between January 2013 and April 2016 in our institution, 48 consecutive asymptomatic patients with mCRPC, who experienced biochemical progression on treatment with AA+P 10 mg/day, were included. A corticosteroid switch to AA+D 0.5 mg/day at PSA increase was administered until radiological and/or clinical progression. The primary endpoint was progression-free-survival (PFS). A prognostic score based on independent prognostic factors was defined. RESULTS:The median time to PSA progression on AA+P was 8.94 months. The median PFS on AA+D and AA+corticosteroids (P then D) was 10.35 and 20.07 months, respectively. A total of 56.25% of patients showed a decrease or stabilization in PSA levels after the switch. In univariate analysis, three markers of switch efficiency were significantly associated with a longer PFS: long hormone-sensitivity duration (≥5 years; median PFS 16.62 vs 4.17 months, hazard ratio [HR] 0.30, 90% confidence interval [CI] 0.16-0.56); low PSA level at the time of switch (<50 ng/mL; median PFS 15.21 vs 3.86 months, HR 0.33, 90% CI 0.18-0.60); and short time to PSA progression on AA+P (<6 months; median PFS 28.02 vs 6.65 months, HR 0.41 (90% CI 0.21-0.81). In multivariate analysis, hormone sensitivity duration and PSA level were independent prognostic factors. CONCLUSION:A steroid switch from P to D appears to be a safe and non-expensive way of obtaining long-term responses to AA in selected patients with mCRPC. A longer PFS has been observed in patients with previous long hormone sensitivity duration, and/or low PSA level and/or short time to PSA progression on AA+P.

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II1 Apr 2018PD34-06 COMPREHENSIVE EVALUATION OF COMPLICATIONS OF FOCAL THERAPY: A STANDARDIZED METHODOLOGY Arnas Bakavicius, Rafael Sanchez-Salas, Paolo Dell'Oglio, Silvia Garcia-Barreras, Adalberto Castro-Alfaro, Francois Rozet, Alexandre Ingels, Eric Barret, Marc Galiano, Jordan Sapetti, Annick Mombet, Nathalie Cathala, Dominique Prapotnich, and Xavier Cathelineau Arnas BakaviciusArnas Bakavicius More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Silvia Garcia-BarrerasSilvia Garcia-Barreras More articles by this author , Adalberto Castro-AlfaroAdalberto Castro-Alfaro More articles by this author , Francois RozetFrancois Rozet More articles by this author , Alexandre IngelsAlexandre Ingels More articles by this author , Eric BarretEric Barret More articles by this author , Marc GalianoMarc Galiano More articles by this author , Jordan SapettiJordan Sapetti More articles by this author , Annick MombetAnnick Mombet More articles by this author , Nathalie CathalaNathalie Cathala More articles by this author , Dominique PrapotnichDominique Prapotnich More articles by this author , and Xavier CathelineauXavier Cathelineau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1573AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Focal therapy (FT) has been proposed as a possible therapeutic option in selected patients with prostate cancer (PCa). However, data regarding perioperative outcomes of this approach is currently limited. The aim of this study was to evaluate the feasibility and safety profile of FT relying on a large contemporary series of patients who underwent FT in a single tertiary care referral center. Specifically, we assessed the prevalence of postoperative complications that were reported in agreement with the standardized Martin criteria. METHODS We identified 236 PCa patients with a Gleason score of 3 + 3 or 3 + 4, clinical stage T2b or less, prostate specific antigen (PSA) 15 ng/dl or less, unilateral disease and life expectancy greater than 10 years treated with partial gland ablation between 2009 and 2016 at a single tertiary care referral center. For partial gland ablation, 188 (79.7%) and 48 (20.3%) patients underwent high intensity focused ultrasound (HIFU) and cryotherapy, respectively. 30-day postoperative complications and length of stay (LoS) were analyzed. Postoperative complications were prospectively recorded according to Martin criteria and categorized according to Clavien-Dindo system. RESULTS Overall, 188 (79.7%) and 48 (20.3%) had Gleason 3+3 and 3+4, respectively. Overall, 186 (78.8%), 43 (18.2%) and 7 (3%) had clinical stage T1c, T2a and T2b, respectively. The median PSA and prostate volume were 6.8 ng/ml and 38 ml, respectively. Nine out of 10 Martin criteria were full satisfied except for risk factors assessment. The overall rate of postoperative complications was 17.4% (n=41). Of these, 15.7% (n=37), 0.4% (n=1) and 1.3% (n=3) were graded II, IIIb and IVa according to Clavien Dindo, respectively. Patients treated with HIFU had higher rate of complications relative to those treated with cryotherapy (19.7 vs. 6.4%, respectively; p=0.001). The most common postoperative complications were acute urinary retention (n=32), followed by fever requiring antibiotics (n=8), urinary tract infection (n=6), hematuria (n=2), sepsis (n=2), cerebrovascular accident (n=1), renal colic (n=1). No postoperative mortality was reported. Median long of stay was 3 days (IQR: 1-4). CONCLUSIONS Applying the standard criteria proposed by Martin et al. to report complications after surgery, we provided evidence that FT is a relatively safe procedure in high volume center. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e657-e658 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Arnas Bakavicius More articles by this author Rafael Sanchez-Salas More articles by this author Paolo Dell'Oglio More articles by this author Silvia Garcia-Barreras More articles by this author Adalberto Castro-Alfaro More articles by this author Francois Rozet More articles by this author Alexandre Ingels More articles by this author Eric Barret More articles by this author Marc Galiano More articles by this author Jordan Sapetti More articles by this author Annick Mombet More articles by this author Nathalie Cathala More articles by this author Dominique Prapotnich More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Radical cystectomy and regional lymph node dissection is the standard treatment for localized muscle-invasive and for high-risk non-muscle-invasive bladder cancer, and represents one of the main surgical urologic procedures. The open surgical approach is still widely adopted, even if in the last two decades efforts have been made in order to evaluate if minimally invasive procedures, either laparoscopic or robot-assisted, might show a benefit compared to the standard technique. Open radical cystectomy is associated with a high complication rate, but data from the laparoscopic and robotic surgical series failed to demonstrate a clear reduction in post-operative complication rates compared to the open surgical series. Laparoscopic and robotic radical cystectomy show a reduction in blood loss, in-hospital stay and transfusion rates but a longer operative time, while open radical cystectomy is typically associated with a shorter operative time but with a longer in-hospital admission and possibly a higher rate of high grade complications.

You have accessJournal of UrologyBladder Cancer: Invasive VII1 Apr 2017PD67-01 LONG-TERM FUNCTIONAL OUTCOMES AND MORBIDITY OF PROSTATE SPARING CYSTECTOMY VERSUS CYSTOPROSTATECTOMY: A CASE CONTROLLED STUDY. Mohamed Saad M., Rafael Sanchez-Salas, Eric Barret, Marc Galiano, François Rozet, Nathalie Cathala, Annick Mombet, Dominique Prapotnich, and Xavier Cathelineau Mohamed Saad M.Mohamed Saad M. More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , Eric BarretEric Barret More articles by this author , Marc GalianoMarc Galiano More articles by this author , François RozetFrançois Rozet More articles by this author , Nathalie CathalaNathalie Cathala More articles by this author , Annick MombetAnnick Mombet More articles by this author , Dominique PrapotnichDominique Prapotnich More articles by this author , and Xavier CathelineauXavier Cathelineau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2977AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate sparing cystectomy (PSC) is arguably a valid option for management of bladder cancer in selected cases. The majority of reported studies however have short term follow up as well as small sample size. We aimed to evaluate retrospectively our long term experience of prostate sparing cystectomy and compare it with our results of nerve sparing cystoprostatectomy (NSCP) in the laparoscopic/robotic era METHODS Between 2001 and 2011, 60 patients were treated with laparoscopic or robotic PSC for muscle invasive or recurrent non muscle invasive bladder cancer. These patients were matched and compared to 47 patients who received laparoscopic or robotic NSCP and orthotopic bladder substitution during the same study period. Regarding continence, surviving patients were postoperatively contacted, at 3 months and 1 year, to answer a questionnaire based on the International Continence Society guidelines for reporting continence after urinary diversion. Potency was accessed by a house made questionnaire addressing the use of any medications or devices to achieve erection. RESULTS Mean patient age was 60.35 and 62.12 for PSC and NSCP respectively. Median follow up was 69.5 months and 62 months for PSC and NSCP respectively. Forty percent of PSC had = pT1N0, 30% pT2N0, 22% = pT3N0 while 8% had N+ disease; compared to NSCP patients whom 38% had =pT1N0, 19% pT2N0, 23% = pT3N0 and 19% N+. (p=0.74) The overall 3- and 5-year cancer specific survivals were 92% and 90% in the PSC group, and 82% and 79% in the NSCP group respectively. The local recurrence rates were 11.7 % and 21.3 % for the PSC and the NSCP groups respectively, and the respective distant recurrence rate was 17% and 28%. Regarding continence; 45% in the PSC showed immediate and full recovery of continence day and night compared to no patient in the NSCP group. After 1 year, 97% and 71% of PSC group were completely leak-free for day and night respectively, compared to 78% and 37% in NSCP (p=0.001). The incidence of self catheterization was equal in both groups at 15%. On long term follow up, 42% of PSC patients developed symptoms secondary to outlet obstruction and 18% of them required endoscopic resection of their prostate. While in NSCP patients, 4% developed anastomotic stricture that required endoscopic fulgration (p=0.001) Regarding potency; 49% of PSC and 23% of NSCP reported maintaining similar preoperative potency level. Sexual intercourse was achievable without any treatment in 68% of PSC compared to 37% in NSCP. The incidence of intracavernosal injection was higher in the NSCP arm compared to the PSC (41% vs.17%) Four patients (9%) in the NSCP group failed all conservative management and required penile prosthesis compared to no patient in the PSC group. ( p=0.001) CONCLUSIONS Prostate sparing cystectomy is superior to nerve-sparing cystoprostatectomy regarding continence and potency. However, candidate patients who wish to retain their prostate should be informed about the long term need to manage outflow obstructive symptoms. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1276 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Mohamed Saad M. More articles by this author Rafael Sanchez-Salas More articles by this author Eric Barret More articles by this author Marc Galiano More articles by this author François Rozet More articles by this author Nathalie Cathala More articles by this author Annick Mombet More articles by this author Dominique Prapotnich More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Background and objective: The primary objective was to evaluate the learning curve of minimally invasive radical prostatectomy (MIRP) in our institution and analyze the salient learning curve transition points regarding oncological outcomes.Methods: Clinical, pathologic, and oncological outcome data were collected from our prospectively collected MIRP database to estimate positive surgical margin (PSM) and biochemical recurrence (BCR) trends during a 15-year period from 1998 to 2013. All the radical prostatectomies (laparoscopic prostatectomy [LRP]/robot-assisted laparoscopic radical prostatectomy [RARP]) were performed by 9 surgeons. PSM was defined as presence of cancer cells at inked margins. BCR was defined as serum prostate-specific antigen >0.2 ng/ml and rising or start of secondary therapy. Surgical learning curve was assessed with the application of Kaplan-Meier curves, Cox regression model, cumulative summation, and logistic model to define the "transition point" of surgical improvement.Results: We identified 5,547 patients with localized prostate cancer treated with MIRP (3,846 LRP and 1,701 RARP). Patient characteristics of LRP and RARP were similar. The overall risk of PSM in LRP was 25%, 20%, and 17% for the first 50, 50 to 350, and >350 cases, respectively. For the same population, the 5-year BCR rate decreased from 30% to 16.7%. RARP started 3 years after the LRP program (after approximately 250 LRP). The PSM rate for RARP decreased from 21.8% to 20.4% and the corresponding 5-year BCR rate decreased from 17.6% to 7.9%. The cumulative summation analysis showed significantly lower PSM and BCR at 2 years occurred at the transition point of 350 cases for LRP and 100 cases for RARP. In multivariable analysis, predictors of BCR were prostate-specific antigen, Gleason score, extraprostatic disease, seminal vesicle invasion, and number of operations (P < 0.05). Patients harboring PSM showed higher BCR risk (23% vs. 8%, P < 0.05).Conclusions: Learning curve trends in our large, single-center experience show correlation between surgical experience and oncological outcomes in MIRP. Significant reduction in PSM and BCR risk at 2 years is noted after the initial 350 cases and 100 cases of LRP and RARP, respectively. (C) 2017 Elsevier Inc. All rights reserved.

La cistectomía radical y disección de los ganglios linfáticos regionales es el tratamiento estándar para el cáncer vesical músculo invasivo localizado y no músculo-invasivo de alto riesgo, y representa uno de los principales procedimientos quirúrgicos urológicos. El abordaje quirúrgico abierto es todavía ampliamente adoptado, aunque en las últimas 2 décadas se han hecho esfuerzos con el fin de evaluar si los procedimientos mínimamente invasivos, ya sean laparoscópicos o asistidos por robot, podrían mostrar un beneficio en comparación con la técnica estándar. La cistectomía radical abierta se asocia con una alta tasa de complicaciones, pero los datos de la serie quirúrgica laparoscópica y robótica no lograron demostrar una clara reducción en las tasas de complicaciones postoperatorias en comparación con la serie quirúrgica abierta. La cistectomía radical laparocópica y robótica muestran una reducción en la pérdida de sangre, las tasas de estancia hospitalaria y de transfusión, pero un mayor tiempo operatorio, mientras que la cistectomía radical abierta se asocia típicamente con un tiempo operatorio más corto, pero con un ingreso más largo en el hospital y, posiblemente, una mayor tasa complicaciones de alto grado.

You have accessJournal of UrologyBladder Cancer: Invasive VII1 Apr 2017PD67-02 CRITICAL EVALUATION OF THE SELECTION CRITERIA FOR PROSTATE SPARING CYSTECTOMY: DO WE NEED TO TIGHTEN THEM? Mohamed Saad M., Rafael Sanchez-Salas, Eric Barret, Marc Galiano, François Rozet, Nathalie Cathala, Annick Mombet, Dominique Prapotnich, and Xavier Cathelineau Mohamed Saad M.Mohamed Saad M. More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , Eric BarretEric Barret More articles by this author , Marc GalianoMarc Galiano More articles by this author , François RozetFrançois Rozet More articles by this author , Nathalie CathalaNathalie Cathala More articles by this author , Annick MombetAnnick Mombet More articles by this author , Dominique PrapotnichDominique Prapotnich More articles by this author , and Xavier CathelineauXavier Cathelineau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2978AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate Sparing cystectomy is a valid option for the treatment of patient with bladder cancer provided that strict selection criteria are used. Although that there is a uniform agreement on excluding patients with bladder neck tumors as well as patients with suspicious prostate that may harbor prostatic carcinoma, there has not been a standardized consensus on how to safely exclude them. Furthermore, the exclusion of other criteria such as carcinoma in situ, tumor characteristics and presence of preoperative hydronephrosis have not been clearly elucidated. METHODS We retrospectively reviewed our laparoscopic/robotic assisted laparoscopic prostate sparing cystectomy series to evaluate our method of selecting patients. RESULTS Between 2001 and 2011, 60 patients were treated with laparoscopic or robotic PSC for muscle invasive or recurrent non muscle invasive bladder cancer. Mean follow up time was 76.9 months ±33.3SD. When the preoperative PSA cut off value for biopsy was = 4ng/dl; prostatic adenocarcinoma was detected on final pathology in 2 patients and arised de novo in 1 patient. When the value was lowered to 2.5ng/dl, no patient had incidental prostatic carcinoma and none developed de novo carcinoma. Distant/solitary carcinoma in situ was associated with more recurrences and so did preoperative hydronephrosis. Tumor grade, size and number were not associated with more recurrences. CONCLUSIONS The presence of any carcinoma in situ should be a contraindication to prostate sparing cystectomy. In addition to standard prostatic evaluation, a cut off PSA value of = 2.5ng/dl for biopsy can eliminate any chance of harboring or developing a prostatic cancer. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1277 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Mohamed Saad M. More articles by this author Rafael Sanchez-Salas More articles by this author Eric Barret More articles by this author Marc Galiano More articles by this author François Rozet More articles by this author Nathalie Cathala More articles by this author Annick Mombet More articles by this author Dominique Prapotnich More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...