You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2017PD62-05 NEOADJUVANT CHEMOTHERAPY IN MUSCLE-INVASIVE BLADDER CANCER: DIFFERENCES IN CLINICAL AND PATHOLOGICAL RESPONCE Andrea Benedetto Galosi, Giulio Milanese, Lucio Giustini, Giulia Sbrollini, Isabella Chiodega, Guevar Maselli, Luciano Burattini, Rossana Berardi, and Rodolfo Montironi Andrea Benedetto GalosiAndrea Benedetto Galosi More articles by this author , Giulio MilaneseGiulio Milanese More articles by this author , Lucio GiustiniLucio Giustini More articles by this author , Giulia SbrolliniGiulia Sbrollini More articles by this author , Isabella ChiodegaIsabella Chiodega More articles by this author , Guevar MaselliGuevar Maselli More articles by this author , Luciano BurattiniLuciano Burattini More articles by this author , Rossana BerardiRossana Berardi More articles by this author , and Rodolfo MontironiRodolfo Montironi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2777AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy (RC) for muscle invasive bladder cancer is underutilized beside has been supported by guidelines. This study was undertaken to determine the rate of neoadjuvant gemcitabine and cisplatin (NGC) use before radical cystectomy (RC) and lymphadenectomy and to assess its effect on the pathologic response rates, surgical outcome and complication rate. METHODS This retrospective study examined all patients having a RC between January 2012 and September 2016. We collected patient demographics, pre-treatment clinical stage, post-RC pathologic data and survival data. Response Evaluation Criteria in Solid Tumors (RECIST, ver. 1.0) was used to asses clinical response to NGC (CR for complete response, PR for partial response, PD for progression of disease and SD for Stable disease on CT). Pathological Tumor Regression Grade (TRG) was evaluated (AJSP). RESULTS A total of 84 RC were performed of which 74 (88%) were for stage cT2-T4 urothelial carcinoma of the bladder. Salvage cystectomy were excluded (n=10). Of the 74 patients, 30 (40.5%) received NGC. Based on CT scan, clinical response to NGC was evaluated (RECIST criteria): CR was observed in 2 pts (6%), PR in 18 (60%); PD in 1 (3%) and SD in 9 (30%) regarding primary bladder tumor. In 12 pts with enlarged lymph-nodes, the response to NGC was CR in 1, PR in 10 and SD in 1. Patients receiving neoadjuvant GC had a greater chance of achieving a pathologically lower stage compared to the untreated population: organ-confined cancer in 53,3% (16/30) vs. 33% (p < 0.001). Lymph-node metastasis resulted in 25% patients after GC (n=10) vs 45.5% of untreated patients (n=20; p < 0.001). Considering patients resulted CR and PR after NGC (n=20), 70% had down-staging on pathologic report after RC. Complication rates were higher in NGC group (4 thromboembolisms; 2 sepsis; 12 hematologic complications); all complications were not related to surgery. Pathological TRG after NGC was not correlated to clinical regression grade. The OS (mean follow-up 30 months) of patients who received NGC resulted of 66.6% compared with 56% of patients undergoing cystectomy alone (p<0,001). Fifty percent of patients in NGC group were alive without cancer vs 40,1% in cystectomy alone group (p<0,001). CONCLUSIONS Neoadjuvant chemotherapy for muscle-invasive bladder cancer increases the rate of down-staging and cancer specific survival. NGC is associated with an increased risk of complications that may be prevented using tailored strategies. Pathological regression grades after NGC are not correlated to RECIST criteria based on CT. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1194-e1195 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Andrea Benedetto Galosi More articles by this author Giulio Milanese More articles by this author Lucio Giustini More articles by this author Giulia Sbrollini More articles by this author Isabella Chiodega More articles by this author Guevar Maselli More articles by this author Luciano Burattini More articles by this author Rossana Berardi More articles by this author Rodolfo Montironi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

We describe our experience in prostate biopsy using a new standardized cognitive fusion techniques, that we call "cognitive zonal fusion biopsy". This new technique is based on two operative options: the first based on target biopsies, the Cognitive Target Biopsy (CTB) if the same target was detected with transrectal ultrasound (TRUS) and multiparametric magnetic resonance (mpMRI); the second based on saturation biopsies, the Zonal Saturation Biopsy (ZSB) on anatomical zone/s containing the region of interest if the same target was not evident with TRUS and MRI. We evaluated results of our technique compared to standard biopsy in order to identify clinically relevant prostate cancer. METHODS This is a single-center prospective study conducted in 58 pts: 25 biopsy-naïve, 25 with previous negative biopsy and in 8 with cancer in active surveillance. Based on mpMRI and transrectal ultrasonography (TRUS), all patients were scheduled for standard 12-core TRUS-guided biopsy. If mpMRI was suggestive or positive (PI-RADS 3, 4 or 5): patients underwent additional targeted 2 to 6 cores using cognitive zonal fusion technique. RESULTS 31/58 (53.4%) patients had a cancer. Our technique detected 80.6% (25 of 31) with clinically significant prostate cancer, leading to detection of insignificant cancer in 20%. Using standard mapping in MR negative areas we found 5 clinically significant cancer and 4 not significant cancers. MRI cancer detection rate was 18/31 (58.1%), and 9/18 (50%) in high grade tumors. Therefore MRI missed 50% of high grade cancers. The mean number of cores taken with cognitive zonal fusion biopsy was 6.1 (2-17), in addition biopsy sampling was done outside the ROI areas. Overall 15.4 cores (12-22) were taken. Cancer amount in Zonal Biopsy was larger than 7.3 mm (1-54.5) in comparison with 5.2 mm (1-23.5) in standard mapping. Largest percentage of cancer involvement with cognitive zonal fusion technique was detected in 19.4% vs 15.9%. CONCLUSIONS Cognitive Zonal Saturation Biopsies should be used to reduce operator variability of cognitive fusion biopsy in addition to standard biopsy. Cognitive zonal biopsy based on mpMRI findings identifies clinically relevant prostate in 80%, has larger cancer extension in fusion biopsies than in random biopsies, and reduce the number of cores if compared to saturation biopsy.

Introduction: Testicular benign tumors are very rare (< 5%). Testicular Angiofibroma (AF) is one of those, however the gold standard of treatment and follow-up is still unclear. Case report: A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. Conclusion: We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.