Oligorecurrent prostate cancer (PCa) can be treated with metastasis-directed therapy (MDT), which may be performed using radioguided surgery (RGS) as an experimental approach. These procedures have shown promising outcomes, largely due to the high lesion detection rate of positron emission tomography/computed tomography (PET/CT). We present a case series of patients who underwent RGS following robot-assisted radical prostatectomy (RARP). All excised recurrences were found in unusual anatomical locations, potentially resulting from prior invasive surgical procedures. Although three out of four patients did not exhibit a reduction in prostate-specific antigen (PSA) levels post-procedure, these procedures allowed for the successful removal of tumor metastases, the exclusion of other malignancies through molecular tests, and the administration of systemic targeted therapy. Additionally, no surgical complications were reported.

You have accessJournal of UrologyCME1 Apr 2023MP73-02 FOCAL THERAPY - 7 YEARS EXPERIENCE WITH FOCAL HIGH INTENSITY FOCUSED ULTRASOUND IN 164 PATIENTS WITH PROSTATE CANCER: SINGLE CENTER RESULTS Yamini Nagaraj, Fabian Falkenbach, Valia Veleva, Randi Marisa Pose, Jonas Ekrutt, Raisa Abrams-Pompe, Jaideep Ratkal, Pierre Tennstedt, Derya Tilki, Hans Heinzer, Markus Graefen, and Georg Salomon Yamini NagarajYamini Nagaraj , Fabian FalkenbachFabian Falkenbach , Valia VelevaValia Veleva , Randi Marisa PoseRandi Marisa Pose , Jonas EkruttJonas Ekrutt , Raisa Abrams-PompeRaisa Abrams-Pompe , Jaideep RatkalJaideep Ratkal , Pierre TennstedtPierre Tennstedt , Derya TilkiDerya Tilki , Hans HeinzerHans Heinzer , Markus GraefenMarkus Graefen , and Georg SalomonGeorg Salomon View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy aims to selectively ablate tumor lesions and preserve prostate tissue, thus minimizing side effect whilst providing oncological control. The experience of the first 2 years lead to improved diagnostic work up prior to HIFU with better patient selection and less tumor recurrence in the following 5 years. The strong recommendation of control biopsy in the follow up, lead to a reliable and early selection of patients requiring salvage therapy and thus improving oncological results. METHODS: This is a prospective evaluation of 164 patients undergoing focal high intensity focused ultrasound (HIFU) in our institution from July 2015 till June 2022. Patients were required to have a unilateral Gleason score (GS) ≤7, stage T1 or T2 and a PSA level of≤15 ng/ml. Tumor localization was done using multiparametric MRI followed by mainly transrectal targeted and systematic biopsies of any lesion PI-RADS≥3. Systematic biopsy was recommended 1 year after HIFU with PSA levels every 3 months. An MRI was scheduled at 3 years post HIFU. In the control biopsy significant cancer recurrence was defined as >3mm GS 3+3, >3 positive cores or any GS≥3+4; these patients were offered further treatment; either a repeat HIFU, radical prostatectomy (RP) or radiation therapy (RT). Urinary and erectile function were assessed using validated questionnaires. RESULTS: Median PSA prior to HIFU was 6 ng/ml, the median follow-up was 61 months. 38% of the patients had low, 60% intermediate and 2% high risk disease. Median PSA level 2 years post HIFU was 1.9 ng/ml. Of the 119 control biopsies 50% had no evidence of tumor, 36% had insignificant tumor evidence and 14 % showed evidence of significant prostate cancer according to the above defined criteria. Significant infield recurrence occurred in 6 patients (4%) and significant outfield recurrence was seen in 10 patients (6%). 5 patients received a repeat HIFU, 4 patients a RT and 7 had a RP. There were no cases of distant metastasis, no need for palliative antiandrogen therapy (ADT) and no major complications. Urinary continence and erectile function were preserved in 99.5% and 85% respectively. CONCLUSIONS: At 7 years, HIFU therapy showed efficient oncological control rates with a radical treatment free survival rate of 93%. Significant infield recurrence was seen in 4% and significant outfield recurrence in 6% of patients. There was no distant metastasis and no need for palliative ADT. HIFU is associated with excellent preservation of continence and erectile function with very low morbidity. Source of Funding: Non funded © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1034 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yamini Nagaraj More articles by this author Fabian Falkenbach More articles by this author Valia Veleva More articles by this author Randi Marisa Pose More articles by this author Jonas Ekrutt More articles by this author Raisa Abrams-Pompe More articles by this author Jaideep Ratkal More articles by this author Pierre Tennstedt More articles by this author Derya Tilki More articles by this author Hans Heinzer More articles by this author Markus Graefen More articles by this author Georg Salomon More articles by this author Expand All Advertisement PDF downloadLoading ...

When considering increased morbidity of apical biopsies, the added diagnostic value of separate targeting of mid-gland and apical segment of the pan-segmental mid-apical mpMRI prostate cancer (PCa) suspicious lesions was assessed. A total of 420 patients with a single mpMRI PCa-suspicious PI-RADS ≥ 3 intraprostatic lesion extending from the mid-gland to the apical segment of the gland underwent transrectal MRI-targeted (TBx) and systematic prostate biopsy. Clinically significant PCa (CsPCa) was defined as Gleason Score (GS) ≥ 3 + 4. PCa detection rates of TBx cores were assessed according to targeted anatomical segments. Finally, the diagnostic values of two theoretical TBx protocols utilizing 1-core (A) vs. 2-cores (B) per anatomical segment were compared. TBx within the pan-segmental mid-apical lesions yielded 44% of csPCa. After stratification into mid- vs. apical segment of the lesion, csPCa was detected in 36% (mid-gland) and 32% (apex), respectively. Within the patients who had no csPCa detection by mid-gland sampling (64%, n = 270), extreme apical TBx yielded additional 8.1% of csPCa. Comparison of extreme apical TBx strategy B vs. overall PCa detection in our cohort revealed corresponding similar rates of 49 vs.50% and 31 vs.32%, respectively. Separate analyses of both segments, mid-gland and apex, clearly revealed the diagnostic contribution of apical TBx. Our findings strongly suggest to perform extreme apical TBx even within pan-segmental lesions. Moreover, our results indicate that a higher number of cores sampled from the mid-gland segment might be avoided if complemented with a two-core extreme apical TBx.

Objective:To examine the perioperative impact of factor V Leiden mutation on thromboembolic events' risk in radical prostatectomy (RP) patients. With an incidence of about 5%, factor V Leiden mutation is the most common hereditary hypercoagulability among Caucasians and rarer in Asia. The increased risk of thromboembolic events is three- to seven-fold in heterozygous and to 80-fold in homozygous patients. Methods:Within our prospectively collected database, we analysed 33 006 prostate cancer patients treated with RP between December 2001 and December 2020. Of those, patients with factor V Leiden mutation were identified. All patients received individualised recommendation of haemostaseologists for perioperative anticoagulation. Thromboembolic complications (deep vein thrombosis and pulmonary embolism) were assessed during hospital stay, as well as according to patient reported outcomes within the first 3 months after RP. Results:Overall, 85 (0.3%) patients with known factor V Leiden mutation were identified. Median age was 65 (interquartile range: 61-68) years. There was at least one thrombosis in 53 (62.4%) patients and 31 (36.5%) patients had at least one embolic event in their medical history before RP. Within all 85 patients with factor V Leiden mutation, we experienced no thromboembolic complications within the first 3 months after surgery. Conclusion:In our cohort of patients with factor V Leiden mutation, no thromboembolic events were observed after RP with an individualised perioperative coagulation management concept. This may reassure patients with this hereditary condition who are counselled for RP.

Introduction: Normothermic machine perfusion ( NMP) is a currently investigated option to evaluate marginal donor kidneys and increase the donor pool.Biomarkers capable of predicting the quality of the graft would be immensely helpful in identifying transplantable kidneys within a cohort of otherwise discarded organs.The correlation of biomarkers with the kidneys' macroscopic appearance and estimated function during NMP was evaluated.Methods: 33 porcine slaughterhouse kidneys underwent NMP for 4 h with whole blood.Two physicians independently assessed a semiquantitative macroscopic score ( MS) based on the criteria of quality of perfusion, urinary output, and organ lesions.Potential functionality was assessed by GFR via inulin clearance.Kidneys were grouped in "poor" and "good" based on GFR and the MS.Plasma concentrations of NAG, NGAL and KIM-1 were measured using ELISA at 0 h, 1 h, 2 h and 4 h NMP.Results: NGAL release was significantly (p < 0,05) higher in morphologically poor (n = 8) than good (n = 20) kidneys after 1 h, 2 h and 4 h.KIM-1 and NAG levels increased as well, but not significantly.5 kidneys could not be grouped based on the MS. 15 kidneys were considered potentially functional based on GFR, 18 kidneys were not.NAG, NGAL and KIM-1 levels did not differ between these two groups.Conclusion: NGAL, and to an extend KIM-1 and NAG, showed that the external appearance of the kidney was mirrored at the molecular level.In contrast, visually good kidneys might not perform well, as only half of the 20 morphologically good kidneys had an acceptable GFR.Therefore, investigations of other laboratory parameters are necessary to achieve an accurate prediction of the potential functional capacity.

Bei einem 62-jährigen (168 cm, 55kg) sportlich aktiven Mann ohne Nebenerkrankungen wurde aufgrund anhaltender Rückenschmerzen, Nachtschweiß sowie eines ungewollten Gewichtsverlusts von 4kgeineComputertomographie(CT)derLendenwirbelsäuledurchgeführt. Hierbei zeigte sich eine diffuse osteoblastischeMetastasierung der Wirbelsäule sowie pathologisch vergrößerte Lymphkoten iliakal und retroperitoneal (. Abb. 1). Nebenbefundlich kam die Prostata inhomogen und vergrößert zur Darstellung. Laborchemisch zeigte sich eine Erhöhung der alkalischen Phosphatase auf 179U/l (Referenzwert: 46–116U/l).

BackgroundStructured implementation of robot-assisted surgery in the field of medical education is lacking. We assessed students' interest in robot-assisted surgery and tested if the implementation of a hands-on robotic course into the curriculum could increase the interest to join a surgical discipline in general and especially in female students, since women are clearly underrepresented in surgical disciplines.MethodsAfter a prostate cancer focused seminar, 100 students were 1:1 randomized into two groups. Group B: Baseline characteristics and professional interest were assessed prior and after a hands-on robotic course, using a da Vinci® console with simulator (da Vinci® Surgical training, Intuitive Surgical Inc., USA). Group A served as post-interventional consistency control group, received the questionnaire only once after the hands-on training.ResultsThe male to female ratio of students was 54% and 46%. The interest to turn into urology/surgery, categorized as yes”, “no”, “maybe” changed from 18 to 16%, 36 to 30% and 46 to 54% respectively after the hands-on robotic course (p < 0.001). Also, the positive attitude towards the surgical field significantly increased (20 vs. 48%; p < 0.001). Comparing male and female students, virtually identical proportions (23 vs. 23%) opted for joining urology or surgery as a discipline, whereas rejection (45 vs. 25%) and perchance (32 vs. 50%) of that notion differed between genders (p = 0.12).ConclusionOur results demonstrate great demand for implementing robotic training into medical education for an up-to-date curriculum. Although the decision process on career choice is widely multifactorial, stereotypes associated with surgical disciplines should be eliminated. This could have a particularly positive effect on the recruitment of female medical students since women are clearly underrepresented in surgical disciplines although currently and with increasing proportions, more female students are enrolled in medical schools then male.