PURPOSE:Evidence supports obtaining MRI before prostate biopsy. Deliverables of MRI include improving prostate cancer detection through targeting of MRI lesions and reducing the total number of biopsies by eliminating the need for nontargeted biopsy. The actionable intelligence metric (AIM) and reduction metric (ReM) have been proposed to quantify these 2 deliverables; however, this work was performed in the transrectal biopsy setting. To assess generalizability, we examined AIM and ReM in a large, multi-institutional cohort of men undergoing transperineal biopsy. MATERIALS AND METHODS:All patients undergoing concurrent MRI-targeted and systematic transperineal biopsy and maintained in prospective prostate cancer databases across 5 institutions were included. AIM is the percent of men in whom targeted biopsy detected a higher Grade Group compared with systematic biopsy alone. ReM is the proportion of men in whom systematic biopsy may be omitted. In addition to total cohort evaluations of AIM and ReM, subgroup analyses and multivariable logistic regression were performed. RESULTS:In total, 1587 transperineal biopsies were analyzed; 797 (50%) had ≥ Grade Group 2 prostate cancer. AIM in the overall cohort was 27.4%, and ReM was 83.3%. When stratified by Prostate Imaging Reporting and Data System score and prior biopsy status, AIM and ReM were > 25% and > 80%, respectively, across all subgroups. On multivariable logistic regression, Prostate Imaging Reporting and Data System 5 lesions and biopsies performed at institution D were predictive of higher rates of upgrading on systematic biopsy, while patients with a prior negative biopsy had a decreased likelihood of systematic upgrading. CONCLUSIONS:AIM and ReM can be applied in the transperineal setting to assess deliverables of MRI-targeted prostate biopsy. Targeted biopsies provided actionable information in 27% of men, while up to 17% of clinically significant cancer would be missed if systematic biopsy were omitted. Individualized assessment of patient risk tolerance is necessary if a targeted biopsy-alone approach is to be adopted.

OBJECTIVE:To compare PrecisionPoint and grid-based biopsies on rates of clinically significant prostate cancer (csPCa) detection and complications when transperineal MRI-fusion targeted biopsy is performed. MATERIALS AND METHODS:We queried a prospectively maintained prostate biopsy database to identify men ages 18-89 who underwent transperineal MRI-fusion targeted prostate biopsies (including concurrent systematic biopsies) between August 1, 2020 and September 1, 2024. The primary outcome was detection of csPCa in the MRI region of interest. 30-day complications and overall rates of csPCa were examined at the patient level. Subgroup outcomes included cancer detection in anterior MRI lesions and stratification by prior biopsy status. Logistic regression was performed. RESULTS:1134 MRI lesions in 890 patients were included in the analysis (PrecisionPoint: 542 patients/714 lesions; grid-based biopsy: 348 patients/420 lesions). There were no differences in prostate cancer detection between the two groups overall. For patients with a prior negative biopsy, a grid-based approach detected a higher rate of csPCa (P=.021). On logistic regression, biopsy approach was not a significant predictor of csPCa at either the patient (P=.797) or lesion (P=.473) levels. Complication rates and the ability to detect csPCa in anterior lesions were similar between approaches. CONCLUSION:PrecisionPoint and grid-based biopsies identified similar rates of prostate cancer, including in anterior MRI lesions, when transperineal MRI-targeted prostate biopsy was performed in this cohort. Complication rates were low and did not differ based on technique.

INTRODUCTION:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy. MATERIALS AND METHODS:We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021. Cases were categorized using Current Procedural Terminology (CPT) codes (38571) for extended lymph node dissection and super-extended lymph node dissection (38572). Using logistic regression, we compared the groups on a number of factors, including recurrence. RESULTS:Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery. Significant differences were observed in the pathologic T stage and pathology grade group. Time on robot was significantly longer for the super-extended group, while estimated blood loss was lower. No differences were observed in length of stay or any complication-related variable. Super-extended had significantly higher node positivity (36.1% vs. 7.6%, p < 0.001) and recurrence. 10.0% of super-extended cases had node positivity in the aortic bifurcation, the common iliac, or the pre-sacral chains that would have been missed with an extended dissection. 2.2% of patients had node positivity in these chains only. CONCLUSIONS:Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer. Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP20)1 May 2024MP20-20 Outcomes Following Robotic-Assisted Simple Prostatectomy in Patients on Active Surveillance/Watchful Waiting or with Incidental Prostate Cancer Diagnosis on Pathology Dylan Buller, Ilene Staff, Tara McLaughlin, Kevin Pinto, Laura Olivo Valentin, Joseph Tortora, David Ahlborn, Brandon Stahl, Ryan Dorin, Stuart Kesler, and Joseph Wagner Dylan BullerDylan Buller , Ilene StaffIlene Staff , Tara McLaughlinTara McLaughlin , Kevin PintoKevin Pinto , Laura Olivo ValentinLaura Olivo Valentin , Joseph TortoraJoseph Tortora , David AhlbornDavid Ahlborn , Brandon StahlBrandon Stahl , Ryan DorinRyan Dorin , Stuart KeslerStuart Kesler , and Joseph WagnerJoseph Wagner View All Author Informationhttps://doi.org/10.1097/01.JU.0001008732.80104.31.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted simple prostatectomy (RASP) is an effective surgical option for men with benign prostatic hyperplasia (BPH), particularly for men with large/very large prostates. Outcomes have not been studied in men undergoing RASP with prior diagnosis of prostate cancer (PCa) on active surveillance (AS)/watchful waiting (WW) or who have PCa incidentally identified on pathology specimen. Additionally, the proportion of patients who subsequently undergo radical treatment for PCa is unknown. Our goal was to analyze oncologic and surgical outcomes of these groups. METHODS: We performed a retrospective analysis of all men aged 18-89 who underwent RASP from 8/1/2016 to 9/30/2023 at our institution. Men who were on AS/WW or who had PCa first identified on RASP pathology were included. Here, we present descriptive statistics on oncologic and surgical outcomes. RESULTS: Of 288 patients who underwent RASP, 23 (8%) were on AS/WW and 20 (7%) had new PCa diagnosis on RASP pathology. Of those 43 patients, median pre-operative PSA was 8.5 and median first post-RASP PSA was 1.2. No patient required additional BPH surgery. There were no instances of bladder neck contracture. All 43 were able to void spontaneously following RASP, including 18 patients (42%) in retention at the time of surgery. Five patients (1.7% of total cohort) underwent subsequent radical therapy for PCa, including 2 with high risk PCa on RASP pathology and 3 with pathologic upstaging on subsequent prostate biopsy; of the five, 2 were on AS/WW and 3 had new PCa diagnosis (Figure 1). Median follow-up after surgery was 14 months. Table 1 lists oncologic and surgical outcomes. CONCLUSIONS: RASP is safe and effective in men with a prior diagnosis of PCa or with new diagnosis of PCa on RASP pathology. Few men undergoing RASP in our cohort proceeded to radical therapy for PCa. Nonetheless, patients on AS/WW undergoing RASP or those with PCa diagnosed on RASP specimen should be monitored for progression of PCa warranting further intervention. Download PPT Source of Funding: Unfunded © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e328 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Dylan Buller More articles by this author Ilene Staff More articles by this author Tara McLaughlin More articles by this author Kevin Pinto More articles by this author Laura Olivo Valentin More articles by this author Joseph Tortora More articles by this author David Ahlborn More articles by this author Brandon Stahl More articles by this author Ryan Dorin More articles by this author Stuart Kesler More articles by this author Joseph Wagner More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction Urologists are increasingly performing prostate biopsies (PBx) via a transperineal (TP) approach. The two predominant methods for performing TP PBx employ either a grid template (G) or a more freehand approach, often with devices such as PrecisionPoint® (PP). As existing data are sparse, our objective was to compare the two techniques on rates of clinically significant prostate cancer (csPCa) detection and complications when MRI-fusion targeted (MRI) TP PBx is performed. Methods We queried a prospectively maintained prostate biopsy database to identify men ages 18-89 who underwent TP MRI-PBx (including concurrent systematic PBx) between August 1, 2020 and September 30, 2022. G-MRI-PBx were performed until April 1, 2022, and PP-MRI-PBx were performed subsequently. All PBx were performed using UroNav software. The primary outcome was detection of csPCa in the MRI region of interest (ROI). 30 day complications and overall rates of csPCa were examined at the patient level. Subgroup outcomes included csPCa detection in anterior MRI ROIs (as anterior ROIs can be challenging to access due to pubic bone interference) and stratification by prior PBx status (active surveillance, prior negative biopsy, or biopsy-naive). csPCa was defined as Grade Group ≥2. Results 551 MRI ROIs in 452 patients were included in the analysis.;Prior biopsy status differed between groups (Table 1); however, when stratified by prior biopsy status, there was no difference in csPCa detection found between a grid or PP approach (Table 2). PP-MRI-PBx and G-MRI-PBx had similar overall and ROI csPCa detection rates (Table 2).;PP-MRI-PBx identified csPCa in 32.1% of ROIs, and G-MRI-PBx identified csPCa in 34.8% of ROIs (p = 0.57). PP-MRI-PBx identified csPCa in 48.1% of patients, and G-MRI-PBx identified csPCa in 48.9% of patients (p = 0.89). Complication rates and the ability to detect csPCa in anterior ROIs was similar between the two groups (Table 2). Conclusions PP-MRI-PBx and G-MRI-PBx identified similar rates of csPCa, including in anterior MRI lesions and when stratified by prior biopsy status. Complication rates were low and did not differ based on biopsy technique.

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP49)1 May 2024MP49-18 DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER USING COGNITIVE VERSUS SOFTWARE-BASED MRI-TARGETING DURING TRANSPERINEAL PROSTATE BIOPSY: A MULTI-INSTITUTIONAL ANALYSIS Benjamin Rosenfeld, Dylan M. Buller, William E. Martin, Amanda Sherman, William C. Faust, Serge Ginzburg, Joseph R. Wagner, Alexander Kutikov, Andres F. Correa, Kevin Pinto, Chia-Ling Kuo, Lucas Godoy, Peter C. Albertsen, and Benjamin T. Ristau Benjamin RosenfeldBenjamin Rosenfeld , Dylan M. BullerDylan M. Buller , William E. MartinWilliam E. Martin , Amanda ShermanAmanda Sherman , William C. FaustWilliam C. Faust , Serge GinzburgSerge Ginzburg , Joseph R. WagnerJoseph R. Wagner , Alexander KutikovAlexander Kutikov , Andres F. CorreaAndres F. Correa , Kevin PintoKevin Pinto , Chia-Ling KuoChia-Ling Kuo , Lucas GodoyLucas Godoy , Peter C. AlbertsenPeter C. Albertsen , and Benjamin T. RistauBenjamin T. Ristau View All Author Informationhttps://doi.org/10.1097/01.JU.0001008696.31772.28.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A randomized trial in the transrectal prostate biopsy setting demonstrated no difference in detection of clinically significant prostate cancer (csPC) whether targeted biopsy (TB) of MRI lesions was performed using cognitive or software-based fusion (PMID 30522912). Retrospective data suggests similar lack of difference in the transperineal biopsy (TP-B) setting (PMID 33207137); however, prior analyses have not accounted for the impact of TP-B indication (biopsy naïve (BN), prior negative biopsy (PNB), active surveillance (AS)). We examined a large, multi-institutional cohort of men to assess differences in detection of csPC between cognitive and software-based TB stratified by TP-B indication. METHODS: Prospectively maintained TP-B databases across five institutions were retrospectively analyzed. All patients with PIRADS 3-5 lesions on MRI undergoing TB of the index lesion(s) were included. Baseline demographic and clinical data were captured. Primary outcome was detection of csPC (≥GG2) within a TB stratified by biopsy indication (BN, PNB, and AS) and whether cognitive or software-based fusion was used. Univariate and multivariate statistical analyses were performed. RESULTS: 1,546 TP-B (804 cognitive, 742 software) were included. Median age was 66 y, median PSA 6.9 ng/ml, and median prostate volume 48 cc. 758 were BN, 254 had PNB, and 510 were on AS. Overall csPC detection on TB was 40.9%. On multivariable analysis, there was no significant difference in detection of csPC between cognitive and software-based TB overall (OR 1.15, 95% CI 0.85-1.55, p=0.38). Stratified by biopsy indication, software-based targeting improved detection of csPC in the PNB population (OR 5.02, 95% CI 1.71-16.5, p<0.01). There was no significant difference for BN (OR 0.78, 95% CI 0.52-1.17, p=0.23) or AS (OR 1.59, 95% CI 0.92-2.79, p=0.10). CONCLUSIONS: In a large, multi-institutional cohort undergoing TB of suspicious MRI lesions, we found no significant difference overall in detection of csPC whether a cognitive or software-based technique was used. When stratified by biopsy indication, this lack of difference persisted for BN and AS patients; however, software-based fusion outperformed cognitive fusion in the PNB population. Source of Funding: Unfunded © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e790 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Benjamin Rosenfeld More articles by this author Dylan M. Buller More articles by this author William E. Martin More articles by this author Amanda Sherman More articles by this author William C. Faust More articles by this author Serge Ginzburg More articles by this author Joseph R. Wagner More articles by this author Alexander Kutikov More articles by this author Andres F. Correa More articles by this author Kevin Pinto More articles by this author Chia-Ling Kuo More articles by this author Lucas Godoy More articles by this author Peter C. Albertsen More articles by this author Benjamin T. Ristau More articles by this author Expand All Advertisement PDF downloadLoading ...

To evaluate a single surgeon’s 20-year experience with robotic radical prostatectomy. Patients who had undergone robot-assisted laparoscopic prostatectomy by a single surgeon were identified via an IRB approved prospectively maintained prostate cancer database. Patients were divided into 5-year cohorts (cohort A 2001–2005; cohort B 2006–2010; cohort C 2011–2015; cohort D 2016–2021) for analysis. Oncologic and quality of life outcomes were recorded at the time of follow-up visits. Continence was defined as 0–1 pad with occasional dribbling. Potency was defined as intercourse or an erection sufficient for intercourse within the last 4 weeks. Three thousand one hundred fifty-two patients met criteria for inclusion. Clavien ≥ 3 complication rates decreased from 5.9

You have accessJournal of UrologyCME1 Apr 2023MP12-12 RACIAL, ETHNIC, AND SEXUAL ORIENTATION REPRESENTATION ON ERECTILE DYSFUNCTION ACADEMIC WEBSITES Leelakrishna Channa, Kevin Pinto, Ilene Staff, Tara McLaughlin, and Jared Bieniek Leelakrishna ChannaLeelakrishna Channa More articles by this author , Kevin PintoKevin Pinto More articles by this author , Ilene StaffIlene Staff More articles by this author , Tara McLaughlinTara McLaughlin More articles by this author , and Jared BieniekJared Bieniek More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Self-identification with images portrayed in patient-facing education materials aids in understanding medical conditions, especially with sensitive topics such as erectile dysfunction (ED). Previous data have shown underrepresentation of minority men in other urologic online content. The current study is designed to assess racial, ethnic, and sexual orientation diversity depicted on academic urology ED websites. METHODS: Websites of the top academic urology departments from U.S. News & World Reports 2022 rankings were reviewed as sources of high quality content. All subpages were reviewed to identify ED and men’s health sites with extraction of photo and video imagery depicting human subjects. A three-person review team interpreted race, ethnicity, and sexual orientation categorically and using a numeric scale, Fitzpatrick skin rating. Median Fitzpatrick ratings were classified as white (1-3) or non-white (4-6). Consensus ratings were summarized descriptively, Spearman’s rank correlation used for interrater reliability of Fitzpatrick ratings, and MedCalc’s z-tests used to compare diversity proportions to national rates. RESULTS: The top 31 ranked academic urology websites were reviewed to exclude non-academic centers. Over a third of reviewed sites did not contain any human images (12/31, 38.7%). A total of 85 images were collected. Race in the 74 (87.0%) interpretable images included 5 (6.8%) Asian, 12 (16.2%) black, 52 (70.3%) white, and 5 (6.8%) other men. Latino men were represented in 3 of 47 (6.4%) images. Utilizing Fitzpatrick ratings, 70 (82.4%) subjects were classified as white and 15 (17.6%) non-white. Most images [46 (54.1%)] demonstrated a man without a partner. Of those with a partner where sexual orientation could be determined, 20 (90.9%) were heterosexual and 2 (9.1%) homosexual. Between reviewer correlation coefficients for Fitzpatrick ratings ranged from 0.68-0.71. Table 1 compares interpreted image data to population benchmarks. CONCLUSIONS: Limited imagery on academic urology ED websites, while displaying modest racial diversity, continues to underrepresent some groups, namely Latinos. Although men in homosexual relationships were depicted, the absolute number of such images was low. Conscious effort to improve diversity in online male sexual dysfunction content is needed. Source of Funding: Hartford HealthCare Health Equity Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e138 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leelakrishna Channa More articles by this author Kevin Pinto More articles by this author Ilene Staff More articles by this author Tara McLaughlin More articles by this author Jared Bieniek More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To assess the effectiveness of a peritoneal flap on the formation of lymphoceles after robotic assisted radical prostatectomy with bilateral extended pelvic lymph node dissection. METHODS We conducted a single surgeon, assessor blinded prospective randomized controlled trial (the Prospective Lymphocele Ultrasound Study) in men undergoing robotic assisted radical pros-tatectomy with bilateral extended pelvic lymph node dissection. At the conclusion of the node dissection, patients were block randomized 1:1 to either standard of care (no bladder peritoneal flap) or to the creation of a bladder peritoneal flap. Lymphocele formation was assessed by pelvic ultrasound postoperatively. The primary outcome was lymphocele forma -tion. Rates of lymphocele formation and complications were analyzed using chi-square. Other outcomes, including length of stay, number of lymph nodes removed, lymphocele volume, and quality of life measures, were analyzed by t-tests or Wilcoxon Ranked Sum Tests, as appropriate. An a priori power calculation was performed using O'Brien-Fleming alpha shar-ing for the interim analyses. Two preplanned interim analyses were performed when 45 and 90 patients per group had follow-up ultrasounds. RESULTS A statistically significant difference in lymphocele formation was seen on the second interim anal-ysis for 183 patients (4.3% vs. 15.6%, p = .011) stopping enrollment; this remained significant in the final analysis of 216 patients (3.6% vs 14.2%, p = .006). No other significant differences were observed. CONCLUSION This prospective randomized trial supports the implementation of this simple modification for robotic assisted radical prostatectomy with bilateral extended pelvic lymph node dissection. UROLOGY 173: 104-110, 2023. (c) 2022 Elsevier Inc.

INTRODUCTION:The current utility of MRI-fusion targeted biopsy as either an adjunct to or replacement for systematic template biopsy for the detection of clinically significant prostate cancer is disputed. The purpose of this study is to assess the current effectiveness of MRI-targeted versus systematic template prostate biopsies at two institutions and to consider possible underlying factors that could impact variability between detection rates in our patient population compared to others.MATERIALS AND METHODS:A retrospective review from our prospectively maintained prostate cancer databases was conducted. Patients with prostate MRI lesions (PI-RADSv2) receiving concurrent systematic 12-core and MRI-fusion targeted biopsies were reviewed. Clinically significant cancer was considered to be Grade Group ≥ 2.RESULTS:A total of 457 patients were included in the analysis; 255 patients received their biopsy at Institution A and 202 at Institution B. Overall cancer detection rate was 68%; the clinically significant cancer detection rate was 34%. Both MRI-targeted and systematic biopsies identified unique cases of clinically significant prostate cancer that the other modality missed. Out of 157 cases of clinically significant prostate cancer, MRI-targeted biopsy identified 29/157 cases (18%) missed by systematic biopsy, while systematic biopsy identified 37/157 cases (24%) missed by MRI-targeted biopsy (p = .39). Individual biopsy performance was similar when stratified by active surveillance or prior biopsy status, PI-RADSv2 score, and institution.CONCLUSIONS:MRI-fusion targeted and systematic biopsy each identified unique cases of clinically significant prostate cancer. Both biopsy modalities should be utilized in order to provide the greatest sensitivity for the detection of clinically significant prostate cancer.

You have accessJournal of UrologyCME1 May 2022PD60-05 A 20 YEAR FOLLOW-UP STUDY OF ONCOLOGIC OUTCOMES, QUALITY OF LIFE AND COMPLICATIONS IN PATIENTS UNDERGOING ROBOTIC RADICAL PROSTATECTOMY Alexander Bandin, Ilene Staff, Joseph Tortora, Kevin Pinto, Tara McLaughlin, Rosa Negron, Laura OlivoValintin, Caner Dinlenc, and Joseph Wagner Alexander BandinAlexander Bandin More articles by this author , Ilene StaffIlene Staff More articles by this author , Joseph TortoraJoseph Tortora More articles by this author , Kevin PintoKevin Pinto More articles by this author , Tara McLaughlinTara McLaughlin More articles by this author , Rosa NegronRosa Negron More articles by this author , Laura OlivoValintinLaura OlivoValintin More articles by this author , Caner DinlencCaner Dinlenc More articles by this author , and Joseph WagnerJoseph Wagner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002645.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Within 10 years of its approval, surgeons were using the Da Vinci surgical robot for the majority of prostatectomies in the USA. Here we evaluate a single surgeon’s 20 year experience with robotic radical prostatectomy. METHODS: Patients were identified via an IRB approved prospectively maintained prostate cancer database. Perioperative variables such as operative time were recorded at time of surgery. EPIC 26 and/or UCLA Prostate Cancer Index scores were collected preoperatively and at each postoperative visit. PSAs, salvage and adjuvant treatment, and complications were prospectively collected. Continence was defined as 0 pads or 1 pad with occasional dribbling. Potency was defined as intercourse or an erection sufficient for intercourse within the last 4 weeks. Biochemical recurrence was defined as a PSA >0.2 or a hypersensitive PSA resulting in early salvage therapy. All surgeries were performed by a single surgeon; the initial 74 cases were performed as a co-surgeon with another fellowship trained minimally invasive urologic surgeon. Patients were divided into five year cohorts (Cohort A 2001-2005; cohort B 2006-2010; cohort C 2011-2015; Cohort D 2016-2021) and we evaluated group differences in perioperative, quality of life, and oncologic outcomes over time. RESULTS: 3152 patients met criteria for inclusion (Table 1). ≥Clavien 3 complication rates decreased from 16.0% to 3.6%, p <0.001. 1 year continence rates improved from 74.8% to greater than 92%, p <0.001. Operative times dropped from Cohort A to B (199 min v 167 min, p <0.001) and then began to gradually increase with increased resident and fellow involvement. There was considerable grade and stage migration between 2001 and 2021, p <0.001. CONCLUSIONS: In this 20 year review of our experience with robotic prostatectomy, complication rates and continence improved over time. Confounding factors such as grade/stage migration, changes in prostate cancer screening, level of resident/fellow involvement, the advent of hypersensitive PSA, and changing recommendations for adjuvant/salvage therapy certainly influenced outcomes such as operative time, BCR, and margin status. Nonetheless, this study provides insight into the changing landscape of prostate cancer treatment over the past two decades. Source of Funding: Unfunded © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1026 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Bandin More articles by this author Ilene Staff More articles by this author Joseph Tortora More articles by this author Kevin Pinto More articles by this author Tara McLaughlin More articles by this author Rosa Negron More articles by this author Laura OlivoValintin More articles by this author Caner Dinlenc More articles by this author Joseph Wagner More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION AND OBJECTIVE: Detection rates of clini- cally signi fi cant prostate cancer (csPCa) in transperineal (TP) and transrectal (TR) MRI-fusion targeted prostate biopsies (MRI-bx) remains in question. We compared TP and TR approaches on rates of detection of csPCa and complications when performing MRI-bx. METHODS: We retrospectively identi fi ed men ages 18-89 who underwent TP or TR MRI-bx with concurrent systematic random biopsy from August, 2020 to August, 2021. Patients undergoing systematic-only TR biopsies were also included. Analyses primarily focused on cancer detection rates between the two MRI-bx groups; comparisons were also made to the standard random biopsy group. Data were additionally strati fi ed by prior biopsy status. Grade Group (cid:4) 2 was considered csPCa. Complications within 30 days of biopsy were also compared. RESULTS: 520 patients were included in the analysis. No de- mographic differences were observed (Table 1). When analyzing only MRI-bx approaches, no signi fi cant differences were observed between TP and TR on any of the outcomes of interest (Table 2). TR MRI-bx identi fi ed csPCA in 47.2% of patients, and TP MRI-bx identi fi ed csPCA in 48.6% of patients (p [ 0.777); systematic-only TR biopsies identi fi ed csPCA in 34.0% of patients. 50.4% of TR MRI-bx and 54.1% of TP MRI-bx identi fi ed csPCa in patients on active surveillance (AS) (p [ 0.589). 30.8% of TR MRI-bx and 41.0% of TP MRI-bx identi fi ed csPCa in patients with a prior negative biopsy (p [ 0.345). 62.5% of TR MRI-bx and 43.8% of TP MRI-bx identi fi ed csPCa in biopsy-naïve patients (p [ 0.194). Signi fi cant differences were observed in csPCa detection between all three approaches for AS (p [ 0.013) and prior negative biopsy patients (p [ 0.045), but not between MRI-TP and MRI-TR biopsies. CONCLUSIONS: Neither the identi fi cation of csPCa by MRI-bx nor rates of complications differed signi fi cantly based on a TR or TP approach. No differences were seen between MRI-guided approaches based on prior biopsy/AS status. tolerability, patient-related prospective included 135 patients, who had undergone RA-TP-PBx at Hospital Basel Peri-operative side effects, functional outcomes and patient satisfaction were assessed. RESULTS: Overall, 18 of 135 patients (13.3%) developed grade I complications according to Clavien-Dindo classi fi cation. No higher-grade complications occurred. Mean pain score on the day of biopsy was 1.1 points on VAS, which remained constant on the day after biopsy. Gross haematuria, hematospermia and acute urinary retention occurred in 91/135 (68.9%), 66/135 (26.5%) and 17/135 (12.6%) patients, respectively. One patient (0.7%) developed urinary tract infection. performed under general anes- thesia is a safe and well tolerated procedure. This technique allows to omit perioperative prophylaxis and at the same time minimizes the risk of infectious complications. We attribute the favorable risk pro fi le and tolerability to the minimal invasive approach via two entry points.