Introduction Positive surgical margin (PSM) predicts biochemical recurrence (BCR) after radical prostatectomy (RP), but the prognostic role of Gleason grade (GG) at the PSM is unclear. We assessed whether PSM GG independently predicts BCR in organ-confined prostate cancer (PCa). Patients and Methods This retrospective cohort study analyzed 4,659 patients with pT2N0 PCa treated with RP at three tertiary centers. Patients were stratified by PSM status: negative margin, PSM with GG3, and PSM with GG4. The primary outcome was BCR-free survival. Multivariable Cox regression adjusted for age, prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group, and lymphovascular invasion (LVI). Model performance was evaluated using the concordance index (C-index), Akaike information criterion (AIC), and time-dependent receiver operating characteristic (ROC) curves. Subgroup, landmark, and propensity score-matched analyses were conducted for sensitivity. Results PSM were present in 9.4% of patients (74.8% GG3, 25.2% GG4). At a median follow-up of 45 mo, higher PSM grade was associated with worse BCR-free survival (p < 0.001). Among PSM cases, GG4 showed higher BCR risk than GG3 (hazard ratio [HR] 2.23, p = 0.002). Compared to negative margins, GG3 and GG4 were associated with 3.26-fold and 4.16-fold increased BCR risks, respectively (both p < 0.001). Including PSM grade improved model discrimination (C-index 0.739 vs. 0.672) and reduced AIC. Stronger effects were observed in lower ISUP grade groups and patients aged 60–70 yr. GG4 independently predicted early recurrence (odds ratio 3.34, p = 0.006). Conclusion GG at the PSM is an independent predictor of BCR, with the strongest effect in lower-grade (ISUP grade group 1-2) tumors (HR 7.08 for GG4), whereas the effect is attenuated in high-grade disease (HR 2.98). Higher PSM grades increase recurrence risk, particularly in otherwise favorable tumors, supporting context-specific incorporation into postoperative risk stratification.

PSMA PET/MRI pairs high sensitivity for PSMA-avid lesions with superior soft-tissue contrast and provides quantitative metrics that may predict clinical outcomes of prostate cancer (PCa). We investigated whether intraprostatic PET-derived metrics and PSA-based variables predict histopathological ISUP grade and biochemical recurrence (BCR) after radical prostatectomy (RPE). Men with primary PCa who underwent [⁶⁸Ga]PSMA PET/MRI before RPE were retrospectively analyzed. PET-derived tumor metrics, initial PSA (iPSA), PSA density (PSAD), and ISUP grade were assessed for association with tumor aggressiveness and BCR. Discriminatory performance was evaluated using ROC AUCs. Multivariable logistic regression retained the better-performing variable within correlated pairs (e.g., SUVpeak vs. SUVmax). Kaplan–Meier and Cox models examined recurrence-free survival. Among 101 men, all evaluated parameters differentiated low- (ISUP 1–2) from high-grade (ISUP 3–5) disease, with PET metrics showing the highest AUCs. In multivariable analysis, SUVpeak independently predicted high-grade disease (OR 1.3, 95

BACKGROUND AND OBJECTIVE:The current European Association of Urology (EAU) guidelines on non-muscle-invasive bladder cancer (NMIBC) categorize patients into four risk groups. In 2024, a specific follow-up schedule was introduced for intermediate-risk (IR) disease. However, recommendations are based on expert opinion and restricted to patients with IR-NMIBC who have primary low-grade or high-grade/grade 2 disease. Our aim was to identify a subgroup of patients with IR-NMIBC who may require more stringent follow-up. METHODS:We conducted a retrospective analysis of 2086 patients with IR-NMIBC classified according to the World Health Organization 1973 grading scheme. Multivariable Cox-regression models were fitted to identify predictors of recurrence, which were then used to dichotomize groups with low risk of recurrence (IR-Low) versus high risk of recurrence (IR-High). Kaplan-Meier curves were plotted to estimate recurrence-free survival (RFS) and progression-free survival (PFS). Smoothed hazard estimates of first recurrence were plotted by risk group. KEY FINDINGS AND LIMITATIONS:Multifocality and tumor size ≥3 cm were significantly associated with higher risk of first recurrence and were used to define the IR-High and IR-Low (unifocal, size <3 cm; n = 1087) groups. The 3-yr RFS rate was significantly worse for the IR-High group (51%, 95% confidence interval [CI] 48-54%) than for IR-Low (68%, 95% CI 65-71%). The risk of progression was low (5-yr PFS rate 96%) with no significant difference between the IR-High and IR-Low groups. CONCLUSIONS AND CLINICAL IMPLICATIONS:During IR-NMIBC follow-up for recurrence, tumor size and focality should be considered rather than grade. If the primary objective is to ensure prompt detection of recurrence, follow-up schedules should be tailored according to the risk of recurrence, with more stringent protocols for patients with IR-NMIBC at higher risk of recurrence.

149 Background: Optimal management of pelvic nodal recurrence of prostate cancer after RP detected by PSMA-PET is still unclear, although a significant change in treatment due to early use of PET in the setting of BCR has been shown in multiple trials. As pelvic nodal recurrence can be seen as a “in between” state of disease before metastatic disease, metastasis directed therapy could improve oncological outcomes in the long term or at least delay the use of systemic treatment. Salvage Lymph node dissection (sLND) has been described in retrospective trials as effective with biochemical response in up to 60% of patients and long term BCR-free survival of up to 20%. Aim of this study was to prospectively evaluate safety as well as biochemical response to sLAE. Methods: In this study we prospectively included 71 patients with PET detected pelvic nodal recurrence after RP. Uptake in the prostatic fossa, previous pelvic radiation and short-term ADT were allowed. Patients with extra-pelvic metastasis, ECOG ≥2 or thromboembolic event within the last 6 months were excluded. Patients received complete bilateral open sLND. The resection margins were cranially the aortic bifurcation up to the level of the IMA, laterally the genitofemoral nerve, caudally the inguinal ligament or Cloquet's lymph node, medially the urinary bladder, and dorsally the pelvic wall. The obturator fossa was excised with exposure of the obturator nerve and removal of the presacral lymph nodes down to the periosteum. The primary endpoints of the study were safety measured by complication-rate and biochemical response to sLAE by PSA. Results: The median follow-up was 40 months. At the time of surgery median PSA was 1.20ng/ml (IQR 0.79-2.69) and the median number of positive spots on PET was 2 (IQR1-3). Overall, 30% patients showed biochemical remission defined as PSA <0.01. Within the follow up 90% (n=63) of patients experienced biochemical progression. The median time from sLND to BCR and additional treatments was 2 months (95%CI 2 – 5) and 12 months (95%CI 9 – 24) respectively. The median number of LNs removed was 39 and the most common site of relapse was the pelvis. Severe postoperative complications were rare yet did occur with 5 patients experiencing Clavien 3,4 and 5 complications of which one was a bilateral central pulmonary embolism which resulted in the death of the patient. Conclusions: Progression and additional treatments can be delayed with the use of sLAE, however long-lasting biochemical remission was rare. Certain patients with good initial PSA response were able to avoid systemic treatment. While mostly safe, severe side-effects did occur. Due to the potential complications of the surgery, it should be reserved for highly selected cases. Additional trials evaluating criteria for patient selection are important to further explore the potential benefit of sLAE. Clinical trial information: NCT02974075 .

Background and objective Extended pelvic lymph node dissection (ePLND) is recommended in selected radical prostatectomy (RP) prostate cancer (PCa) patients for staging purposes. We aim to externally validate available tools to predict lymph node invasion (LNI) in men with negative preoperative prostate-specific membrane antigen positron emission tomography (miN0). Methods Overall, 282 intermediate- to high-risk PCa patients with miN0 disease undergoing RP and ePLND at ten centers between 2016 and 2023 were identified. The Memorial Sloan Kettering Cancer Center (MSKCC); Amsterdam-Brisbane-Sydney; and Briganti 2017, 2019, and 2023 tools predicting LNI were validated externally using calibration plots, C-indexes, and decision-curve analyses to assess calibration, discrimination, and net benefit. Key findings and limitations Overall, 36 (13%) patients had LNI. The C-indexes of the MSKCC, Briganti 2017, Briganti 2019, Amsterdam-Brisbane-Sydney, and Briganti 2023 nomograms were 64%, 69%, 72%, 64%, and 77%, respectively. The Briganti 2023 nomogram exhibited higher net benefit than the other available nomograms, and the use of a 5% cutoff would have spared 47% ePLND procedures (vs 14% and 4.3% for the Briganti 2019 and Amsterdam-Brisbane-Sydney nomograms, respectively) at the cost of missing only five (3.8%) LNI cases. Heterogeneity in patient selection and imaging protocols represents the main limitations. Conclusions and clinical implications The Briganti 2023 nomogram outperformed other available tools in predicting LNI in men with miN0 PCa. The use of this tool resulted in a considerable number of unnecessary ePLND procedures spared and optimization of ePLND recommendations in a contemporary clinical setting.

Background High-intensity focused ultrasound (HIFU) emerged as a novel approach for the treatment of localized prostate cancer (PCa). However, prospective studies on HIFU-related outcomes and predictors of treatment failure (TF) remain scarce. Materials and Methods We conducted a multinational prospective cohort study among patients undergoing HIFU therapy for localized, low- to intermediate-risk PCa. Follow-up data on serial prostate specific antigen (PSA), multi-parametric magnetic resonance imaging (mpMRI), targeted/systematic biopsies, adverse events and functional outcomes were collected. The primary endpoint was TF, defined as histologically confirmed PCa requiring whole-gland salvage treatment. Uni- and multi-variable adjusted hazard ratios (HRs) were calculated using Cox proportional hazard regression models. Results At baseline, mean (standard deviation) age was 64.14 (7.19) years, with the majority of patients showing T-stage 1 (73.9%) and International Society of Urological Pathology grading system Grade 2 (58.8%). PSA nadir (median, 1.70 ng/mL) was reached after 6 months. Of all patients recruited, 16% had clinically significant PCa, as confirmed by biopsy, of which 13.4% had TF. Notably, T-stage and number of positive cores at initial biopsy were independent predictors of TF during follow-up (HR [95% CI] 1.27 [1.02-1.59] and 5.02 [1.80-14.03], respectively). Adverse events were minimal (17% and 8% early and late adverse events, respectively), with stable or improved functional outcomes in the majority of patients. Conclusions This interim analysis of a multinational study on HIFU therapy for the management of low-to-intermediate-risk PCa reveals good functional outcomes, minimal adverse events and low incidence of TF over the short-term. Data on long-term outcomes, specifically as it relates to oncological outcomes, are awaited eagerly.

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II (MP14)1 May 2024MP14-18 ONCOLOGICAL OUTCOMES OF PN1 PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY: DOES MOLECULAR IMAGING HAVE A PROGNOSTIC IMPACT? RESULTS OF A LARGE, MULTI-INSTITUTIONAL SERIES Francesco Barletta, Giorgio Gandaglia, Pawel Rajwa, Juan Gomez Rivas, Luca Afferi, Claudia Kesch, Christopher Darr, Junlong Zhuang, Fabio Zattoni, Helena Lanzafame, Giancarlo Marra, Nicolai Huebner, Steven Joniau, Eugenio Brunocilla, Agostino Mattei, Cristian Fiori, Cabrera Maria, Enrico Checcucci, Maria Picchio, Arturo Chiti, Roderick van den Bergh, Shahrok Shariat, Francesco Montorsi, and Alberto Briganti Francesco BarlettaFrancesco Barletta , Giorgio GandagliaGiorgio Gandaglia , Pawel RajwaPawel Rajwa , Juan Gomez RivasJuan Gomez Rivas , Luca AfferiLuca Afferi , Claudia KeschClaudia Kesch , Christopher DarrChristopher Darr , Junlong ZhuangJunlong Zhuang , Fabio ZattoniFabio Zattoni , Helena LanzafameHelena Lanzafame , Giancarlo MarraGiancarlo Marra , Nicolai HuebnerNicolai Huebner , Steven JoniauSteven Joniau , Eugenio BrunocillaEugenio Brunocilla , Agostino MatteiAgostino Mattei , Cristian FioriCristian Fiori , Cabrera MariaCabrera Maria , Enrico CheccucciEnrico Checcucci , Maria PicchioMaria Picchio , Arturo ChitiArturo Chiti , Roderick van den BerghRoderick van den Bergh , Shahrok ShariatShahrok Shariat , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001009428.69695.82.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nodal metastases (pN1) represent a predictor of adverse cancer control outcomes in prostate cancer (PCa) patients treated with radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND). Among pN1 patients, cN status has not been shown to impact on cancer control in the conventional imaging era. However, it is unclear whether these findings are applicable to patients staged with PSMA. We tested whether the presence of PSMA-PET nodal lesions (miN1) and their number have a prognostic impact in pN1 patients. METHODS: Overall, we retrieved 106 pN1 PCa patients with preoperative PSMA-PET treated with RP+ePLND without neoadjuvant therapies at 9 referral centres between 2016-2023. Study outcome was biochemical failure (BCF) after RP defined as a PSA value≥0.1 ng/ml at 6-week or two consecutive PSA values ≥0.2 ng/ml. Kaplan-Meier (KM) plots depicted BCF-free survival. Multivariable Cox-regression (MCR) models were fitted to test for the impact of miN1 stage and nodal burden at PSMA-PET (0 vs ≥1; 0 vs 1 vs ≥2) on BCF. In MCR models covariates consisted of: PSA at diagnosis, biopsy grade group (GG; 1-3 vs 4 vs 5), and MRI stage (organ-confined vs extracapsular-extension vs seminal vesicles invasion). Accuracy of MCR models without (model 1) vs including PET-PSMA information (model 2) vs stratifying PSMA-PET results according to number of nodal lesions (0 vs 1 vs ≥2, model 3) were assessed with models derived C-index. RESULTS: Median age and PSA at diagnosis were 67 (62-71) and 10 (7-22) ng/ml. A total of 50 (47%) patients had miN1 disease, with 21 (42%) vs 29 (58%) of these exhibiting 1 vs ≥2 lesions. The 2-yr BCF-free rates were 48% for miN0 vs 29% for miN1 patients. In MCR models miN1 stage (HR: 2.6, 95% CI 1.4-4.9, p=0.003) achieved independent predictor status for higher BCF risk. When stratifying patients according to the number (0 vs 1 vs ≥2) of suspicious nodal lesions at PSMA-PET, only the presence of ≥2 nodal lesions achieved independent predictor status for BCF (HR: 5.4, 95% CI 2.4-12.2, p<0.001). MCR models derived C-index were respectively 68 (model 1) vs 77 (model 2) vs 84% (model 3). CONCLUSIONS: In pN1 patients, the presence of visible nodal lesions at PSMA-PET is associated with BCF after RP+ePLND. Inclusion of information on PSMA-PET nodal burden increased the accuracy of MCR models predicting BCF. Presence of multiple PSMA-PET uptakes in the pelvis, but not a single positive spot, was associated with adverse cancer control and might prompt the use of early intensification approaches. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e227 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Barletta More articles by this author Giorgio Gandaglia More articles by this author Pawel Rajwa More articles by this author Juan Gomez Rivas More articles by this author Luca Afferi More articles by this author Claudia Kesch More articles by this author Christopher Darr More articles by this author Junlong Zhuang More articles by this author Fabio Zattoni More articles by this author Helena Lanzafame More articles by this author Giancarlo Marra More articles by this author Nicolai Huebner More articles by this author Steven Joniau More articles by this author Eugenio Brunocilla More articles by this author Agostino Mattei More articles by this author Cristian Fiori More articles by this author Cabrera Maria More articles by this author Enrico Checcucci More articles by this author Maria Picchio More articles by this author Arturo Chiti More articles by this author Roderick van den Bergh More articles by this author Shahrok Shariat More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To assess the distribution of key mutations across tumour sizes in clear-cell renal cell carcinoma (ccRCC), and secondarily to examine the prognostic impact of aggressive mutations in smaller ccRCCs. PATIENT AND METHODS:The distribution of mutations (VHL, PBRM1, SETD2, BAP1 and CDKN2A loss) across tumour sizes was assessed in 1039 ccRCCs treated with nephrectomy in cohorts obtained from the Tracking Cancer Evolution (TRACERx), The Cancer Genome Atlas (TCGA) and the Cancer Genomics of the Kidney (CAGEKID) projects. Logistic regression was used to model the presence of each mutation against size. In our secondary analysis, we assessed a subset of ccRCCs ≤7 cm for associations of key aggressive mutations (SETD2, BAP1, and CDKN2A loss) with metastasis, invasive disease and overall survival, while controlling for size. A subset of localised tumours ≤7 cm was also used to assess associations with recurrence after nephrectomy. RESULTS:On logistic regression, each 1-cm increase in tumour size was associated with aggressive mutations, SETD2, BAP1, and CDKN2A loss, at odds ratios (ORs) of 1.09, 1.10 and 1.19 (P < 0.001), whereas no significant association was observed between tumour size and PBRM1 (OR 1.02; P = 0.23). VHL was mildly negatively associated with a 1-cm increase in size (OR 0.95; P = 0.01). Among tumours ≤7 cm, SETD2 and CDKN2A loss were associated with metastatic disease at ORs of 3.86 and 3.84 (P < 0.05) while controlling for tumour size. CDKN2A loss was associated with worse overall survival, with a hazard ratio (HR) of 2.19 (P = 0.03). Among localised tumours ≤7 cm, SETD2 was associated with worse recurrence-free survival (HR 2.00; P = 0.03). CONCLUSION:Large and small ccRCCs are genomically different. Aggressive mutations, namely, SETD2, BAP1, and CDKN2A loss, are rarely observed in small ccRCCs and are observed more frequently in larger tumours. However, when present in tumours ≤7 cm, SETD2 mutations and CDKN2A loss were still independently associated with invasive disease, metastasis, worse survival, and recurrence after resection, after controlling for size.

Summary Introduction Metastatic hormone-sensitive prostate cancer (mHSPC) displays both simultaneous and sequential patterns of metastasis, emphasizing a comprehensive treatment approach that integrates both local therapy and systemic treatment strategies. The increasing use of molecular imaging has led to a rise in mHSPC diagnoses, underscoring the importance of identifying the right patient population and effective treatment concepts for this disease state. Results Two prospective trials, HORRAD and STAMPEDE, investigated prostate radiotherapy (RT) for mHSPC; however, they did not show an overall survival (OS) benefit in the unselected cohort. Nonetheless, RT showed favorable outcomes in patients with fewer than five bone metastases, resulting in a 7% 3‑year survival improvement and supporting the integration of RT in multimodal treatment for men with oligometastatic mHSPC. Regarding cytoreductive prostatectomy (cRP), the TRoMbone Trial confirmed its feasibility and safety. In addition, findings from the FUSCC-OMPCa Trial demonstrated improved 3‑year radiographic progression-free survival and OS rates with acceptable rates of complications and incontinence. Recent data from the LoMP registry have further supported superior OS and cancer-specific survival (CSS) in patients undergoing cRP compared to systemic therapy alone. Notably, no significant differences in OS and CSS were observed between the cRP and RT groups. However, cRP-treated patients exhibited superior 2‑year local event-free survival when compared to those treated with RT. Conclusion RT in combination with systemic therapy remains the established first-line treatment for low-burden mHSPC, though the exact definition of low metastatic burden remains contentious. Precise assessment of metastatic burden is vital to identify patients who would derive the greatest benefit from RT. As treatment paradigms evolve, embracing multimodal approaches holds potential for optimizing outcomes in patients with mHSPC. Further research is needed to solidify the role of cRP as a standard therapeutic approach and to refine treatment strategies for improved patient outcomes.

You have accessJournal of UrologyProstate Cancer: Staging I (PD17)1 May 2024PD17-07 CAN WE RELY ON AVAILABLE MODELS PREDICTING PATHOLOGICAL OUTCOMES IN PROSTATE CANCER PATIENTS STAGED WITH 68GA PSMA-PET/CT? EXTERNAL VALIDATION OF THE EXISTING NOMOGRAMS FOR EXTRACAPSULAR EXTENSION AND SEMINAL VESICLE INVASION AND DEVELOPMENT OF A NOVEL TOOL INCLUDING INTRAPROSTATIC SUVMAX Simone Scuderi, Giorgio Gandaglia, Pawel Rajwa, Juan Gomez Rivas, Lorenzo Bianchi, Claudia Kesch, Christopher Darr, Hongqian Guo, Junlong Zhuang, Fabio Zattoni, Wolfgang Fendler, Giancarlo Marra, Nicolai Huebner, Steven Joniau, Riccardo Schiavina, Agostino Mattei, Cristian Fiori, Francesco Porpiglia, Maria Picchio, Roderick van den Bergh, Shahrok Shariat, Arturo Chiti, Francesco Montorsi, and Alberto Briganti Simone ScuderiSimone Scuderi , Giorgio GandagliaGiorgio Gandaglia , Pawel RajwaPawel Rajwa , Juan Gomez RivasJuan Gomez Rivas , Lorenzo BianchiLorenzo Bianchi , Claudia KeschClaudia Kesch , Christopher DarrChristopher Darr , Hongqian GuoHongqian Guo , Junlong ZhuangJunlong Zhuang , Fabio ZattoniFabio Zattoni , Wolfgang FendlerWolfgang Fendler , Giancarlo MarraGiancarlo Marra , Nicolai HuebnerNicolai Huebner , Steven JoniauSteven Joniau , Riccardo SchiavinaRiccardo Schiavina , Agostino MatteiAgostino Mattei , Cristian FioriCristian Fiori , Francesco PorpigliaFrancesco Porpiglia , Maria PicchioMaria Picchio , Roderick van den BerghRoderick van den Bergh , Shahrok ShariatShahrok Shariat , Arturo ChitiArturo Chiti , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001010044.70939.31.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Existing multivariable models predicting seminal vesicle invasion (SVI) and extracapsular extension (ECE) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) have never been validated in the PSMA era. We hypothesized that the intraprostatic SUVmax (iSUVmax) values in patients staged with 68Ga-PSMA-PET/CT might improve models' performances. METHODS: A total 328 men staged with 68Ga-PSMA-PET/CT and treated with RP±pelvic lymph node dissection (pLND) at 7 referral centers between 2016 and 2023 were identified. Existing models based on preoperative PSA, ISUP Grade Group (GG), the presence of ECE or SVI at mpMRI, the maximum diameter of the index lesion at MRI, and the percentage of cores with ISUP GG ≥2 at systematic biopsy were externally validated. Loess function graphically explored the relationship between the iSUVmax and the risk of ECE and SVI. Novel models based on the coefficients of the previously mentioned variables with the addition of the SUVmax were developed to predict ECE and SVI. Model's performances were assessed with the ROC-derived AUC, calibration plot, and decision-curve analyses (DCAs). RESULTS: The median iSUVmax was 11.2. Overall, 186 (59%) and 62 (20%) patients had ECE and SVI. The existing models' discriminations were 60% for ECE and 71% for SVI at external validation. At multivariable analyses, iSUVmax was significantly associated with ECE (OR 1.05, 95% CI 1.01-1.09, p=0.01) and SVI (OR 1.03, 95% CI 1.00-1.06, p=0.04) after adjusting for confounders. Given the presence of a non-linear relationship between iSUVmax and ECE and SVI, iSUVmax as a restricted cubic spline term was incorporated into the two new prediction models. The new models showed higher discrimination for ECE (66%) and SVI (75%), better calibration and a higher net benefit compared to the available ones. CONCLUSIONS: In patients staged with 68Ga-PSMA-PET/CT, the addition of iSUVmax improved the performances of two validated models predicting adverse pathologic outcomes. 68Ga-PSMA-PET features, such as iSUVmax, should be considered for preoperative risk assessment. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e372 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Simone Scuderi More articles by this author Giorgio Gandaglia More articles by this author Pawel Rajwa More articles by this author Juan Gomez Rivas More articles by this author Lorenzo Bianchi More articles by this author Claudia Kesch More articles by this author Christopher Darr More articles by this author Hongqian Guo More articles by this author Junlong Zhuang More articles by this author Fabio Zattoni More articles by this author Wolfgang Fendler More articles by this author Giancarlo Marra More articles by this author Nicolai Huebner More articles by this author Steven Joniau More articles by this author Riccardo Schiavina More articles by this author Agostino Mattei More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Maria Picchio More articles by this author Roderick van den Bergh More articles by this author Shahrok Shariat More articles by this author Arturo Chiti More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: De novo oligometastatic prostate cancer (omPCa) on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is a new disease entity and its optimal management remains unknown. Objective: To analyze the outcomes of patients treated with cytoreductive radical prostatectomy (cRP) for omPCa on PSMA-PET. Design, setting, and participants: Overall, 116 patients treated with cRP at 13 European centers were identified. Oligometastatic PCa was defined as miM1a and/or miM1b with five or fewer osseous metastases and/or miM1c with three or fewer lung lesions on PSMA-PET. Intervention: Cytoreductive radical prostatectomy. Outcome measurements and statistical analysis: Thirty-day complications according to Clavien-Dindo, continence rates, time to castration-resistant PCa (CRPC), and overall sur- vival (OS) were analyzed. Results and limitations: Overall, 95 (82%) patients had miM1b, 18 (16%) miM1a, and three (2.6%) miM1c omPCa. The median prebiopsy prostate-specific antigen was 14 ng/ml, and 102 (88%) men had biopsy grade group >= 3 PCa. The median number of metastases on PSMA-PET was 2; 38 (33%), 29 (25%), and 49 (42%) patients had one, two, and three or more distant positive lesions. A total of 70 (60%) men received neoad- juvant systemic therapy, and 37 (32%) underwent metastasis-directed therapy. Any and Clavien-Dindo grade >= 3 complications occurred in 36 (31%) and six (5%) patients, respectively. At a median follow-up of 27 mo, 19 (16%) patients developed CRPC and eight (7%) patients died. The 1-yr urinary continence rate was 82%. The 2-yr CRPC-free survival and OS were 85.8% (95% confidence interval [CI] 78.5-93.7%) and 98.9% (95% CI 96.8-100%), respectively. The limitations include retrospective design and short- term follow-up. Conclusions: Cytoreductive radical prostatectomy is a safe and feasible treatment option in patients with de novo omPCa on PSMA-PET. Despite overall favorable oncologic outcomes, some of these patients have a non-negligible risk of early progression and thus should be considered for multimodal therapy. Patient summary: We found that patients treated at expert centers with surgery for prostate cancer, with a limited number of metastases detected using novel molecular imaging, have favorable short-term survival, functional results, and acceptable rates of complications. (c) 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Background and objective There are limited data on real-world outcomes for patients with advanced or metastatic urothelial cancer (mUC) since immune checkpoint inhibitors (ICIs) became available. Our objective was to analyze outcomes for patients with mUC since ICIs became available. Methods We performed a retrospective analysis of 131 patients with mUC attending the outpatient clinic of a single tertiary care center who received systemic therapy between June 2017 and July 2021 with follow-up up to December 2022. Summary and descriptive statistics were calculated for categorical and continuous variables. The Kaplan-Meier method was applied to calculate survival, and a Cox proportional-hazards model was used to explore associations between clinical variables and outcomes. Key findings and limitations The median patient age was 68 yr (range 35-90). The first systemic therapy administered was platinum-based in 79% of cases and ICI-based in 21%. Some 61% of the cohort received a second systemic treatment, with 75% of these an ICI. Median overall survival for the entire cohort was 24 mo (interquartile range 9-35). Patients on ICI therapy for >= 6 mo had median overall survival of 59 mo (95% confidence interval 39 mo-not reached). Metastatic sites on initiation of ICI therapy and C-reactive protein kinetics were prognostic in patients receiving ICIs. Limitations include the retrospective design and inherent selection bias. Conclusions and clinical implications More than 60% of patients with mUC received second-line treatment, and 75% of these received an ICI. Patients staying on immunotherapy for more than 6 mo have substantially better outcomes in comparison to patients with less time on immunotherapy and historical cohorts. Patient summary We looked at the lines of therapy and outcomes for patients with advanced or metastatic cancer of the urinary tract, starting from when immunotherapy drugs called immune checkpoint inhibitors (ICIs) became available. We found that 60% of patients have received second-line therapy, which is a double the rate in comparison to historical groups of patients. Patients with long-term ICI therapy (>6 months) had significantly better outcomes, with a median survival of more than 3 years. (c) 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Background: Depending on the risk of LN metastasis ePLND at RP is recommended. As ePLND has potential side effects, and diagnostics have improved substantially, our objective was to evaluate the performance of the Briganti 2019 nomogram in a contemporary cohort with preoperative negative PSMA-PET. Methods: Patients with intermediate- and high -risk prostate cancer (CaP), undergoing RP and ePND at our center with preoperative negative [ 68 Ga]Ga-PSMA-11 PET were included. The Accuracy of the nomogram was assessed using ROC analysis. The association of clinical parameters with the presence of LN metastasis was assessed using logistic regression. Specimen of prostate and LNs in patients with false negative PSMA-PET were additionally stained for AR and PSMA expression and assessed by IHC. Results: The study included 108 patients, 28% intermediate- and 72% high -risk. Twelve patients harbored occult LN metastasis. Accuracy of the nomogram was 0.62. [ 68 Ga]Ga-PSMA-11 PET showed a NPV of 89%. IHC showed expression of PSMA and AR in the primary and LN metastasis in all patients. On logistic regression analysis only DRE (OR 2.72; 95%CI 1.01 - 7.35; P = 0.05) and percentage of cores with significant CaP (OR 1.29; 95%CI 1.05 - 1.60; P = 0.02) showed a significant association with LN metastasis. Conclusion: The currently used nomogram is suboptimal in detecting patients with occult LNM. While the cut-off value to perform ePLND can be increased slightly following a negative PSMA-PET scan, more accurate methods of identifying these patients are needed. Whether ePLND can have a therapeutic benefit, as opposed to a diagnostic only, needs to be re-evaluated in the PSMA-PET era. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Summary Focal therapy is a treatment option for clinically localized prostate cancer, finding increased use in recent years. It is generally associated with very good functional outcome regarding pad-free continence and preservation of erections. Oncologic outcomes are controversial, especially depending on the ideal endpoint. Both the presence of clinically significant prostate cancer (csPCA) on biopsy and the absence of any whole-gland or systemic treatment as “failure-free survival” (FFS) have been used. While salvage whole-gland and systemic therapy is rare, a substantial number of patients will have csPCA on follow-up biopsies after focal therapy, either in-field or out of field. Generally, patients selected for focal therapy are considered intermediate-risk, although some patients with high-risk features have been included into focal therapy studies. With the data currently available focal therapy presents a good treatment option for patients with feasible intermediate-risk prostate cancer, interested in functional outcome, after proper counseling on the higher recurrence rate, and the need for surveillance biopsies during follow-up.

BACKGROUND:The role of local therapies including radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies on prostate-specific membrane antigen (PSMA) positron emission tomography/computerized tomography (PET/CT) has scarcely been explored. Limited data are available to identify men who would benefit from RP; on the contrary, those more likely to benefit already have systemic disease. OBJECTIVE:We aimed to assess the predictors of prostate-specific antigen (PSA) persistence in surgically managed PCa patients with lymphadenopathies on a PSMA PET/CT scan by integrating clinical, magnetic resonance imaging (MRI), and PSMA PET/CT parameters. DESIGN, SETTING, AND PARTICIPANTS:We identified 519 patients treated with RP and extended lymph node dissection, and who received preoperative PSMA PET between 2017 and 2022 in nine referral centers. Among them, we selected 88 patients with nodal uptake at preoperative PSMA PET (miTxN1M0). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The outcome was PSA persistence, defined as a PSA value of ≥0.1 ng/ml at the first measurement after surgery. Multivariable logistic regression models tested the predictors of PSA persistence. Covariates consisted of biopsy International Society of Urological Pathology (ISUP) grade group, clinical stage at MRI, and number of positive spots at a PET/CT scan. A regression tree analysis stratified patients into risk groups based on preoperative characteristics. RESULTS AND LIMITATIONS:Overall, lymph node invasion (LNI) was detected in 63 patients (72%) and 32 (36%) experienced PSA persistence after RP. At multivariable analyses, having more than two lymph nodal positive findings at PSMA PET, seminal vesicle invasion (SVI) at MRI, and ISUP grade group >3 at biopsy were independent predictors of PSA persistence (all p < 0.05). At the regression tree analysis, patients were stratified in four risk groups according to biopsy ISUP grade, number of positive findings at PET/CT, and clinical stage at MRI. The model depicted good discrimination at internal validation (area under the curve 78%). CONCLUSIONS:One out of three miN1M0 patients showed PSA persistence after surgery. Patients with ISUP grade 2-3, as well as patients with organ-confined disease at MRI and a single or two positive nodal findings at PET are those in whom RP may achieve the best oncological outcomes in the context of a multimodal approach. Conversely, patients with a high ISUP grade and extracapsular extension or SVI or more than two spots at PSMA PET should be considered as potentially affected by systemic disease upfront. PATIENT SUMMARY:Our novel and straightforward risk classification integrates currently available preoperative risk tools and should, therefore, assist physician in preoperative counseling of men candidates for radical treatment for prostate cancer with positive lymph node uptake at prostate-specific membrane antigen positron emission tomography.

Gutartige Prostataerkrankungen sind häufig mit Blasenfunktionsstörungen und Schmerzen verbunden und können die Lebensqualität der Patienten beeinträchtigen. Bei der benignen Prostatahyperplasie (BPH) handelt es sich ausschließlich um eine histologische Diagnose. Der Begriff LUTS (lower urinary tract symptoms) beschreibt das klinische Bild von Symptomen des unteren Harntraktes, welche verschiedene Ursachen habe können. Sofern LUTS im Zusammenhang mit BPH auftritt, wird international von „LUTS suggestive of BPH“ und im deutschsprachigen Raum vom „benignen Prostatasyndrom (BPS)“ gesprochen. Die Symptome gutartiger Prostataerkrankungen sind klinisch oftmals ähnlich, die Ursachen multikausal. Während das BPS häufig ein Phänomen bei Männern in der 2. Lebenshälfte (Alter >40 Jahre) darstellt, tritt die Prostatitis gehäuft bei jüngeren Männern (18- bis 40-jährigen) auf. Die Therapie richtet sich nach der Ursache der Erkrankung. Eine vergrößerte Prostata kann sowohl medikamentös als auch chirurgisch behandelt werden. Bei der bakteriellen Prostatitis hingegen ist eine antibiotische Therapie Mittel der Wahl.

You have accessJournal of UrologyCME1 Apr 2023MP61-12 WHICH MEN WITH CN1 PROSTATE CANCER AT PSMA PET/CT REPRESENT THE IDEAL CANDIDATE TO RADICAL PROSTATECTOMY? DEVELOPMENT OF A NOVEL RISK STRATIFICATION TOOL FOR INDIVIDUALIZED APPROACHES BASED ON A LARGE, MULTI-INSTITUTIONAL SERIES Francesco Barletta, Elio Mazzone, Giorgio Gandaglia, Lorenzo Bianchi, Riccardo Schiavina, Luca Afferi, Agostino Mattei, Fabio Zattoni, Giuseppe Reitano, Pawel Rajwa, Shahrok Shariat, Claudia Kesch, Juan Gomez Rivas, Giancarlo Marra, Hongqian Guo, Junlong Zhuang, Daniele Amparore, Francesco Porpiglia, Nicolai Huebner, Eugenio Brunocilla, Enrico Checcucci, Fabrizio Dal Moro, Jesus Moreno-Sierra, Christopher Darr, Alida Sartorello, Francesco Montorsi, and Alberto Briganti Francesco BarlettaFrancesco Barletta More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Lorenzo BianchiLorenzo Bianchi More articles by this author , Riccardo SchiavinaRiccardo Schiavina More articles by this author , Luca AfferiLuca Afferi More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Fabio ZattoniFabio Zattoni More articles by this author , Giuseppe ReitanoGiuseppe Reitano More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Shahrok ShariatShahrok Shariat More articles by this author , Claudia KeschClaudia Kesch More articles by this author , Juan Gomez RivasJuan Gomez Rivas More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Hongqian GuoHongqian Guo More articles by this author , Junlong ZhuangJunlong Zhuang More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Nicolai HuebnerNicolai Huebner More articles by this author , Eugenio BrunocillaEugenio Brunocilla More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Fabrizio Dal MoroFabrizio Dal Moro More articles by this author , Jesus Moreno-SierraJesus Moreno-Sierra More articles by this author , Christopher DarrChristopher Darr More articles by this author , Alida SartorelloAlida Sartorello More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Limited data is available to identify men who would benefit the most from radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies (cN+) at PSMA PET and, on the other hand, to select patients for proper management. We aimed at assessing predictors of early recurrence in surgically managed PCa patients with cN+at PSMA PET scan by integrating clinical, magnetic resonance imaging (MRI) and PET parameters. METHODS: We identified 662 patients treated with RP and lymph node dissection who received preoperative PSMA PET between 2017 and 2022 at nine referral Centers. We selected 93 patients with positive nodal uptake at preoperative PSMA PET. The study outcome was PSA persistence, defined as a PSA≥0.1ng/ml at first postoperative measurement. Multivariable logistic regression tested predictors of persistence. Covariates consisted of biopsy ISUP grade group (IGG) (2-3 vs 4-5), stage at MRI (organ-confined disease [OC] vs. extracapsular extension [ECE] vs. seminal vesicles invasion [SVI)) and number of positive spots at PET scan. Regression tree analysis stratified patients into risk groups based on their preoperative characteristics. RESULTS: Median number of positive spots at preoperative PET was 2. LNI was detected in 64 patients (69%). Comparing PSMA PET and final pathology, concordance of positive nodes location was 85%. 32 patients (34%) experienced PSA persistence after RP. At multivariable analyses, biopsy IGG 4-5 represented the strongest predictor of PSA persistence (OR: 2.44; p=0.001). At regression tree analysis, patients were stratified in four risk group according to IGG, number of positive spots at PET and stage at MRI (Figure 1). This model depicted a good discrimination (AUC 78%). Notably, patients in high and very-high risk groups showed higher PSA persistence (62 and 83%, respectively) compared to low-risk group (27%). CONCLUSIONS: Patients with IGG 2-3, as well as patients with IGG 4-5 but with OC or ECE at MRI and a single positive spot at PET are those where RP may achieve the best oncological. Conversely, patients with high GG and SVI or>1 spots at PSMA PET should be considered as potentially affected by a systemic disease upfront. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e857 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Barletta More articles by this author Elio Mazzone More articles by this author Giorgio Gandaglia More articles by this author Lorenzo Bianchi More articles by this author Riccardo Schiavina More articles by this author Luca Afferi More articles by this author Agostino Mattei More articles by this author Fabio Zattoni More articles by this author Giuseppe Reitano More articles by this author Pawel Rajwa More articles by this author Shahrok Shariat More articles by this author Claudia Kesch More articles by this author Juan Gomez Rivas More articles by this author Giancarlo Marra More articles by this author Hongqian Guo More articles by this author Junlong Zhuang More articles by this author Daniele Amparore More articles by this author Francesco Porpiglia More articles by this author Nicolai Huebner More articles by this author Eugenio Brunocilla More articles by this author Enrico Checcucci More articles by this author Fabrizio Dal Moro More articles by this author Jesus Moreno-Sierra More articles by this author Christopher Darr More articles by this author Alida Sartorello More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...