You have accessJournal of UrologyPlenary: Next Frontier1 Apr 2018LBA5 INITIAL RESULTS OF A PROSPECTIVE COHORT STUDY EVALUATING RELIABILITY OF ENDOSCOPIC EVALUATION IN PREDICTING PT0 DISEASE AT THE TIME OF RADICAL CYSTECTOMY: WHERE AND HOW DOES CYSTOSCOPY FALL SHORT? Daniel Parker, Aeen Asghar, John O'Neill, Richard Greenberg, Marc Smaldone, David Chen, Rosalia Viterbo, Robert Uzzo, Joshua Eccles, Daniel Geynisman, Matthew Zibelman, Eric Ross, Philip Abbosh, Elizabeth Plimack, and Alexander Kutikov Daniel ParkerDaniel Parker More articles by this author , Aeen AsgharAeen Asghar More articles by this author , John O'NeillJohn O'Neill More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , David ChenDavid Chen More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Joshua EcclesJoshua Eccles More articles by this author , Daniel GeynismanDaniel Geynisman More articles by this author , Matthew ZibelmanMatthew Zibelman More articles by this author , Eric RossEric Ross More articles by this author , Philip AbboshPhilip Abbosh More articles by this author , Elizabeth PlimackElizabeth Plimack More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.03.084AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Concern for discordance between endoscopic evaluation and final pathology drives current clinical management of patients deemed appropriate candidates for radical cystectomy (RC). Yet some 30% of patients who undergo neoadjuvant chemotherapy (NAC) prior to RC do not harbor detectable malignancy within the bladder at the time of surgery. Our objective was to better understand reliability and shortcomings of cystoscopic evaluation in RC candidates utilizing a protocol where all patients undergoing RC at our institution first receive a Systematic Endoscopic Evaluation (SEE). METHODS Patients undergoing RC for urothelial carcinoma (UC) at our institution were enrolled in a prospective, non-randomized, IRB-approved cohort study to evaluate the reliability of SEE in predicting pT0 bladder cancer. Rigid cystoscopy with targeted biopsy of visible tumor and/or tumor bed/scar, plus two additional random biopsies were performed immediately prior to RC. A standardized bladder map diagram was used to index cystoscopic findings. The endoscopic findings and transurethral biopsy results were then compared to the final pathologic cystectomy specimen RESULTS To date, 39 patients consented to the study, and 36 have received RC. 35 had adequate data for analysis. 22 (63%) underwent RC for MIBC, while 13 (37%) had high-risk NMIBC. 21 (60%) received NAC. On SEE, 17 (49%) patients were noted to have detectable cancer. Upon extirpation, pT0, pTis, pTa, pT1, pT2, pT3, and pT4 UC was found in 11 (31%), 7 (20%), 1 (3%), 2 (6%), 2 (6%), 6 (17%), 6 (17%), respectively. The sensitivity of SEE to predict presence of MIBC at RC was 80.0%. Negative predictive value of SEE to rule out any residual cancer at RC was 55%, and to rule out MIBC was 77.8%. Of 18 patients with no residual disease on SEE, 10 had concordant and 8 had discordant findings on final pathology. MIBC was found in 4 of the 8 discordant patients (Table 1), two of whom had prostatic stromal involvement and were known to have cT4a disease prior to NAC. CONCLUSIONS Our assessment of SEE′s test characteristics immediately prior to RC affords a unique understanding of its limitations and provides potential opportunities for identifying patients whose bladders no longer harbor malignancy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e578-e579 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniel Parker More articles by this author Aeen Asghar More articles by this author John O'Neill More articles by this author Richard Greenberg More articles by this author Marc Smaldone More articles by this author David Chen More articles by this author Rosalia Viterbo More articles by this author Robert Uzzo More articles by this author Joshua Eccles More articles by this author Daniel Geynisman More articles by this author Matthew Zibelman More articles by this author Eric Ross More articles by this author Philip Abbosh More articles by this author Elizabeth Plimack More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II1 Apr 2018PD34-01 USING ADT-FREE SURVIVAL TO EVALUATE THE UTILITY OF SALVAGE CRYOABLATION IN MEN WITH LOCALLY RECURRENT PROSTATE CANCER AFTER RADIATION Shreyas Joshi, David Strauss, Andres Correa, David Cahn, Brian Kadow, Richard Greenberg, Rosalia Viterbo, Marc Smaldone, Alexander Kutikov, Robert Uzzo, and David Chen Shreyas JoshiShreyas Joshi More articles by this author , David StraussDavid Strauss More articles by this author , Andres CorreaAndres Correa More articles by this author , David CahnDavid Cahn More articles by this author , Brian KadowBrian Kadow More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and David ChenDavid Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1568AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate retreatment for locally recurrent prostate cancer (PC) after definitive radiation therapy is infrequently considered. Most men who develop biochemical failure are reflexively started on hormone therapy (ADT). However, as the toxicity of ADT becomes increasingly evident, non-curative therapy that results in prolonged ADT-free survival may be beneficial. We report our experience with salvage prostate cryoablation and its clinical impact and benefit. METHODS Patients were identified from a prospective database of men undergoing salvage cryoablation after definitive prostate radiation by EBRT, brachytherapy, or both. Inclusion required having non-metastatic, biopsy-confirmed, locally recurrent PC with complete PSA information. Pre- and post-salvage PSA characteristics were assessed. A one-sided paired samples T-test (significance p <0.05) was used to evaluate the effect of prostate cryoablation on serum PSA. RESULTS Of 56 identified men, 52 cases met criteria for analysis. Median time between radiation and salvage was 88mo (IQR 19-62.5mo). Median follow-up was 12mo (IQR 4-24mo). The pre- and post-salvage median PSAs were, respectively, 5.49 (IQR 5.68) and 0.14 (IQR 1.16), which were significantly different (mean difference 4.93, 95% CI 3.83-6.03, p <0.001). The median PSA decline following treatment was 96.1% (IQR 33.8%). 29 (56%) men achieved an undetectable nadir PSA. At last follow-up, 41 (79%) men have not progressed to ADT; 11 (21.2%) men eventually received ADT at a median time to initiation of 9mo (IQR 7-29mo). Figure 1 demonstrates the observed pattern for salvage therapy. CONCLUSIONS Salvage prostate therapy for locally recurrent PC is beneficial for men able to defer ADT initiation. 56% of men demonstrated a complete PSA nadir following salvage cryoablation, suggestive for possible curative outcomes. Even for men with a non-zero PSA after salvage, the majority did not require ADT; and 41 (80%) men remain free from treatment within the follow-up period. Salvage prostate cryoablation is an effective secondary treatment that results in prolonged ADT-free survival in carefully selected men. Further follow-up will help define the extent of response and duration of ADT-free survival following salvage therapy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e655 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Shreyas Joshi More articles by this author David Strauss More articles by this author Andres Correa More articles by this author David Cahn More articles by this author Brian Kadow More articles by this author Richard Greenberg More articles by this author Rosalia Viterbo More articles by this author Marc Smaldone More articles by this author Alexander Kutikov More articles by this author Robert Uzzo More articles by this author David Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

RESULTS: Mean Tumor size was 4.3 (AE0.96)cm.The mean RENAL and PADUA scores were 9.9 and 10.6, respectively.There were 42 % of highly complex tumors, 53% of moderate complex tumors and 5% of low complexity tumors.NSS was pursued in all cases.Off-Clamp tumorectomy was achieved in 27% of cases.SRAC success, when attempted, was at 85% and mean superselective WIT was 34(AE19.6)min, mean EBL was 356(AE386) cc.There were two Clavien grade II medical complications, and two Clavien II surgical complications.Mean LOS was 2.3 (AE1.7)days.Pathology reported 7 benign tumors.The surgical margins were all negative.Mean POD-1 eGFR preservation was -15,6%(AE26)% (49 data sets) and at -9.5%(AE21.5)%at POM-3(47 data sets).No local relapse was observed at the 3-months follow-up (55 data sets).We had a 48% achievement of NSS trifecta.. CONCLUSIONS: Our initial experience applied to complex RAPN showed a promising low complications rate with a satisfying 48% trifecta.The implementation of 3D models available to the surgeon during RAPN provides him with pre-operative planning and intraoperative surgical guidance.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2017MP59-12 VALIDATION OF A MATHEMATICAL MODEL TO PREDICT RENAL FUNCTION AFTER NEPHRON SPARING SURGERY Miki Haifler, Andrew Higgins, Benjamin Ristau, Andres Correa, shreyas Joshi, Richard Greenberg, David Chen, Alexander Kutikov, Rosalia Viterbo, Amnon Zisman, and Robert Uzzo Miki HaiflerMiki Haifler More articles by this author , Andrew HigginsAndrew Higgins More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , Andres CorreaAndres Correa More articles by this author , shreyas Joshishreyas Joshi More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David ChenDavid Chen More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Amnon ZismanAmnon Zisman More articles by this author , and Robert UzzoRobert Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1828AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several nephrometry scores have been published in recent years for the purpose of standardizing the anatomy of renal tumors. The most common is the RENAL nephrometry score (NS) that has been associated with peri-operative outcomes. The association of NS with post-operative renal function is still unclear. Recently the concept of Contact Surface Area (CSA) has been introduced and shown to correlate with post-operative renal function. Our aim was to validate CSA as a predictive tool for renal function after nephron sparing surgery (NSS). METHODS The study included all patients who were diagnosed with renal cell carcinoma and underwent NSS at our institute between 1998 and 2014. Patients without renal function, adequate cross sectional imaging or NS information were excluded. CSA was calculated based on abdominal computerized tomography or magnetic resonance imaging using the formula developed by Hsieh et al (The Journal of urology;196(1):33-40). eGFR was calculated using the most recent pre-operative and last follow-up creatinine. The correlation between CSA and NS, absolute and percent change in eGFR (ACE and PCE respectively) was examined by spearman correlation coefficient (SCC). Linear regression model was fitted to examine the association of NS and CSA with ACE and PCE. ROC curve analysis was performed to examine CSA and NS ability to predict more than 10% loss in renal function. RESULTS 234 patients underwent NSS and had sufficient renal function, NS information and adequate imaging to assess CSA (all between 2005-2014). Mean (SD) CSA was 35.3 (52.1) cm2 and median (IQR) NS was 9 (7-10). Median follow-up was 55 months (IQR 37-78). CSA was significantly correlated with NS (SCC 0.727, p<0.001). Furthermore, CSA was significantly correlated with ACE and PCE (SCC -0.97 and -0.95 respectively, p<0.001). Both CSA and RS independently affected change in renal function on multivariable analysis (p<0.001). However, CSA better predicted 10% renal function decline compared with NS on ROC curve analysis (figure, AUC 0.93 vs 0.83). CONCLUSIONS CSA is significantly correlated with NS. Both CSA and NS are significantly correlated with renal function change after NSS. However, CSA is a better predictor of renal function decline compared to RS. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e785 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Miki Haifler More articles by this author Andrew Higgins More articles by this author Benjamin Ristau More articles by this author Andres Correa More articles by this author shreyas Joshi More articles by this author Richard Greenberg More articles by this author David Chen More articles by this author Alexander Kutikov More articles by this author Rosalia Viterbo More articles by this author Amnon Zisman More articles by this author Robert Uzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging III1 Apr 2017PD52-08 CAN LOOKS DECEIVE? NOT ALL CLINICALLY “CYSTIC” RENAL MASSES HARBOR INDOLENT BIOLOGY Benjamin Ristau, Lyudmila DeMora, Eric Ross, Randall Lee, Michael Haifler, Shreyas Joshi, Andres Correa, David Chen, Richard Greenberg, Rosalia Viterbo, Marc Smaldone, Robert Uzzo, and Alexander Kutikov Benjamin RistauBenjamin Ristau More articles by this author , Lyudmila DeMoraLyudmila DeMora More articles by this author , Eric RossEric Ross More articles by this author , Randall LeeRandall Lee More articles by this author , Michael HaiflerMichael Haifler More articles by this author , Shreyas JoshiShreyas Joshi More articles by this author , Andres CorreaAndres Correa More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2196AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cystic renal cell carcinomas (RCC) are suggested to be clinically indolent. As such, a distinct pathologic staging category for these lesions was recently proposed. While not without merit, these recommendations fail to account for limitations in the ability of modern imaging to differentiate cystic RCC from more biologically aggressive mimics. We evaluated the frequency of high grade kidney cancer in the highly selected cohort of surgically resected renal masses having cystic appearance on pre-operative radiographic imaging. METHODS A prospectively maintained institutional database was queried for clinically cystic renal masses that underwent surgery from January 2000 - June 2016 (n=2,729 kidney surgeries). Patient and tumor characteristics including age at surgery, smoking history, Charlson comorbidity index (CCI), gender, race, BMI, surgery date, laterality, Bosniak classification, histology, grade, size, and nearness to the collecting system were tabulated. Associations between tumor grade and patient/tumor characteristics were evaluated using generalized estimating equations. RESULTS Eighty-nine patients (n=101 cystic lesions) met strict inclusion criteria; the majority (77%) were older than 50 years of age and the mean Charlson comorbidity index was 1.15 (SD1.48) (Table 1). Of the 101 clinically cystic renal masses, 23% were confirmed pathologically as high grade RCC while 77% were low grade RCC (n=56) or benign (n=22). CCI was associated with high grade surgical pathology (OR 1.37, 95% CI 1.05-1.79, p = 0.02). There was no association between tumor grade and the remainder of the patient/tumor characteristics analyzed. CONCLUSIONS Recently proposed changes to the kidney cancer staging system define a tumor's cystic nature based on pathologic examination. Proceeding with surgery for a radiographically “cystic” renal mass was a rare event in our cohort; however, among those that went onto surgery, nearly a quarter harbored high grade pathology. Before making changes to the clinical RCC staging system, a better understanding of the limitations inherent to radiographic determination of low malignant potential, cystic renal masses is necessary. © 2017FiguresReferencesRelatedDetailsCited byRistau B and Kutikov A (2017) Editorial CommentJournal of Urology, VOL. 199, NO. 3, (639-640), Online publication date: 1-Mar-2018. Volume 197Issue 4SApril 2017Page: e992 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Benjamin Ristau More articles by this author Lyudmila DeMora More articles by this author Eric Ross More articles by this author Randall Lee More articles by this author Michael Haifler More articles by this author Shreyas Joshi More articles by this author Andres Correa More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Rosalia Viterbo More articles by this author Marc Smaldone More articles by this author Robert Uzzo More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Active Surveillance1 Apr 2017PD59-05 ACTIVE SURVEILLANCE FOR RENAL MASSES WITH > 5 YEARS OF FOLLOW-UP: TUMOR GROWTH, DELAYED INTERVENTION RATES, AND CLINICAL OUTCOMES Andrew McIntosh, Pranav Parikh, Anthony Tokarski, Eric Ross, David Chen, Richard Greenberg, Alexander Kutikov, Marc Smaldone, Rosalia Viterbo, and Robert Uzzo Andrew McIntoshAndrew McIntosh More articles by this author , Pranav ParikhPranav Parikh More articles by this author , Anthony TokarskiAnthony Tokarski More articles by this author , Eric RossEric Ross More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , and Robert UzzoRobert Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2633AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We reviewed our large single center experience with active surveillance (AS) for localized renal masses focusing on patients with > 5 years (yrs) of follow-up. METHODS We queried our prospectively maintained kidney cancer database (n = 2574) for patients (pts) enrolled on AS. Estimated tumor volume (ETV) was calculated using a standard formula and linear growth rate (LGR) was evaluated. Wilcoxon rank sums and Chi-squared tests were used to assess for demographic differences in growth rates and cross-over to DI. Kaplan-Meier curves were used evaluate clinical outcomes. A sub-set analysis (n = 156) was performed of pts with ≥5 yrs follow-up and no cross-over to DI. RESULTS We identified 601 pts enrolled in our AS program (60.1% male, mean age 67.3 yrs, mean ETV of 22.9 cm3). The median follow-up for the entire cohort was 62.6 months (mo). Mean change in ETV was 6.9 cm3/yr (IQR -0.03 to 4.14 cm3/yr) and mean LGR was 2.6 mm/yr. Mean change in ETV of solid masses was more rapid than cystic masses (11.4 vs. 5.8 cm3/yr, p <0.04). Of the entire cohort, 190 pts (32%) crossed over to DI (Figure 1). Among those who crossed over, median time to DI was 16.4 mo (IQR 9.2 to 32.6 mo). Cross over to DI was uncommon after 24 mo whereas nearly two-thirds of patients who crossed over to DI did so within 2 yrs and 77% crossed over within 36 mo of enrolling in AS. Younger pts (63.6 vs. 69.0 yrs, p < 0.0001) and pts with solid versus cystic masses (33.9% vs. 23.3%, p < 0.016) were more likely to cross-over to DI. A majority of pts (89.5%) were still alive at 60 mo follow-up. A subset of 156 pts had ≥5 years of follow-up without crossing over to DI (62.9% men and mean ETV at presentation of 4.26 cm3). 16 pts died, however, only 6 pts (1.5%) exhibited disease progression. One pt died from RCC and 5 developed lymph node or distant metastasis. Mean ETV growth rate for this sub-set was 2.81 cm3/year and mean LGR was 1.4 mm/yr. CONCLUSIONS AS with or without DI is a successful strategy in well selected pts with localized renal masses. Most patients who cross over into DI are likely to do so within the first 2 yrs on AS. Metastasis and death from disease are rare in well selected pts who have been followed for ≥5 yrs. AS of localized renal masses is a sound oncologic practice in select pts beyond 5 yrs of follow-up. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1134 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Andrew McIntosh More articles by this author Pranav Parikh More articles by this author Anthony Tokarski More articles by this author Eric Ross More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Rosalia Viterbo More articles by this author Robert Uzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2017MP58-12 CLINICAL DESTINY OF INDETERMINATE PULMONARY NODULES IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA OF THE BLADDER David Cahn, Brian McGreen, Albert Lee, Karen Ruth, Elizabeth Plimack, Daniel Geynisman, Matthew Zibelman, Benjamin Ristau, Marc Smaldone, Richard Greenberg, Rosalia Viterbo, David Chen, Robert Uzzo, and Alexander Kutikov David CahnDavid Cahn More articles by this author , Brian McGreenBrian McGreen More articles by this author , Albert LeeAlbert Lee More articles by this author , Karen RuthKaren Ruth More articles by this author , Elizabeth PlimackElizabeth Plimack More articles by this author , Daniel GeynismanDaniel Geynisman More articles by this author , Matthew ZibelmanMatthew Zibelman More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , David ChenDavid Chen More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1807AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Perioperative risks and significant quality of life concerns following radical cystectomy (RC) render accurate pre-operative staging paramount. Incidental indeterminate pulmonary nodules (IPNs) are a common pre-operative finding in clinical practice, thus representing a significant management challenge since metastatic patients are unlikely to benefit from extirpation. Thus, we sought to evaluate the natural history of IPNs in a large institutional cohort that underwent RC. METHODS We reviewed our institutional database for patients who underwent RC from 2000-2014 for urothelial carcinoma (UCC) of the bladder & had ≥1 identifiable pulmonary lesion on preoperative staging imaging measuring <2cm in any axis. Patients who were M1 at surgery or had non urothelial histology were excluded. Cumulative incidence of any lung metastasis was estimated, adjusting for competing risk of death; overall survival (OS) was estimating using Kaplan Meier methods. We sought to determine the natural history of these pulmonary lesions and evaluated predictors of metastatic etiology. RESULTS During the study period, 681 RC were performed at our institution. Of which, 73 patients with an identifiable preoperative IPN met inclusion criteria & underwent RC. In this subset, 23% were female, 22% were active smokers & 55% former smokers. The median age at surgery was 70 yrs (range 43-88). 51% received neoadjuvant chemotherapy & 62% of RC were performed using the traditional open approach (vs 38% robotically). Final pathologic staging included 16% pT0N0Mx, 19% pTa/Tis/T1N0Mx, 43% pT2-4N0Mx, & 22% pTanyN+Mx. Median IPN size was 0.7±0.3cm. At median follow up of 23.5 months, the IPNs in 92% (67/73) of patients were clinically benign, with metastatic urothelial cancer confirmed in only 5 patients, & a primary lung malignancy diagnosed in 1 patient. In the IPN cohort, lung metastasis at non-IPN sites were detected in 2 additional patients. Cumulative incidence of any lung metastasis at 12, 24 & 36 months was 5.9% (95%CI 1.9-13.3%), 7.6% (95%CI 2.8-15.7%), & 10.3% (95%CI 3.9-20.2%), respectively. OS at 12, 24 & 36 months was 75.3% (95%CI 62.3-83.9%), 65.8% (95%CI 53-1-75.9%), & 54.0% (95%CI 39.7-66.2%), respectively. CONCLUSIONS The majority of IPNs in patients who proceeded to RC for UCC of the bladder were stable upon follow-up & rarely represented malignancy. Patients with IPNs have OS consistent with previously published literature. As such, in appropriately screened UCC patients, IPNs should not be a barrier to proceeding with extirpative surgical therapy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e776-e777 Advertisement Copyright & Permissions© 2017MetricsAuthor Information David Cahn More articles by this author Brian McGreen More articles by this author Albert Lee More articles by this author Karen Ruth More articles by this author Elizabeth Plimack More articles by this author Daniel Geynisman More articles by this author Matthew Zibelman More articles by this author Benjamin Ristau More articles by this author Marc Smaldone More articles by this author Richard Greenberg More articles by this author Rosalia Viterbo More articles by this author David Chen More articles by this author Robert Uzzo More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease III1 Apr 2017MP80-19 TREATMENT TRENDS AND OUTCOMES FOR LYMPH NODE POSITIVE PENILE CANCER PATIENTS Shreyas Joshi, Handorf Elizabeth, Andres Correa, Michael Haifler, Benjamin Ristau, Robert Uzzo, Richard Greenberg, David Chen, Rosalia Viterbo, Alexander Kutikov, Marc Smaldone, and Daniel Geynisman Shreyas JoshiShreyas Joshi More articles by this author , Handorf ElizabethHandorf Elizabeth More articles by this author , Andres CorreaAndres Correa More articles by this author , Michael HaiflerMichael Haifler More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David ChenDavid Chen More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , and Daniel GeynismanDaniel Geynisman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2524AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile cancer is an uncommon disease with little level I evidence to guide therapy. The NCCN guidelines advocate a lymph node dissection (LND) with consideration of perioperative chemotherapy (CT) for all lymph node positive (LN+) penile cancer (PC) pts. Using a large national cancer registry, we assessed temporal trends in utilization of CT for LN+M0 PC, and evaluated outcomes between those who did (LND+) and did not (LND-) receive a LND and/or chemotherapy (CT+ vs. CT-). METHODS The National Cancer Database (NCDB) was queried for all non-metastatic PC patients with LN+ squamous cell carcinoma of the penis from 2004-2014. Temporal trends were assessed using Cochran-Armitage tests. Adjusting for patient, clinical, and tumor characteristics, multivariable logistic models were used to examine the association between clinicopathologic characteristics and receipt of CT. Kaplan Meier analyses with log-rank tests and multivariable Cox regressions were used to analyze overall survival (OS). RESULTS Of 1123 pts identified, 750 (67%) underwent a LND. Receipt of chemotherapy was similar in both LND+ (40%) and LND- (42%) pts (p=0.53). From 2004-2014, the overall utilization of systemic therapy significantly increased (38% vs. 48%. p=0.0009). However, only 53% of N3 patients received CT (N1 31%, N2 40%). Following adjustment, older patients (76 + years: OR 0.34 [CI 0.19-0.59], p=0.0002) were less likely to receive CT, while N2 (OR 1.62 [CI 1.16-2.27], p=0.005) and N3 (OR 2.32 [CI 1.67-3.22], p<0.0001) pts were more likely to receive CT. High volume centers (≥ 4 cases of PC/year; 29% of all LN+ cases) delivered less CT (OR 0.69 [CI 0.48-1.00], p=0.047). OS varied from 14.9 mo in the LND-/CT- group to 42.6 mo in the LND+/CT+ group. On multivariable analysis, receipt of CT was not associated with OS (HR 0.95 [CI 0.77-1.19], p=0.67). CONCLUSIONS In hospitals reporting to the NCDB, only 67% of LN+ PC pts receive a LND. While CT utilization has increased since 2004, rates remain low, even for N3 pts for whom the NCCN clearly recommends systemic therapy. Surprisingly, high volume centers were less likely to deliver CT for LN+ patients. Receipt of CT does not appear to affect OS, which likely reflects the aggressive natural history of PC. Nonetheless, these data highlight opportunities to improve adherence to guideline-recommended care. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1088 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Shreyas Joshi More articles by this author Handorf Elizabeth More articles by this author Andres Correa More articles by this author Michael Haifler More articles by this author Benjamin Ristau More articles by this author Robert Uzzo More articles by this author Richard Greenberg More articles by this author David Chen More articles by this author Rosalia Viterbo More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Daniel Geynisman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2017MP52-03 CLASSIFICATION OF KIDNEY TUMORS WITH 1064 NM DISPERSIVE RAMAN SPECTROSCOPY Miki Haifler, Isaac Pence, Benjamin Ristau, Andres Correa, shreyas Joshi, Richard Greenberg, David Chen, Marc Smaldone, Alexander Kutikov, Rosalia Viterbo, Robert Uzzo, Amnon Zisman, Anita Mahadevan-Jansen, and Chetan Patil Miki HaiflerMiki Haifler More articles by this author , Isaac PenceIsaac Pence More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , Andres CorreaAndres Correa More articles by this author , shreyas Joshishreyas Joshi More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David ChenDavid Chen More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Amnon ZismanAmnon Zisman More articles by this author , Anita Mahadevan-JansenAnita Mahadevan-Jansen More articles by this author , and Chetan PatilChetan Patil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1633AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The number of small, incidentally detected renal masses increase steadily. About 6,000 benign cases are misclassified radiographically as malignant and removed surgically yearly. Raman spectroscopy (RS) has been widely demonstrated for tissue characterization, however current implementations with either 785 or 830 nm near-infrared excitation have been ineffectual in tissues with intense auto-fluorescence such as the kidney. Recently, a RS system using 1064 nm light source was described which may have greater sensitivity for malignant and benign tissue discrimination due to decreased bulk tissue auto-fluorescence. Our aim was to evaluate the ability of 1064nm RS to distinguish normal and malignant renal tissue. METHODS Ex vivo specimens of Renal Cell Carcinoma and healthy human kidney were obtained from the Cooperative Human Tissue Network at Vanderbilt university. Measurements were made using of a benchtop dispersive 1064 nm Raman system. Multiple spectra were acquired from at least 5 physical locations across each specimen. A total of 93 measurements were used for the final analysis. The resulting spectra were put into a machine learning algorithm, sparse multinomial logistic regression (SMLR), to predict class membership of healthy and malignant tissues, and cross-validated using a leave-one-specimen out approach. Posterior probabilities of group classifications were extracted. Spectral bands that robustly differentiated between malignant and benign tissue were identified by the SMLR algorithm. A quantitative metric based on SMLR outputs called feature importance, defined as the product of the mean weight and frequency of usage of each feature, guided the association of spectral features with biological indicators of healthy and diseased Kidney tissue. RESULTS The SMLR algorithm identified 152 significant Raman spectral bands. most important features are depicted in figure 1. Correct classification by the SMLR algorithm was obtained in 93.33% of the trials with sensitivity, specificity, negative and positive predictive value of 93.2%, 88.6, 92.9% and 89.2% respectively. CONCLUSIONS RS can accurately differentiate normal and malignant renal tissue. This suggests implications for utilizing RS for optical biopsy and surgical guidance in nephron sparing surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e704 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Miki Haifler More articles by this author Isaac Pence More articles by this author Benjamin Ristau More articles by this author Andres Correa More articles by this author shreyas Joshi More articles by this author Richard Greenberg More articles by this author David Chen More articles by this author Marc Smaldone More articles by this author Alexander Kutikov More articles by this author Rosalia Viterbo More articles by this author Robert Uzzo More articles by this author Amnon Zisman More articles by this author Anita Mahadevan-Jansen More articles by this author Chetan Patil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 2017MP08-01 ACTIVE SURVEILLANCE FOR CYSTIC RENAL MASSES WITH ≥5 YEARS OF FOLLOW-UP Andrew McIntosh, Pranav Parikh, Anthony Tokarski, Eric Ross, David Chen, Richard Greenberg, Alexander Kutikov, Marc Smaldone, Rosalia Viterbo, and Robert Uzzo Andrew McIntoshAndrew McIntosh More articles by this author , Pranav ParikhPranav Parikh More articles by this author , Anthony TokarskiAnthony Tokarski More articles by this author , Eric RossEric Ross More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , and Robert UzzoRobert Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.288AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We review our large singe center experience with active surveillance (AS) for cystic renal masses (CRMs), focusing on patients with ≥ 5 years (yrs) of follow-up. METHODS We queried our prospectively maintained kidney cancer database (n = 2574) to identify patients with CRMs enrolled on AS. Estimated tumor volume (ETV) at presentation was calculated using a standard formula and linear growth rate (LGR) was evaluated. Wilcoxon rank sums were used to assess for demographic differences in growth rates and crossover to delayed intervention (DI). Kaplan-Meier curves were used to evaluate pts who crossed over to DI. A sub-set analysis was performed of patients with ≥5 years follow-up and no cross-over to DI. RESULTS Of 601 AS patients, we identified 196 patients with CRMs enrolled in AS (64.3% male, median age 64.3 yrs, and mean ETV of 39.1 cm3). The median follow-up for the CRM cohort was 59.7 months. 48 patients (24%) with cystic renal masses crossed over to DI with a median time to DI of 16.7 months (IQR 10.8 - 27.7 months). When compared to solid masses, patients with CRMs (33.9% vs. 23.3%, p < 0.016) were less likely to proceed to treatment. The majority of patients (64%) with CRMs who crossed over to DI did so within 2 years. Younger patients (57.2 vs. 64.4 yrs, p < 0.001) were more likely to crossover to DI. Mean change in ETV was 5.8 cm3/yr and mean LGR was 2.6 mm/yr. Mean change in ETV of cystic masses was slower than solid masses (5.8 vs. 11.4 cm3/yr, p <0.04). A majority of patients (95.4%) were still alive at 60 months follow-up. A subset of 37 patients with CRMs had ≥5 years of follow-up without crossing over to DI. All of the patients were alive and only one patient developed distant metastasis. Mean LGR for this sub-set was 0.1 mm/yr. CONCLUSIONS Active surveillance with or without delayed intervention is a successful strategy in well selected patients with localized cystic renal masses. Most patients who cross over into DI are likely to do so within the first 2 years on AS. Metastasis and death are rare events in a well selected group of patients. Cystic masses grow more slowly and are less likely to proceed to intervention when compared to solid masses. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e90 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Andrew McIntosh More articles by this author Pranav Parikh More articles by this author Anthony Tokarski More articles by this author Eric Ross More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Rosalia Viterbo More articles by this author Robert Uzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

441 Background: There is currently no consensus regarding the use of systemic therapy (ST) for surgically-treated patients with invasive UTUC. Using a large national cancer registry, our objective was to assess temporal trends in utilization of ST for stage II-IV UTUC undergoing definitive resection. Methods: The National Cancer Database (NCDB) was queried for all patients surgically treated (nephroureterectomy, segmental resection) for stage II-IV UTUC from 1998-2012. Temporal trends in receipt of ST [neoadjuvant (NAT), adjuvant (AT), or unknown timing (UKT)] were assessed using chi square analyses. After exclusion of patients receiving NAT or UKT, adjusting for patient and clinicopathologic characteristics, multivariable logistic models were used to examine the association between clinicopathologic characteristics and receipt of ST within 9 months of resection. Kaplan Meier analyses and stratified log-rank tests were performed comparing overall survival (OS) between patients receiving ST < 9 months and those who did not. Results: Of 7,629 patients identified over the study period, 24.1% of patients surgically treated for stage II-IV UTUC received any ST (NAT: 1.44%, AT: 19.11%, UKT: 3.51%). Utilization of any ST significantly increased from 1998-2012 (20.2% vs. 28.7%, p < 0.0001). Following adjustment, patients of increased age (61-70 years: OR 0.62 [CI 0.42-0.91], 71+ years: OR 0.26 [CI 0.17-0.38]) were less likely to receive ST, and patients with high grade (OR 2.46 [CI 1.95-3.09]), Stage III (OR 4.75 [CI 3.89-5.79]), and Stage IV (OR 9.37 [CI 7.49-11.74]) disease were more likely to be treated with ST. When restricted to stage III-IV disease, receipt of ST < 9 months was significantly associated with improved OS after adjustment for age, grade, and charlson index (p < 0.002). Conclusions: In hospitals reporting to the NCDB, while utilization has significantly increased from 1998-2012, less than one third of patients surgically treated for stage II-IV UTUC receive ST. In addition to unmeasured characteristics (decline of renal function following surgery), the lack of explicit guidelines and prospective evidence may contribute to limited use of systemic treatment.

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy1 Apr 2016MP14-05 POST-SALVAGE THERAPY, PARTICULARLY WITH NADIR PSA<1, DELAYS THE TIME TO SUBSEQUENT ANDROGEN DEPRIVATION THERAPY Anuj Desai, Mohammed Haseebuddin, Daniel Parker, Karthik Devarajan, Nikhil Waingankar, Benjamin Ristau, Michael Haifler, Eric Horwitz, Colleen Turrisi, Alexander Kutikov, Marc Smaldone, Richard Greenberg, Robert Uzzo, Rosalia Viterbo, and David Chen Anuj DesaiAnuj Desai More articles by this author , Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Daniel ParkerDaniel Parker More articles by this author , Karthik DevarajanKarthik Devarajan More articles by this author , Nikhil WaingankarNikhil Waingankar More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , Michael HaiflerMichael Haifler More articles by this author , Eric HorwitzEric Horwitz More articles by this author , Colleen TurrisiColleen Turrisi More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , and David ChenDavid Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2508AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Androgen Deprivation Therapy (ADT) is associated with bothersome hot flashes, sexual dysfunction, psychological well being, cardiovascular toxicity, anemia, bone-loss, and skeletal-related events. Recent data suggests ADT to be detrimental, and may increase non-cancer related incidence of death. Many prostate cancer patients who fail after radiation therapy are routinely placed on ADT. Our aim is to assess whether salvage therapy may decrease and delay the need for ADT. METHODS Prostate cancer patients who failed radiation therapy identified with clinically localized recurrence and underwent salvage cryotherapy (SC) or prostatectomy (SRP) and had subsequent follow-up at Fox Chase Cancer Center between 2003 and 2015 were included in our study. Clinicopathological variables were retrieved retrospectively. ADT-free survival (ADFS) curves were estimated with Kaplan-Meier methods and compared with the log-rank test. RESULTS 37 patients were included, 28 had SC and 9 had SRP. The median follow-up was 32.0 months (range 1.6-122.5 months). 70.3% of salvage treatment patients (19/28 SC, 7/9 SRP) have not progressed to ADT treatment at last follow-up. The median ADFS was 49.2 mo (see figure). There was no difference in ADFS between SC or SRP group (p = 0.52). 77.77% (7/9) SRP patients and 51.9% (14/27) SC experienced nadir PSA <1 (p = 0.25). Patients with nadir PSA >1 had shorter time to median ADFS than those with PSA<1 (9.7 months vs 83.6 months, p <0.0001). Similar trend in median ADFS between nadir PSA<1 and PSA>1 was also seen in SC and SRP groups [SC 13 mo vs 83.6 mo, p = 0.0038; SRP 7.65 vs not-reached, p = 0.0026]. CONCLUSIONS Salvage therapy for local failure after radiation therapy can significantly delay time to ADT. PSA nadir < 1, rather than treatment modality, predicts the need for ADT after salvage therapy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e144-e145 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Anuj Desai More articles by this author Mohammed Haseebuddin More articles by this author Daniel Parker More articles by this author Karthik Devarajan More articles by this author Nikhil Waingankar More articles by this author Benjamin Ristau More articles by this author Michael Haifler More articles by this author Eric Horwitz More articles by this author Colleen Turrisi More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Richard Greenberg More articles by this author Robert Uzzo More articles by this author Rosalia Viterbo More articles by this author David Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII1 Apr 2016MP53-01 DEFINING DELIVERABLES OF MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING (MPMRI)/ULTRASOUND (US) FUSION-GUIDED TARGETED PROSTATE BIOPSY: ACTIONABLE INTELLIGENCE METRIC (AIM) AND REDUCTION METRIC (RM) Benjamin Ristau, Aseem Malhotra, Serge Ginzburg, David Chen, Rosaleen Parsons, Barton Milestone, Marion Brody, Michael Haifler, Mohammed Haseebuddin, Nikhil Waingankar, Rosalia Viterbo, Richard Greenberg, Marc Smaldone, Robert Uzzo, and Alexander Kutikov Benjamin RistauBenjamin Ristau More articles by this author , Aseem MalhotraAseem Malhotra More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , David ChenDavid Chen More articles by this author , Rosaleen ParsonsRosaleen Parsons More articles by this author , Barton MilestoneBarton Milestone More articles by this author , Marion BrodyMarion Brody More articles by this author , Michael HaiflerMichael Haifler More articles by this author , Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Nikhil WaingankarNikhil Waingankar More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.498AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transrectal ultrasound-guided prostate biopsy (TRUS-B) is the gold standard for prostate cancer (CaP) diagnosis. mpMRI/US fusion targeted biopsy (TB) has emerged as a technique to optimize the procedure. The ideal prostate biopsy would: (1) identify all non-low risk CaP with greater sensitivity than TRUS-B; (2) eliminate the need for unnecessary sampling. Using our institutional dataset and the available literature, the objective of the present study was to define metrics that more accurately demonstrate the deliverables of TB and facilitate meaningful data comparisons. METHODS Patients (pts) with indications for TRUS-B having identified prostate lesions (PIRADS 3-5) on mpMRI were included. The UroNav System (Invivo) was used to obtain 1-4 TBs of each targeted lesion. All men underwent concurrent 12-core TRUS-B. Actionable intelligence metric (AIM) was defined as all pts with higher Gleason score (GS) on TB (minimum GS≥3+4=7) relative to TRUS-B ÷ total pts with GS≥3+4=7 CaP (i.e. % for whom TB offered actionable data over TRUS-B). Reduction metric (RM) was defined as 1 - [all pts with higher GS on TRUS-B (minimum GS≥3+4=7) relative to TB ÷ total pts undergoing biopsy] (i.e. % who could have foregone TRUS-B). Cohort metrics were compared to previously published data. RESULTS 149 pts (mean age 64±7.4y, PSA 9.1±8.6 ng/ml, and prostate volume 53.6±34.2 cc) were examined: 21 (14.1%) biopsy naive men (G1), 74 (49.7%) men with prior negative TRUS-B (G2), and 54 (36.2%) men with prior positive TRUS-B on an active surveillance (AS) protocol (G3). Overall cancer detection rate was 90/149 (60.4%): 12/21 (57%) for G1, 33/74 (44.6%) for G2, and 45/54 (83.3%) for G3. AIM and RM for the entire cohort was 22.6% and 78.5%; 25% and 81.0% for G1, 28.6% and 81.1% for G2, and 12.0% and 72.2% for G3. These findings are similar to previously published cohorts in which the AIM and RM are 13.6% and 95.5% and 23.6% and 93.6% for G1 and G2, respectively. AIM and RM for men on AS is not calculable from the currently published literature. CONCLUSIONS TB harbors potential for improvement over TRUS-B; however, deliverables of this costly technology must be outlined. We define two metrics, AIM and RM, for use in future reports to help quantify, communicate, and compare the added value of TB technology. At present, 12-core TRUS-B remains a necessary adjunct to TB, particularly in the AS setting. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e697 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Benjamin Ristau More articles by this author Aseem Malhotra More articles by this author Serge Ginzburg More articles by this author David Chen More articles by this author Rosaleen Parsons More articles by this author Barton Milestone More articles by this author Marion Brody More articles by this author Michael Haifler More articles by this author Mohammed Haseebuddin More articles by this author Nikhil Waingankar More articles by this author Rosalia Viterbo More articles by this author Richard Greenberg More articles by this author Marc Smaldone More articles by this author Robert Uzzo More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

INTRODUCTION AND OBJECTIVES: Recent reports suggest that patients who experience de novo chronic kidney disease (CKD) due to surgical removal of nephrons (CKD-S) differ from patients with pre-existing CKD who undergo similar procedures (CKD-M/S).Here, we evaluate survival in these groups following kidney surgery.METHODS: We queried our prospective Kidney Cancer Database for all patients who underwent radical or partial nephrectomy during January 1990 to July 2015 where survival data was available.New baseline GFR (nbGFR) was calculated 30 days after surgery.We divided the cohort into 3 groups: no post-op CKD (nbGFR >60); new onset post-op CKD (CKD-S ¼nbGFR< 60 with normal pre-op GFR); and persistent CKD (CKD-M/S ¼nbGFR and preoperative GFR both < 60).New onset CKD patients (CKD-S) patients were then further divided into 2 groups: nbGFR <45 (severe) and nbGFR>45 (mild).Kaplan-Meier estimates were used to assess overall survival (OS) and cancer specific survival (CCS).Cox proportional hazards model was fitted while controlling for age, gender and comorbidities.RESULTS: 947 patients were included in the study.No CKD, new onset CKD-S and persistent CKD-M/S groups included 525 (55.4%), 267 (28.19%) and 155 (16.37%) patients respectively.67.27% of the patients were male and 65.8% had measured comorbidities.CKD-M/S had a lower nbGFR compared with CKD-S and no CKD (40 vs. 49 vs. 81, p<0.0001).The median follow-up was 40.1 m (IQR 18.6-69.9).CKD-M/S and CKD-S groups experienced similar overall and cancer specific survival for the first 5 years after surgery, but CKD-M/S survival declined thereafter.In the multivariable analysis, gender, age and comorbidities did not affect OS and CSS in patients with CKD post-op.In this cohort, CKD-S (HR 1.8 [95%CI 1.31-2.47],p<0.003) and CKD-M/S (HR 2.01 [95%CI 1.45-3.024],p<0.0001) status did influence OS and CSS compared with no CKD.Similar results were found for cancer specific mortality.Mild and severe CKD-S groups had similar overall survival in our cohort (p¼0.746), while mild CKD-S group had better mean cancer specific survival (105 m vs. 56.m,p ¼0.013).CONCLUSIONS: Our data support the finding that post-operative CKD subtype status is associated with survival outcomes.We note that CKD-S patients demonstrated outcomes superior to CKD-M/S patients, but inferior to the no CKD group.

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) II1 Apr 2016PD04-02 RENAL FUNCTION BEFORE AND AFTER CYTOREDUCTIVE NEPHRECTOMY IN A PHASE 3 RANDOMIZED CLINICAL TRIAL Erik N. Mayer, BS William T. Lowrance, MD, MPH Robert Uzzo, MD Christopher Wood, MD, FACS Alexander Kutikov, MD, FACS Marc Smaldone, MD, MSHP Jason Gee, MD William Huang, MD Thomas Gardner, MD Gennady Bratslavsky, MD Jeff Holzbeierlein, MD, FACS Lawrence Karsh, MD Viraj Master, MD, PhD, FACS Neal Shore, andMD Brian LaneMD, PhD, FACS Erik N. MayerErik N. Mayer More articles by this author , William T. LowranceWilliam T. Lowrance More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Christopher WoodChristopher Wood More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Jason GeeJason Gee More articles by this author , William HuangWilliam Huang More articles by this author , Thomas GardnerThomas Gardner More articles by this author , Gennady BratslavskyGennady Bratslavsky More articles by this author , Jeff HolzbeierleinJeff Holzbeierlein More articles by this author , Lawrence KarshLawrence Karsh More articles by this author , Viraj MasterViraj Master More articles by this author , Neal ShoreNeal Shore More articles by this author , and Brian LaneBrian Lane More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2407AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cytoreductive nephrectomy (CN) in the setting of metastatic renal cell carcinoma (mRCC) has shown improvement in overall survival for select patients when combined with systemic therapy, but its impact on renal function is not completely understood. Our objective was to assess renal function before and after CN in patients with mRCC participating in the ADAPT (The Autologous Dendritic Cell Immunotherapy (AGS-003) Plus Standard Treatment of Advanced Renal Cell Carcinoma) trial. METHODS We examined pre-/post-CN renal function from the ongoing phase 3 clinical trial involving administration of AGS-003 + Sunitinib vs. Sunitinib alone after CN in patients with mRCC. Records of patients at trial sites between January 2013 and July 2015 were reviewed for tumor characteristics, established CKD risk factors, and demographic information. A univariate and multivariate logistic regression analysis was used to evaluate the impact of patient and disease specific factors on pre-operative renal function. RESULTS The ADAPT trial has enrolled >1000 patients at 113 centers worldwide since April 2012. Trial accrual completed mid-2015. Pre-operative info was available for 1007 patients. Of those undergoing CN, 198 (19.7%) had stage 3 or greater CKD (GFR < 60ml/min/1.73 m2) at baseline. Factors independently associated with an increased risk of pre-operative stage 3 or greater CKD included age at diagnosis (OR: 1.064, 95% CI: 1.042-1.087, p < .0001), LDH above the upper limit of normal (OR: 1.851, 95% CI: 1.231-2.781, p<0.003), and advanced tumor stage. The likelihood of having at least stage 3 CKD at surgery was lower for T stage 1 (OR 0.432, 95% CI: 0.192-0.969, p<0.042) and T stage 2 disease (OR: 0.303, 95% CI: 0.117-0.788, p<0.014) than for T stage 3. Gender, race, low albumin, symptoms of metastasis, and adenopathy were not significantly associated with pre-operative CKD stage 3 or greater. Post-operative GFR data was limited to 426 patients; the median change after CN was -21.6 ml/min/1.73 m2. Of these patients, 160 (37.6%) developed CKD 3 or greater post CN in the setting of previously normal renal function. CONCLUSIONS The ADAPT trial is the largest randomized CN trial completed to date. Here we observed that one fifth of patients with mRCC in this trial had baseline stage 3 or worse CKD. Increasing tumor stage and age were associated with a greater risk for pre-operative CKD in patients undergoing CN. Moreover, 37.6% of patients with available data developed de novo CKD 3 or worse post-CN. Older patients with advanced disease may be at higher risk of significant renal insufficiency after CN. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e120-e121 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Erik N. Mayer More articles by this author William T. Lowrance More articles by this author Robert Uzzo More articles by this author Christopher Wood More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Jason Gee More articles by this author William Huang More articles by this author Thomas Gardner More articles by this author Gennady Bratslavsky More articles by this author Jeff Holzbeierlein More articles by this author Lawrence Karsh More articles by this author Viraj Master More articles by this author Neal Shore More articles by this author Brian Lane More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2016PD41-11 DIFFERENCES IN OVERALL SURVIVAL FOR PATIENTS WITH STAGE I-II RENAL CELL CARCINOMA TREATED WITH PARTIAL OR RADICAL NEPHRECTOMY Benjamin Ristau, Elizabeth Handorf, Robert Uzzo, David Cahn, Simon Kim, Miki Haifler, Nikhil Waingankar, Mohammed Haseebuddin, Rosalia Viterbo, David Chen, Richard Greenberg, Alexander Kutikov, and Marc Smaldone Benjamin RistauBenjamin Ristau More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Robert UzzoRobert Uzzo More articles by this author , David CahnDavid Cahn More articles by this author , Simon KimSimon Kim More articles by this author , Miki HaiflerMiki Haifler More articles by this author , Nikhil WaingankarNikhil Waingankar More articles by this author , Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , and Marc SmaldoneMarc Smaldone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1557AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite conflicting evidence regarding a survival benefit, partial nephrectomy (PN) remains the gold standard treatment for Stage Ia renal masses and the preferred treatment for Stage Ib/II tumors when technically feasible. Our objective was to assess overall survival (OS) differences for Stage I-II Renal Cell Carcinoma (RCC) stratified by surgical type using a large national tumor registry METHODS The National Cancer Database (NCDB) was queried for all patients with Stage I-II RCC undergoing PN or radical nephrectomy (RN) from 2003-2012. Patients were stratified by clinical stage and tumor size as T1a (≤4cm) and T1b/T2 (>4cm). Temporal trends were assessed using Cochran-Armitage tests. Following adjustment, differences in OS by procedure type were assessed using Kaplan Meier methods. The effects of procedure type on overall mortality were assessed using Cox proportional hazards models (CPHM) adjusted by propensity score based weighting. RESULTS 179,846 patients with Stage I-II RCC undergoing RN (62%) or PN (38%) met inclusion criteria. Stratified by size, 54.6% of T1a and 15.8% of T1b/2 tumors were treated with PN respectively. A significant increase in receipt of PN was noted from 2003-2012 (T1a: 37.1 to 69.1%, p<0.001; T1b/2: 7.9 to 25.8% p<0.001). Adjusted 5-year OS was significantly longer for patients receiving PN over RN in both subsets, however these benefits were tempered in the T1b/2 cohort (89.0% vs. 84.6% for T1a, p<0.01; 81.3% vs 80.0% for T1b/2, p=0.045; Figure 1). On CPHM, a statistically significant survival advantage for patients with T1a tumors treated with PN compared to RN was observed (HR 0.74 [CI 0.71-0.76]), while the observed survival benefit was diminished for patients with T1b/2 tumors treated with PN (HR 0.90 [CI 0.85-0.96]). CONCLUSIONS In patients captured by the NCDB, receipt of PN is associated with improved OS for T1a RCC, which is consistent with prior observational studies and likely reflects some degree of selection bias. In comparison, differences in OS between PN and RN were markedly attenuated for T1b/2 tumors. In the absence of level I evidence, the decision to perform a PN for a clinical stage T1b/2 tumor should be based on individualized risk assessment. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e944 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Benjamin Ristau More articles by this author Elizabeth Handorf More articles by this author Robert Uzzo More articles by this author David Cahn More articles by this author Simon Kim More articles by this author Miki Haifler More articles by this author Nikhil Waingankar More articles by this author Mohammed Haseebuddin More articles by this author Rosalia Viterbo More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2015MP24-05 TREATMENT DELAYS IN THE MANAGEMENT OF MUSCLE INVASIVE BLADDER CANCER: ANALYSIS OF THE NATIONAL CANCER DATABASE Nikhil Waingankar, Thomas Churilla, Elizabeth Handorf, Mohammed Haseebuddin, Jeffrey Tomaszewski, Daniel Canter, Alexander Kutikov, Eric Horwitz, Richard Greenberg, David Chen, Rosalia Viterbo, Robert Uzzo, and Marc Smaldone Nikhil WaingankarNikhil Waingankar More articles by this author , Thomas ChurillaThomas Churilla More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski More articles by this author , Daniel CanterDaniel Canter More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Eric HorwitzEric Horwitz More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David ChenDavid Chen More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Marc SmaldoneMarc Smaldone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1147AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An association between treatment delay greater than 90 days and inferior survival outcomes has been observed in patients undergoing radical cystectomy (RC) for muscle invasive bladder cancer (MIBC). Our objective was to characterize delays to definitive therapy in patients with MIBC stratified by treatment type using a large national cancer registry. METHODS The National Cancer Database (NCDB) was queried for all patients diagnosed with cT2-4N0M0 bladder cancer from 2003 to 2010 who underwent local therapy (primary RC, neoadjuvant chemotherapy [NC] followed by RC, or bladder preservation therapy [defined as radiation therapy with or without chemotherapy]). Treatment delay was defined as first definitive treatment greater than 90 days from time of diagnosis. Adjusting for clinicopathologic characteristics, generalized estimating equations were used to assess for associations between treatment type and treatment delay. RESULTS In the NCDB, 27,284 patients met inclusion criteria. Of these, 61.3% underwent RC, 11.3% received NC, and 27.4% were treated with bladder preservation. 13.6% of patients experienced a treatment delay, and this proportion increased over the study period (11.7 to 14.1%, p<0.001). Mean time to treatment (days) differed between treatment groups (RC: 50.8±40.1, NC: 42.5±42.3, bladder preservation: 58.4±46.0, p<0.001) as did the proportion experiencing treatment delays (RC: 12.6%; NC: 10%; bladder preservation: 17.2%, p<0.001). Following adjustment, covariates associated with treatment delay included age (61-70 years: OR 1.46 [CI 1.15-1.86]; >70 years: OR 1.39 [CI 1.09-1.78]), male gender (OR 1.26 [CI 1.17-1.37]), African American (OR 1.30 [CI 1.12-1.50]) or Hispanic (OR 1.39 [CI 1.12-1.72]) race, Medicaid insurance (OR 1.5 [CI 1.22-1.85]), and Charlson count >1 (OR 1.22 [CI 1.07-1.40]. Compared to RC, patients were more likely to experience a delay to treatment if undergoing bladder preservation therapy (OR 1.53 [CI 1.39-1.68]), while patients undergoing NC were less likely to experience a treatment delay (OR 0.64 [CI 0.52-0.79]). CONCLUSIONS In the NCDB, 13.6% of patients with MIBC undergoing local therapy experience treatment delay >90 days, with the greatest proportion being those treated with bladder preservation. Mechanisms to improve the efficiency of multidisciplinary referral and evaluation at the time of diagnosis may be effective in reducing treatment delays in this at risk patient population. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e277 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Nikhil Waingankar More articles by this author Thomas Churilla More articles by this author Elizabeth Handorf More articles by this author Mohammed Haseebuddin More articles by this author Jeffrey Tomaszewski More articles by this author Daniel Canter More articles by this author Alexander Kutikov More articles by this author Eric Horwitz More articles by this author Richard Greenberg More articles by this author David Chen More articles by this author Rosalia Viterbo More articles by this author Robert Uzzo More articles by this author Marc Smaldone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

383 Background: Per the NCCN guidelines, inguinal lymph node dissection (ILND) is recommended for patients with intermediate (T1b) or high (Any T2 or Grade 3) risk disease even in the absence of palpable inguinal nodes. Our objective was to assess temporal trends in utilization of ILND and to determine factors associated with the receipt of ILND using National Cancer Database (NCDB). Methods: The NCDB was queried for all patients diagnosed with T2 penile cancer from 1998-2011. Temporal trends for receipt of ILND were assessed. Adjusting for patient, demographic, and clinicopathologic characteristics, multivariable logistic regression models were used to examine the association between available covariates and receipt of ILND. Results: Of 2019 patients identified over the study period, 693 (34.3%) underwent ILND. Rates of ILND did not significantly improve from 1998 to 2011 (34.2 to 40.0%; p = 0.09). Significant differences were observed in patients undergoing ILND with respect to age (p<0.001), Hispanic ethnicity (p=0.04), insurance status (p<0.001), and facility type (p<0.001), while no changes were seen with respect to race, income, education, urban/rural location, tumor grade, or Charlson co-morbidity score. Following adjustment, patients with high grade disease (OR 1.35 [CI 1.1-1.7]) and those treated at academic centers (OR 3.2 [CI 2.2-4.7]) were more likely to receive ILND, while patients >70 years of age (OR 0.41 [CI 0.28-0.60]) were less likely to receive ILND. Conclusions: In the NCDB, less then 35% of patients with T2 penile cancer receive ILND and the rates have not significantly changed over the last decade. Referral of patients with this uncommon, highly morbid lethal disease to experienced centers may increase adherence to guideline recommended care.

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging III1 Apr 2015MP50-14 CLINICAL STAGE I RENAL MASS UPSTAGING TO PATHOLOGICAL T3A DISEASE PORTENDS A WORSE PROGNOSIS ONLY WHEN SINUS FAT INVASION IS PRESENT Sumit De, Robert Uzzo, Elizabeth Handorf, David Chen, Rosalia Viterbo, Richard Greenberg, Nikhil Waingankar, Mohammed Haseebuddin, Marc Smaldone, and Alexander Kutikov Sumit DeSumit De More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , David ChenDavid Chen More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Nikhil WaingankarNikhil Waingankar More articles by this author , Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2925AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Invasion of intrarenal or perirenal adipose tissue carries a pT3a designation in the AJCC 7 Staging System for Renal Cell Carcinoma and thus implies an inferior prognosis. We sought to reevaluate in a large prospectively maintained dataset the association between oncologic outcomes and pT3a upstaging due to adipose invasion in patients undergoing surgery for a cT1 renal mass. METHODS Patients with cT1N0M0 renal masses who were surgically treated between February 2001 and July 2014 were identified in our prospectively maintained institutional registry. We used Kaplan-Meier survival curves with log rank statistic to evaluate overall and progression free survival. Univariable and multivariable Cox regression analyses were used to assess prognostic roles of perirenal and sinus fat invasion, controlling for age, sex, tumor size, histology, and grade. RESULTS A total of 792 of 3240 patients met inclusion criteria. Median follow-up was 2.4 years for the cohort with 92 (11.6%) patients demonstrating disease progression. Upstaging to T3a disease was noted in 52 (6.6%) patients. Of these, 21 (40.4%) patients exhibited invasion of sinus fat. Perinephric fat invasion was not a significant predictor of progression on univariable analysis (HR 0.69, 95% CI 0.17-2.84, p=0.613). Meanwhile, on both univariable (HR 4.05, 95% CI 1.87-8.81, p=<0.001) and multivariable analyses (HR 2.83, 95% CI 1.23-6.53, p=.01) sinus fat invasion was strongly associated with disease progression. CONCLUSIONS Not all T3a disease is the same. Only invasion of sinus fat in patients undergoing surgery for clinical stage I renal mass was associated with disease recurrence. Perirenal fat invasion, on the other hand, was not linked with worse oncologic outcomes when compared with patients without tumor upstaging. If validated in other datasets, these data may help inform decision-making when formulating future AJCC staging criteria. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e616 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumit De More articles by this author Robert Uzzo More articles by this author Elizabeth Handorf More articles by this author David Chen More articles by this author Rosalia Viterbo More articles by this author Richard Greenberg More articles by this author Nikhil Waingankar More articles by this author Mohammed Haseebuddin More articles by this author Marc Smaldone More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2015PD12-07 DECLINE IN THE USE OF RADIATION FOR STAGE I SEMINOMA: ANALYSIS OF THE NATIONAL CANCER DATABASE Nikhil Waingankar, Elizabeth Handorf, Marc Smaldone, Elizabeth Plimack, Yu-Ning Wong, Mohammed Haseebuddin, Eric Horwitz, Robert Uzzo, and Alexander Kutikov Nikhil WaingankarNikhil Waingankar More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Elizabeth PlimackElizabeth Plimack More articles by this author , Yu-Ning WongYu-Ning Wong More articles by this author , Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Eric HorwitzEric Horwitz More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1059AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Historically, primary radiotherapy has been the preferred treatment modality for stage I seminoma. However, there is emerging consensus that observation or primary chemotherapy may be the preferred management strategies to reduce overtreatment and risk of secondary malignancy. Hypothesizing that the use of radiotherapy has decreased in the modern era, our objective was to assess temporal practice patterns in stage I seminoma using a large national cancer registry. METHODS The National Cancer Database (NCDB) was queried for all patients diagnosed with stage I seminoma from 1998 to 2011. Temporal trends for receipt of systemic chemotherapy, radiation, and observation (defined as no treatment) were assessed. Following adjustment for patient, demographic, and clinicopathologic characteristics, generalized estimating equations were used to assess for associations between covariates and receipt of primary radiotherapy. RESULTS Of the 34,251 patients identified with stage I seminoma in the NCDB, 20,627 were treated with radiation (60.2%), 2,278 were treated with chemotherapy (6.7%), and 11,346 were managed with observation (33.1%). Radiation use significantly declined from 73.5% in 1998 to 29.6% in 2011 (p<0.0001), while utilization of chemotherapy (1.9% to 16.5%, p<0.0001) and observation (24.6% to 53.9%, p<0.0001) markedly increased (FIGURE 1). Following adjustment, age categories 30−39 years (OR 1.06 [CI 1.01−1.13]) and 40−49 years (OR 1.10 [CI 1.03−1.17]), pathologic stage T2 (OR 1.25 [CI 1.17−1.32]) and T3 (OR 1.21 [CI 1.04−1.41]), and facilities located in the East (IL, IN, MI, OH, WI; OR 1.59 [CI 1.32-1.92]) and West North Central states (IA, KS, MN, MO, ND, SD, NE; OR 1.82 [CI 1.44-2.28]) were associated with increased utilization of radiotherapy. Uninsured patients (OR 0.78 [CI 0.71−0.86]) and those with Medicaid (OR 0.82 [CI 0.73−0.92]) or Medicare (OR 0.62 [CI 0.55−0.69]) were less likely to undergo primary radiotherapy. CONCLUSIONS Utilization of radiation therapy for stage I seminoma is on the decline. Coinciding with shifts in evidence−based guidelines, observation is now the most commonly employed management strategy for patients with Stage I seminoma. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e258-e259 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Nikhil Waingankar More articles by this author Elizabeth Handorf More articles by this author Marc Smaldone More articles by this author Elizabeth Plimack More articles by this author Yu-Ning Wong More articles by this author Mohammed Haseebuddin More articles by this author Eric Horwitz More articles by this author Robert Uzzo More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...