"Saturation prostate biopsy in patients with raised age-related PSA and non-malignant previous TRUS biopsies"

Abstract

s / International Journal of Surgery 10 (2012) S53–S109 S97 ABSTRACTS year survival estimates, but follow up limits comparison of actual survival. However, a recent study has suggested that 2 year follow up data correlates well with 5-year survival. 0486: PROSTATE BIOPSY IN PATIENTS WITH RAISED AGERELATED PSA AND NON-MALIGNANT PREVIOUS TRUS Michelle Christodoulidou, Mohsen El-Gammal. Southport and Ormskirk Hospital NHS Trust, Southport,Merseyside, UK Aim: To review the demographic data of patients that underwent Saturation Prostate Biopsies over an 18 month period with emphasis on the indications, antibiotic cover, complications and histological outcome. Method: Patients were traced by the Theatres Register and GALAXY system. Data were collected from case notes. Results: 28 Saturation Biopsies were performed between July 2010 and December 2011. Median age was 67, 54% of patients had LUTS and 7% had family history of prostate cancer. 14% had abnormal DRE. Median value of 2 TRUS biopsies were taken prior to the Saturation Biopsy. All patients were given 160mg Gentamicin IV and a 3 day course of Ciprofloxacin orally. Only one case presentedwith Urosepsis requiring IV antibiotics. Saturation biopsy diagnosedmalignancy in36%ofpatients.1patientwhohadbenign saturation biopsy subsequently underwent a Template biopsy that showedmalignancy. Conclusions: Saturation Biopsy is useful in diagnosing prostate cancer in about 36% of cases after 2 inconclusive TRUS Biopsies. The pick up rate of cancer is higher than a 3rd TRUS biopsy. The currently adopted antibiotic prophylaxis appears appropriate with 3.6% risk of urosepsis. When Saturation Biopsy is non malignant and PSA is still rising, template biopsy maybe considered. 0524: USE OF THE SWOP CALCULATOR TO REDUCE UNNECESSARY PROSTATE BIOPSIES IN MEN WITH ELEVATED PSA Andrew Birch , John Withington , Janette Kinsella , Peter Acher , Ben Challacombe . 1 East Sussex Healthcare NHS Trust, East Sussex, UK; Guy's and St. Thomas' NHS Foundation Trust, London, UK Background: The SWOP calculator is a nomogram derived from the European Randomised Study of Screening for Prostate Cancer which predicts the percentage probability ofmalignant prostate biopsy by using the variables of age, DRE finding, PSA, ultrasound appearance and prostate volume. Aim: To investigate whether using a 10% or 15% risk threshold could avert unnecessary biopsies. Method: Data from 207 eligible patients (median age 60) biopsied from 2004-2010 were entered retrospectively into the risk calculator. The clinical outcomes for patients with 15% SWOP risk were investigated. Results: Of the 42 patients with 15% SWOP risk 13 patients (31%) had malignant histology at biopsy (9 Gleason 3+3, 4 Gleason 3+4), 7 received radical treatment (5 radical prostatectomies, 2 brachytherapy) and 5 entered active surveillance. Of the 17 patients with a SWOP risk 10% 4 (24%) had positive biopsies (Gleason 3+3); none required treatment, 3 entered active surveillance (one patient has no follow-up data). Conclusions: These data show that were a 15% risk threshold applied, then significant prostate cancers requiring treatment would have been missed but a 10% risk-threshold may have avoided unnecessary biopsies. The SWOP calculator may be useful for avoiding unnecessary biopsies in low-risk patients; this has significant implications for reducing biopsy and treatment morbidity and cost. 0551: TRANSPERINEAL TEMPLATE-GUIDED SATURATION BIOPSIES OF THE PROSTATE – EARLY EXPERIENCES IN A DISTRICT GENERAL HOSPITAL OF A NOVEL TECHNIQUE OF SATURATION BIOPSY Jaspal Phull, Alison Townsend, Megan Whitaker, Llinos Davies, Andy Thomas. Princess of Wales Hospital, Bridgend, UK Aims: Transrectal ultrasound-guided (TRUS) biopsy may miss 30% of significant prostate cancer, likely to be in the anterior zone. Transperineal template-guided saturation biopsies (TTB) is a NICE approved means of saturation-biopsy. We assessed detection rates with TTB. Methods: A prospective, non-randomized, cohort study of TTBs between July 2010 and August 2011. All cases were peer-reviewed at MDT, and would seek radical treatment if positive. The primary outcome was detection of malignancy. Results: 22 TTBs were performed. 81.8% (n1⁄418) had >1 negative TRUS, 9.1% (n1⁄42) were on active surveillance, 4.5% (n1⁄41) was post-radiotherapy PSArelapse, and 4.5% (n1⁄41) chose to have TTB as the primary biopsy method. 12 of the 22 cases (54.5%) had new-diagnosis carcinoma only detected at TTB. 7 were benign (31.8%). Of the malignant histology (n1⁄415) 13.3% were Gleason 6 (n1⁄42), 73.3% were Gleason 7 (n1⁄411), and 13.3% were Gleason 8 carcinomas (n1⁄42). Conclusion: TTB should be considered for men with rising PSAs and negative TRUS biopsy. We advocate TTB as the preferred technique for saturation biopsy for detection of significant prostate cancer in men who would benefit from further treatment. 0572: OUT-PATIENT FLEXIBLE CYSTOSCOPY CAUSES PSYCHOLOGICAL DISTRESS TO A SIGNIFICANT NUMBER OF PATIENTS BEING INVESTIGATED FOR BLADDER CANCER Gidon Ellis , Jamie Fairweather , Ninaad Awsare , Sam Osaghae , Sam Smith , Thomas McNicholas , James Green . Whipps Cross University Hosptial, London, UK; Morriston Hospital, Swansea, UK; 3 Pilgrim Hospital, Lincolnshire, UK; University College London, London, UK; 5 Lister Hospital,