Benign Prostate Research Articles

Quantification of Multi-Parametric Magnetic Resonance Imaging Based on Radiomics Analysis for Differentiation of Benign and Malignant Lesions of Prostate.

The most common cancer (non-cutaneous) malignancy among men is prostate cancer. Management of prostate cancer, including staging and treatment, playing an important role in decreasing mortality rates. Among all current diagnostic tools, multiparametric MRI (mp-MRI) has shown high potential in localizing and staging prostate cancer. Quantification of mp-MRI helps to decrease the dependency of diagnosis on readers' opinions. The aim of this research is to set a method based on quantification of mp-MRI images for discrimination between benign and malignant prostatic lesions with fusion-guided MR imaging/transrectal ultrasonography biopsy as a pathology validation reference. It is an analytical research that 27 patients underwent the mp-MRI examination, including T1- and T2- weighted and diffusion weighted imaging (DWI). Quantification was done by calculating radiomic features from mp-MRI images. Receiver-operating-characteristic curve was done for each feature to evaluate the discriminatory capacity and linear discriminant analysis (LDA) and leave-one-out cross-validation for feature filtering to estimate the sensitivity, specificity and accuracy of the benign and malignant lesion differentiation process is used. An accuracy, sensitivity and specificity of 92.6%, 95.2% and 83.3%, respectively, were achieved from a subset of radiomics features obtained from T2-weighted images and apparent diffusion coefficient (ADC) maps for distinguishing benign and malignant prostate lesions. Quantification of mp-MRI (T2-weighted images and ADC-maps) based on radiomics feature has potential to distinguish benign with appropriate accuracy from malignant prostate lesions. This technique is helpful in preventing needless biopsies in patients and provides an assisted diagnosis for classifications of prostate lesions.

MP40-11 CONTRIBUTION OF GLEASON PATTERN 4 PROSTATE CANCER TISSUE TO PRE-OPERATIVE PSA VALUES IN INTERMEDIATE RISK PROSTATE CANCER: RESULTS FROM 4 860 RP SPECIMENS

You have accessJournal of UrologyCME1 Apr 2023MP40-11 CONTRIBUTION OF GLEASON PATTERN 4 PROSTATE CANCER TISSUE TO PRE-OPERATIVE PSA VALUES IN INTERMEDIATE RISK PROSTATE CANCER: RESULTS FROM 4 860 RP SPECIMENS Fabian Falkenbach, Lukas Hohenhorst, Zhe Tian, Mykyta Kachanov, Tobias Maurer, Sophie Knipper, Markus Graefen, and Lars Budäus Fabian FalkenbachFabian Falkenbach More articles by this author , Lukas HohenhorstLukas Hohenhorst More articles by this author , Zhe TianZhe Tian More articles by this author , Mykyta KachanovMykyta Kachanov More articles by this author , Tobias MaurerTobias Maurer More articles by this author , Sophie KnipperSophie Knipper More articles by this author , Markus GraefenMarkus Graefen More articles by this author , and Lars BudäusLars Budäus More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite advances in imaging and genetic testing, blood PSA remains the cornerstone of prostate cancer (PCa) diagnosis and risk stratification. Especially in the management of intermediate-risk PCa, the PSA value has strong implications for clinical decision-making. It is known, that within this group Gleason pattern (GP) 4 drives biological aggressiveness. Aim of our study was to assess the relationship between pre-operative blood PSA values and volume of GP 4 compared to GP 3 and benign tissue in Radical Prostatectomy (RP) specimens. METHODS: Overall, 4860 patients with localized pT2pN0cM0, intermediate risk PCa without tertiary GP were assessed. Individual GPs were quantified at the whole-mount section analysis of RP specimen. For analysis, patients with biochemical recurrence after RP and a pre-operative PSA >50 ng/ml were further excluded for avoiding contamination of the cohort by occult metastasis. Moreover, patients with prior / neoadjuvant treatment, a gland size <10 cc after TUR-P or gland size >150 cc (associated risk of chronic inflammation) were excluded. Multivariable linear regression analysis addressed the relationship between volume of tissue types and PSA values. RESULTS: Of 4860 patients, in 4390 (90%) a Gleason Score of 3+4 and in 470 (10%) a Gleason Score of 4+3 was present. Median age at RP was 63 years (IQR: 58-68 years), median PSA was 6.4ng/ml (IQR: 4.8-8.7ng/ml) and median prostate volume was 30cc (IQR: 23-40cc). PSA as well as PSA-Density were associated with the quantitative GP 4 fraction above 50% (p-value: <0.001). GP 4 tissue contributed to the pre-operative PSA by 0.37 ng/ml per cc, GP 3 and benign prostate tissue combined contributed by 0.062 ng/ml per cc (p-value: <0.001). There was no significant difference in PSA contribution between GP 3 and benign tissue. CONCLUSIONS: The highest contribution to PSA prior RP originates from GP 4 PCa tumor foci. PSA expression of GP 3 and benign tissue were not significantly different. This confirms the discussed potential indolent nature of GP 3 PCa. Within intermediate risk PCa, PSA is a strong surrogate parameter for the amount of GP 4 PCa tissue. Further confirmatory studies including e.g. imaging data are needed for excluding potential selection bias. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e549 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fabian Falkenbach More articles by this author Lukas Hohenhorst More articles by this author Zhe Tian More articles by this author Mykyta Kachanov More articles by this author Tobias Maurer More articles by this author Sophie Knipper More articles by this author Markus Graefen More articles by this author Lars Budäus More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-06 AQUABLATION FOR BENIGN PROSTATIC HYPERPLASIA IN LARGE PROSTATES (80-150 ML): FINAL 5-YEAR RESULTS

You have accessJournal of UrologyCME1 Apr 2023MP13-06 AQUABLATION FOR BENIGN PROSTATIC HYPERPLASIA IN LARGE PROSTATES (80-150 ML): FINAL 5-YEAR RESULTS Naeem Bhojani and Mitchell R. Humphreys Naeem BhojaniNaeem Bhojani More articles by this author and Mitchell R. HumphreysMitchell R. Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To report 5-year safety and efficacy outcomes of the Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH) and large-volume prostate glands. METHODS: 101 men with moderate-to-severe BPH symptoms and prostate volumes between 80-150 mL underwent a robotic-assisted Aquablation procedure in a prospective multicenter international trial. Herein we report the final 5-year results. RESULTS: The study successfully met its safety and efficacy performance goal, which was based upon TURP outcomes typically done in smaller prostates, at three months. Mean prostate volume was 107 mL (range 80-150 mL). Mean operative time (TRUS in to catheter in), was 55 minutes (range 24-111 minutes) and mean Aquablation resection time was 8 minutes (range 2.5-17 minutes). Most (89%) adverse events were low grade defined as either non-procedure related or Clavien-Dindo grade 2 or less. There was no reported de novo erectile dysfunction and 15% of patients developed ejaculatory dysfunction. The TRUS results showed a 42% reduction in prostate volume at 3 months, which aligned to the 44% reduction in serum PSA at 6 months. At 5-years, IPSS scores improved from 23.2 at baseline to 6.9 and Qmax improved from 8.7 cc/sec at baseline to 18.6 cc/sec. Improvements in both IPSS, IPSS Quality of Life, Qmax, and PVR were immediate (p<.0001) and sustained (p<.0001) throughout the follow-up period, Figure 1. The annualized retreatment rate was less than 1% per year. CONCLUSIONS: At 5-year of prospective follow-up, the Aquablation procedure was shown to be safe and effective in men with large prostates (80-150 mL). ClinicalTrials.gov number, NCT03123250. Source of Funding: Procept BioRobotics © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e175 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naeem Bhojani More articles by this author Mitchell R. Humphreys More articles by this author Expand All Advertisement PDF downloadLoading ...

Targeting benign prostate hyperplasia treatments: AR/TGF-β/NOX4 inhibition by apocynin suppresses inflammation and proliferation

IntroductionApocynin (Apo), an NADPH oxidase (NOX) inhibitor, has been widely used to treat various inflammatory diseases. However, the therapeutic effects of Apo on benign prostatic hyperplasia (BPH), a multifactorial disease associated with chronic inflammation and hormone imbalance, remain unknown. ObjectivesThe link between androgen signaling, reactive oxygen species (ROS), and prostate cell proliferation may contribute to the pathogenesis of BPH; therefore, the aim of this study was to identify the specific signaling pathway involved and to demonstrate whether the anti-oxidant Apo plays a role in the prevention and treatment of BPH. MethodsIngenuity pathway analysis and si-RNA transfection were conducted to demonstrate the androgen receptor (AR) and NOX4 linkage in BPH. Pathological markers of BPH were measured by H&E staining, immunoblotting, ELISA, qRT-PCR, and immunofluorescence to examine the effect of Apo. Rats stimulated with testosterone and BPH-1 cells were used as BPH models. ResultsAR and NOX4 network-mediated oxidative stress was upregulated in the BPH model. Next, we examined the effects of Apo on oxidative stress and chronic prostatic inflammation in BPH mouse models. In a testosterone-induced BPH rat model, Apo alleviated pathological prostate enlargement and suppressed androgen/AR signaling. Apo suppressed the upregulation of proinflammatory markers and promoted the expression of anti-oxidant factors. Furthermore, Apo regulated the TGF-β/Glut9/activin pathway and macrophage programming. In BPH-1 cells, Apo suppressed AR-mediated proliferation and upregulation of TGFB and NOX4 expression by alleviating oxidative stress. Apo activated anti-oxidant and anti-inflammatory systems and regulated macrophage polarization in BPH-1 cells. AR knockdown partially abolished the beneficial effects of Apo in prostate cells, indicating AR-dependent effects of Apo. ConclusionIn contrast with existing BPH therapies, Apo may provide a new application for prostatic disease treatment, especially for BPH, by targeting the AR/TGF-β/NOX4 signaling pathway.

MP44-13 GENETIC RISK ASSESSMENT OF LETHAL PROSTATE CANCER USING BENIGN PROSTATIC HYPERPLASIA OR PROSTATE VOLUME-RELATED POLYGENIC RISK SCORE AND HEREDITARY CANCER SUSCEPTIBILITY GENES

You have accessJournal of UrologyCME1 Apr 2023MP44-13 GENETIC RISK ASSESSMENT OF LETHAL PROSTATE CANCER USING BENIGN PROSTATIC HYPERPLASIA OR PROSTATE VOLUME-RELATED POLYGENIC RISK SCORE AND HEREDITARY CANCER SUSCEPTIBILITY GENES Xiaohao Ruan, Da Huang, Jingyi Huang, Danfeng Xu, Shanghai, People's Republic of China, James Tsu, Rong Na, Hong Kong, and People's Republic Of China Xiaohao RuanXiaohao Ruan More articles by this author , Da HuangDa Huang More articles by this author , Jingyi HuangJingyi Huang More articles by this author , Danfeng XuDanfeng Xu More articles by this author , Shanghai Shanghai More articles by this author , People's Republic of ChinaPeople's Republic of China More articles by this author , James TsuJames Tsu More articles by this author , Rong NaRong Na More articles by this author , Hong KongHong Kong More articles by this author , and People's Republic Of ChinaPeople's Republic Of China More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Genetic risk of aggressive prostate cancer (PCa) is hard to be assessed due to the lack of aggressiveness-related single-nucleotide polymorphisms (SNPs). Prostate volume (PV) is a potential well-established risk factor for aggressive PCa, we hypothesize that polygenic risk score (PRS) based on benign prostate hyperplasia (BPH) or PV-related SNPs may also predict the risk of aggressive PCa or PCa death. METHODS: A PRS using 27 BPH/PV-associated SNPs, two established PCa risk-related PRS (PRATICAL PRS and PHS) and 10 guideline-recommended hereditary cancer susceptibility genes were evaluated and compared in the population-based UK Biobank cohort. Multivariable logistic regression and Cox regression analyses were applied to evaluate the association with the primary outcome (PCa death), adjusting for age at onset, charlson comorbidity index score and 10 principal components. Survival time after PCa diagnosis and the differences across PRS categories were estimated with restricted mean survival time (RMST). RESULTS: The study included a total of 14,564 males were diagnosed with PCa, of which 959 (8.2%) died of PCa, 1,173 (8.1%) died due to other reasons and 12,193 (83.7%) survived till the latest follow-up in Jan 1st, 2022. The BPH/PV PRS was significantly inversely associated with the incidence of lethal PCa as well as the natural progress in PCa patients (hazard ratio, HR=0.92, 95% confidence interval, 95%CI: 0.85–0.99, p=0.03; HR=0.92, 95%CI: 0.86-0.99, p=0.02, Table). Compared with men at top 25th PRS, PCa patients with bottom 25th PRS would have a 1.40-fold (HR, 95%CI: 1.16-1.69, p=0.001) increased PCa fatal risk and shorter survival time at 0.37 yr (RMST, 95%CI: 0.14-0.61, p=0.002). On the contrary, PRACTICAL PRS and PHS showed poor prognostic value (p>0.05). Importantly, BPH/PV PRS could further distinguish the risk of PCa death in addition to the pathogenic mutations in known genes (ie. BRCA2/PALB2), especially in non-carriers. CONCLUSIONS: BPH/PV PRS and germline pathogenic mutation in BRCA2/PALB2 were significantly associated with PCa death and cancer-specific survival. Source of Funding: This work was in supported by grants from National Natural Science Foundation of China (Grant No. 81972645), Innovative research team of high-level local universities in Shanghai, Shanghai Youth Talent Support Program, intramural grant of The University of Hong Kong to Dr. Rong Na, and Shanghai Sailing Program (22YF1440500) to Dr. Da Huang. All the funders had no role in study design, data collection, data analysis, interpretation, and writing of the report © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e616 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xiaohao Ruan More articles by this author Da Huang More articles by this author Jingyi Huang More articles by this author Danfeng Xu More articles by this author Shanghai More articles by this author People's Republic of China More articles by this author James Tsu More articles by this author Rong Na More articles by this author Hong Kong More articles by this author People's Republic Of China More articles by this author Expand All Advertisement PDF downloadLoading ...

PD02-08 ESR1+ LUMINAL EPITHELIAL CELLS DRIVE THE PROSTATE GROWTH AND SURVIVAL IN THE ABSENCE OF SRD5A2

You have accessJournal of UrologyCME1 Apr 2023PD02-08 ESR1+ LUMINAL EPITHELIAL CELLS DRIVE THE PROSTATE GROWTH AND SURVIVAL IN THE ABSENCE OF SRD5A2 Christina Sharkey, Xingbo Long, Ra'ad Al-Faouri, Aria F. Olumi, and Zongwei Wang Christina SharkeyChristina Sharkey More articles by this author , Xingbo LongXingbo Long More articles by this author , Ra'ad Al-FaouriRa'ad Al-Faouri More articles by this author , Aria F. OlumiAria F. Olumi More articles by this author , and Zongwei WangZongwei Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003219.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Steroid 5α reductase 2 (SRD5A2) is the predominant enzyme responsible for prostatic development and growth. 5α reductase inhibitors (5ARI) are the only class of benign prostate hyperplasia-related medications that reduce prostate size. However, why the patients respond variably to 5ARI therapies is still largely unknown. We previously demonstrated that 30% of adult human prostatic tissues do not express the SRD5A2 gene and protein via epigenetic modifications. We established a SRD5A2 null (Srd5a2-/-) mouse model and through single cell RNA sequencing, we identified LE2, a sub-cell population of ESR1+ luminal epithelial that is upregulated in Srd5a2-/- mice. Our goal in this study is to characterize the spatial expression of LE2 markers and its functional phenotype when SRD5A2 is absent. METHODS: Homozygous Srd5a2-/- mice and littermate control heterozygous SRD5A2+/- mice were generated and differentially expressed gene profiles of LE2 were obtained from single-cell RNA sequencing (scRNA seq). Spatial expression of LE2 markers was evaluated by RNA fluorescence in-situ hybridization (RNA-FISH). Cell proliferation was detected by Ki67 and BrdU staining. The Cell Death and ER signaling pathways were evaluated with RT2 PCR profiler arrays (84 genes per array) and downstream signaling pathways were analyzed by western blot. Prostate biopsies from the clinical trial of 5ARI for Medical Therapy of Prostatic Symptoms (MTOPS) were used for immunohistochemistry. RESULTS: The prostate weight of Srd5a2-/- mice was significantly decreased compared to Srd5a2+/- littermate control mice (p<0.001). The prostate cell proliferation was suppressed in Srd5a2-/- mice (p=0.05). The cell death signaling akt1, caspase 7, caspase 9, and ER target genes cyp1a1 and vegfa were downregulated (p<0.05). On the other hand, in the anterior lobe of prostate of Srd5a2-/- mice, the cell proliferation was higher than that in control. scRNA seq showed that ESR1 was expressed mainly in the prostate anterior lobe and the number of ESR1+ LE2 cells was significantly increased upon SRD5A2 absence. This was confirmed by RNA-FISH using the probes of LE2 cell markers ESR1 and PVT1. Co-staining of LE2 cell markers ESR1 and PKCa in prostate biopsies of MTOPS further confirmed the existence of an equivalent LE2 cell population in the human prostate with BPH. CONCLUSIONS: Our data demonstrate that LE2, the subpopulation of prostate cells may play an important role in alternative pathways for prostate growth and survival in absence of SRD5A2 and androgen deprivation. Understanding the underlying androgen-independent pathways contributing to prostate growth can help identify novel therapeutic targets for the management of prostatic diseases. Source of Funding: NIH/R01 DK124502 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e71 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christina Sharkey More articles by this author Xingbo Long More articles by this author Ra'ad Al-Faouri More articles by this author Aria F. Olumi More articles by this author Zongwei Wang More articles by this author Expand All Advertisement PDF downloadLoading ...

PD41-04 FIRST IN MAN CLINICAL DATA THROUGH 24-MONTHS OF A NOVEL, MINIMALLY INVASIVE TREATMENT FOR LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023PD41-04 FIRST IN MAN CLINICAL DATA THROUGH 24-MONTHS OF A NOVEL, MINIMALLY INVASIVE TREATMENT FOR LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA Thomas H. Lynch, Peter E. Lonergan, and Paul Anderson Thomas H. LynchThomas H. Lynch More articles by this author , Peter E. LonerganPeter E. Lonergan More articles by this author , and Paul AndersonPaul Anderson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The ProVee Expander is a nitinol implant which is deployed between the bladder neck and the verumontanum to mechanically open the prostatic urethra without ablation, resection or piercing of the prostate. The first in man (FIM) evaluation to demonstrate the safety and feasibility of the ProVee was conducted at the Royal Melbourne Hospital, Australia. The Primary Endpoint was successful deployment of the implant. Secondary endpoints included 1) the rates of complications throughout the follow-up periods and 2) a preliminary assessment of the effectiveness in alleviating lower urinary tract symptoms LUTS using the IPSS, QoL and Qmax measurements METHODS: This was a prospective, non-randomised, 10 patient safety and feasibility study. Males ≥50 years, IPSS >15, Qmax <12 mL/s and prostate volume 30-80 cc were enrolled. No washout for medications was mandated and it is noteworthy that 7 of the 10 subjects were on BPH or OAB drug therapy immediately prior to the procedure and discontinued their medication from the day of the index procedure. Follow up visits were performed at 2 weeks, 1, 3, 6, 12 and 24 months using the IPSS, Qmax, PVR, IIEF, pain score and flexible cystoscopy at 3, 6 and 12 months. RESULTS: Men aged 58 – 75 years with a mean IPSS of 23 and mean Qmax of 8 ml/s were enrolled. The ProVee was successfully deployed in all subjects and all men voided following the procedure and no catheterisations were required. Reported postoperative AEs were typically mild and transient. All 10 subjects have completed 24-month follow up and all data has been independently monitored from source. The device was well tolerated with no unexpected procedural or device related adverse events or complications in any subject. No device migration was detected and there were no reported cases of de novo retrograde ejaculation. Although the trial was not powered to demonstrate efficacy there was a 40% improvement in Qmax at 24-months. All men not on LUTS medication prior to the procedure showed a≥30% improvement in IPSS at 24-months and there were no surgical re-treatments through 24-months. CONCLUSIONS: The ProVee Expander can be safely and reliably deployed in the prostatic urethra. The 24-month data from this FIM study of 10 subjects demonstrates the ProVee can safely alleviate LUTS in men with benign prostatic hyperplasia. Further larger clinical studies commenced in June 2022 and are ongoing. Source of Funding: ProVerum Limited © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1059 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas H. Lynch More articles by this author Peter E. Lonergan More articles by this author Paul Anderson More articles by this author Expand All Advertisement PDF downloadLoading ...

TCTAP A-084 The Risk of Cardiovascular Disease in Patients With Benign Prostate Hyperplasia on 5-Alpha Reductase Inhibitors Treatment: A Meta-Analysis

TCTAP A-084 The Risk of Cardiovascular Disease in Patients With Benign Prostate Hyperplasia on 5-Alpha Reductase Inhibitors Treatment: A Meta-Analysis

MP20-12 PiR-hsa-24683 IS ESSENTIAL FOR PROSTATE TUMOR-PROPAGATING CELLS AND PROMOTE THE DEVELOPMENT OF CASTRATION RESISTANCE

You have accessJournal of UrologyCME1 Apr 2023MP20-12 PiR-hsa-24683 IS ESSENTIAL FOR PROSTATE TUMOR-PROPAGATING CELLS AND PROMOTE THE DEVELOPMENT OF CASTRATION RESISTANCE Qiang Peng, Peter Ka-Fung Chiu, Tingting Xie, Jeremy Yuen-Chun Teoh, and Chi-Fai Ng Qiang PengQiang Peng More articles by this author , Peter Ka-Fung ChiuPeter Ka-Fung Chiu More articles by this author , Tingting XieTingting Xie More articles by this author , Jeremy Yuen-Chun TeohJeremy Yuen-Chun Teoh More articles by this author , and Chi-Fai NgChi-Fai Ng More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003245.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PIWI-interacting RNAs (piRNAs) are a class of small non-coding RNAs (sncRNAs) mechanistically similar to but much less studied than microRNAs. piRNAs represent the most diversified sncRNAs that are widely involved in the pathogenesis of different types of cancers including prostate cancer (PCa). Our study aimed to investigate the role of piRNAs in the development of castration-resistant prostate cancer (CRPC). METHODS: Small RNA sequencing was used to explore the CRPC associated piRNAs on a basis of 10 benign prostate tissues, 10 paired hormone-sensitive PCa tissues and CRPC tissues from the same patients. The top 8 upregulated piRNAs were validated through qRT-PCR in a bigger cohort. piR-hsa-24683 was selected and investigated its biological function by gain of function in vitro. To study its loss of function role, an androgen-independent PCa cell (LNCaP-AI) was established. For mechanistic investigation, the mRNA sequencing analysis of differentially expressed genes (DEGs) was conducted in PCa cells transfected with control/piR-hsa-24683 mimics. Then, potential downstream targets were further predicted by miRanda program and validated by qRT-PCR. RESULTS: piR-hsa-24683 demonstrated a relatively higher expression level in both CRPC tissues and CRPC cell lines when compared with PCa tissues and cells. Functionally, overexpression of piR-hsa-24683 could confer resistance to androgen deprivation and anti-androgen in PCa cells in vitro, whereas anti-sense RNA against the piR-hsa-24683 could potentiate the sensitivity to androgen deprivation in LNCaP-AI cell. In addition, piR-hsa-24683 showed the ability in promoting sphere formation, migration and invasion of PCa cells. Mechanistically, mRNA sequencing results identified a panel of downstream target-genes. Among them, serine/threonine kinase 3 (STK3) was predicted to have a direct binding relationship with piR-hsa-24683, and was successfully verified to be negatively regulated by piR-hsa-24683. CONCLUSIONS: Our study showed, for the first time, that piR-hsa-24683 can contribute to androgen insensitivity in CRPC. This sheds a new insight into the regulation of CRPC by a sncRNA piRNA, which may form the basis of a novel target in the treatment of CRPC. Source of Funding: UGC Research Matching Fund 8601404 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e279 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Qiang Peng More articles by this author Peter Ka-Fung Chiu More articles by this author Tingting Xie More articles by this author Jeremy Yuen-Chun Teoh More articles by this author Chi-Fai Ng More articles by this author Expand All Advertisement PDF downloadLoading ...

Associations of CTCF and FOXA1 with androgen and IGF pathways in men with localized prostate cancer

AimsTo examine associations between the transcription factors CCCTC-binding factor (CTCF) and forkhead box protein A1 (FOXA1) and the androgen receptor (AR) and their association with components of the insulin-like growth factor (IGF)-pathway in a cohort of men with localized prostate cancer. MethodsUsing prostate tissue samples collected during the Prostate cancer: Evidence of Exercise and Nutrition Trial (PrEvENT) trial (N = 70 to 92, depending on section availability), we assessed the abundance of CTCF, FOXA1, AR, IGFIR, p-mTOR, PTEN and IGFBP-2 proteins using a modified version of the Allred scoring system. Validation studies were performed using large, publicly available datasets (TCGA) (N = 489). ResultsWe identified a strong correlation between CTCF and AR staining with benign prostate tissue. CTCF also strongly associated with the IGFIR, with PTEN and with phospho-mTOR. FOXA1 was also correlated with staining for the IGF-IR, with IGFBP-2 and with staining for activated phosphor-mTOR. The staining for the IGF-IR was strongly correlated with the AR. ConclusionOur findings emphasise the close and complex links between the endocrine controls, well known to play an important role in prostate cancer, and the transcription factors implicated by the recent genetic evidence.

MP24-17 TAMSULOSIN VERSUS TADALAFIL FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATIC ENLARGEMENT: ASSESSMENT OF TREATMENT DISCONTINUATION RATE AND SYMPTOMS IMPROVEMENT

You have accessJournal of UrologyCME1 Apr 2023MP24-17 TAMSULOSIN VERSUS TADALAFIL FOR MANAGEMENT OF SYMPTOMATIC BENIGN PROSTATIC ENLARGEMENT: ASSESSMENT OF TREATMENT DISCONTINUATION RATE AND SYMPTOMS IMPROVEMENT Ahmed Elqaffas, Ahmed Elshal, Adel Nabeeh, and Ahmed M Shoma Ahmed ElqaffasAhmed Elqaffas More articles by this author , Ahmed ElshalAhmed Elshal More articles by this author , Adel NabeehAdel Nabeeh More articles by this author , and Ahmed M ShomaAhmed M Shoma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: both tamsulosin and tadalafil 5 mg are used for treatment of symptomatic benign prostatic enlargement. Nevertheless, the incidence and causes of treatment discontinuation (TD) was not evaluated. A randomized trial is conducted to compare TD rate and symptoms improvement between the two drugs. METHODS: A randomized controlled trial (RCT) is conducted with estimate sample size of 160 cases. Sexually active LUTS/BPO patients with concomitant ED were included and randomly allocated in two groups: the first received tadalafil 5 mg once daily and the second one received tamsulosin for twelve months. The therapeutic outcomes are assessed at 2 weeks , 4 weeks , 12 weeks, 6 months and 12 months. The evaluation includes International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-15) questionnaire, quality of life (QoL), uroflowmetry, post voiding residual (PVR) and incidence and causes of (TD). RESULTS: In tadalafil group 5 patients lost follow up. thirty out of 80 patients showed drug discontinuation (37.5%), 6 of them developed adverse effects in view of headache and musculoskeletal pain, other 24 patients developed no response. IPSS, QoL & IIEF-15 improved in 12 months follow-up compared to baseline criteria (Table 1). In tamsulosin group, 7 patients lost follow up. Eighteen out of 80 patients showed drug discontinuation (22.5%), 5 of them developed adverse effects in view of dizziness and orthostatic hypotension, while 13 patients showed no response. IPSS, QoL & Qmax improved in 12 months follow-up compared to baseline criteria. (Table 1) CONCLUSIONS: When both groups were compared, discontinuation was higher in tadalafil group due to lack of response with significant statistical difference with comparable adverse events. IPSS & QoL were improved in both drugs. Source of Funding: mansoura urology and nephrology center (UNC) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e324 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Elqaffas More articles by this author Ahmed Elshal More articles by this author Adel Nabeeh More articles by this author Ahmed M Shoma More articles by this author Expand All Advertisement PDF downloadLoading ...

MP75-13 RACIAL DISPARITIES IN SURGICAL TREATMENT RATES FOR BENIGN PROSTATE HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023MP75-13 RACIAL DISPARITIES IN SURGICAL TREATMENT RATES FOR BENIGN PROSTATE HYPERPLASIA Yuqin Wei and Usha Periyanayagam Yuqin WeiYuqin Wei More articles by this author and Usha PeriyanayagamUsha Periyanayagam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003349.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign Prostatic Hyperplasia (BPH) is a common urological condition treated medically and/or surgically. Racial disparities persist throughout medicine in both access to care and treatment of disease. The objective of this study is to compare the rates of surgical treatment in BPH across racial and ethnic groups. METHODS: A retrospective cohort study was performed using Komodo Health’s claims database of 330 million patients from 2017-2021. Deidentified male patients older than 40, continuously enrolled for 1 year prior/3 years after initial medication treatment of BPH, were abstracted and cleaned in a standardized pipeline. Patients were required to have at least 1 BPH diagnosis code and no history of malignancy. Diagnosis of BPH and medical/surgical treatment was determined by ICD, NDC, and CPT codes. Logistic regression was used to determine surgical rates between races by adjusting for age, charlson’s comorbidity index, and the use of BPH medications. The cumulative incidence of surgical treatment was summarized using one minus the Kaplan-Meier (KM) estimator. All analyses were conducted in R 4.2.1. RESULTS: Of 330 million patients, 246,959 were included. This included 179,496 (72.7%) White, 11,812 (4.7%) Asian, 24,959 (10.1%) Black, and 30,692 (12.4%) Hispanic patients. 49.5% were over 65 and 6.2% had received surgery within 3 years of initiating medication. Black (5.1%) and Asian (4.2%) patients were less likely than White (6.5%) and Hispanic (6.0%) patients to have surgery in this time frame. The median time to surgery was 342 days. Variation was seen across races: White: 340 days, Asian: 368 days, Black: 343 days, and Hispanic: 345 days. In the logistic regression model adjusting for age, comorbidities, and medication use, White patients were more likely to receive surgery than Asian (OR 0.58, p<0.001), Black (OR 0.82, p<0.001), and Hispanic (OR 0.90, p<0.001) patients. The cumulative incidence curve (1- KM) is seen in Figure 1. CONCLUSIONS: Black, Asian, and Hispanic men were less likely than White men to receive surgical treatment after medication treatment of BPH. This could be attributed to barriers to access, trust in the medical system, or systematic bias. Further studies are needed to discern potential causes and meaningful solutions to ensure equitable access to care. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1085 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuqin Wei More articles by this author Usha Periyanayagam More articles by this author Expand All Advertisement PDF downloadLoading ...

PD41-02 12-MONTH OUTCOMES FROM THE FIRST NORTH AMERICAN STUDY OF THE ZENFLOW SPRING SYSTEM FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH)

You have accessJournal of UrologyCME1 Apr 2023PD41-02 12-MONTH OUTCOMES FROM THE FIRST NORTH AMERICAN STUDY OF THE ZENFLOW SPRING SYSTEM FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) Dean Elterman, Edward D. Matsumoto, and Kevin C. Zorn Dean EltermanDean Elterman More articles by this author , Edward D. MatsumotoEdward D. Matsumoto More articles by this author , and Kevin C. ZornKevin C. Zorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The ZEST-CAN study is a prospective single-arm study evaluating the Zenflow Spring System for BPH. The Zenflow Spring System is a novel minimally invasive surgical therapy (MIST) that delivers an appropriately sized nitinol stent-like device into the prostatic urethra displacing the lateral lobes for improved urinary flow. METHODS: Ten (10) subjects received the device at 3 centers in Canada. Symptom improvement was measured utilizing the International Prostate Symptom Score (IPSS) and IPSS-QOL, and functional improvement was measured by peak urinary flow rate (Qmax). Erectile and ejaculatory function were evaluated utilizing validated questionnaires. The clinical events committee independently adjudicated any adverse event. RESULTS: Subjects treated with the Zenflow Spring showed a significant reduction in IPSS from baseline to 12 months (21.2 vs 11.4, p<0.01), representing a 47% reduction in IPSS. IPSS QOL significantly improved from baseline to 12 months (5.4 vs 2.4, p<0.010, representing a 56% improvement. Qmax improved from 9.7 mL/sec at baseline to 14.0 mL/sec after treatment (p<0.05) representing a 45% improvement. There were no changes in sexual or ejaculatory function as assessed by the validated questionnaires. The responder rate at 12 months calculated as those with 30% improvement in IPSS was 70%. (7/10 subjects). Adverse events post procedure were typically mild and transient and common to events reported in similar procedures. CONCLUSIONS: The Zenflow Spring System resulted in immediate and significant symptomatic improvements from 3 through 12 months. Subjects experienced improvements in symptoms, quality of life, maximum flow rate without any sexual dysfunction through 12 months of follow up. These results are currently being validated through a large, multiple centers, prospective randomized study in the United States and Canada. Source of Funding: Zenflow Inc © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1058 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean Elterman More articles by this author Edward D. Matsumoto More articles by this author Kevin C. Zorn More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-08 HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) OUTCOMES AFTER MINIMALLY INVASIVE SURGICAL THERAPIES (MIST) FOR BPH

You have accessJournal of UrologyCME1 Apr 2023MP13-08 HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) OUTCOMES AFTER MINIMALLY INVASIVE SURGICAL THERAPIES (MIST) FOR BPH Mark Assmus, Nick Dean, Matthew Lee, Jenny Guo, and Amy Krambeck Mark AssmusMark Assmus More articles by this author , Nick DeanNick Dean More articles by this author , Matthew LeeMatthew Lee More articles by this author , Jenny GuoJenny Guo More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 2021 American Urologic Association benign prostate hyperplasia (BPH) guideline recommends several minimally invasive surgical therapies (MIST). We look to describe outcomes of individuals undergoing holmium laser enucleation of the prostate (HoLEP) after failing prior minimally invasive BPH procedures, specifically prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), robotic waterjet treatment (RWT) or prostatic artery embolization (PAE). METHODS: We retrospectively examined patients within our IRB approved clinical database that underwent HoLEP over a 19-month period (March 2021 – Oct 2022). Patient demographics, surgical BPH treatments, operative variables, and perioperative courses were examined. Patients with a prior neurological diagnosis or prior bladder cancer were excluded from the analysis. Descriptive statistics, two-tailed T-Tests, and ANOVA were performed with SPSS (p<0.05). Although PAE is not an office-based procedure, due to its minimally invasive nature we included it in the MIST category. RESULTS: We identified 600 HoLEP patients who met inclusion criteria, with 24.2% (n=145) of patients having undergone a prior BPH procedure. Of these procedures, 31.7% (n=46) were MISTs including PUL (n=22), WVTT (n=11), RWT (n=3), and PAE (n=10) and the remaining 68.3% (n=99) of procedures were TURP (n=63) and photo-selective vaporization of the prostate (PVP) (n=36). Time from original treatment to HoLEP did not differ between MIST procedures (p>0.05), but was significantly shortened comparing MISTs to TURP and PVP (2.9 versus 6.8 years, p<0.01). Patients with a prior BPH procedure were older (72.4 versus 69.7 years, p<0.01) than those without a history of BPH procedures; however, there were no other differences in pre-operative patient variables or post-operative functional outcomes including catheter free status, anti-cholinergic requirements, and continence rates, or 90-day complications (all p>0.05). Patients with a prior PUL had a significantly worse morcellation efficiency (7.3 vs 9.0 grams/min, p=0.03) and required more sets of morcellator blades per case (1.3 vs 1.0, p=0.03) compared to other prior BPH treatments. CONCLUSIONS: Patients undergoing HoLEP after prior failed BPH surgery experienced equivalent outcomes to patients without prior BPH surgery. Patient functional outcomes after HoLEP were maintained regardless of prior treatment modality. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e176 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Assmus More articles by this author Nick Dean More articles by this author Matthew Lee More articles by this author Jenny Guo More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-01 COMPARING THE TREATMENT OF PATIENTS WITH AQUABEAM® AND HOLEP FOR BENIGN PROSTATE HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023MP51-01 COMPARING THE TREATMENT OF PATIENTS WITH AQUABEAM® AND HOLEP FOR BENIGN PROSTATE HYPERPLASIA Carlos Toribio-Vázquez, Ramon Cansino, Esaú Fernández-Pascual, Aritz Eguibar, Hector Ayllon, Pablo Solano-Heranz, Jose Ramon Perez-Carral, Juan Antonio Mainez, Alvaro Yebes, Andrea Rodriguez, Maria Alonso, and Luis Martinez-Piñeiro Carlos Toribio-VázquezCarlos Toribio-Vázquez More articles by this author , Ramon CansinoRamon Cansino More articles by this author , Esaú Fernández-PascualEsaú Fernández-Pascual More articles by this author , Aritz EguibarAritz Eguibar More articles by this author , Hector AyllonHector Ayllon More articles by this author , Pablo Solano-HeranzPablo Solano-Heranz More articles by this author , Jose Ramon Perez-CarralJose Ramon Perez-Carral More articles by this author , Juan Antonio MainezJuan Antonio Mainez More articles by this author , Alvaro YebesAlvaro Yebes More articles by this author , Andrea RodriguezAndrea Rodriguez More articles by this author , Maria AlonsoMaria Alonso More articles by this author , and Luis Martinez-PiñeiroLuis Martinez-Piñeiro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.01AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic prostatic hydroablation (AquaBeam®) is a novel technique for the surgical treatment of benign prostatic hyperplasia (BPH). The objective of this study is to compare perioperative morbidity and treatment efficacy of prostatic hydroablation and Holmium laser prostate enucleation (HoLEP). METHODS: A total of 202 patients were analysed (101 by AquaBeam® and 101 by HoLEP) were analysed. A propensity score matching system was generated to obtain comparable cases from the HoLEP database at our institution. Patients included for analysis had undergone surgery in our department from April 2016 to October 2021. The following parameters where analysed: surgical time, haemoglobin (Hb) loss, length of stay, variation in Q-max, PSA, International Prostate Symptoms Score (IPSS), change in IPSS and in IPSS QoL, sexual function measured by the International Index of Erectile Function-5 item (IIEF-5), presence of ejaculation and perioperative morbidity. Median follow up was 12 months (IQR 12-36). RESULTS: Preoperative parameters were comparable between both groups (including prostate size, p=0.548). The perioperative and follow-up variables are shown in the following Table. No major differences in intraoperative complications were observed between both groups. With regards to postoperative complications, 17.3% vs 20.5% presented early urinary incontinence (AquaBeam® vs. HoLEP; p=0.62). 5 patients in the AquaBeam® group and 1 patient treated with HoLEP required blood transfusion (p=0.02). 2 patients treated with HoLEP and 5 with AquaBeam® required reoperation due to haematuria (p=0.03). 1 rectal perforation occurred and 1 patient died after a pneumonic process in the AquaBeam® group. CONCLUSIONS: Hydroablation surgery is an effective technique for patients with benign prostate hyperplasia. It offers good functional results whilst allowing the preservation of ejaculation. AquaBeam® presents a longer hospital admission mainly due to haematuria. The data presented compare our initial experience and learning curve with AquaBeam® with a well-established HoLEP technique in our department. Therefore, it must be regarded as preliminary. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e692 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlos Toribio-Vázquez More articles by this author Ramon Cansino More articles by this author Esaú Fernández-Pascual More articles by this author Aritz Eguibar More articles by this author Hector Ayllon More articles by this author Pablo Solano-Heranz More articles by this author Jose Ramon Perez-Carral More articles by this author Juan Antonio Mainez More articles by this author Alvaro Yebes More articles by this author Andrea Rodriguez More articles by this author Maria Alonso More articles by this author Luis Martinez-Piñeiro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD02-04 SINGLE CELL TRANSCRIPTIONAL PROFILES OF BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023PD02-04 SINGLE CELL TRANSCRIPTIONAL PROFILES OF BENIGN PROSTATIC HYPERPLASIA Rei Unno, Jon Akutagawa, Hanging Song, Heiko Yang, Thomas Chi, and Franklin W. Huang Rei UnnoRei Unno More articles by this author , Jon AkutagawaJon Akutagawa More articles by this author , Hanging SongHanging Song More articles by this author , Heiko YangHeiko Yang More articles by this author , Thomas ChiThomas Chi More articles by this author , and Franklin W. HuangFranklin W. Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003219.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) affects the majority of aging men and leads to lower urinary tract symptoms. Based on histological characteristics and bulk sequencing data, the pathophysiology and underlying mechanisms of BPH are poorly understood. The aim of this study was to investigate the transcriptional profile of BPH at single cell resolution to improve our understanding of the molecular features of BPH. METHODS: Fifteen BPH specimens were collected from patients undergoing holmium laser enucleation of the prostate. Cells from each specimen were isolated, captured, and sequenced using a bead-based single-cell RNA sequencing platform (Seq-well). Transcriptomic analysis of the gene expression matrices was performed using software including Scanpy and cellxgene. The absence of malignant pathologic diagnoses was independently confirmed. RESULTS: 16,234 cells from 15 BPH specimens were analyzed. By canonical cell type markers, we annotated three major cell types (epithelial, stromal, and immune cells). Using significantly upregulated genes in BPH compared to normal prostates previously derived from a bulk RNA sequencing comparison, the signature score of the bulk sequencing data was high only in the fibroblast populations. After performing a sub-clustering analysis of the 6249 epithelial cells, we identified four luminal cell subclusters showing similar levels of luminal epithelial markers KLK3, KLK2, and NKX3-1, as well as one distinct basal and one club cell population. Analysis of the differentially expressed genes among the four luminal subclusters revealed that luminal subcluster 4 was enriched in a specific signature gene set, including ribosomal genes and KLK4, which has been shown to be abundant in BPH, compared to the other subclusters. Gene ontology analysis using this gene set demonstrated that luminal subcluster 4 was associated with pathways such as oxidative phosphorylation and adipogenesis. Analyses of the BPH immune microenvironment showed a larger proportion of pro-inflammatory cells, such as M1 macrophages, compared to anti-inflammatory cells within the myeloid cell population. CONCLUSIONS: Single cell profiling of BPH identified epithelial cells, stromal cells, and immune cells. We confirmed the upregulation of previously derived BPH-associated genes in the fibroblast population and the enrichment of pro-inflammatory myeloid cells in the immune microenvironment. Within the epithelial cell population, we identified a luminal epithelial subcluster that may represent a cell state associated with BPH. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e70 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rei Unno More articles by this author Jon Akutagawa More articles by this author Hanging Song More articles by this author Heiko Yang More articles by this author Thomas Chi More articles by this author Franklin W. Huang More articles by this author Expand All Advertisement PDF downloadLoading ...

V07-08 INTRAPROSTATIC DELIVERY OF LOCAL ANESTHETICS VIA TRANSURETHRAL CATHETER (SCHELIN CATHETER) IN REZŪM WATER VAPOR THERAPY

You have accessJournal of UrologyCME1 Apr 2023V07-08 INTRAPROSTATIC DELIVERY OF LOCAL ANESTHETICS VIA TRANSURETHRAL CATHETER (SCHELIN CATHETER) IN REZŪM WATER VAPOR THERAPY Ho Ming Chris Wong, Ka Lun Lo, Chi Fai Ng, and Peter Ka-Fung Chiu Ho Ming Chris WongHo Ming Chris Wong More articles by this author , Ka Lun LoKa Lun Lo More articles by this author , Chi Fai NgChi Fai Ng More articles by this author , and Peter Ka-Fung ChiuPeter Ka-Fung Chiu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This video describes the technique of local anaesthetics delivery in a intraprostatic manner via a transurethral catheter for Rezūm water vapor therapy for a patient with urinary retention on indwelling catheter. METHODS: The case was a 65 year-old gentleman. He had been on combination therapy of Alfuzosin and Finasteride and later presented with refractory urinary retention. Transrectal ultrasound sizing of the prostate showed a 52cc prostate. Digital rectal examination showed a benign prostate. Fleet enema and a course of oral antibiotics were given. While awake, he was put into lithotomy position. Schelin catheter was inserted. Aside from the balloon and the drainage channel, the catheter had an extra needle injection channel. Balloon was inflated with 10mL water. Transrectal ultrasound was also adopted in this demonstration for illustration purpose but it was not a pre-requisite. The catheter was turned with the injection channel pointing to the 2 o’clock direction. The needle was inserted fully. It was aspirated to ensure no inadvertent puncture of vessel. Transrectal ultrasound confirms the distal end of the needle was within the prostate stroma. Delivery of local anesthesia intraprostatically was visualised and confirmed on transrectal ultrasound. Needle was withdrawn. The catheter was inserted slightly to detwist its shaft to ensure the whole catheter was rotated to the desired angle. It was then subsequent turned to 5 and 11 o’clock and the above procedure was repeated. 10 ml of 1% lignocaine with adrenaline was injected to each lobe of prostate. Balloon was deflated and the Schelin catheter was removed. Rezūm water vapor therapy was carried out. A total of 9 cycles including 4 cycles to left and right lobe each, and 1 cycle to the median lobe, each lasting 9 seconds, were delivered. RESULTS: No additional analgesics or sedation was given on top of local anaesthetics. After the procedure, the patient was asked to report on the pain score according to the Visual Analogue Scale. Upon catheter injection he reported a score of 1/10, upon local anesthesia administration 3/10 and upon the Rezūm procedure 3/10. He was discharged with a drainage catheter in situ. He returned for voiding trial 14 days after the procedure and successfully weaned off catheter. CONCLUSIONS: Schelin catheter allow transurethral intraprostatic delivery of local anaesthetics. It is a possible alternative to transperineal block or regional anesthesia for the Rezūm water vapor therapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e598 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ho Ming Chris Wong More articles by this author Ka Lun Lo More articles by this author Chi Fai Ng More articles by this author Peter Ka-Fung Chiu More articles by this author Expand All Advertisement PDF downloadLoading ...

MP59-04 HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR VERY LARGE BENIGN PROSTATIC HYPERPLASIA (&gt;200 ML): LONG TERM OUTCOME OF A LARGE SERIES.

You have accessJournal of UrologyCME1 Apr 2023MP59-04 HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR VERY LARGE BENIGN PROSTATIC HYPERPLASIA (>200 ML): LONG TERM OUTCOME OF A LARGE SERIES. Matteo Tallè, Francesco Mengoni, Roberto Orciani, Donato Dente, and Angelo Cafarelli Matteo TallèMatteo Tallè More articles by this author , Francesco MengoniFrancesco Mengoni More articles by this author , Roberto OrcianiRoberto Orciani More articles by this author , Donato DenteDonato Dente More articles by this author , and Angelo CafarelliAngelo Cafarelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients presenting with very large prostates (>200 ml of total volume) are a challenge to both patients and surgeons. Nowadays, although the efficacy and the less invasiveness of HoLEP compared to open techniques has been proven, still high level evidences for the best treatment of large prostates are limited. Aim of the study is to evaluate the short and long term outcomes of patients with very large prostates (>200 cc) in the largest series available so far. METHODS: Clinical data were collected in a prospective maintained database, we performed 183 HoLEP procedures on prostates greater than 200 gr in 86 months. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Surgical technique: we used a Gilling modified technique with a three-lobe enucleation with a high power 120 W Holmium laser (Lumenis Pulse). Morcellation is conducted with a 7 gr/min morcellator (Lumenis VersaCut) together with basket for removal of the small prostate chips, in order to reduce operating time. Patients results were collected in a proper database Patients with limited follow-up and with data unavailable were excluded. RESULTS: We collected retrospectivally data of consecutive male patients who underwent HoLEP from July 2015 to September 2022 (86 months). There were 183 patients with a mean preoperative gland size of 218.9 cc (200-366 cc). Mean operative (145 min) and enucleation time (83 min) .Enucleation efficiency was greater for glands ≥300 cc (4.5 cc/min). Mean length of stay was 2.2±days and catheter duration was 2.8±days. Mean haemoglobin loss was (3,6 gr/dl, SD 0,1 - 6 gr/dl). 7 cases required blood transfusion (3.8%). 52 patients (28.4%) had indwelling catheter before surgery for urinary retention; this population experienced higher incidence of post-operative UTI and fever (42% vs 13%; p=0.001) Mean variation of Qmax was+14 ml/s (p<0,05) and IPSS score -16 points (p<0.05) at long term follow-up, these results stayed stable for during time with a mean follow 24 months (range 2-86) 3 (7.1%) patient required retreatment of BPH at last follow-up. CONCLUSIONS: HoLEP for giant prostate is a minimally invasive option with low morbidity and good post-operative outcomes. These data support the feasibility of HoLEP regardless the size of the prostate and suggest that HoLEP could become the “gold standard” approach for prostate >200 cc. Source of Funding: 1) World Journal of Urology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e807 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matteo Tallè More articles by this author Francesco Mengoni More articles by this author Roberto Orciani More articles by this author Donato Dente More articles by this author Angelo Cafarelli More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-03 COMBINATION PROSTATIC ARTERY EMBOLIZATION PRIOR TO AQUABLATION® FOR BENIGN PROSTATIC HYPERTROPHY: A PROPENSITY SCORE ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP51-03 COMBINATION PROSTATIC ARTERY EMBOLIZATION PRIOR TO AQUABLATION® FOR BENIGN PROSTATIC HYPERTROPHY: A PROPENSITY SCORE ANALYSIS Sandeep Bagla, Anthony Sare, Abin Sajan, Pratik Desai, and Inderjit Singh Sandeep BaglaSandeep Bagla More articles by this author , Anthony SareAnthony Sare More articles by this author , Abin SajanAbin Sajan More articles by this author , Pratik DesaiPratik Desai More articles by this author , and Inderjit SinghInderjit Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Aquablation has been previously reported with a 10% bleeding risk and a 6% requiring transfusion rate. The purpose of this study was to demonstrate the feasibility and safety of Prostatic Artery Embolization (PAE) before Aquablation® in patients with Benign Prostatic Hypertrophy (BPH). METHODS: A retrospective chart review identified 148 patients treated with Aquablation® for BPH from May 2018 to June 2021. Patients were divided into two groups: Aquablation® alone (n=56) vs. combination PAE and Aquablation® (n=89). Patient demographics, pertinent laboratory values, operative reports, and the hospital courses between the two groups were reviewed. After propensity score matching for age and prostate gland size, outcomes were compared between Aquablation alone vs combination therapy. RESULTS: PAE was technically successful in 89/89(100%) combination patients and all 89 patients underwent successful Aquablation® within a median time of 2 days. Compared to Aquablation® alone, PAE prior resulted in significant reduction in hospital length of stay (34.4±23.5 vs 13.8±26.1 hours, p<0.001). Additionally, PAE before Aquablation® resulted in 16 times (p=0.001) less likely use of perioperative hemostatic measures (balloon traction, cautery). Patients without prior PAE were 7.8 times more likely (p<0.001) to require >2 hours of post-operative continuous bladder irrigation. Patients with Aquablation® alone were also more likely to return to the operating room within 30 days of the procedure (p<0.001). Lastly, the incidence of persistent hematuria at 2 or 4 week followup was 3.2 times higher in the Aquablation® alone group (p<0.001) compared to the combination group. There were no major PAE related adverse events reported in the combination arm. CONCLUSIONS: Combination PAE and Aquablation® resulted in a reduction in length of hospital stay, intraprocedural hemostastatic maneuvers, and less post-operative bleeding complications than patients undergoing Aquablation® monotherapy for treatment of BPH. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e692 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sandeep Bagla More articles by this author Anthony Sare More articles by this author Abin Sajan More articles by this author Pratik Desai More articles by this author Inderjit Singh More articles by this author Expand All Advertisement PDF downloadLoading ...

MP73-09 A RETROSPECTIVE CLINICAL SERVICE EVALUATION OF LESION-TARGETED MRI-GUIDED TRANSURETHRAL ULTRASOUND ABLATION (TULSA) FOR THE TREATMENT OF LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP73-09 A RETROSPECTIVE CLINICAL SERVICE EVALUATION OF LESION-TARGETED MRI-GUIDED TRANSURETHRAL ULTRASOUND ABLATION (TULSA) FOR THE TREATMENT OF LOCALIZED PROSTATE CANCER Rolf Muschter, Leonhard Steinmeister, and Agron Lumiani Rolf MuschterRolf Muschter More articles by this author , Leonhard SteinmeisterLeonhard Steinmeister More articles by this author , and Agron LumianiAgron Lumiani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MR-guided transurethral ultrasound ablation (TULSA) is a novel minimally-invasive therapy option for the treatment of organ-confined prostate cancer (PCa) through a whole-gland or lesion-targeted approach. TULSA has shown promising safety and oncological outcomes with minimum side-effect on patients urinary, bowel, and sexual functions. The objective of this retrospective single-center study was to perform a clinical service evaluation of lesion-targeted TULSA for patients with localized PCa. METHODS: Men with organ-confined PCa (proved by MRI and biopsy) received lesion-targeted TULSA with sparing of sphincter, urethra, and rectum. A customized treatment was planned for every patient based on his expectations and PCa characteristics. For a subset of men with concurrent PCa and benign prostate hyperplasia (BPH), TULSA was applied as a combined therapy. Repeat TULSA was allowed and a suprapubic catheter was used. The Clavien-Dindo stratification was used to assess the frequency and severity of all adverse events (AEs). Mid-term oncological outcomes were evaluated using multi-parametric MRI (mpMRI) and prostate-specific antigen (PSA). Surgeon-assessed functional outcomes were recorded. RESULTS: 180 patients (150 primary and 30 salvage) with median [IQR] age, baseline PSA, and follow-up availability of 67 [63-76], 8.0 ng/ml [5.2-13], and 12-mon (max 48), respectively, were treated. 40 patients experienced Grade 1 and 2 AEs, resolving within 4 weeks using antibiotics or relevant medication. Grade 3 AEs (urinary retention requiring surgical intervention) occurred in two patients, resolving within 3 months. No grade 4 or higher events and no bowel-related complications occurred. 98% of men preserved pad-free continence. 94/94 men, who were previously potent, maintained erectile potency. 85% of men with concurrent BPH and PCa experienced symptom relief. The mid-term oncological success rate was 88%. A single repeat TULSA was performed on 13 patients. CONCLUSIONS: Lesion-targeted TULSA is a safe and customizable prostate ablation therapy with promising mid-term oncological outcomes and minimal side-effect profile on patients erectile, bowel, and urinary functions. TULSA offers the flexibility to treat localized prostate cancer in a primary, salvage, or concurrent setting of BPH through a patient-tailored whole-gland or lesion-targeted approach. Source of Funding: No funding was received © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1038 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rolf Muschter More articles by this author Leonhard Steinmeister More articles by this author Agron Lumiani More articles by this author Expand All Advertisement PDF downloadLoading ...