Henk Van Der Research Articles

MP33-08 PENILE CANCER CARE IN THE NETHERLANDS OVER THREE DECADES: INCREASED INCIDENCE, CENTRALISATION OF CARE, AND OVERALL SURVIVAL

You have accessJournal of UrologyCME1 Apr 2023MP33-08 PENILE CANCER CARE IN THE NETHERLANDS OVER THREE DECADES: INCREASED INCIDENCE, CENTRALISATION OF CARE, AND OVERALL SURVIVAL Manon Vreeburg, Hielke-Martijn de Vries, Henk van der Poel, and Oscar Brouwer Manon VreeburgManon Vreeburg More articles by this author , Hielke-Martijn de VriesHielke-Martijn de Vries More articles by this author , Henk van der PoelHenk van der Poel More articles by this author , and Oscar BrouwerOscar Brouwer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The process of centralization of Penile Squamous Cell Carcinoma (PSCC) care in the Netherlands was initiated around 1990 and based on acknowledgement of one national center of expertise. Other regional PSCC centers should have an annual caseload of ≥10 T1aG1 patients per year and experience in high-level multidisciplinary care. The aim of this study was to evaluate incidence and centralization trends, and the potential benefit on overall survival of centralization of PSCC care in the Netherlands. METHODS: All new PSCC diagnoses between 1990-2020 were retrospectively identified from the Netherlands Cancer Registry (NCR), a population-based cancer registry with nationwide coverage. Cancer diagnoses are reported by registry of histology after which the NCR can provide per-patient data on age, clinical and pathological tumor staging, follow-up and vital status. All patients that were treated in the national referral center (NCI, Amsterdam) were known, all other patients were treated at one of the regional centers (anonymity kept by NCR). Overall survival (OS) was calculated with multivariate cox regression analysis, with T- and N-stage, treatment at the NCI (y/n) and age as independent variables. RESULTS: In total, 3276 patients were diagnosed with PSCC in the Netherlands. There was a significant incidence increase, from 0.92 per 100,000 men in 1990 to 1.83 per 100,000 men in 2020. The percentage of NCI-patients increased from 1% to 63% during this period, while in other centers it decreased from 99% to 37%. The median age of NCI-patients was 68 years and 70 years in other centers. At the NCI, 27% of the patients had lymph node metastases (pN+), compared to 10% in other centers (p-value<0.001). Despite of this, and corrected for T-, N-stage and age, the OS of NCI-patients was higher compared to patients in other centers (HR 1.29, 95% CI 1.13–1.47, p-value=0.001). The median OS at the NCI is 10 years (IQR 9–11 years) and in other centers 7 years (IQR 7–8 years). CONCLUSIONS: PSCC incidence in the Netherlands is rising and centralization of care has increased. Despite a relatively higher N-stage at presentation, patients treated at the national referral center of expertise seem to have higher OS, suggesting a beneficial effect of centralized care. Source of Funding: No conflict of interest to declare © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e453 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manon Vreeburg More articles by this author Hielke-Martijn de Vries More articles by this author Henk van der Poel More articles by this author Oscar Brouwer More articles by this author Expand All Advertisement PDF downloadLoading ...

PD22-01 ONCOLOGICAL OUTCOMES OF SENTINEL LYMPH NODE PROCEDURE-GUIDED RADIOTHERAPY VERSUS IMAGING-GUIDED RADIOTHERAPY FOR CLINICALLY LOCALIZED PROSTATE CANCER – A MULTICENTER, RETROSPECTIVE, PROPENSITY SCORE WEIGHTED COMPARISON

You have accessJournal of UrologyCME1 May 2022PD22-01 ONCOLOGICAL OUTCOMES OF SENTINEL LYMPH NODE PROCEDURE-GUIDED RADIOTHERAPY VERSUS IMAGING-GUIDED RADIOTHERAPY FOR CLINICALLY LOCALIZED PROSTATE CANCER – A MULTICENTER, RETROSPECTIVE, PROPENSITY SCORE WEIGHTED COMPARISON Hilda de Barros, Nikolaos Grivas, Jan Duin, Daan Mulder, Vincent van der Noort, Arjen Noordzij, Esther Wit, Eva Schaake, Pim van Leeuwen, and Henk van der Poel Hilda de BarrosHilda de Barros More articles by this author , Nikolaos GrivasNikolaos Grivas More articles by this author , Jan DuinJan Duin More articles by this author , Daan MulderDaan Mulder More articles by this author , Vincent van der NoortVincent van der Noort More articles by this author , Arjen NoordzijArjen Noordzij More articles by this author , Esther WitEsther Wit More articles by this author , Eva SchaakeEva Schaake More articles by this author , Pim van LeeuwenPim van Leeuwen More articles by this author , and Henk van der PoelHenk van der Poel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002564.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Insufficient sensitivity of current imaging techniques for nodal staging has led to the exploration of the sentinel lymph node biopsy (SLNB) to select primary prostate cancer (PCa) patients that might benefit from whole-pelvic nodal radiotherapy (WPRT). In this study, we aimed to evaluate oncological outcomes of SLNB-based RT compared to imaging-based RT in cN0M0 PCa patients with an increased estimated risk of nodal metastases. METHODS: This multicenter, retrospective cohort study included 522 cN0 primary PCa patients with a Briganti nomogram-estimated nodal risk >5% treated with external beam RT (EBRT) between 2007-2018. Nodal staging was performed either by radiological staging (261 (50%) patients) or by radiological staging and an additional robot-assisted laparoscopic SLNB (261 (50%) patients). All patients received RT to the prostate and 6 months to 3 years of androgen deprivation therapy (ADT), whereas patients with a histologically positive sentinel node (pN1) also received RT to the pelvic LNs with 3 years of ADT. Endpoints included biochemical recurrence-free survival (BCR-FS) and radiological recurrence-free survival (RR-FS). Propensity score weighted (PSW) multivariable Cox regression analysis was performed to determine independent predictors of BCR and RR. RESULTS: Patients staged with SLNB had a higher rate of extracapsular extension (63% vs 35%, P <0.001) and were at higher risk of nodal metastases (43% vs 29%, P=0.002) compared to imaging-only staged patients. Median follow-up after primary treatment was 64 months (IQR 41-95). In total, 111 patients developed a BCR (SLNB=51, non-SLNB=60) and 98 patients developed a radiological recurrence (SLNB=50, non-SLNB=48; Fig 1). In PSW multivariable Cox regression analyses, SLNB-based RT was an independent predictor of both BCR (HR 0.38, 95% CI 0.25-0.59, P <0.001) and RR (HR 0.44, 95% CI 0.28-0.69, P <0.001). CONCLUSIONS: SLNB-guided RT is associated with a decreased risk of BCR and RR when compared to prostate-only RT in cN0 PCa patients. These results suggest an important role for SLNB in selecting cN0 PCa patients that might profit from WPRT and ADT intensification, and justify a prospective comparison. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e402 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hilda de Barros More articles by this author Nikolaos Grivas More articles by this author Jan Duin More articles by this author Daan Mulder More articles by this author Vincent van der Noort More articles by this author Arjen Noordzij More articles by this author Esther Wit More articles by this author Eva Schaake More articles by this author Pim van Leeuwen More articles by this author Henk van der Poel More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD17-12 EXTENDED—TARGETED-PLUS-REGIONAL—MRI-DIRECTED BIOPSY APPROACH IN PROSTATE CANCER DIAGNOSIS–A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 May 2022PD17-12 EXTENDED—TARGETED-PLUS-REGIONAL—MRI-DIRECTED BIOPSY APPROACH IN PROSTATE CANCER DIAGNOSIS–A SYSTEMATIC REVIEW AND META-ANALYSIS Marinus Hagens, Mar Fernandez Salamanca, Anwar Padhani, Pim van Leeuwen, Henk van der Poel, and Ivo Schoots Marinus HagensMarinus Hagens More articles by this author , Mar Fernandez SalamancaMar Fernandez Salamanca More articles by this author , Anwar PadhaniAnwar Padhani More articles by this author , Pim van LeeuwenPim van Leeuwen More articles by this author , Henk van der PoelHenk van der Poel More articles by this author , and Ivo SchootsIvo Schoots More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002555.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To systematically evaluate the diagnostic performance of MRI-directed targeted-plus-regional biopsy (TBx+RBx; index-test-1) and targeted-only biopsy (TBx; index-test-2) approaches in prostate cancer (PCa) suspected men, in comparison with the MRI-directed targeted-plus-systematic biopsy (TBx+SBx; reference-test) approach. METHODS: MEDLINE and EMBASE databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses process (updated to August 2021). Identified reports were critically appraised to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. Detection of grade group (GG) ≥2 PCa was extracted as endpoint of interest. Random-effect meta-analyses were conducted to characterize summary effect sizes and quantify heterogeneity. Only MRI-positive men were included. RESULTS: A total of eight studies were included for analysis. There was no heterogeneity between studies. In a cumulative total of 2603 PCa suspected men, a non-significant difference between TBx+RBx and TBx+SBx was obtained in detection of GG≥2 cancers (Risk Ratio (RR) 0.95 [95% CI 0.90-1.01; p=0.09)(Figure 1a). TBx+RBx, however, did significantly outperform TBx in detection of GG≥2 cancers (RR 1.18 [95% CI 1.10-1.25]; p<0.001) (Figure 1b). These results were obtained by 3-4 targeted and 4-10 regional cores, avoiding contralateral systematic biopsies. CONCLUSIONS: A TBx+RBx approach detected equivalent GG≥2 cancers in comparison with the recommended practice of TBx+SBx, subsequently minimizing biopsy cores. Prospective clinical trials are needed to substantiate the arguments to obviate additional systematic biopsies currently recommended for the diagnostic work-up in men with positive MRI scans. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e341 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marinus Hagens More articles by this author Mar Fernandez Salamanca More articles by this author Anwar Padhani More articles by this author Pim van Leeuwen More articles by this author Henk van der Poel More articles by this author Ivo Schoots More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD57-01 PREDICTING EARLY BIOCHEMICAL PROGRESSION IN PROSTATE CANCER PATIENTS STAGED WITH PSMA PET AND MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (PD57)1 Sep 2021PD57-01 PREDICTING EARLY BIOCHEMICAL PROGRESSION IN PROSTATE CANCER PATIENTS STAGED WITH PSMA PET AND MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING Dennie Meijer, Pim van Leeuwen, Maarten Donswijk, Thierry Boellaard, Ivo Schoots, Henk van der Poel, Harry Hendrikse, Daniela Oprea-Lager, and André Vis Dennie MeijerDennie Meijer More articles by this author , Pim van LeeuwenPim van Leeuwen More articles by this author , Maarten DonswijkMaarten Donswijk More articles by this author , Thierry BoellaardThierry Boellaard More articles by this author , Ivo SchootsIvo Schoots More articles by this author , Henk van der PoelHenk van der Poel More articles by this author , Harry HendrikseHarry Hendrikse More articles by this author , Daniela Oprea-LagerDaniela Oprea-Lager More articles by this author , and André VisAndré Vis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002091.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study was to point out predictors for early oncological outcome in patients who opt for robot-assisted laparoscopic radical prostatectomy (RARP) for localized prostate cancer (PCa) including conventional prognostic variables as well as multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging. METHODS: This observational study included 500 patients who underwent RARP and extended pelvic lymph node dissection (ePLND). Outcome measurement was biochemical progression of disease, defined as any post-operative PSA ≥0.2 ng/mL. A Cox-regression analysis was performed to assess predictors for biochemical progression, including initial prostate-specific antigen (PSA)-value, biopsy Grade Group (GG), T-stage on mpMRI, and lymph node status on PSMA PET imaging (miN0 vs. miN1). RESULTS: The median total follow-up of all included patients was 12.8 months (IQR 6.6-22.3). When assessing biochemical progression after surgery, initial PSA-value (per doubling; OR 1.24 (95%CI 1.08-1.43), p=0.003), biopsy GG ≥4 vs. GG 1-2 (OR 2.33 (95%CI 1.47-3.69), p<0.001), T-stage on mpMRI (rT3a vs. rT2: OR 2.04 (95%CI 1.30-3.20), p=0.002; ≥rT3b vs. rT2: OR 4.87 (95%CI 3.24-7.32), p<0.001) and miN1 on PSMA PET imaging (OR 2.16 (95%CI 1.46-3.20), p<0.001) were independent predictors of biochemical progression of disease. Moreover, the number of pelvic lymph node metastases on PSMA PET was significantly associated with biochemical progression: one pelvic lymph node metastasis vs. no metastatic disease resulted in an OR 2.60 (95%CI 1.57-4.31), p<0.001; two pelvic lymph node metastases or more on PSMA PET vs. no metastatic disease resulted in an OR 4.61 (95%CI 2.84-7.48), p<0.001. CONCLUSIONS: Initial PSA-value, biopsy GG ≥4, ≥rT3 disease on mpMRI and miN1 disease on PSMA PET were predictors for early biochemical progression after RARP. Furthermore, the number of pelvic lymph node metastases on staging PSMA PET was associated with biochemical progression. Identifying patients with an increased risk of biochemical progression after surgery may have implications for patient counseling in radical treatment decisions and on patient selection for modern (neo-)adjuvant and systematic treatments. Source of Funding: No funding was received for conducting this study. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1009-e1009 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dennie Meijer More articles by this author Pim van Leeuwen More articles by this author Maarten Donswijk More articles by this author Thierry Boellaard More articles by this author Ivo Schoots More articles by this author Henk van der Poel More articles by this author Harry Hendrikse More articles by this author Daniela Oprea-Lager More articles by this author André Vis More articles by this author Expand All Advertisement Loading ...

Abstract 5198: Androgen receptor signaling affects macrophage differentiation in the human prostate cancer microenvironment

Abstract Increasing evidence from epidemiologic and pathologic studies suggests a role of macrophages in the initiation and progression of prostate cancer (PCa). During PCa development, macrophages (CD68+) are recruited into the human prostate cancer microenvironment, including inflammation-associated M1 and cancer-promoting M2 macrophages. Like other prostate cancer-associated stromal cells, macrophages express the androgen receptor (AR); however, its functionality is not known. CD68+ cells generated in vitro from peripheral white blood cells and PMA activated and IFN and LPS polarized human acute monocytic leukemia THP-1 cells also expressed AR. In these cells AR is an 80KD splice variant, lacking parts of exon 1 and exon 2. AR translocated to the nucleus upon testosterone stimulation, which was counteracted by the AR signaling inhibitor RD162. In vitro generated M1 macrophages expressed the M2 markers CD163 and CD206 upon testosterone stimulation, which was reversed by RD162. AR-ChIP sequencing suggested AR regulated Macrophage Triggering Receptor 1 (TREM1) signaling. Expression of key cytokines (e.g., CCL2, CXCL8, CCL7, IL10, IL1B) involved in TREM1 signaling was upregulated upon testosterone stimulation. Actions of these cytokines is generally associated with a protumor phenotype of macrophages. Conditioned medium from macrophages stimulated with testosterone for 8 hrs resulted in enhanced proliferation and migration of human prostate LNCap and CWRR1 cells. In conclusion, AR signaling might affect differentiation of prostate cancer-associated macrophages into cancer-promoting M2, which affects prostate cancer cell proliferation and migration. Maintaining macrophages in M1 might be a novel mechanism of action of androgen receptor inhibitors. Citation Format: Bianca Cioni, Ekatarina Nevedomskaya, Suzan Stelloo, Monique Melis, Johan van Burgsteden, Jeroen de Jong, Henk van der Poel, Jan Paul de Boer, Wilbert Zwart, Andries M. Bergman. Androgen receptor signaling affects macrophage differentiation in the human prostate cancer microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5198.

PD41-06 ROBOT-ASSISTED TRAINING - EXPERT PERFORMANCE IN FULL IMMERSION SIMULATION, SETTING THE BENCHMARK (CONCURRENT VALIDITY)

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment II1 Apr 2017PD41-06 ROBOT-ASSISTED TRAINING - EXPERT PERFORMANCE IN FULL IMMERSION SIMULATION, SETTING THE BENCHMARK (CONCURRENT VALIDITY) Talisa Ross, Nicholas Raison, Lauren Wallace, Thomas Wood, Catherine Lovegrove, Henk Van der Poel, Prokar Dasgupta, and Kamran Ahmed Talisa RossTalisa Ross More articles by this author , Nicholas RaisonNicholas Raison More articles by this author , Lauren WallaceLauren Wallace More articles by this author , Thomas WoodThomas Wood More articles by this author , Catherine LovegroveCatherine Lovegrove More articles by this author , Henk Van der PoelHenk Van der Poel More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , and Kamran AhmedKamran Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1885AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate surgical trainee performance, technical and non-technical skills can be assessed during full immersion simulation. This study aimed to define the benchmark that novices must attain before achieving competency in urethro-vesical anastomosis (UVA). Benchmark scores are important to reflect when a trainee is safe to perform the task on a real patient by providing an objective assessment of a trainee's performance. METHODS 14 expert and intermediate robotic surgeons were assessed for technical and non-technical skills whilst performing UVA in full immersion simulation, with actors playing the roles of scrub nurse and anaesthetist. UVA requires suturing the urethra to the bladder. A series of stressors were applied during the task to enable full assessment of non-technical skills. Data was compared to the performance of 22 medical student novices to establish construct validity. Video footage was assessed by an international expert using GEARS and NOTSS. Mean expert scores were then used to define a competency benchmark. RESULTS There was a statistically significant difference in technical and non-technical skills between novices, intermediates and experts (p = 0.031, p = 0.047 respectively). As construct validity was displayed, mean expert scores were used to define a benchmark score of 2.9 for technical skills and 2.8 for non-technical skills. There was no significant difference between laparoscopic and robotic experts, suggesting there may be some transference of skill from previous laparoscopic experience. CONCLUSIONS Trainees should aim to achieve a mean GEARS score of 2.9 and a mean NOTSS score of 2.8 to achieve competency in performing UVA. Using these benchmark scores will help to deem whether a trainee is competent to perform an unassisted UVA on a patient and can be incorporated into robot-assisted surgery training programmes to monitor progression. Future work must be carried out to further evaluate whether there is a role for transference of skills from laparoscopic experience to robot-assisted surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e809 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Talisa Ross More articles by this author Nicholas Raison More articles by this author Lauren Wallace More articles by this author Thomas Wood More articles by this author Catherine Lovegrove More articles by this author Henk Van der Poel More articles by this author Prokar Dasgupta More articles by this author Kamran Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP79-05 VALIDATION OF THE NOVEL 5-GROUP GLEASON GRADING SYSTEM: 3+5 DISEASE RISK MAY BE OVERESTIMATED

You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2016MP79-05 VALIDATION OF THE NOVEL 5-GROUP GLEASON GRADING SYSTEM: 3+5 DISEASE RISK MAY BE OVERESTIMATED Roderick van den Bergh, Theo van der Kwast, Jeroen de Jong, Homi Zargar, Declan Murphy, and Henk van der Poel Roderick van den BerghRoderick van den Bergh More articles by this author , Theo van der KwastTheo van der Kwast More articles by this author , Jeroen de JongJeroen de Jong More articles by this author , Homi ZargarHomi Zargar More articles by this author , Declan MurphyDeclan Murphy More articles by this author , and Henk van der PoelHenk van der Poel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2003AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The International Society of Urological Pathology after a 2014 consensus meeting, suggested to change the classical Gleason grading system to 5 prognostic grade groups (1: 3+3, 2: 3+4, 3: 4+3, 4: Gleason score 8, and 5: Gleason score 9-10). We compared the predictive value for biochemical recurrence (BCR) after surgery of the classical grading system to the new risk group system. METHODS The radical prostatectomy database from a single referral centre was used (N=1,384). BCR was defined as a post-operative PSA of >=0.2 ng/ml and rising. The classical 9-group system (3+3, 3+4, 3+5, 4+3, 4+4, 5+3, 4+5, 5+4, and 5+5) was compared to the novel 5-group system. Separate analyses were performed for biopsy Gleason score and for prostatectomy Gleason score. Kaplan-Meier curves with Log-Rank test for comparisons between curves were used. P-values of <0.05 were considered statistically significant. RESULTS Prostatectomy Gleason score patient numbers were: 3+3: 479, 3+4: 474, 4+3: 142, 3+5: 52, 4+4: 46, 5+3: 13, 4+5: 44, 5+4: 13, 5+5: 7. For biopsy, the classical grading showed overlap between different subgroups of Gleason 7 and 8 and between 8 and 9 (all p>0.05). The new risk group 2 overlapped with 3 (p=0.282), and 3 with 4 (p=0.161), other group comparisons were significantly different. For prostatectomy, the classical grading showed overlap between different Gleason 9 subgroups and 10 (all p>0.05). The new risk group 3 overlapped with 4 (p=0.893), other group comparisons were significantly different. Within risk group 4, 3+5 patients (3-year BCR-free 65%) had more favorable (p<0.01) BCR than 4+4 patients (18%) and were even similar (p=0.524) to 3+4 (73%) [Figure]. No corrections for margin or lymph node status were made. Limitations include the use of a single database, the intermediate endpoint BCR, and limited patient numbers for some subgroups. CONCLUSIONS Condensing the classical 9-group Gleason system to the suggested 5-group system resulted in less overlap between BCR rates, suggesting increased prognostic stratification. However, in the new grading system, prognostic stratification value between some higher risk disease patients may be lost. Most markedly, the risk of prostatectomy Gleason 3+5 patients (new risk group 4) may be overestimated, as the BCR resembles that of Gleason 3+4 (new risk group 2) patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1036 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Roderick van den Bergh More articles by this author Theo van der Kwast More articles by this author Jeroen de Jong More articles by this author Homi Zargar More articles by this author Declan Murphy More articles by this author Henk van der Poel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP15-14 PATIENTS NOT SUITABLE FOR ACTIVE SURVEILLANCE BUT IN WHOM GLEASON UPGRADING COULD BE EXCLUDED HAVE BIOCHEMICAL RECURRENCE RATES SIMILARLY FAVORABLE TO PATIENTS WHO ARE SUITABLE FOR ACTIVE SURVEILLANCE

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II1 Apr 2016MP15-14 PATIENTS NOT SUITABLE FOR ACTIVE SURVEILLANCE BUT IN WHOM GLEASON UPGRADING COULD BE EXCLUDED HAVE BIOCHEMICAL RECURRENCE RATES SIMILARLY FAVORABLE TO PATIENTS WHO ARE SUITABLE FOR ACTIVE SURVEILLANCE Roderick van den Bergh, Declan Murphy, Declan Murphy, and Henk van der Poel Roderick van den BerghRoderick van den Bergh More articles by this author , Declan MurphyDeclan Murphy More articles by this author , Declan MurphyDeclan Murphy More articles by this author , and Henk van der PoelHenk van der Poel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2538AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Novel prostate imaging techniques with MRI in combination with guided biopsy aim to reduce Gleason score undergrading. We compared biochemical recurrence rates (BCR) after radical prostatectomy between patients with active surveillance (AS) suitable prostate cancer versus wider defined low risk prostate cancer and the effect of Gleason score upgrading after surgery. METHODS Two prostatectomy cohorts were combined. Low-risk PC was defined as T1-2, Gleason 6 prostate cancer and AS-suitable prostate cancer was defined using the ‘PRIAS-criteria’ as T1-2, PSA =<10 ng/ml, PSA density <0.2 ng/ml/ml, 1-2 positive biopsies, Gleason 3+3=6. Kaplan-Meier curves of patients with and without Gleason score upgrading were compared using the Log-Rank test. We hypothesized that perfect pre-operative biopsy Gleason grading would lead to 0% upgrading after surgery. RESULTS We included 755 patients of whom 181 (24%) suitable for AS, 324 (44%) had Gleason upgrading after surgery (to 6.5 in non-AS suitable versus 6.3; p=0.005), and 132 (18%) showed BCR a median of 1.0 year after prostatectomy. For the total group, the 5-year BCR rate was 27%. Regarding the entire low risk group of T1-2 Gleason 6 prostate cancer, Gleason upgrading at surgery was significantly associated with unfavorable BCR rates (Figure 1a; p<0.01). Within the selected group of more favorable risk disease suitable for AS, Gleason upgrading at surgery was not associated with BCR rates (Figure 1b; p=0.936). In patients who did not have Gleason upgrading, patients who were not suitable for AS showed similar BCR rates to patients who did fulfill all AS criteria (Figure 1c; p=0.155). A limitation is the retrospective design; prospective validation is needed. CONCLUSIONS In the selected group of favorable risk patients considered suitable for AS, no unfavorable effect on BCR rates was found of Gleason undergrading. This may question the additional value of reducing biopsy undergrading with new imaging techniques. In patients not fulfilling the strict AS criteria, exclusion of Gleason upgrading resulted however in BCR rates similarly favorable to patients who were suitable for AS. This may suggest that MRI could be used to expand selection criteria for AS if Gleason upgrading could be excluded. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e156-e157 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Roderick van den Bergh More articles by this author Declan Murphy More articles by this author Declan Murphy More articles by this author Henk van der Poel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP11-03 MODULAR TRAINING FOR RARP: WHERE TO BEGIN?

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2016MP11-03 MODULAR TRAINING FOR RARP: WHERE TO BEGIN? Catherine Lovegrove, Giacomo Novara, Khurshid Guru, Alex Mottrie, Ben Challacombe, Johar Raza, Henk Van der Poel, James Peabody, Rick Popert, Prokar Dasgupta, and Kamran Ahmed Catherine LovegroveCatherine Lovegrove More articles by this author , Giacomo NovaraGiacomo Novara More articles by this author , Khurshid GuruKhurshid Guru More articles by this author , Alex MottrieAlex Mottrie More articles by this author , Ben ChallacombeBen Challacombe More articles by this author , Johar RazaJohar Raza More articles by this author , Henk Van der PoelHenk Van der Poel More articles by this author , James PeabodyJames Peabody More articles by this author , Rick PopertRick Popert More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , and Kamran AhmedKamran Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2374AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Effective training is paramount in ensuring patient safety. The Halstedian approach to education has become redundant, replaced by evidence-based curricula models. Modular training entails advancing through surgical steps of increasing difficulty, moving to the next step once competence in the previous has been attained. This study aimed to compare theory-based training recommendations with how surgeons are trained in reality and thus construct a modular training pathway for use in RARP. METHODS This multi-institutional, prospective, observational, longitudinal study was conducted using 15 urology trainees from across Europe and Australia. They utilised a validated training tool and data regarding surgeons' stage of training and progress was collected for analysis. With reference to training recommended in the literature, a modular pathway for RARP training was constructed. RESULTS 15 surgeons were assessed by their mentors in 425 RARP cases over eight months (range 7-79). There were substantial differences in the order of RARP stages according to the chronology of the procedure, difficulty level and the order in which surgeons were trained in reality. Difficulty for stages of RARP level as recommended by ERUS ranged from I-IV. Median case number for first attempting a stage of RARP ranged from 1-5 (minimum case number 1, maximum case number 59). “Stage 4: Initiation of the console” was the most frequently attempted stage (372 attempts by 15 trainees). “Stage 17: Lymph node dissection” was least frequently attempted (82 attempts by 11 trainees). A new modular training route has been designed (Figure 1). This incorporates the stages of RARP with the following order of priority: difficulty level > median case number of first attempt > most frequently undertaken in surgical training. CONCLUSIONS An evidence-based modular training pathway has been developed. This should be used to aid surgeons, ensuring that they operate within their capabilities as they progress through their training. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e111-e112 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Catherine Lovegrove More articles by this author Giacomo Novara More articles by this author Khurshid Guru More articles by this author Alex Mottrie More articles by this author Ben Challacombe More articles by this author Johar Raza More articles by this author Henk Van der Poel More articles by this author James Peabody More articles by this author Rick Popert More articles by this author Prokar Dasgupta More articles by this author Kamran Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract 5075: The composition and interactions in the microenvironment of human prostate cancer

Abstract Background: Prostate cancer is a heterogeneous disease both genetically and in its clinical behavior. It is widely accepted that a tumor does not only consist of cancer cells but also contains many other non-malignant cells, including immune cells and cancer associated fibroblasts. These non-malignant cells create the tumor microenvironment. It is previously suggested that the tumor microenvironment modulates the behavior of various cancers, including prostate cancer. Little is known about the exact interactions between prostate cancer cells and its micro environment. In this study we aim to gain insight into the composition of the microenvironment and the interaction between malignant and non-malignant cells. Moreover, these interactions might hold a predictive signature for disease progression and metastatic disease. Methods: Biopsies were obtained from Formalin Fixed Paraffin Embedded (FFPE) human prostate cancers from 10 patients with pelvic lymph node metastases and 10 gleason score (7-8-9) matched patients with non-metastatic disease. RNA was isolated from the FFPE samples and sequenced. A tissue micro array was constructed from the same prostate cancers. Fresh prostate cancer biopsies were taken right after radical prostatectomy, and fibroblast cells were isolated for short term culture. Results: The RNA sequencing of FFPE prostate biopsies revealed an increased expression of cancer related stroma genes in tumor tissue compared to non-tumorous tissue. Presence of various cell types was confirmed by immunohistochemistry (IHC). The subtypes of various immune cell populations could be identified, including regulatory T cells and pro-tumorous M2-like macrophages. The percentage of M2-like macrophages identified by the CD163 marker showed a significant increase in tumor tissue compared to non-tumorous tissue, which was unique for patients with metastatic disease. Furthermore we could confirm that decreased stromal Androgen Receptor (AR) expression correlated with disease progression and also correlated with metastatic disease. To investigate which stromal cells were AR positive we performed double stainings of PDGFR beta and AR. Costaining of both markers confirmed AR expression in fibroblasts. The stromal cells cultured from the fresh prostate cancer biopsies were morphologically fibroblasts and expressed AR, Smooth Muscle Actin and PDGFR beta, suggesting a cancer associated phenotype. Testosterone stimulation of these fibroblasts showed increased chromatin binding of the AR. This suggests that the AR is functional in these cancer associated fibroblasts. Conclusions: This study gained insight into the composition of the prostate cancer microenvironment. The increased expression of CD163 and the decreased expression of stromal AR was related to pelvic lymph node metastases. Citation Format: Monique Melis, Bianca Cioni, Ekaterina Nevedomskaya, Johan van Burgsteden, Emma Hodel, Annegien Broeks, Henk van der Poel, Jeroen de Jong, Andre Bergman. The composition and interactions in the microenvironment of human prostate cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5075. doi:10.1158/1538-7445.AM2015-5075

MP22-05 EVALUATION OF TECHNICAL LEARNING-CURVES FOR ROBOT ASSISTED RADICAL PROSTATECTOMY - A MULTI-INSTITUTIONAL STUDY

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment I1 Apr 2015MP22-05 EVALUATION OF TECHNICAL LEARNING-CURVES FOR ROBOT ASSISTED RADICAL PROSTATECTOMY - A MULTI-INSTITUTIONAL STUDY Catherine Lovegrove, Giacomo Novara, Khurshid Guru, Alex Mottrie, Ben Challacombe, Johar Raza, Henk Van der Poel, James Peabody, Rick Popert, Prokar Dasgupta, and Kamran Ahmed Catherine LovegroveCatherine Lovegrove More articles by this author , Giacomo NovaraGiacomo Novara More articles by this author , Khurshid GuruKhurshid Guru More articles by this author , Alex MottrieAlex Mottrie More articles by this author , Ben ChallacombeBen Challacombe More articles by this author , Johar RazaJohar Raza More articles by this author , Henk Van der PoelHenk Van der Poel More articles by this author , James PeabodyJames Peabody More articles by this author , Rick PopertRick Popert More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , and Kamran AhmedKamran Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Use of robot-assisted radical prostatectomy (RARP) has become the current standard of care. Surgical training and its—assessment are critical in assuring optimal outcomes after robot-assisted approach towards prostatectomy. Learning curves can be used to identify learning needs and evaluate the success of training methods to ensure efficient use of resources in helping trainee surgeons achieve competence. This study aims to evaluate the technical skills of trainees by constructing learning curves for individual steps of RARP. METHODS This multi-institutional, observational, prospective study used a validated assessment score designed to examine the technical skills required for the most hazardous steps of RARP. The RARP Assessment Score was distributed to 15 trainees who performed numerous RARP cases and were scored by their mentors. Results were analysed relative to RARP experience to examine learning—curves for each step. RESULTS 15 trainees were assessed for 8 months. They participated in 426 RARP cases (Range 4–79) and, all 17 procedural steps were attempted. Of reported data, the majority of cases were T stage 2 (40.3%), N stage 0 (59.9%) and “Intermediate” D'Amico risk (36.1%). Learning curves derived demonstrated several findings. Of note were the plateaus for Anterior Bladder Neck Transection (16 cases), Posterior Bladder Neck Transection (18 cases), Posterior Dissection (9 cases), Dissection of Prostatic Pedicle and Seminal Vesicles (15 cases) and Anastomosis (17 cases). For the rest of the steps the LC did not plateau for the data collection period (e.g. Expose Prostatic Apex and Endopelvic Fascia; 31 cases, Stitching and Division of Dorsal Venous Plexus; 32 cases). CONCLUSIONS RARP Assessment Score based on HFMEA methodology identified critical hazardous steps specific to RARP and was used to assess and evaluate surgeons while performing RARP. The learning curves derived demonstrate the experience necessary to reach a level of competence in essential technical skills required to protect patient safety. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e242-e243 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Lovegrove More articles by this author Giacomo Novara More articles by this author Khurshid Guru More articles by this author Alex Mottrie More articles by this author Ben Challacombe More articles by this author Johar Raza More articles by this author Henk Van der Poel More articles by this author James Peabody More articles by this author Rick Popert More articles by this author Prokar Dasgupta More articles by this author Kamran Ahmed More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

MP58-01 MULTI-INSTITUTIONAL VALIDATION OF THE ERUS ROBOTIC SURGERY TRAINING CURRICULUM

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 2014MP58-01 MULTI-INSTITUTIONAL VALIDATION OF THE ERUS ROBOTIC SURGERY TRAINING CURRICULUM Alessandro Volpe, Kamran Ahmed, Prokar Dasgupta, Vincenzo Ficarra, Henk Van der Poel, Alexandre Mottrie, and ERUS board members Alessandro VolpeAlessandro Volpe More articles by this author , Kamran AhmedKamran Ahmed More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , Vincenzo FicarraVincenzo Ficarra More articles by this author , Henk Van der PoelHenk Van der Poel More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , and ERUS board members ERUS board members More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1817AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The criteria set for surgeon’s competence before starting robotic surgery are neither structured nor evidence based. The development of structured and validated training curricula represents one of the current priorities in the robotic urologic field. METHODS A 12-weeks structured training program/curriculum was developed based on a focused group expert panel discussion and used to train 10 fellows from major teaching institutions across Europe. The key components of the curriculum were e-learning, an intensive week of structured simulation laboratory training (virtual reality simulator and dry/wet lab simulation platforms) and modular training in robot-assisted radical prostatectomy (RARP) at each institutions under supervision of the mentors. The technical and non- technical skills of the fellows were assessed by the mentors at the end of the program using previously validated GEARS (score 1- 5) and NOTTS (score 1-4) scales. At the end of the training, a full RARP performed by the fellows was video-recorded and blindly assessed by two independent expert robotic surgeons using a dedicated assessment scale. The scores of the fellows were compared with those of two expert robotic surgeons. The educational impact was evaluated with a dedicated questionnaire. RESULTS The fellows had limited previous console exposure (4 mos, IQR 0-6.5). At the end of the training, the fellows received an average score >4 (4.1-4.7) from their mentors for all the technical skills domains of the GEARS scale, with no negative scores (≤2). An average score ≥3.5 was also achieved for the 4 non-technical skills domains of the NOTTS scale, with no negative scores (≤2). Eight fellows were deemed able to perform a RARP alone by their mentors. At the assessment of the video-recorded RARP, 6 fellows received a sufficient score by the reviewers for all steps of the surgical procedure and 8 reached an average overall sufficient score. The robotic experts significantly outperformed the fellows for all surgical steps. At the final questionnaire, all fellows considered the program effective in improving their robotic skills and ability to perform the surgical steps of RARP with a mean score of 4.7 on a Likert-type scale (1=strongly disagree to 5=strongly agree). CONCLUSIONS This 12-weeks structured training program was successful to improve the robotic skills of fellows and their ability to perform the surgical steps of RARP. Further studies are needed to define the ideal length and schedule of these programs. This pilot study represents a step towards the definition of validated curricula for RARP and other robotic procedures. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e658 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alessandro Volpe More articles by this author Kamran Ahmed More articles by this author Prokar Dasgupta More articles by this author Vincenzo Ficarra More articles by this author Henk Van der Poel More articles by this author Alexandre Mottrie More articles by this author ERUS board members More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP55-06 PROSTATE SPARING CYSTECTOMY: 20 YEARS SINGLE CENTER EXPERIENCE

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2014MP55-06 PROSTATE SPARING CYSTECTOMY: 20 YEARS SINGLE CENTER EXPERIENCE Laura Mertens, Richard Meijer, Remco de Vries, Jakko Nieuwenhuijzen, Henk van der Poel, Axel Bex, Bas van Rhijn, Wim Meinhardt, and Simon Horenblas Laura MertensLaura Mertens More articles by this author , Richard MeijerRichard Meijer More articles by this author , Remco de VriesRemco de Vries More articles by this author , Jakko NieuwenhuijzenJakko Nieuwenhuijzen More articles by this author , Henk van der PoelHenk van der Poel More articles by this author , Axel BexAxel Bex More articles by this author , Bas van RhijnBas van Rhijn More articles by this author , Wim MeinhardtWim Meinhardt More articles by this author , and Simon HorenblasSimon Horenblas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1554AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Radical cystoprostatectomy (RC) is the standard treatment for men with muscle invasive bladder cancer (MIBC) or refractory high risk non-MIBC. With removal of the prostate and seminal vesicals, there is a very high probability of loss of normal sexual function. Prostate sparing cystectomy (PSC) has been introduced as a modification of standard RC for selected males with bladder cancer (BC), leaving the prostate, seminal vesicles and prostatic urethra in situ. The goal of PSC is to improve functional results without jeopardizing oncological results. In the present study, we evaluated the long-term oncological and functional results after PSC for BC, starting 20 years ago. Methods Between 1994 and 2013, 120 patients with cT1-4N0-3 BC were treated with PSC. One hundred and ten patients had a follow up of ≥2 years and were eligible for analysis. In order to rule out tumour in the bladder neck and/or prostatic urethra, all patients had undergone preoperative transurethral biopsy of the bladder neck and prostatic urethra as well as prostate specific antigen measurement and transrectal ultrasound with biopsies, to rule out prostate cancer. We assessed oncological outcome (disease specific survival (DSS) and recurrence free survival (RFS); recurrence rates, prostate cancer and functional results (continence, voiding, erectile and ejaculatory function). Results Mean age of the patients was 56.2 years (standard deviation: 8.3 years). The median follow up was 77.0 months (interquartile range: 57-116 months). The 2- and 5-year DSS rates were 76.2% and 66.5%, respectively, and the 2- and 5-year RFS rates 71.2% and 66.6%. The total distant recurrence rate was 34.2% and the local recurrence rate 10.0%. One of the local recurrences was in the remnant prostatic urothelium. Prostate cancer was diagnosed in 2.7% of the patients. Complete daytime and nighttime continence was achieved in 96.2% and 81.9%, respectively. Erectile function and antegrade ejaculation could be maintained in 89.7% and 36.0% of the patients, respectively. Conclusions Our long-term data show that, for a subset of carefully selected BC patients with no evidence of urothelial carcinoma in the prostatic urethra/bladder neck and no prostate cancer, PSC is an oncologically safe procedure with excellent functional results. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e557 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Laura Mertens More articles by this author Richard Meijer More articles by this author Remco de Vries More articles by this author Jakko Nieuwenhuijzen More articles by this author Henk van der Poel More articles by this author Axel Bex More articles by this author Bas van Rhijn More articles by this author Wim Meinhardt More articles by this author Simon Horenblas More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Notes on the Flora of Madagascar, 30–34

Callmander, M. W., P. B. Phillipson, T. Deroin & L. Gautier (ed.) (2013). Notes on the flora of Madagascar, 30–34. Candollea 68: 301–320. In English and French, English and French abstracts.Ongoing research on Madagascar's flora is revealing numerous taxonomic novelties and nomenclatural inconsistencies, and providing new data on species distribution. This is the seventh set of notes in a series that aims to provide the botanical community working on the flora of Madagascar an opportunity to publish short communications on these topics, and this issue comprises five notes.— Note 30. Nomenclatural notes on Cryptocarya R. Br. (Lauraceae) from Madagascar, by Henk van der Werff. Five species of Malagasy Ravensara Sonn. are transferred to Cryptocarya R. Br. following the merging of these two genera and the accepted conservation of Cryptocarya over Ravensara. This necessitates two new combinations and two new names. The fifth species is placed in synonymy.— Note 31. Further nomenclatural notes on Malagasy Diospyros L. (Ebenaceae): Goudot types in the Geneva herbarium, by George E. Schatz, Porter P. Lowry II, Cyrille Mas & Martin W. Callmander. Discovery of several Goudot collections of Malagasy Diospyros L. deposited in the Geneva herbarium clarifies the typifications of Diospyros leucocalyx Hiern and Maba madagascariensis A. DC. Resolution of the type of Diospyros leucocalyx requires that the long used name Diospyros megasepala Baker be placed into synonymy under Diospyros leucocalyx Hiern. Past confusion between the two Paris specimens Perrier de la Bâthie 700 and Pervillé 700, the former of which is the type of Dichapetalum thouarsianum var. pubescens Desc. and the latter of which was previously cited as the type of Maba madagascariensis, is also discussed and clarified.— Note 32. Hybrid origin of Arthropteris boutoniana (Hook.) Pic. Serm. (Arthropteridaceae) from Mauritius and Madagascar, by France Rakotondrainibe & Catherine Reeb. The study of the Arthropteris Hook. f. collections from the Malagasy Region undertaken as a part of the revision of Filicophyta from Madagascar currently in progress, has revealed the intraspecific morphological heterogeneity of Arthtropteris boutoniana (Hook.) Pic. Serm. and demonstrated its hybrid origin. The putative parents are Arthropteris monocarpa (Cordem.) C. Chr. and Arthropteris orientalis (J. F. Gmel.) Posth. var. orientalis. The hybrid Arthropteris ×boutoniana is characterized by its hairy indusia, and its reduced fertility with few or totally aborted sporangia. It has been reported from Mauritius and Madagascar.— Note 33. Lectotypifications and a new combination in Polygala L. (Polygalaceae) from Madagascar, by Gregory A. Wahlert, Peter B. Phillipson & George E. Schatz. Polygala longeracemosa var. retamoides H. Perrier, narrowly distributed on soils derived from marble and quartzite in the Ambatofinandrahana area, was found to be morphologically distinct from the nominate variety. The authors conclude that it merits recognition at the rank of species and provide the necessary new combination; they also designate lectotypes for both taxa, and provide a key, preliminary conservation assessments and a distribution map.— Note 34. Adieu Adelosa Blume (Lamiaceae): Further observations on Rotheca Raf. for Madagascar, by Martin W. Callmander, Peter B. Phillipson, James A. Wearn & Rogier P. J. de Kok. Adelosa microphylla Blume is equated with the widespread and variable Rotheca incisa (Klotzsch) Steane & Mabb., and the status of the poorly-known Clerodendrum mirabile Baker and Rotheca myricoides (Hochst.) Steane & Mabb. are examined. Two new combinations in the genus Rotheca Raf. are proposed.

Patrick Fournier, Henk van der Kolk, R. Kenneth Carty, Andre Blais and Jonathan Rose, When citizens decide: Lessons from citizen assemblies on electoral reform, reviewed by Paul Webb

Patrick Fournier, Henk van der Kolk, R. Kenneth Carty, Andre Blais and Jonathan Rose, When citizens decide: Lessons from citizen assemblies on electoral reform, reviewed by Paul Webb

Special Issue on Accurate Solution of Eigenvalue Problems

The occasion for this special issue is the Sixth International Workshop on Accurate Solution of Eigenvalue Problems, which took place at The Pennsylvania State University from May 22–25, 2006. This special issue provides an outlet for papers from the workshop and recognizes advances in the numerical solution of eigenvalue and related problems. This is the second such special issue published in the SIAM Journal on Matrix Analysis and Applications; the first was published in number 4 of volume 28 in connection with the Fifth International Workshop on Accurate Solution of Eigenvalue Problems, which took place in Hagen, Germany, from June 29 to July 1, 2004. The twelve papers in the current issue are concerned with a variety of aspects that arise in the computation of eigenvalues and invariant subspaces: perturbation bounds and sensitivity, accuracy and convergence behavior of algorithms, exploitation of structure in matrices, and particular engineering applications. Thanks go to SIMAX Editor-in-Chief, Henk van der Vorst; guest editors Jesse Barlow, Froilán Dopico, and Zlatko Drmač, who put great effort into the careful and timely review of papers; and Mitch Chernoff, Cherie Trebisky, and other members of the SIAM staff who worked hard to publish this special issue.

Special Issue on Tensor Decompositions and Applications

This issue of SIAM Journal on Matrix Analysis and Applications was motivated by the Workshop on Tensor Decompositions and Applications, held in Luminy, France from August 29 to September 2, 2005. The issue was announced through both the SIMAX and the workshop web sites. Though decompositions of higher-order tensors have been around for many years, the door is now opening on greater mathematical understanding and new applications. Tensor decompositions have been applied by researchers in psychometrics and chemometrics since the seventies. More recently, tensors have found their way to signal processing via the use of high-order statistics, joint matrix techniques, and applications in telecommunications. Other applications include complexity theory, (blind) system identification, biomedical engineering, numerical analysis, and data mining, among others. This volume contains 15 papers that together form a nice cross-section of current research on tensor decompositions. The papers present new algorithms, basic algebraic results including the introduction of new decompositions, and applications in signal processing, scientific computing, and large-scale problems. Many thanks are due to all the authors for their valuable contributions. We would also like to thank Henk van der Vorst, Mitch Chernoff, and the SIAM staff for their support. Since the initial submission of the papers, two of the authors have passed away. Richard Harshman and Gene Golub were both authorities in their field.

Copper Mountain Special Issue on Iterative Methods

The 9th Copper Mountain Conference on Iterative Methods was held April 2–7, 2006, in Copper Mountain, Colorado. The conference is organized by Front Range Scientific Computations, Inc., with co-organizers the Center for Applied Scientific Computing at Lawrence Livermore National Laboratory, and the University of Maryland. Traditionally, the SIAM Journal on Scientific Computing (SISC) hosts a special issue on iterative methods that is open to the public and is announced well in advance through both the SISC and the Copper Mountain Conference web sites. I would like to thank the current members of the program committee for their service as guest editorial board. The committee members are Xiao-Chuan Cai, University of Colorado; Iain Duff, RAL and CERFACS; Roland Freund, University of California, Davis; Kirk Jordan, IBM, Watson Research Center; Tim Kelley, North Carolina State University; David Keyes, Columbia University; Tom Manteuffel, University of Colorado; Steve McCormick, University of Colorado; David Silvester, University of Manchester; Ray Tuminaro, Sandia National Laboratory; Henk van der Vorst, University of Utrecht; Homer Walker, Worcester Polytechnic Institute; Carol Woodward, Lawrence Livermore National Laboratory; Irad Yavneh, Technion. The committee is chaired by Howard Elman (University of Maryland) and myself. This issue contains 21 papers that largely reflect the topics presented at the conference, including papers that were part of the student papers competition. More specifically, we have papers covering the more traditional numerical linear algebra topic of preconditioning, including preconditioners for nonsymmetric problems in GMRES, radial basis function interpolation via preconditioned Krylov iterations, preconditioned eigensolvers, graph-based algorithms for preconditioning, and strategies for constructing block preconditioners for systems of PDEs, as well as some emerging new topics, such as preconditioners for stochastic elliptic PDEs and linear systems arising in interior point optimization methods. Most of the papers deal with some aspects of iterative methods for systems of algebraic equations; however, a paper on iterative optimization procedures with application to image registration also found its place in the issue. The overwhelming majority of the papers deal with various aspects of (mostly algebraic) multigrid (or (A)MG), ranging from theory of geometric MG applied to nontraditional formulation of Stokes problems to investigation of a number of algorithmic issues in AMG (such as the construction of the interpolation operator, coarsening strategies including for nonsymmetric problems), as well as the construction of specialized AMG algorithms for Google PageRank-like problems and for problems arising from higher-order spectral elements discretizations. Many thanks are due to all authors for their valuable contributions. I would like also to thank the SIAM staff for their constant support and efforts to bring this issue to life. Finally, let me acknowledge the traditional support for the conference from the US Department of Energy, the National Science Foundation, IBM, Los Alamos National Laboratory, Lawrence Livermore National Laboratory, and Sandia National Laboratory.

Special Issue on Accurate Solution Of Eigenvalue Problems

The occasion for this special issue is the Sixth International Workshop on Accurate Solution of Eigenvalue Problems, which took place at The Pennsylvania State University from May 22-25, 2006. This special issue provides an outlet for papers from the workshop and recognizes advances in the numerical solution of eigenvalue and related problems. This is the second such special issue published in the SIAM Journal on Matrix Analysis and Applications; the first was published in number 4 of volume 28 in connection with the Fifth International Workshop on Accurate Solution of Eigenvalue Problems, which took place in Hagen, Germany, from June 29 to July 1, 2004. The twelve papers in the current issue are concerned with a variety of aspects that arise in the computation of eigenvalues and invariant subspaces: perturbation bounds and sensitivity, accuracy and convergence behavior of algorithms, exploitation of structure in matrices, and particular engineering applications. Thanks go to SIMAX Editor-in-Chief, Henk van der Vorst; guest editors Jesse Barlow, Froilan Dopico, and Zlatko Drmac, who put great effort into the careful and timely review of papers; and Mitch Chernoff, Cherie Trebisky, and other members of the SIAM staff who worked hard to publish this special issue.

Copper Mountain Special Issue on Iterative Methods

The biennial Copper Mountain Conference on Iterative Methods was held March 28-April 2, 2004, in Copper Mountain, Colorado. In addition to the traditional management services provided by Front Range Scientific Computations, Inc., Howard Elman (University of Maryland) and Panayot Vassilevski (Center for Applied Scientific Computing at LLNL) served as co-chairs representing the conference's new organizing institutions. The Conference gratefully acknowledges support from all three major national labs---Los Alamos, Lawrence Livermore, and Sandia---as well as support from the Department of Energy, IBM, and the National Science Foundation. Traditionally, the Copper Mountain Conference is organized in cooperation with the Society for Industrial and Applied Mathematics (SIAM). This special issue was open to the public and was advertised in advance on the web sites of both the SIAM Journal on Scientific Computing (SISC) and the Copper Mountain Conference. There were 35 manuscripts submitted; 15 found their place in this special issue. It is the guest editor-in-chief's opinion that these papers reflect state-of-the-art trends in iterative methods, among them parallel-block preconditioning, various improved versions of GMRES (block, relaxed, and flexible), approximate factorization preconditioners for saddle-point problems, and iterative methods exploiting deflation. But above all, this special issue clearly demonstrates the strong impact of multigrid/multilevel methods as the unique optimal-order iterative methods in various areas of applications. It also demonstrates the search for optimal-order methods or preconditioners on the basis of multilevel ideas in variety of nontraditional areas. I would like to thank the guest editorial board---Loyce Adams, Xiao-Chuan Cai, Iain Duff, Roland Freund, Anne Greenbaum, Tim Kelley, David Keyes, Tom Manteuffel, Steve McCormick, Ray Tuminaro, Henk van der Vorst, Olof Widlund, and Carol Woodward of the conference program committee---as well as Raymond Chan of the SISC editorial board and the many anonymous referees for their hard work to help meet the strict deadlines. I would also like to thank the SIAM staff for their constant support and efforts to bring this issue to life. Of course, this issue would not have been possible without the authors' contributions. Some of these submissions also appeared in the student paper competition, a unique event at the Copper Mountain conferences that has proven to be a very successful forum for presenting the latest results in the field. We have had increasingly strong participation from very talented recent Ph.D. holders and current Ph.D. students in this competition. We thank all the authors for their valuable contributions and hope that this special issue will stimulate further progress in this exciting area of research.