Larger Prostate Size Research Articles

Risk factors for prostate-specific antigen persistence in pT3aN0 prostate cancer after robot-assisted laparoscopic radical prostatectomy: a retrospective study.

The aim of this study was to evaluate the risk factors for prostate-specific antigen (PSA) persistence in pathological stage T3aN0 prostate cancer (PCa) after robot-assisted laparoscopic radical prostatectomy (RALP). A retrospective study was performed on 326 patients with pT3aN0 PCa who underwent RALP between March 2020 and February 2022. PSA persistence was defined as nadir PSA of >0.1 ng/mL after RALP, and the risk factors for PSA persistence were evaluated using logistic regression analysis. Among 326 patients, 61 (18.71%) had PSA persistence and 265 (81.29%) had PSA of <0.1 ng/mL after RALP (successful radical prostatectomy [RP] group). In the PSA persistence group, 51 patients (83.61%) received adjuvant treatment. Biochemical recurrence occurred in 27 patients (10.19%) in the successful RP group during the mean follow-up period of 15.22 months. Multivariate analysis showed that the risk factors for PSA persistence were large prostate volume (hazard ratio [HR], 1.017; 95% confidence interval [CI], 1.002-1.036; p=0.046), lymphovascular invasion (LVI) (HR, 2.605; 95% CI, 1.022-6.643; p=0.045), and surgical margin involvement (HR, 2.220; 95% CI, 1.110-4.438; p=0.024). Adjuvant treatment may be needed for improved prognosis in patients with pT3aN0 PCa after RALP with a large prostate size, LVI, or surgical margin involvement.

MP02-16 DESCRIBING TRENDS IN THE PROSTATE OF TRANSGENDER WOMEN ON ANDROGEN DEPRIVATION HORMONE THERAPY

You have accessJournal of UrologyCME1 Apr 2023MP02-16 DESCRIBING TRENDS IN THE PROSTATE OF TRANSGENDER WOMEN ON ANDROGEN DEPRIVATION HORMONE THERAPY Tatyana Yatsenko, Kenan Celtik, Dara Lundon, Ariel Zisman, Miroslav Djordjevic, and Rajveer Purohit Tatyana YatsenkoTatyana Yatsenko More articles by this author , Kenan CeltikKenan Celtik More articles by this author , Dara LundonDara Lundon More articles by this author , Ariel ZismanAriel Zisman More articles by this author , Miroslav DjordjevicMiroslav Djordjevic More articles by this author , and Rajveer PurohitRajveer Purohit More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The impact of gender-affirming androgen deprivation hormone therapy (HT) on the prostate of transgender females (TF) has not been well described. The aim of our study is to understand prostate characteristics on ultrasound in TF. METHODS: We retrospectively evaluated the charts of TF on medical or surgical androgen deprivation (AD) as part of their gender transition who had transrectal ultrasound (US) imaging of the prostate. Ultrasounds were performed using a 10-5 MHz biplane probe for surgical planning. Variables evaluated included age, body mass index (BMI), prostate size, PSA values, if present, and duration of hormonal therapy. We performed age-matched comparisons between our cohort, published literature, and an internal data set of cisgender male patients. Pearson’s R, Student’s T test, and one-way ANOVA with Tukey’s HSD were performed for hypothesis testing. RESULTS: Between 2020 and 2022, 60 TF patients underwent prostate US. Demographics and findings are summarized in Table 1. There was no correlation in prostate size with duration of HT (DHT) or BMI. Older current age was associated with increased prostate size (R=0.58, p<0.001). Starting AD at a later age of hormone transition (AHT) was also associated with larger prostate size (R=0.59, p<0.001). When stratifying by age at hormone transition and current age, patients over age 50 had significantly larger prostates, compared to age groups <26 and 26-50 (p<0.01, Figure 1). Linear regression modeling both AHT and DHT as predictors of prostate size showed that AHT was about twice as impactful as DHT (R=0.68, p<0.001). We also noted that our cohort’s prostate volumes were significantly smaller than known population means for patients under age 51 (p<0.001), and were smaller than an age-matched cis male cohort from the same institution (Table 1). CONCLUSIONS: TF, primarily after 50, have larger prostates despite ongoing HT. Duration of HT and BMI were not independently correlated to prostate size, but older age at hormone transition and current age were associated with larger prostate size. [1] J Urol. 1984 Sep;132(3):474-9. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e18 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tatyana Yatsenko More articles by this author Kenan Celtik More articles by this author Dara Lundon More articles by this author Ariel Zisman More articles by this author Miroslav Djordjevic More articles by this author Rajveer Purohit More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-10 PERIOPERATIVE AND FUNCTIONAL OUTCOMES OF GREENLIGHT 180-W PHOTOVAPORIZATION IN LARGE (&gt;80 CC) PROSTATES: AN ANALYSIS FROM 7 CENTERS IN THE INTERNATIONAL GLOBAL GREENLIGHT GROUP

You have accessJournal of UrologyCME1 Apr 2023MP13-10 PERIOPERATIVE AND FUNCTIONAL OUTCOMES OF GREENLIGHT 180-W PHOTOVAPORIZATION IN LARGE (>80 CC) PROSTATES: AN ANALYSIS FROM 7 CENTERS IN THE INTERNATIONAL GLOBAL GREENLIGHT GROUP Nicholas Corsi, David-Dan Nguyen, Adel Arezki, Iman Sadri, Kyle Law, David Bouhadana, Claudia Deyirmendjian, Naeem Bhojani, Dean S. Elterman, Franck Bruyère, Luca Cindolo, Giovanni Ferrari, Carlos Vasquez-Lastra, Tiago Borelli-Bovo, Edgardo F. Becher, Hannes Cash, Maximillian Reimann, Enrique Rijo, Vincent Misrai, Bilal Chughtai, and Kevin C. Zorn Nicholas CorsiNicholas Corsi More articles by this author , David-Dan NguyenDavid-Dan Nguyen More articles by this author , Adel ArezkiAdel Arezki More articles by this author , Iman SadriIman Sadri More articles by this author , Kyle LawKyle Law More articles by this author , David BouhadanaDavid Bouhadana More articles by this author , Claudia DeyirmendjianClaudia Deyirmendjian More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Dean S. EltermanDean S. Elterman More articles by this author , Franck BruyèreFranck Bruyère More articles by this author , Luca CindoloLuca Cindolo More articles by this author , Giovanni FerrariGiovanni Ferrari More articles by this author , Carlos Vasquez-LastraCarlos Vasquez-Lastra More articles by this author , Tiago Borelli-BovoTiago Borelli-Bovo More articles by this author , Edgardo F. BecherEdgardo F. Becher More articles by this author , Hannes CashHannes Cash More articles by this author , Maximillian ReimannMaximillian Reimann More articles by this author , Enrique RijoEnrique Rijo More articles by this author , Vincent MisraiVincent Misrai More articles by this author , Bilal ChughtaiBilal Chughtai 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.0000000000003233.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. However, prior reports expressed concern with the use of PVP in large prostates. The aim of this study was to investigate the adjusted outcomes of Greenlight PVP in men with larger prostates (≥80 cc) from the largest international experience METHODS: Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011-2019 were eligible and assigned into two groups based on their prostate size (≥80 cc and <80 cc). 11 functional and perioperative covariates were collected. Analyses were adjusted for patient age and presence of median lobe. RESULTS: 3,426 men met the inclusion criteria. 34.6% (n=1,187) patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups. The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥80 cc) prostate group at 12 months, with an absolute change of 19.17 points (95% CI: 18.46 – 19.88; Figure 1, p<0.01). There was also a significant drop in PVR at both 6- (p=0.007) and 12-months (p=0.005). There were no significant differences in transfusion (p=0.42), hematuria (p=0.80), or 30-day readmission rates (p=0.28). CONCLUSIONS: Our results from >3000 patients suggest Greenlight PVP-180 W is a safe and effective alternative for patients with prostate sizes ≥80 cc, with outcomes relatively independent from prostate size. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e177 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Corsi More articles by this author David-Dan Nguyen More articles by this author Adel Arezki More articles by this author Iman Sadri More articles by this author Kyle Law More articles by this author David Bouhadana More articles by this author Claudia Deyirmendjian More articles by this author Naeem Bhojani More articles by this author Dean S. Elterman More articles by this author Franck Bruyère More articles by this author Luca Cindolo More articles by this author Giovanni Ferrari More articles by this author Carlos Vasquez-Lastra More articles by this author Tiago Borelli-Bovo More articles by this author Edgardo F. Becher More articles by this author Hannes Cash More articles by this author Maximillian Reimann More articles by this author Enrique Rijo More articles by this author Vincent Misrai More articles by this author Bilal Chughtai More articles by this author Kevin C. Zorn More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-18 LARGE PROSTATE SIZE AND ITS EFFECT ON LUTS IMPROVEMENT AND SEXUAL PRESERVATION FOLLOWING CONVECTIVE WATER VAPOR THERMAL THERAPY

You have accessJournal of UrologyCME1 Apr 2023MP13-18 LARGE PROSTATE SIZE AND ITS EFFECT ON LUTS IMPROVEMENT AND SEXUAL PRESERVATION FOLLOWING CONVECTIVE WATER VAPOR THERMAL THERAPY Owen Lewer, Michael Felice, Gaurav Pahouja, Amy Wozniak, and Kevin McVary Owen LewerOwen Lewer More articles by this author , Michael FeliceMichael Felice More articles by this author , Gaurav PahoujaGaurav Pahouja More articles by this author , Amy WozniakAmy Wozniak More articles by this author , and Kevin McVaryKevin McVary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: LUTS/BPH can affect quality of life in men. Convective water vapor thermal therapy (CWVTT - Rezum) is a minimally invasive surgical treatment (MIST) for LUTS/BPH which produces significant, 5-year improvement of LUTS in men with prostates between 30 and 80 cc with minimal de-novo sexual dysfunction. However, CWVTT outcomes based on variable prostate volume (PV) are incompletely described thus is an unmet need. We aim to elucidate the relationship between PV and outcomes post-CWVTT in men with LUTS/BPH. METHODS: In this retrospective study of men undergoing CWVTT from 1/2018 to 3/2022, PV was categorized by tertiles. The primary outcome measured was mean change in I-PSS post-CWVTT between tertiles over 24 months, and analyzed using general linear mixed models. Secondary outcomes include SHIM and IPSS-QOL. Results were adjusted for relevant patient characteristics. RESULTS: 232 patients were included and broken into PV tertiles: small (≤38.5 cc, N=78), medium (38.5-≤55.6 cc, N=76), and large (>55.6 cc, N=78). For IPSS, the change from baseline to 3-months post-op was -7.6 (p=<0.01), -10.4 (p=<0.01) and -11.6 (p=<0.01), small, medium, and large PV, respectively. Post-operatively, small and medium PV had decreasing IPSS scores while large PV IPSS scores were relatively stable. Large PV tended to have the lowest IPSS scores, regardless of time. These trends were similar for IPSS-QOL. For SHIM scores, all PV tertiles decreased from baseline to 3-months post-op. All 3 tertiles had improved SHIM scores over time. Large PV had significant increases in SHIM scores when unadjusted for other patient factors [0.18 per month (95% CI: 0.03 - 0.33, p=0.02)]. Small PV tended to have the lowest SHIM scores, regardless of time. In all three outcomes, when adjusted for other patient characteristics, the trends were not statistically significant. CONCLUSIONS: Interestingly, patients with larger PV may exhibit a more dramatic improvement in sexual function as measured by SHIM than those with smaller PV. In contrast, larger prostates may have a less dramatic improvement in LUTS as measured by I-PSS and I-PSS QoL than smaller ones. However, adjusted analyses show no significant improvement or decline in any of our outcomes by PV after the first post-operative appointment. Source of Funding: NIAID T35 AI125220 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e180 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Owen Lewer More articles by this author Michael Felice More articles by this author Gaurav Pahouja More articles by this author Amy Wozniak More articles by this author Kevin McVary More articles by this author Expand All Advertisement PDF downloadLoading ...

Does a large prostate size, small lesion volume, or long needle distance from the probe to the lesion reduce magnetic resonance imaging-targeted cancer detection?

We aimed to evaluate whether large prostate size, small lesion volume, or long lesion distance from the ultrasound probe tip would decrease cancer detection in transrectal magnetic resonance imaging (MRI)-targeted biopsies. Patients who underwent MRI-targeted biopsy at our institution between May 2017 and August 2019 were enrolled in a prospective database. Three to 5 cores were obtained from ≥2 prostate imaging reporting and data system v2 lesions. A multivariable model was created that included needle distance to the lesion, prostate specific antigen, prostate imaging reporting and data system, lesion volume, and prostate volume. A total of 377 patients with 533 lesions underwent a biopsy during the study period. A total of 233 (44%) lesions were positive for prostate cancer, and 173 (32%) lesions had clinically significant prostate cancer. The mean needle distance to the lesion was 11.7 mm (interquartile range, 7.6-15.5 mm). The likelihood of obtaining a positive core on biopsy decreased as the distance from the ultrasound probe increased for all prostate cancers and clinically significant prostate cancer (p = 0.018 and p = 0.004, respectively). Every 10 mm from the rectum, there was an 8%-10% decrease in the rate of cancer detection. Similarly, as the prostate volume increased, the odds of obtaining a positive core also decreased (p = 0.039). There was no significant association between the lesion size and amount of cancer obtained on biopsy. Our data showed that transrectal MRI-targeted biopsy cancer detection modestly decreased the lesion from the ultrasound probe and with a large prostate volume but could not prove that lesion volume was a significant predictor of the amount of cancer detected.

Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database.

GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates.The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80cc) vs. small prostates (< 80cc). Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and < 80cc). 11 functional and perioperative covariates were collected.Analyses were adjusted for patient age and presence of median lobe. 3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups.The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80cc) prostate group at 12months, with an absolute change of 19.17 points (95% CI 18.46-19.88; p < 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12months (p = 0.005).Therewere no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28). Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80cc, with durable outcomes relatively independent from prostate size.

PD41-01 DETECTION OF OCCULT PROSTATE ADENOCARCINOMA USING STEREOTACTIC TRANSPERINEAL BIOPSY FOLLOWING NEGATIVE TRANSRECTAL ULTRASOUND-GUIDED BIOPSIES

You have accessJournal of UrologyCME1 May 2022PD41-01 DETECTION OF OCCULT PROSTATE ADENOCARCINOMA USING STEREOTACTIC TRANSPERINEAL BIOPSY FOLLOWING NEGATIVE TRANSRECTAL ULTRASOUND-GUIDED BIOPSIES Russell Maxwell, Roksana Tech, Manuj Agarwal, and Brian Moran Russell MaxwellRussell Maxwell More articles by this author , Roksana TechRoksana Tech More articles by this author , Manuj AgarwalManuj Agarwal More articles by this author , and Brian MoranBrian Moran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002602.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There remains concern for prostate cancer in men who have a persistently elevated or rising serum PSA despite having a non-diagnostic transrectal ultrasound-guided biopsy (TRUS-B). Stereotactic transperineal prostate biopsy (STPB) may address this challenging clinical dilemma. Using transrectal ultrasound guidance and a transperineal template allows for comprehensive prostatic tissue sampling and lower likelihood of underestimating disease volume and grade. This study sought to determine occult prostate cancer detection rates utilizing STPB in men following negative TRUS-B. METHODS: Consecutive patients at a single institution between 2004 to 2020 who underwent STPB following a non-diagnostic TRUS-B were included. Patients who had primary STPB, non-STPB biopsy, a prior positive biopsy, or no core sampling were excluded. Well-protocolized STPB using prostate brachytherapy clinical setup and systematic comprehensive tissue sampling has been previously described in detail (Moran et al. Urology 2009). Multivariate logistic regression models were constructed to evaluate potential predictors of positive STPB. RESULTS: Out of 3756 patients, 2647 (70%) met final inclusion criteria and were analyzed (median age: 64 years, IQR: 59-69 years). Included patients had at least one prior negative TRUS-B (median 1, IQR: 1-2) before STPB and had median pre-STPB serum PSA levels of 8.1 ng/mL (IQR: 5.7-11.6 ng/mL). Median prostate size and number of cores sampled were 47 cc (IQR: 36-63 cc) and 37 (IQR: 30-44), respectively. STPB detected prostate adenocarcinoma in 956 of the 2647 patients (36%, 95% CI: 34-38%) with a median of 2 cores positive (IQR: 1-3). Of those with positive STPB, pathology findings revealed grade group 1-5 disease rates of 51%, 22%, 14%, 9%, and 4%, respectively. On multivariate analyses, older age (OR 1.79, 95% CI: 1.59-2.01, p <0.001) and higher pre-STPB PSA levels (OR 1.35, 95% CI: 1.19-1.52, p <0.001) were associated with higher odds of obtaining a positive STPB result, while large prostate size (OR 0.38, 95% CI: 0.34-0.44, p <0.001) and higher number of prior negative biopsies (OR 0.89, 95% CI: 0.82-0.97, p=0.011) were associated with lower odds. CONCLUSIONS: STPB can detect a significant number of occult and clinically significant prostate cancer in men with prior negative TRUS-B. This is the largest series to date and further supports the use of STPB to address this difficult clinical dilemma. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e689 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Russell Maxwell More articles by this author Roksana Tech More articles by this author Manuj Agarwal More articles by this author Brian Moran More articles by this author Expand All Advertisement PDF DownloadLoading ...

Non-infectious complications following transrectal prostate needle biopsy - Outcomes from over 8000 procedures.

BackgroundProstate needle biopsy (PNB) remains the referent standard for diagnosing prostate cancer. Contemporary data highlight an increase in PNB-related infections particularly when performed transrectally. Non-infectious complications, however, may similarly contribute to biopsy-related morbidity. We review the incidence and predictors of non-infectious complications following transrectal PNB in a large statewide quality registry.MethodsTransrectal ultrasound-guided prostate needle biopsies performed between 2015 and 2018 were retrospectively reviewed. The incidence and distribution of non-infectious complications were annotated. Clinical, demographic, and biopsy variables of interest were evaluated by logistic regression for potential association with specific types of non-infectious complications.ResultsOf 8,102 biopsies, 277 (3.4%) biopsies had reported post-procedure complications including 199 (2.5%) non-infectious and 78 (0.9%) infectious. Among the non-infectious complications, the most common events included urinary or rectal bleeding (74; 0.9%), urinary retention (70, 0.9%), vasovagal syncope (13, 0.2%), and severe post-operative pain (10, 0.1%). Approximately 56% of these non-infectious complications required an Emergency Department visit (111/199) and 27% (54/199) hospital admission for monitoring. Increasing transrectal ultrasound prostate volume was associated with post-procedure urinary retention (Odds ratio (OR) 1.07, 1.02–1.11, p = 0.002). No specific variables noted association with post-biopsy bleeding.ConclusionNon-infectious complications occurred 2.5 times more often than infectious complications following transrectal ultrasound prostate needle biopsies. Larger prostate size was associated with a greater risk of post-procedure urinary retention. These data originating from experience from over 100 urologists across different health systems provide an important framework in counseling patients regarding expectations following transrectal prostate biopsy.

Conversion of Holmium Laser Enucleation of Prostate to Open Prostatectomy

ObjectiveTo determine the incidence and predictive factors for conversion to an open procedure during Holmium Laser Enucleation of Prostate (HoLEP). MethodsA retrospective review was performed on files of all patients that underwent HoLEP at our institution between 2013 and 2020. Data collected included demographics, pre-operative estimated prostate size, intraoperative data, pathologic data, and functional baseline. A univariate and multivariate comparison between the pre-operative data of converted and un-converted cases was conducted. ResultsAmong a total of 807 HoLEP procedure performed during the above period, 20 cases were converted to open procedures (2.4%). Median pre-operative estimated prostate size in cases of conversion was 228ml compared to 95ml for unconverted cases (P <.001). The reasons for conversion were anatomical in 8 cases (40%), bleeding that was difficult to control endoscopically in 4 cases (20%), expected procedure to be too long due to large prostate size in 6 cases (30%), one case of morcellation technical malfunction, and one case with very large bladder stones not suitable for endoscopic treatment. Prostate size was the only factor that was found to be associated with conversion in univariate and multivariate analysis. ConclusionThe risk of conversion of HoLEP to open procedures is size-dependent. The risk for conversion to open prostatectomy/cystotomy must be communicated to patients who choose HoLEP to improve the informed consent process and provide the highest quality of patient care and transparency. Open prostatectomy/cystotomy should be a part of the armamentarium of every HoLEP surgeon operating on large prostates

Impact of Prostate Size on the Outcomes of Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Simple SummaryProstate size can vary widely among men regardless of whether they have prostate cancer or not. Many studies reported very conflicting results regarding the impact of prostate size on the outcome of radical prostatectomy. This is the first systematic review and meta-analysis on this topic to investigate the impact of prostate size on the operative, functional and oncological outcomes of radical prostatectomy. In general, a smaller prostate can be associated with fewer surgical complications, but with a higher chance of positive surgical margins. This can be useful when counseling patients before surgery.Background: The impact of prostate size on the radical prostatectomy outcome is not clear. Several published reports have shown conflicting results. Objectives: To investigate the effect of prostate size on the surgical, functional and oncological results of radical prostatectomy. Methods: A systematic review and meta-analysis were carried out in accordance with the PRISMA criteria. Finally, we investigated the research that reported on the impact of prostate size on radical prostatectomy outcome. The Review Manager (RevMan) software version 5.4 was utilized for statistical analysis. Results: Eighteen studies including 12,242 patients were included. Estimated blood loss was significantly less with smaller prostates (Z = 3.01; p = 0.003). The complications rate was 17% with larger prostates, compared to 10% for smaller prostates (Z = 5.73; p < 0.00001). Seventy-three percent of patients with a smaller prostate were continent within one month, compared to 64% with a larger prostate (Z = 1.59; p = 0.11). The rate of positive surgical margins was significantly higher with smaller prostates (20.2% vs. 17.8%). (Z = 2.52; p = 0.01). The incidence of biochemical recurrence was higher with smaller prostates (7.8% vs. 4.9%) (Z = 1.87; p = 0.06). Conclusion: Larger prostate size is associated with more blood loss and a higher rate of complications. However, the oncological outcome is better, compared to that in patients with smaller prostates. The impact of the size on the functional outcome is not clear.

Assessing the Outcome of Holmium Laser Enucleation of the Prostate by Age, Prostate Volume, and a History of Blood Thinning Agents: Report from a Single-Center Series of >1800 Consecutive Cases.

Purpose: To assess perioperative outcomes of holmium laser enucleation of the prostate (HoLEP) in a real-world scenario and with a focus on demanding patient factors, such as large prostate size, advanced patient age, and anticoagulation therapy (AT). Materials and Methods: We retrospectively analyzed HoLEP procedures at our institution between 2010 and 2016. After stratification by prostate volume, age, and AT, perioperative and early voiding characteristics were compared. A multivariable regression model was employed to identify predictors of prolonged time of catheterization (defined as being above group's median). Results: The study cohort consisted of 1816 men with a median age of 71 years (interquartile range [IQR]: 66-76), a median prostate volume of 80 mL (IQR: 58-105), and American Society of Anesthesiologists score ≥3 in 618 men (34%). Median time of enucleation and morcellation was 43 minutes (IQR: 31-60) and 10 minutes (IQR: 6-18), respectively. Perioperative blood transfusions were administered in 44 (2.4%) cases, severe postoperative complications (Clavien-Dindo grade ≥3b) occurred in 61 (3.3%) cases. The median time of catheterization was 2 days (IQR: 2-2), with prolonged catheterization occurring in 277 (15%) cases. After adjustment, large prostates (fourth volume quartile [106-280 mL]) (odds ratio [OR]: 1.8, 95% confidence interval [CI]: 1.3-2.6, p = 0.001), therapeutic low-molecular-weight heparin bridging regimen (OR: 2.2, 95% CI: 1.4-3.6, p = 0.037), low-dose acetylsalicylic acid (OR: 1.5, 95% CI: 1.0-2.2, p = 0.015), and a history of direct oral anticoagulation (OR: 2.3, 95% CI: 1.2-4.0, p = 0.022), but not patient age, were independently associated with prolonged catheterization. Conclusions: We confirm HoLEP as safe and efficient; however, patients with large prostates and patients with a history of AT are at risk of prolonged catheterization.

Prostate artery embolization for the treatment of urinary retention caused by large (>80 ​mL) benign prostatic hyperplasia: Results of 21 patients

ObjectiveA large prostate size (>80 ​mL) of benign prostatic hyperplasia (BPH) is technically challenging to treat surgically. This study aimed to investigate the safety and efficacy of super-selective prostatic artery embolization (PAE) for the treatment of urinary retention caused by large BPH. MethodsA total of 21 patients with urinary retention, indwelling urinary catheter, or suprapubic cystostomy as a consequence of giant BPH (prostate volume [PV] ​> ​80 ​mL) who sought treatment between January 2013 and December 2017 were enrolled. A microcatheter (1.9–2.7 Fr) and a “two-step embolization” combining 50-μm and 100-μm polyvinyl alcohol embolization particles were used in all patients. International Prostate Symptom Score (IPSS), quality of life (QoL), PV, and prostate-specific antigen (PSA) were evaluated at 3, 6, and 12 months post-PAE. Clinical success was defined as removal of urinary catheter or suprapubic cystostomy and ability to void spontaneously. ResultsThe clinical success rate was 95.2% (20/21). Compared with pre-procedural values, IPSS, QoL, PV, and PSA showed statistically significant differences at 3, 6, and 12 months post-PAE (P ​< ​0.05). There were no serious complications after PAE. ConclusionsPAE was safe and effective for the treatment of urinary retention caused by large BPH in patients without surgical treatment options.

3:27 PM Abstract No. 339 Efficacy of prostate artery embolization in patients with large prostate size (>100 g) presenting with lower urinary tract symptoms

3:27 PM Abstract No. 339 Efficacy of prostate artery embolization in patients with large prostate size (>100 g) presenting with lower urinary tract symptoms

Effect of prostate gland weight on the surgical and oncological outcomes of extraperitoneal robot-assisted radical prostatectomy

BackgroundRobot-assisted radical prostatectomy (RARP) is performed by urologists as one of the surgical procedures for treating prostate cancer. Numerous studies have been published with regard to the impact of prostate weight on performing RARP but were limited by the insufficient number of patients and use of the transperitoneal approach. This study aimed to determine the effect of prostate gland weight on the surgical and short-term oncological outcomes of RARP using the extraperitoneal approach.MethodsIn total, 1168 patients who underwent extraperitoneal RARP (EP-RARP) performed by a single surgeon at Yonsei University Severance Hospital between May 2009 and May 2016 were included in the study. The patients were divided into 4 groups according to the prostate weight measured by transrectal ultrasonography preoperatively. Intraoperative and postoperative outcomes were analyzed retrospectively. One-way analysis of variance and the chi-square test were used in the statistical analyses.ResultsAge, the Gleason score, clinical stage, and pathological stage were significantly different. Patients with a larger prostate size had a longer console time and higher estimated blood loss (P < 0.05). There were no significant differences between the 4 groups in length of hospital stay, duration of catheterization, blood transfusion, body mass index, prostate-specific antigen (PSA) level, history of abdominal surgery, intraoperative complications, positive surgical margin, incidence of lymphocele, and PSA recurrence after 1 year.ConclusionsThe console time and estimated blood loss were significantly increased with a larger prostate size. However, there were no significant differences in the oncologic outcome and intraoperative complications, suggesting that EP-RARP requires meticulous bleeding control in patients with a prostate weighing > 75 g, and if appropriate management is implemented for blood loss intraoperatively, EP-RARP can be performed regardless of the prostate size.

Impact of Prostate Gland Size ≥60 cc on Physician and Patient-Reported Toxicity after High Dose Rate Prostate Brachytherapy

Prostate volume of ≥60 cubic centimeters (cc) has been a relative contraindication to treatment with interstitial prostate brachytherapy (BT), with some studies showing associations between large prostate size and increased acute toxicity. These studies primarily used low dose rate BT. Few studies have explored toxicity in men with large glands undergoing high dose rate (HDR) BT. We compared the acute patient and physician reported toxicity between men undergoing HDR BT with gland size <60 cc and those with gland size ≥60 cc. We performed a retrospective cohort study of men undergoing prostate HDR BT as part of a prospectively maintained database. The 13.5 Gy x 2 was used for monotherapy and 13.5-15 Gy x 1 for boost to supplement EBRT. Gland size was determined using pre-treatment MRI or TRUS. The International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite Short Form (EPIC-26) were used to assess urinary, bowel, and sexual function at baseline and in follow-up. The Common Terminology Criteria for Adverse Events (CTCAE) v4.0 criteria were used to assess genitourinary (GU) and gastrointestinal (GI) toxicity. Baseline demographic and clinical characteristic data were compared between men with gland size <60 cc and those with gland size ≥60 cc using Fisher’s exact and non-parametric Wilcoxon Rank Sum tests. Patient-reported toxicities were compared using Generalized estimating equations (GEE) with an independent weight matrix to account for the correlation between multiple observations. Physician reported toxicities were assessed using a generalized linear mixed effects model. One hundred nineteen men were included in this analysis. Median follow-up was 7.6 months. Median prostate size was 36 cc (range: 13.9-91.9 cc). Thirteen men (10.9%) had a gland size ≥60 cc. There were no differences in baseline urinary medication use, baseline IPSS, or baseline EPIC-26 domain scores between the two groups. There were no differences in mean IPSS over time between the two groups (p=0.9). Men with gland size ≥60 cc had a greater decline in the EPIC-26 urinary incontinence domain score at 1 month (p<0.01) that met criteria for minimal clinically important difference (MCID), but no difference at 3 or 6 months. Men with gland size ≥60 cc had higher urinary irritative/obstructive domain scores at 3 months (p=0.03) that met criteria for MCID, but no difference at 1 or 6 months. There was no difference between groups in bowel or sexual domains. There was a trend towards higher acute urinary retention (AUR) in the ≥ 60 cc group (p=0.06). There was no difference in grade ≥2 GU toxicity and grade ≥2 GI toxicity. Men with prostate gland size of ≥60 cc have no difference in acute physician-reported toxicity, but a trend towards worse AUR and worse urinary incontinence at one month, yet better urinary irritative/obstructive scores at 3 months. Further investigation is needed to limit the impact of therapy on urinary function in men with gland size ≥60 cc.

Role of Surveillance Biopsy with No Cancer as a Prognostic Marker for Reclassification: Results from the Canary Prostate Active Surveillance Study

BackgroundMany patients who are on active surveillance (AS) for prostate cancer will have surveillance prostate needle biopsies (PNBs) without any cancer evident. ObjectiveTo define the association between negative surveillance PNBs and risk of reclassification on AS. Design, setting, and participantsAll men were enrolled in the Canary Prostate Active Surveillance Study (PASS) between 2008 and 2016. Men were included if they had Gleason ≤3+4 prostate cancer and <34% core involvement ratio at diagnosis. Men were prescribed surveillance PNBs at 12 and 24 mo after diagnosis and then every 24 mo. Outcome measurements and statistical analysisReclassification was defined as an increase in Gleason grade and/or an increase in the ratio of biopsy cores to cancer to ≥34%. PNB outcomes were defined as follows: (1) no cancer on biopsy, (2) cancer without reclassification, or (3) reclassification. Kaplan–Meier and Cox proportional hazard models were performed to assess the risk of reclassification. Results and limitationsA total of 657 men met inclusion criteria. On first surveillance PNB, 214 (32%) had no cancer, 282 (43%) had cancer but no reclassification, and 161 (25%) reclassified. Among those who did not reclassify, 313 had a second PNB. On second PNB, 120 (38%) had no cancer, 139 (44%) had cancer but no reclassification, and 54 (17%) reclassified. In a multivariable analysis, significant predictors of decreased future reclassification after the first PNB were no cancer on PNB (hazard ratio [HR]=0.50, p=0.008), lower serum prostate-specific antigen, larger prostate size, and lower body mass index. A finding of no cancer on the second PNB was also associated with significantly decreased future reclassification in a multivariable analysis (HR=0.15, p=0.003), regardless of the first PNB result. The major limitation of this study is a relatively small number of patients with long-term follow-up. ConclusionsMen who have a surveillance PNB with no evidence of cancer are significantly less likely to reclassify on AS in the PASS cohort. These findings have implications for tailoring AS protocols. Patient summaryMen on active surveillance for prostate cancer who have a biopsy showing no cancer are at a decreased risk of having worse disease in the future. This may have an impact on how frequently biopsies are required to be performed in the future.

Assessment of Needle Tip Deflection During Transrectal Guided Prostate Biopsy: Implications for Targeted Biopsies.

To measure needle tip deflection during transrectal ultrasound (TRUS) prostate biopsy and evaluate predictors for needle tip deflection. Analysis of 568 prostate biopsies obtained from 51 consecutive patients who underwent a standard 12-core TRUS guided prostate biopsy. TRUS guided prostate biopsies were performed using BK flex500, with a side-fire biplane probe. Each biopsy core image was captured and clinical data were recorded prospectively. The angle between the expected trajectory of the needle and actual needle course was measured using the longitudinal view of the captured image. The distance between expected and actual needle tip was calculated. We measured median and interquartile needle tip deflection rate stratified by side and location (apex, midgland, base). Univariable and multivariable linear regressions analysis were performed. The overall median needle tip deflection was 1.77 mm (IQR 1.35-2.47). Location did not significantly alter needle deflection measurements. On multivariable linear regression analysis, higher prostate volume (B = 0.007 95%, CI 0.004, 0.011; p < 0.001) and the right sided biopsy (B = 0.191 95%, CI 0.047, 0.336; p = 0.010) emerged as predictors of higher needle tip deflection. To the best of our knowledge this is the first study to measure needle tip deflection during TRUS guided prostate biopsies. We demonstrated that larger prostate size and biopsy side may affect the accuracy of biopsies. These results may have clinical implication to those performing targeted biopsies.

Gene expression of insulin receptor, insulin-like growth factor increases and insulin-like growth factor-binding protein-3 reduces with increase in prostate size in benign prostatic hyperplasia

Introduction: Although the role of insulin in the development of benign prostatic hyperplasia (BPH) is well established, there are no studies regarding alteration in the gene expression of components of insulin-signaling pathway and their association with prostate size in BPH. Hence, the study was designed to analyze the gene and protein expression of insulin receptor and its related components in patients with BPH.Materials and methods: Twenty-seven BPH patients aged between 55 and 75 years were recruited in the study and prostatic tissues were obtained after transurethral resection of the prostate. Gene expression levels of Insulin receptor (IR), insulin receptor substrate (IRS), insulin-like growth factor (IGF) and insulin-like growth factor-binding protein-3 (IGFBP-3) were assessed by q-PCR.Results: Insulin receptor (IR-A and B) and insulin-like growth factors (IGF-1 and IGF-2) gene expression were significantly increased and IGFBP-3 gene expression was reduced in BPH patients with larger prostate size. Also, serum insulin was significantly increased and IGFBP-3 was significantly reduced in patients with larger prostate size.Conclusion: Increased expression of IR-A, B and IGF-1, 2 genes and reduced IGFBP-3 gene expression was associated with larger prostate size in BPH.

Efficacy and Safety of Medium-to-long-term Use of Tolterodine Extended Release with or without Tamsulosin in Patients with Benign Prostate Hyperplasia and Larger Prostate Size: A Double-blind, Placebo-controlled, Randomized Clinical Trial.

Background:The medium-to-long-term use of antimuscarinics alone or in combination with an α-blocker in men with an enlarged prostate is still controversial. This double-blind, placebo-controlled, randomized clinical trial aimed to investigate the efficacy and safety of medium-to-long-term use of tolterodine extended release (ER) with or without tamsulosin in patients with benign prostate hyperplasia (BPH) and larger prostate size.Methods:Totally, 152 patients (age ≥50 years) with BPH, International Prostate Symptom Score (IPSS) ≥12, quality-of-life (QoL) score ≥3, and total prostate volume ≥25 ml were enrolled in this study. The patients were randomized into four groups (n = 38 in each) to receive tolterodine ER placebo plus tamsulosin placebo, 0.2 mg tamsulosin plus tolterodine ER placebo, 4 mg tolterodine ER plus tamsulosin placebo, or tolterodine ER plus tamsulosin once daily for 24 weeks. IPSS (total, storage, and voiding subscales), QoL, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR) were collected at baseline, and at weeks 4, 12, and 24.Results:Compared with placebo, tolterodine ER plus tamsulosin significantly improved total IPSS (−7.15, −12.20, and −14.66 vs. −3.51, −5.78, and −7.23), storage IPSS (−3.56, −5.63, and −6.66 vs. −1.52, −1.21, and −2.43), voiding IPSS (−2.88, −5.10, and −6.48 vs. −1.52, −3.03, and −2.97), QoL (−1.21, −2.40, and −3.21 vs. −0.39, −1.41, and −1.60), Qmax (2.21, 7.97, and 9.72 ml/s vs. 2.15, 2.44, and 2.73 ml/s), and PVR (−17.88, −26.97, and −27.89 ml vs. −12.03, −11.16, and −16.73 ml) at weeks 4, 12, and 24, respectively; the differences were all statistically significant (P < 0.05). Adverse events (AEs) were not increased with treatment progression. Tolterodine ER alone did not improve total IPSS (−4.61, −6.79, and −5.70), voiding IPSS (−0.64, −1.83, and −1.45), QoL (−0.69, −1.21, and −1.41), or Qmax (−0.79, 2.83, and 1.11 ml/s), compared with placebo (all P > 0.05). However, a gradual increase in PVR (10.03, 10.41, and 12.89 ml) and more urinary AEs suggestive of urinary retention (11/38 vs. 4/38) were observed.Conclusion:Medium-to-long-term use of tolterodine ER plus tamsulosin should be recommended in patients with BPH and an enlarged prostate volume.Trial Registration:www.chictr.org.cn, ChiCTR-TRC-09000596; http://www.chictr.org.cn/showproj.aspx?proj=8939.

Plan quality and dosimetric association of patient-reported rectal and urinary toxicities for prostate stereotactic body radiotherapy

Background and purposeTo study the association between dosimetric parameters with patient-reported quality-of-life (QOL) in urinary irritative/incontinency and bowel functions for prostate stereotactic body radiotherapy (SBRT). Material and methodsThe patient-reported QOL was evaluated using the Expanded Prostate Cancer Index Composite (EPIC-26). According to the progression in QOL score over 12months, patients were assigned to one of three subgroups: score decrement, no change, or increment. The dosimetric parameters were cross-compared among subgroups in urinary and bowel domains using univariate Analysis of Variance (ANOVA). The evaluated dosimetric metrics included target volume, V100 (volume receiving 100% prescription dose); rectal volume/dose–volume endpoints, maximum/mean doses; bladder volume/dose–volume endpoints, and maximum/mean doses. ResultsPatients with consistent QOL reduction in urinary irritation function were significantly associated with greater mean bladder dose, greater V85/V90/V95/V100 and D2cc/D10cc. Patients with QOL reduction in urinary incontinence were marginally associated with greater mean bladder dose (p=0.06). None of the evaluated dosimetric parameters showed a significant correlation with QOL score change in bowel function. ConclusionsPatients with large prostate size were more susceptible to QOL decrements for urinary irritative and incontinency functions. Large bladder V85/V90/V95/V100 was associated with QOL decrements in the urinary irritative domain at 1-year after prostate SBRT.