Post Prostatectomy Research Articles

Remote dosimetric auditing for intensity modulated radiotherapy: A pilot study

Abstract Background and Purpose Electronic portal imaging devices (EPIDs) can be used to reconstruct dose inside a virtual phantom. This work aims to study the feasibility of using this method for remote dosimetry auditing of clinical trials. Materials and Methods Six centres participated in an intensity modulated radiotherapy (IMRT) pilot study of this new audit approach. Each centre produced a head and neck (HN) and post-prostatectomy (PP) trial plan and transferred the plans to virtual phantoms to calculate a reference dose distribution. They acquired in-air images of the treatment fields along with calibration images using their EPID. These data were sent to the central site where the images were converted to 2D field-by-field doses in a flat virtual water phantom and to 3D combined field doses in a cylindrical virtual phantom for comparison with corresponding reference dose distributions. Additional test images were used to assess the accuracy of the method when using different EPIDs. Results Field-by-field 2D analysis yielded mean gamma pass-rates of 99.6% (±0.3%) and 99.6% (±0.6%) for HN and PP plans respectively (3%/3 mm, doses greater than 10% global max). 3D combined field analysis gave mean pass-rates of 97.9% (±2.6%) and 97.9% (±1.8%) for the HN and PP plans. Dosimetry tests revealed some field size limitations of the EPIDs. Conclusions The remote auditing methodology using EPIDs is feasible and potentially an inexpensive method.

A Pilot Study: The Role of Radio-Opaque Hydrogel Tissue Marker in the Treatment of Postprostatectomy Intensity Modulated Radiation Therapy

It is well documented that the prostate bed is highly susceptible to inter-fraction motion leading to larger treatment planning margins to account for daily treatment set up uncertainties when matching to bony anatomy. The use of fiducial markers in the prostate bed has significantly improved accuracy of treatment delivery. This pilot study aims to investigate the role and benefits of radio-opaque hydrogel tissue marker in the treatment of post prostatectomy intensity modulated radiation therapy (IMRT). Twenty patients treated with IMRT to a dose of 70.2Gy in 39 fractions between Jan 2016 to Jan 2017 were included in this study. All patients underwent transperineal injection of hydrogel tissue marker at the level of vesico-urethral anastomosis and cystoscopically into the posterior bladder wall. Instructions for bladder and bowel preparation to be followed during CT simulation and daily treatments were provided to the patients. Daily on-line cone beam CT matching to the hydrogel tissue marker was performed prior to each treatment and off-sets relative to skin tattoos were recorded in 3 directions: left-right (LR); superior-inferior (SI) and anterio-posterior (AP). Daily image registration using bony matching was then assessed off-line and off-sets relative to skin tattoos were again recorded. The mean and standard deviation of the differences between the hydrogel tissue markers and bony off-sets were calculated for all fractions for each patient; then the overall mean and systematic (Σ) and random errors (σ) for the entire cohort were calculated. The planning target volume (PTV) margin required for bony matching was estimated using van Herk's formula of 2.5Σ + 0.7σ, which is designed to ensure a minimum dose of 95% of prescribed dose to the clinical target volume (CTV) in 90% of patients. These margins are relative to the hydrogel tissue markers which are assumed to be in the target tissue. A total of 1520 images were analysed. The overall mean shift differences between the hydrogel tissue markers and bones for the entire cohort were LR: 0.13mm (Σ 0.38mm, σ 1.35mm); SI: 0.92mm (Σ 1.40mm, σ 2.50mm) and AP: 0.40mm (Σ 1.98mm, σ 3.18mm). The calculated PTV margins for bony matching relative to hydrogel tissue markers were 1.90mm in LR, 5.25mm in SI and 7.17mm AP directions. Prostate bed motion is independent of pelvic bone anatomy and soft tissue matching has shown to be superior compared with pelvic bone matching. With a required PTV margin of 7.17mm in the AP direction, the use of hydrogel tissue marker can significantly improve treatment set up accuracy even in patients with optimal bowel and bladder preparations who undergo image guidance with pelvic bone matching. This will provide the best CTV coverage whilst minimising the current PTV margin and mitigating bladder and rectal toxicities.

Virtue Quadratic Male Sling for stress incontinence-surgical guide for placement and delayed revision.

The algorithm for surgical management of post prostatectomy incontinence classically includes male slings and artificial urinary sphincter (AUS) placement. The Virtue Quadratic Male Sling was designed to provide both urethral elevation and prepubic compression making it a viable option for a wider spectrum of incontinent men whose symptoms range from mild to severe. With a focus on two key steps of the surgery, (I) sling fixation (II) use of intraoperative retrograde leak point pressure (RLPP), this guide is intended to outline a safe and efficacious treatment for post-prostatectomy incontinence. Intriguingly, the sling can be revised in the event of refractory or worsening leakage, and does not preclude the placement of an AUS should it be needed. This paper describes a step by step approach to performing the procedure as well as expert tips to improve outcomes and avoid/manage complications that have been learned over the years.

Normalized periprostatic fat MRI measurements can predict prostate cancer aggressiveness in men undergoing radical prostatectomy for clinically localised disease

Periprostatic and pelvic fat have been shown to influence prostate cancer behaviour through the secretion of chemokines and growth factors, acting in a paracrine mode. We have measured periprostatic fat volume (PFV) with normalisation to prostate gland volume on pelvic magnetic resonance imaging (MRI) and have correlated this with grade (Gleason score; GS) and pathological staging (pT) of prostate cancer (PCa) following radical prostatectomy (RP). PFV was determined using a segmentation technique on contiguous T1-weighted axial MRI slices from the level of the prostate base to the apex. The abdominal fat area (AFA) and subcutaneous fat thickness (SFT) were measured using T1-weighted axial slices at the level of the umbilicus and the upper border of the symphysis pubis, respectively. PFV was normalised to prostate volume (PV) to account for variations in PV (NPFV = PFV/PV). Patients were stratified into three risk groups according to post-operative GS: ≤6, 7(3 + 4), and ≥7(4 + 3). NPFV was significantly different between the groups (p = 0.001) and positively correlated with post-operative GS (ρ = 0.294, p < 0.001). There was a difference in NPFV between those with upgrading of GS from 6 post prostatectomy (2.43 ± 0.98; n = 26) compared to those who continued to be low grade (1.99 ± 0.82; n = 17); however, this did not reach statistical significance (p = 0.11).

Impact of bladder dysfunction in the management of post radical prostatectomy stress urinary incontinence-a review.

Bladder dysfunction is a relatively common urodynamic finding post radical prostatectomy (RP). It can be the sole cause of post prostatectomy incontinence (PPI) or may be found in association with stress urinary incontinence (SUI). The aim of this review is to provide a comprehensive review of the diagnosis and different treatments of post RP bladder dysfunction. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, PPI, detrusor overactivity (DO), detrusor underactivity (DU), impaired compliance, anticholinergic, onabotulinumtoxinA (Botox®) and sacral neuromodulation (SNM). Definitions, general overview and management options were extracted from the relevant medical literature. DO, DU and impaired compliance are common and may occur alone or in combination with SUI. In some patients the conditions exist pre RP, in others they arise due to denervation and surgical changes. DO can be treated with anticholinergics, Botox® and SNM. DO may need to be treated before SUI surgery. DU may be a contraindication to male sling surgery as some patients may go into urinary retention. Severely impaired bladder compliance may be a contraindication to SUI surgery as the upper tracts may be at risk. Each individual dysfunction may affect the outcome of PPI treatments and clinicians should be alert to managing bladder dysfunction in PPI patients.

Lithiasis in urinary diversions or post prostatectomy

Lithiasis in urinary diversions or post prostatectomy

The role of male slings in post prostatectomy incontinence: ICI-RS 2015.

Post prostatectomy stress urinary incontinence can significantly impact on quality of life and is bothersome for patients. The artificial urinary sphincter is still considered the gold standard surgical treatment. Male slings are an alternative surgical option and several designs are currently available. This review will focus on efficacy, adverse events, and mechanism of action of male slings. The context of this review was a proposal at the ICI-RS meeting 2015. Following synthesis of the evidence we address the question: does it matter how male slings work? The proposal lecture was reviewed and a comprehensive review of the literature undertaken utilising the PubMed database. Male slings can be broadly divided into adjustable retropubic and suburethral transobturator slings. Male slings are efficacious and can improve quality of life. Adjustable retropubic slings appear to be compressive but studies suggest efficacy can be achieved without voiding dysfunction. Transobturator slings work by urethral compression and/or re-locating the urethral bulb. There is a recognized failure rate in all sling types and most studies suggest radiotherapy as a risk factor for failure. Adjustable slings have the ability to be altered to optimize continence or to prevent retention of urine. However, there appears to be a higher explantation rate in some of these systems. It is important to understand how male slings work and by doing so we are more reliably able to choose the appropriate sling, predict outcomes, and as a result counsel patients. Suggestions for future research are proposed.

MP51-20 PROSTATE SPECIFIC COMMUNICATIONS: WHAT THE NEXT GENERATION OF UROLOGY TRAINEES ARE TELLING PATIENTS ABOUT PROSTATE CANCER SCREENING, DIAGNOSIS, AND TREATMENT DURING A VIRTUAL OBJECTIVE STRUCTURED CLINICAL ENCOUNTER.

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2017MP51-20 PROSTATE SPECIFIC COMMUNICATIONS: WHAT THE NEXT GENERATION OF UROLOGY TRAINEES ARE TELLING PATIENTS ABOUT PROSTATE CANCER SCREENING, DIAGNOSIS, AND TREATMENT DURING A VIRTUAL OBJECTIVE STRUCTURED CLINICAL ENCOUNTER. Bruce Kava, Allen Andrade, Robert Marcovich, and Jorge Ruiz Bruce KavaBruce Kava More articles by this author , Allen AndradeAllen Andrade More articles by this author , Robert MarcovichRobert Marcovich More articles by this author , and Jorge RuizJorge Ruiz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1629AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer screening, diagnosis, and treatment may have adverse physical, psychological, and social implications for a patient and his family. Studies suggest that urologists do not foster reasonable expectations when communicating with patients about these issues, often leading to decisional regret. We performed a qualitative analysis of communication skills exhibited by 12 Urology housestaff, as they perform objective structured clinical encounters (OSCEs) with a virtual-world prostate cancer patient. METHODS Following informed consent, 12 Urology housestaff participated in several scripted, virtual- world OSCEs with a 52 year old avatar patient. The “Wizard of Oz” technique was used in which an unseen associate portrayed a standardized patient. The encounters included shared decision making and PSA screening, delivering a prostate cancer diagnosis, and informed consent for a prostatectomy. De-identified audio recordings of the encounters were analyzed using open, axial, and selective coding. RESULTS Ten residents successfully elicited the patient's perspective of PSA screening and all shared their knowledge of the benefits of screening. All housestaff indicated that PSA screening was controversial, and may result in over-diagnosis of prostate cancer. Only one discussed overtreatment. All housestaff discussed prognosis and that surgery and radiation could be used. None of the housestaff mentioned cryo-therapy or focal therapy, and 11/12 discussed active surveillance. In delivering informed consent, the disclosed risks of ED post prostatectomy ranged from “ a small percentage” to “50-70%.” With regard to additional adverse sexual effects: climacturia was mentioned by one resident, and none mentioned painful orgasm or penile shortening. Disclosed estimates for urinary incontinence varied from “<10%” to “almost all men have some degree of incontinence.” Most housestaff directed the patient to on-line decision support materials. CONCLUSIONS Physician communications with patients regarding prostate cancer screening, diagnosis, and treatment directly impact patient expectations and may contribute to decisional regret. Despite our small cohort of providers, we have shown that the majority of housestaff were able to discuss the technical aspects of PSA screening, prognosis, and treatment options in a fairly consistent manner. However, there was tremendous variability in the estimated risks and the impact of ED and incontinence. Other complications, such as penile shortening, orgasmic dysfunction, and climacturia were rarely discussed. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e702 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Bruce Kava More articles by this author Allen Andrade More articles by this author Robert Marcovich More articles by this author Jorge Ruiz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

P-03-014 Vitaros for the treatment of post prostatectomy erectile dysfunction. An effective alternative?

P-03-014 Vitaros for the treatment of post prostatectomy erectile dysfunction. An effective alternative?

Post Prostatectomy Vesicourethral Stenosis or Bladder Neck Contracture with Concomitant Urinary Incontinence: Our Experience and Recommendations

Objectives: To present our experience in the management of bladder neck contracture with concomitant post prostatectomy incontinence and to provide our recommendations based on the updated literature. Materials and Methods: Between Jan 2010 and June 2015, 37 patients from our cohort of 341 patients with post prostatectomy incontinence were evaluated. Patient data were retrospectively collected. Patients with bladder neck contracture confirmed on flexible cystoscopy underwent subsequent rigid cystoscopy and deep endoscopic bladder neck incision (BNI). A follow up flexible cystoscopy would be performed 3 months later. If there was no recurrence of the bladder neck contracture, an artificial urethral sphincter (AUS) or a male sling was recommended. Results: The mean age of patients was 68 years (range 59-77) and the mean BMI was 31 (range 21-41) kg/m². Twenty-five (67.7%) patients had open prostatectomy and 12 (32.4%) patients had laparoscopic prostatectomy. Fourteen patients (37.8%) underwent adjuvant radiotherapy. Twenty-four (64.8%) patients had one BNI procedure, 8 (21.6%) patients had two procedures and 5 (13.5%) patients had more than 2 procedures. Twenty-one (91.3%) patients had AUS implantation and 2 (8.7%) patients had male sling placement. Besides, 85.7% of AUS and 50% of male sling patients managed to achieve successful outcomes with a mean follow up period of 13.1 months ( range 2-33 months). Conclusion: Initial management with aggressive BNI followed by implantation of an AUS or male sling when bladder neck is stable is essential to achieve a satisfactory urinary continence outcome.

Role of MRI-US Fusion Biopsy in Diagnosing Prostatic Cancer.

Reaching a histologic diagnosis of prostatic cancer (CaP) is central to its treatment and outcome. Preoperative transrectal ultrasound (TRUS) guided biopsies miss 25-40% of higher grade CaP found in post prostatectomy specimen. MRI-US fusion biopsy technique is a technological advance with software based integration of prior MRI images and real time TRUS to improvise the prostatic biopsy yield. On combining systematic biopsies with targeted ones, along with MRI detected high risk CaP areas, 22% more low risk CaP were found. Hence, fusion biopsy leads to better detection of "clinically relevant" CaP. In certain groups of patients like elevated PSA with negative biopsies and those on active surveillance (AS), this fusion technique would make a difference in management.

1152 - Continent ileovesicostomy after bladder neck closure as salvage procedure for intractable incontinence

Introduction. We evaluated the success rate of continent vesicostomy using an ileal segment with seroserosally embedded, tapered ileum for bladder augmentation with continent stoma following bladder neck closure (BNC) for severely damaged bladders or persistent urinary incontinence. Material and methods. A total of 15 patients were treated for persistent urinary incontinence or non– reconstructible bladder outlet between 2003 and 2012. Underlying diagnosis included post–prostatectomy incontinence (n = 5), recurrent bladder neck stenosis (n = 5), neurogenic bladder (n = 3), urethral tumor recurrence following orthotopic neobladder (n = 1) and post–TVT and colposuspension inconti nence (n = 1). All patients underwent open BNC, omental interposition and continent vesicoileostomy. The continent outlet was placed in the lower abdomen using a circumferential subcutaneous and skin plasty to avoid retraction. Data collected included age, underlying diagnosis, stoma site, time to compli cations and need for subsequent surgical revisions. All patients received a standardized questionnaire at the time of data acquisition and were personally interviewed. Results. Median follow–up was 24 months (range: 2–111). Primary BnC was successful in all patients and primary continence rate was 86.7%. Two patients (13.3%) suffered from failure of the continence mechanism, caused by stoma stenosis at skin level and insufficiency of the bladder augmentation and stoma due to local infection. One additional patient developed a mild stomal incontinence without need for further reconstruction. Regardless of the number of revisions, at the last follow–up 93.3% of patients had a functional channel. All complications occurred within the first postoperative year. Conclusions. This technique is an effective last resort treatment for patients with non–reconstructible bladder outlet.

Evaluation of inflammatory cytokines and oxidative stress markers in prostate cancer patients undergoing curative radiotherapy.

Prostate cancer is the second leading cause of cancer-related death in men. The present study was carried out to investigate the radiation response of serum cytokines and oxidative markers to find out if these novel biomarkers have significant applications regarding radiation outcome in prostate cancer patients. Significant elevations of prostatic specific antigen (PSA), asymmetric dimethyl arginine (ADMA) and nitric oxide (NO) were recorded in cancer prostate patients at the time of diagnosis compared to controls. Patients were subjected to radiotherapy post prostatectomy with a total dose of 66 Gy in 33 fractions (5 sessions/week) for 7 weeks. At the end of the seventh week post radiotherapy, ADMA levels were accentuated while the levels of PSA and NO were lower than before therapy. The level of inflammatory cytokines (interleukins IL-4, IL-5 and interferon-gamma) in post radiation therapy patients were significantly elevated compared to both controls and prostate cancer patients. A significant inverse correlation was observed in prostate cancer patients between ADMA and NO. Moreover, a significant inverse correlation in post radiation therapy patients was observed between IL-5 and PSA. These results are highly suggestive that there is a specific cytokine response in patients undergoing curative radiotherapy for prostate cancer.

Target volume definition for post prostatectomy radiotherapy: Do the consensus guidelines correctly define the inferior border of the CTV?

AimWe compare urethrogram delineation of the caudal aspect of the anastomosis to the recommended guidelines of post prostatectomy radiotherapy. BackgroundLevel one evidence has established the indications for, and importance of, adjuvant radiotherapy following radical prostatectomy. Several guidelines have recently addressed delineation of the prostate bed target volume including identification of the vesico-urethral anastomosis, taken as the first CT slice caudal to visible urine in the bladder neck. The inferior border of clinical target volume is then variably defined 5–12mm below this anastomosis or 15mm cranial to the penile bulb. Methods and materialsThirty-three patients who received adjuvant radiotherapy following radical prostatectomy were reviewed. All underwent planning CT with urethrogram. The authors (MM, JC) independently identified the CT slice caudal to the last slice showing urine in the bladder neck (called the CT Reference Slice), and measured the distance between this and the tip of the urethrogram cone. Five patients also had a diagnostic MRI at the time of CT planning to better visualize the anatomy. ResultsSixty-six readings were obtained. The mean distance between the Bladder CT Reference Slice and the most cranial urethrogram contrast slice was 16.1mm (MM 16.4mm, JC 15.8mm), range: 6.8–34.2mm. The mean distance between the urethrogram tip and the ischial tuberosities was 19.9mm (range 12.5–29.8mm). The mean distance between the CT Reference Slice and the ischial tuberosities was 36.9mm (range 28.3–52.4mm). ConclusionsGuidelines for prostate bed radiation post prostatectomy have been developed after publication of the trials proving benefit of such treatment, and are thus untested. The anastomosis is a frequent site of local relapse but is variably defined by the existing guidelines, none of which take into account anatomic patient variation and all of which are at variance with urethrogram data. We recommend the use of planning urethrogram to better delineate the vesico-urethral junction and minimize the potential for geographic misses.

Decipher correlation patterns post prostatectomy: initial experience from 2 342 prospective patients.

Background:Currently, there are multiple commercially available RNA-based biomarkers that are Medicare approved and suggested for use by the National Comprehensive Cancer Network guidelines. There is uncertainty as to which patients benefit from genomic testing and for whom these tests should be ordered. Here, we examined the correlation patterns of Decipher assay to understand the relationship between the Decipher and patient tumor characteristics.Methods:De-identified Decipher test results (including Decipher risk scores and clinicopathologic data) from 2 342 consecutive radical prostatectomy (RP) patients tested between January and September 2015 were analyzed. For clinical testing, tumor specimen from the highest Gleason grade was sampled using a 1.5 mm tissue punch. Decipher scores were calculated based on a previously locked model. Correlations between Decipher score and clinicopathologic variables were computed using Spearman's rank correlation. Mixed-effect linear models were used to study the association of practice type and Decipher score. The significance level was 0.05 for all tests.Results:Decipher score had a positive correlation with pathologic Gleason score (PGS; r=0.37, 95% confidence interval (CI) 0.34−0.41), pathologic T-stage (r=0.31, 95% CI 0.28−0.35), CAPRA-S (r=0.32, 95% CI 0.28−0.37) and patient age (r=0.09, 95% CI 0.05-0.13). Decipher reclassified 52%, 76% and 40% of patients in CAPRA-S low-, intermediate- and high-risk groups, respectively. We detected a 28% incidence of high-risk disease through the Decipher score in pT2 patients and 7% low risk in pT3b/pT4, PGS 8−10 patients. There was no significant difference in the Decipher score between patients from community centers and those from academic centers (P=0.82).Conclusions:Although Decipher correlated with baseline tumor characteristics for over 2 000 patients, there was significant reclassification of tumor aggressiveness as compared to clinical parameters alone. Utilization of the Decipher genomic classifier can have major implications in assessment of postoperative risk that may impact physician-patient decision making and ultimately patient management.

TU-FG-201-06: Remote Dosimetric Auditing for Clinical Trials Using EPID Dosimetry: A Pilot Study

Purpose: To perform a pilot study for remote dosimetric credentialing of intensity modulated radiation therapy (IMRT) based clinical trials. The study introduces a novel, time efficient and inexpensive dosimetry audit method for multi-center credentialing. The method employs electronic portal imaging device (EPID) to reconstruct delivered dose inside a virtual flat/cylindrical water phantom. Methods: Five centers, including different accelerator types and treatment planning systems (TPS), were asked to download two CT data sets of a Head and Neck (H&N) and Postprostatectomy (P-P) patients to produce benchmark plans. These were then transferred to virtual flat and cylindrical phantom data sets that were also provided. In-air EPID images of the plans were then acquired, and the data sent to the central site for analysis. At the central site, these were converted to DICOM format, all images were used to reconstruct 2D and 3D dose distributions inside respectively the flat and cylindrical phantoms using inhouse EPID to dose conversion software. 2D dose was calculated for individual fields and 3D dose for the combined fields. The results were compared to corresponding TPS doses. Three gamma criteria were used, 3%3mm-3%/2mm–2%/2mm with a 10% dose threshold, to compare the calculated and prescribed dose. Results: All centers had a high pass rate for the criteria of 3%/3 mm. For 2D dose, the average of centers mean pass rate was 99.6% (SD: 0.3%) and 99.8% (SD: 0.3%) for respectively H&N and PP patients. For 3D dose, 3D gamma was used to compare the model dose with TPS combined dose. The mean pass rate was 97.7% (SD: 2.8%) and 98.3% (SD: 1.6%). Conclusion: Successful performance of the method for the pilot centers establishes the method for dosimetric multi-center credentialing. The results are promising and show a high level of gamma agreement and, the procedure is efficient, consistent and inexpensive. Funding has been provided from Department of Radiation Oncology, TROG Cancer Research and the University of Newcastle. Narges Miri is a recipient of a University of Newcastle postgraduate scholarship.

Monocyte Chemotactic Protein-1 (MCP-1) as a Predictor of Prolonged Urinary Incontinence After Radical Prostatectomy

Objectives: To investigate monocyte chemotactic protein-1 (MCP-1) as a novel urinary biomarker to predict prolonged post prostatectomy incontinence. Methods: Men submitted urine samples prior to robotic radical prostatectomy. MCP-1 values were derived using an ELISA test. Pad usage at 7, 30, and 60 days were documented by patient post cards mailed when zero pads was reached. The primary outcome was defined as no incontinence pad usage at 30 days at prostatectomy. Results: After exclusions, 76 patients were included in analyses. Continence was reached by 29% (22/76), 56% (42/76), and (75/76) 98% at 7, 30, and 60 days, respectively. The average MCP-1 (p=0.258) was not different between the continent and incontinent groups. Highest quartile of MCP-1 (MCP &gt; 166 pg/mL) and normalized MCP-1 (MCP-1/TV &gt;0.53) noted a significant delay in continence at 30 days (p=0.050 and p=0.003). Only 26% (5/19) in the highest MCP1/TV quartile were continent, whereas 65% (37/57) of men in the 3 lower quartiles reached zero pad continence (p=0.003). In a logistic regression model the highest quartile of MCP1/TV had a significant chance of being incontinent at 30 days (OR 0.22; 95% CI 0.058-0.80; p=0.022). Conclusion: MCP-1/TV is a urinary biomarker that may predict prolonged urinary incontinence after radical prostatectomy.

OC-0560: Plan of the day approach in post prostatectomy radiation therapy

OC-0560: Plan of the day approach in post prostatectomy radiation therapy

MP87-08 DOES THE ISTOP TOMSTM MALE SLING REMAIN EFFICIENT OVER TIME?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2016MP87-08 DOES THE ISTOP TOMSTM MALE SLING REMAIN EFFICIENT OVER TIME? Philippe Grise, Benoit Malval, Renaud Vautherin, Christian Saussine, and Jean Nicolas Cornu Philippe GrisePhilippe Grise More articles by this author , Benoit MalvalBenoit Malval More articles by this author , Renaud VautherinRenaud Vautherin More articles by this author , Christian SaussineChristian Saussine More articles by this author , and Jean Nicolas CornuJean Nicolas Cornu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2358AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Male sub-urethral slings are widely used for the treatment of post prostatectomy urinary incontinence (PPUI). However, the results of male sling implantation have only been evaluated through short-term studies, and long term outcomes are still unknown. Our objective was to assess the long term efficacy of ISTOP-TOMSTM male sling implantation for PPUI management. METHODS A multicenter prospective observational study was carried out. All patients implanted with an ISTOP-TOMSTM sling between 2007 and 2012 were included. Indications for ISTOP-TOMS implantation was PPUI without bladder dysfunction on urodynamics, with mild to moderate incontinence (24h Pad-Test <400g), and without history of pelvic radiation therapy. Follow-up was performed through a physical examination every year and a phone interview for the last follow-up. The primary endpoint was the number of daily pad use. The statistical analysis was performed using SAS 9.2. RESULTS One hundred patients were considered in the present analysis with a median follow-up of 60 months [19-78]. A significant reduction of daily pad use and a better quality of life according to questionnaires were found up to 5 years (p<0.001). At 3 years follow up, 51% of the patients were dry and 90% used 0 to 1 pad daily, but these rates dropped to 38% and 71% at 5 years, respectively. Nevertheless, quality of life questionnaires and treatment satisfaction remained high at 5 years. No severe complication was recorded. CONCLUSIONS Implantation of ISTOP-TOMSTM for PPUI management in patients without radiation therapy and presenting mild to moderate incontinence appears safe and effective in the long term. However, our results are in favor of recurrence of incontinence with time. These data highlight the need of long term studies in this field, for optimal patient information and clinical decision making. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1117 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Philippe Grise More articles by this author Benoit Malval More articles by this author Renaud Vautherin More articles by this author Christian Saussine More articles by this author Jean Nicolas Cornu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD43-07 UPSTAGING ON FINAL PATHOLOGY IN PATIENTS ELIGIBLE FOR ACTIVE SURVEILLANCE WITH SUBDIVISION BY AGE

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI1 Apr 2016PD43-07 UPSTAGING ON FINAL PATHOLOGY IN PATIENTS ELIGIBLE FOR ACTIVE SURVEILLANCE WITH SUBDIVISION BY AGE Mona Yezdani, Sylvia Yu, Ben Katz, Daniel Maass, Benjamin Taylor, Alexandra Lee, Alice McGill, Kelly Monahan, and David Lee Mona YezdaniMona Yezdani More articles by this author , Sylvia YuSylvia Yu More articles by this author , Ben KatzBen Katz More articles by this author , Daniel MaassDaniel Maass More articles by this author , Benjamin TaylorBenjamin Taylor More articles by this author , Alexandra LeeAlexandra Lee More articles by this author , Alice McGillAlice McGill More articles by this author , Kelly MonahanKelly Monahan More articles by this author , and David LeeDavid Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1785AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) has become increasingly utilized and has gained acceptance for the management of men with localized prostate cancer who have low risk clinical features. Our goal was to analyze the preoperative data in men with adenocarcinoma of the prostate and compare this with post prostatectomy specimens in patients who were eligible for AS but chose to undergo robotic-assisted radical prostatectomy (RARP). We also subdivided our data into age categories to assess for a difference. METHODS We performed a single-institution; single-surgeon review of 3433 patients who underwent RARP from 2005 to 2014 under an IRB approved protocol. The inclusion criteria were: PSA ≤ 10, clinical stage T1-T2a, Gleason score 6 or less on biopsy, less than 33% of cores positive and less than 50% of tumor percentage in one core. We compared preoperative data with the pathological features of prostate cancer using t-test (continuous) and chi-square test (categorical). We also subdivided our cohort based on age<50, 50-59, 60-69, >70 and analyzed for a difference in upstaging based on age. RESULTS 3,029 patients had all data points available and of these patients, 1145 qualified for AS. Among them, 571 (50%) were found to have upgraded Gleason scores on their prostatectomy specimen. There were 547 patients upgraded to Gleason 7 (497 to 3+4 and 50 to 4+3), 19 to Gleason 8, and 2 to Gleason 9. Only 1 patient downgraded from Gleason 6 to 5. Positive margins were found in 116 patients (10.1%). Pathologic stage T3 was identified in 103 patients (9%). Also, one patient presented with lymph node involvement on surgical pathology report. 45% of men age <50, 45% of men age 50-59, 54% of men age 60-69, and 63% of men >70 were upstaged after prostatectomy. On chi-squared analysis, this difference across age groups was statistically significant (p=0.0053) CONCLUSIONS Our large cohort study highlights a disturbing percentage of men whose Gleason score was upgraded and staged following RARP. Interestingly, men who were older had a higher risk of upstaging than those that were younger. AS is an encouraging treatment option in the management of prostate cancer; however, appropriate education and counsel should be given to patients about the risks associated with this management style. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e994-e995 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mona Yezdani More articles by this author Sylvia Yu More articles by this author Ben Katz More articles by this author Daniel Maass More articles by this author Benjamin Taylor More articles by this author Alexandra Lee More articles by this author Alice McGill More articles by this author Kelly Monahan More articles by this author David Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...