Preoperative PSA Research Articles

Comparison of histopathological features, survival, and oncological outcome between patients under and above 55-year-old with prostate cancer who underwent radical prostatectomy.

To compare the disease course, histopathological features and survival rates of prostate cancer (PCa) between patients aged ⩽ 55 and > 55 year old. In this retrospective study, we enrolled 644 patients with organ-confide prostate cancer who had undergone radical prostatectomy from 2005 to 2018. Seventy-six (11.8%) patients were under 55 years of age (group 1) and 568 (88.2%) patients were >55 years old (group 2). Pre-operative hypertension was detected in 4 (5.3%) patients of group 1 and 80 (14.1%) patients of groups 2 (p = 0.029). The mean (±SD) prostate volume was higher in group 2 compared with group 1 (34.1(±8.4) ml vs 54.1(±9.9) ml, p < 0.001). Positive surgery margin was observed in 15 (19.7%) and 58 (10.2%) patients in group 1 and 2, respectively (p = 0.020). Co-existence of diabetes mellitus, mean pre-operative PSA, Gleason's score, and permanent pathology and pathologic stage were similar between the two groups. Log-rank test failed to show any statistical difference in terms of biochemical-relapse free survival, local recurrence-free survival, and metastasis-free survival between the two groups (p = 0.316, 0.441, 0.654, respectively). After performing multivariate analysis, positive surgical margin was the only factor that was independently predictive of biochemical relapse (p < 0.001) and local recurrence/metastasis (p < 0.001). No difference was observed in terms of histopathologic features, biochemical relapse, and local recurrence/metastasis-free survival rates between patients younger and older than 55 years of age.

Cohort study of oligorecurrent prostate cancer patients: Oncological outcomes of patients treated with salvage lymph node dissection via PSMA radioguided surgery.

106 Background: Prostate-specific membrane antigen (PSMA) positron-emission tomography (PET) allows detection of small and/or atypically localized metastatic prostate cancer (PCa) lesions. In a subset of patients with recurrent oligometastatic PCa salvage surgery with PSMA-targeted radioguidance (PSMA-RGS) may be of value. We aimed to evaluate the oncological outcomes of salvage PSMA-RGS for oligorecurrent PCa and determine predictive preoperative factors of improved outcomes. Methods: In this cohort study within two tertiary care centers, patients with biochemical recurrence (BCR) after radical prostatectomy (RP) and imaging with PSMA PET receiving salvage PSMA-RGS between 2014 and 2020 were analyzed. Kaplan-Meier and multivariable Cox regression models adjusted for various parameters were used to test for BCR-free survival (BFS) and therapy-free survival (TFS) differences. Postoperative complications were classified according to Clavien-Dindo. Results: Overall, 364 patients were assessed. At PSMA-RGS, median (IQR) age and preoperative PSA was 67 (61-71) years and 1.0 (0.5-1.9) ng/ml. Metastatic soft-tissue lesions were removed in 356 (94.4%) patients. Within three months from surgery, 25 (6.6%) patients suffered from Clavien-Dindo complications grade III-IV. During follow-up, 235 patients experienced BCR and 129 patients received further therapy. Median follow-up for patients who did not experience BCR and who did not receive further therapy was 11.1 months and 10.5 months, respectively. Median (IQR) BFS and TFS was 7.8 (5.4-10.9) and 34.9 (24.7-43.5) months. At two years of follow-up, BFS rate was 31.9% and TFS rate was 56.6%. In multivariable analyses, higher preoperative PSA (HR: 1.06), higher number of PSMA-avid lesions on preoperative imaging (HR: 1.2) and multiple (pelvic plus retroperitoneal) localizations (HR: 1.7), as well as retroperitoneal localization (HR: 2.0) of lesions in PSMA PET imaging were independent predictors of BCR after PSMA-RGS. Limitations are the retrospective design and lack of a control group. Conclusions: As salvage surgery in oligorecurrent PCa currently constitutes an experimental treatment approach careful patient selection is mandatory based on life expectancy, low PSA values and low number of PSMA PET avid lesions located in the pelvis. Further studies are needed to confirm our findings and define the oncological value of salvage surgical procedures in oligorecurrent PCa.

Feasibility and outcome of radical prostatectomy following inductive neoadjuvant therapy in patients with suspicion of rectal infiltration.

To determine the feasibility and outcome of radical prostatectomy (RP) following neoadjuvant therapy (NAT) in patients with initial inoperable, rectum-infiltrating cT4 prostate cancer (PCa). From 01/2018 to 12/2020, 26 patients with clinical (DRE) or radiographical (mpMRI) suspicion of rectum infiltrating PCa at diagnosis and NAT prior to RP were retrospectively identified from our prospective institutional database. Two patients were still inoperable after NAT. Downsizing was administered for at least 20 weeks and RP was performed after excluding ongoing rectal infiltration. At diagnosis, median PSA was 42.5 ng/ml (IQR: 23.0-66.1). Inductive NAT consisted of androgen deprivation therapy (ADT) in combination with chemotherapy (n = 9) or without chemotherapy (n = 14). Median preoperative PSA was 0.93 ng/ml (IQR: 0.24-0.40). Median time from NAT to RP was 6 months (IQR: 5-7). Two patients were still inoperable after NAT. Of 24 patients undergoing RP, abortion of surgery due to inoperability was observed in 2 patients (8.4%), demonstrating a total failure rate of NAT in 4 out of 26 patients (15.4%). One patient suffered a rectal injury with consecutive colostomy (4.2%). No Clavien-Dindo complication Grade IV or V were observed. Urinary continence was achieved in 16 patients (84.2%). Sufficient erection for sexual intercourse was present in 2 patients (10.5%). All patients received adjuvant ADT with or without radiation therapy. Median PSA at 13 months was 0.08 ng/ml (IQR: 0.01-0.74). RP of initially rectum infiltrating PCa is feasible and safe after inductive NAT, however complications rates tend to be higher compared to standard RP.

Cribriform Morphology in Gleason Score 3+4 Moderate-Risk Prostate Cancer: Is it Risk Factor for Biochemical Recurrence?

Studies have reported that the cribriform morphology observed in prostate biopsy is associated with increased up-staging, upgrading, positive surgical margins and aggressive prognosis after radical prostatectomy. In our study, we aimed to evaluate the relationship between cribriform morphology and biochemical recurrence in patients with moderate-risk localized PCa with a Gleason score of 3+4 (ISUP grade 2) after radical prostatectomy. Datas of 177 patients in the moderate-risk group who were evaluated as ISUP grade 2 after radical prostatectomy were retrospectively evaluated. Patients were divided into 2 groups as without (Group 1) and with biochemical recurrence (Group 2). Age, preoperative PSA level, T stage, follow-up time and presence of cribriform morphology in both groups were evaluated and compared. The mean preoperative serum total PSA level (group 1: 8.2 ± 3.9 and group 2: 11.9 ± 4.7) and presence of cribriform morphology (group 1: 25 (16%) and group 2: 9 (42%)) was significantly higher in group 2 (p = 0.001 and p = 0.007, respectively). According to the results of univariate and multivariate logistic regression analysis, preoperative serum total PSA level and pres-ence of cribriform morphology were found to be independent risk factors for biochemical recurrence (OR: 4,4; %95 Cl: 1,6-11,7; p=0.003 and OR: 4,7; %95 Cl: 1,7-13,1; p=0,003, respectively). Cribriform morphology of PCa is a risk factor for biochemical recurrence in patients with moderate risk and GS 3+4. In this respect, individualizing PCa cases accompanied by cribriform morphology from other Gleason Score 3+4 cases seems to be an appropriate approach.

Abstract PO-146: Copy number landscape of primary African-American and European-American prostate tumors

Abstract African-American (AA) men are more likely to be diagnosed with and to die of prostate cancer than their European-American counterparts. Much of this disparity is due to access to care and social determinants of health; however, there is emerging evidence of molecular differences in prostate tumors arising in patients of different genetic ancestry. We investigated the copy number landscape of 290 grade and race-matched primary prostate tumors through interrogation of Infinium MethylationEPIC Array (Illumina) data derived from primary prostate tumors at radical prostatectomy. Our cohort was composed of 145 self-identified AA patients and 145 self-identified EA surgically-treated patients with accompanying genetic ancestry estimation via SNP array (GSAv3). EPIC array-derived copy number data estimated through the Conumee package on R was significantly correlated with genomic losses and gains identified by exome sequencing of a panel with 100 cancer driver genes. We also observed a significant association between genomic losses of the PTEN gene and PTEN protein loss by immunohistochemistry (P&amp;lt;0.001). Similar observations were made for p53 protein nuclear accumulation detected by immunohistochemistry and TP53 gene copy loss (P&amp;lt;0.001). Next, we derived percent genome altered (PGA) from EPIC array data for our 290 patients. PGA from EPIC array was significantly correlated with PGA obtained from targeted sequencing of a subset of AA tumors (n=119, P&amp;lt;0.0001, R²=0.50). No difference in PGA was found between self-identified AA and EA patients (P&amp;lt;0.05), though PGA levels were significantly associated with Gleason Grade groups for both AA (P&amp;lt;0.0001) and EA (P=0.003). We then used the genetic ancestry estimation derived from SNP arrays to identify regions of genomic loss and gain differing by percent African ancestry. We used a comprehensive genome annotation with &amp;gt;80k coding and non-coding regions from FANTOM CAT. Adjusted LIMMA models with age, Gleason Grade Group, and pre-operative PSA levels showed significant copy number differences by percent African ancestry in chromosomes 6p, 10q, 11p, 12p, and 17p. PTEN losses (as expected) and WT1 gains were more frequent in patients with lower percent African ancestry. Gene expression data from TCGA data showed that WT1 expression was significantly increased for self-identified EA patients. Multivariable Cox regression models adjusted for age, Gleason Grade Group, and pre-operative PSA levels revealed that chromosome 8q gains (including MYC, GRHL2, and FZD6) were significantly associated with biochemical recurrence and metastasis. However, when we stratified the models by self-identified race, only AA tumors showed significant associations with 8q gains and poor outcome. Further in silico and mechanistic validation will be conducted to confirm whether chromosome 8 gains may be a potential biomarker for prostate cancer outcome in AA men. Citation Format: Thiago Vidotto, Eddie Imada, Farzana Faizal, Siqun Zheng, Jianfeng Xu, Karen S. Sfanos, Luigi Marchionni, Tamara L. Lotan. Copy number landscape of primary African-American and European-American prostate tumors [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-146.

Mast cells as a tumor microenvironment factor associated with the aggressiveness of prostate cancer.

We aimed to investigate the relationship between the degree of mast cells' (MCs) infiltration and clinicopathological features of prostate cancer (PCa) malignancy and to find out the possible mechanisms of the involvement of these cells in the formation of the aggressive course of the PCa development. The study was conducted on the clinical material of 60 patients with PCa of stages II-III. MCs in the PCa tissue were determined by a histochemical method using toluidine blue. The expression of osteopontin (OPN) was studied by the immunohistochemical method. The expression of miRNA-21, -126, -146a, -181a, and -221 was investigated by quantitative real-time PCR. Statistical processing of the results was performed using the GraphPad Prism 8 program. Our results demonstrated that the increased level of infiltration and degranulation of MCs in the PCa tissue was associated with such indices of the malignancy of the tumor process as the Gleason score and the preoperative PSA level in the blood serum of patients. A high level of MCs infiltration of the PCa tissue was associated with a significant decrease in the two-year recurrence-free survival rates of the patients by 23.3% (р=0.0455). A high degree of MCs infiltration of the PCa tissue was associated with 1.2 times (p=0.0347) higher level of OPN expression and 1.7 (p=0.0051) and 1.65 (p=0.0087) times lower levels of miR-126 and miR-181a expression, respectively. The obtained results indicate the participation of MCs as a factor of the tumor microenvironment in the PCa progression.

Primary Prostatic Tuberculosis: A Rare Entity

Objectives: To clarify the clinical, histological and therapeutic features of prostatic tuberculosis. Methods: We conducted a single-centre retrospective descriptive study of all patients presenting with prostatic tuberculosis between January 2002 and December 2020. Patients who were lost to follow-up, could not be reached by telephone or whose records were not usable were excluded from this study. Results: 240 patients were treated for urogenital tuberculosis, including 13 for isolated prostatic tuberculosis. The average age of the patients was 75 years. None of our patients had a history of tuberculosis. The average of international prostate symptom score (IPSS) was 27. Lower urinary tract symptoms in the filling phase were predominant. The digital rectal examination was suspicious in only one patient. The mean preoperative PSA was 9.24 ng/ml. 46.15% of patients underwent transurethral resection of the prostate and 53.85% underwent ultrasound-guided prostate biopsy. Histological examination showed epithelioid gigantocellular granuloma with isolated caseous necrosis in 61.53% of patients and associated adenomyomatous hyperplasia in 38.47% of patients. Antituberculosis treatment was given for 6 months. The average of follow up was 15 months. All patients reported an improvement in clinical signs with a mean post operative IPSS score of 17 and a normalisation of PSA levels. Conclusion: Isolated prostatic tuberculosis is a rare entity, it can simulate a cancer. In front of the symptoms of the lower urinary tract, the clinicians must think of it especially in the developing countries where tuberculosis still prevails in an endemic state.

Independent Factors Affecting Postoperative Short-Term Urinary Continence Recovery after Robot-Assisted Radical Prostatectomy.

Background Our team had firstly applied the transvesical approach to robot-assisted radical prostatectomy (RARP) in patients afflicted with localized prostate cancer (PCa). The present study aims to present the postoperative recovery of urinary continence (UC) following the anterior, transvesical, and posterior approaches to RARP for localized PCa and evaluate the independent predictors to early UC recovery after RARP. Methods Patients harboring localized PCa and receiving anterior, transvesical, and posterior approaches to RARP between January 2017 and June 2020 were enrolled in this analysis. Results on UC recovery were compared between these three approaches with the Kaplan–Meier method. All clinical and pathological variables were further analyzed via univariable and multivariable regression analysis to determine the independent factors contributing to short-term UC recovery after RARP. Results A total of 135, 73, and 66 instances were included in the anterior, transvesical, and posterior groups, respectively. Over the postoperative follow-up period, both the transvesical and posterior approaches showed an advantage over the anterior approach in promoting postoperative UC recovery (both p values <0.001). Three months after surgery, 55 (40.7%), 4 (5.5%), and 5 (7.6%) patients failed to UC in the anterior, transvesical, and posterior groups, respectively. Patient age, preoperative PSA, prostate volume, biopsy Gleason score, surgical approach, extended lymph node dissection technique, nerve-sparing technique, and positive lymph node were related to UC status based on univariable analyses (p < 0.05). Multivariable analysis results point patient age, prostate volume, surgical approach, and nerve-sparing technique as independent factors that affect postoperative UC recovery after RARP. Conclusions The application of transvesical approach to RARP for localized PCa could obtain promising outcomes in terms of postoperative UC recovery. In addition, surgical strategies encompassing the nerve-sparing technique and the Retzius-sparing procedures, namely, the transvesical or posterior approach, during RARP could independently enable early achievement of postoperative continence.

CAPRA-S ile radikal prostatektomi sonrası biyokimyasal rekürrens zamanı arasındaki ilişki

Objective: In this study, we aimed to evaluate the relationship between biochemical recurrence time and the “cancer of the prostate risk assessment post-surgery” score (CAPRA-S) after radical prostatectomy (RP). Material and Methods: Retrospective evaluation was made of the records of 328 patients applied with RP for a diagnosis of clinically localized prostate cancer. The patients were separated into groups according to the CAPRA-S score determined according to the preoperative PSA level and pathological characteristics of the RP specimen and the biochemical recurrence time after RP. Results: The mean follow-up period was 76.9±34.5 months. Biochemical recurrence was determined in 23.2% (n:69) of the cases, as early recurrence in 71% (n:49) and late in 29% (n:20). According to the CAPRA-S score, 186 (62.4%) patients were classified as low risk, 66 (22.1%) as moderate risk, and 46 (15%) as high risk. The 3 and 5-year BRFS rates of all the patients were 88.9% and 81.8% respectively. Patients with a low CAPRA-S score were determined to have a statistically significantly higher 3 and 5-year BRFS rate than patients in the moderate and high groups. Early biochemical recurrence after RP was statistically significantly correlated only with lymph node involvement (OR: 2.42, 95% CI: 1.07-5.47, p=0.03). Conclusion: This study showed that the CAPRA-S score, which is effective in predicting the risk of biochemical recurrence after RP, was not effective in predicting the time of biochemical recurrence after RP. Keywords: Biochemical recurrence, CAPRA-S score, prostate cancer, radical prostatectomy

Oncological and functional outcomes of extraperitoneal laparoscopic radical prostatectomy: An 18-years, single-center experience.

To present a retrospective analysis on the oncological and functional outcomes of a single-center experience on a large series of extraperitoneal laparoscopic radical prostatectomies (eLRP) with an extended follow-up. Herein we present a retrospective review of patients who underwent eLRP. Oncological and functional follow-up data were collected by means of outpatient visits and telephone interviews, assessing overall mortality and biochemical recurrence-free survival. Patients with clinical T4 stage prostate cancer (PCa), previous surgery for benign prostatic hyperplasia (BPH), previous androgen deprivation, radiotherapy, concomitant chemotherapy and/or experimental therapies, and with insufficient follow-up data were excluded. Preoperative data recorded were age, body mass index, ultrasound prostate volume, preoperative PSA and clinical stage of PCa. Operative data (operative time, nerve sparing technique and any perioperative complication) and pathological findings were obtained by consulting the surgical and pathological reports. Oncological and functional follow-up were collected during follow-up visits and telephone interview. Between January 2001 and December 2019, overall 938 eLRP were performed at our Institution. The median follow-up was 132 months. 69.7% of the patients had complete dataset. The estimated overall biochemical recurrence (BCR)-free survival was 71.4% at 5 years and 58.9% at 10 years. Cancer specific survival was 84,5%. Erectile function was preserved in the most of patients as postoperative IIEF-5 score within 12 months after surgery was > 12 in the 82.1%. About the urinary incontinence, 0.76% of the patients presented severe incontinence (continued and persistent loss of urine) and 7.0% were mildly incontinent (using up to one pad per day). Conclusions; eLRP has shown oncological and functional results comparable to other minimally invasive techniques and to open radical prostatectomy (ORP), with favorable perioperative outcomes than the open technique and a reduced complication rate.

Comparison of enhanced recovery after surgery protocol and conventional approach after laparoscopic transperitoneal radical prostatectomy: a retrospective analysis

BackgroundAlthough open radical prostatectomy has been used in the treatment of localized prostate cancer for a long time, minimally invasive surgical approaches such as laparoscopic radical prostatectomy and robot-assisted radical prostatectomy have recently gained importance in order to improve postoperative results and shorten hospital stay. Although the enhanced recovery after surgery (ERAS) protocol was first defined for gastrointestinal surgeries in 2001, it has now been used in gynecological, orthopedic, thoracic and urological surgeries. In our study, we aimed to compare the results of the ERAS protocol with the conventional approach in patients who underwent laparoscopic radical prostatectomy.MethodsThere is a retrospective analysis of 70 patients who underwent laparoscopic radical prostatectomy at Kayseri City Hospital between May 2018 and January 2021. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 25.0 (IBM SPSS, Armonk, NY, USA). Seventy patients were included in the study. While 48 patients who underwent perioperative care with the traditional approach were included in the conventional group, 22 patients were included in the ERAS group. Age, comorbidities, preoperative PSA level, digital rectal examination findings, preoperative imaging, extra prostatic spread and lymph node involvement, location of tumors, time between biopsy and surgery, lymphadenectomy status, and histopathological findings of transrectal ultrasound biopsy and prostatectomy specimens were recorded for each patient. Initiation of enteral feeding, time to first defecation, duration of antibiotic use, ileus development rate and length of hospital stay (LOS) were compared for both groups.ResultsThe mean age of 48 patients in the conventional group was 63.37 ± 7.01 years, while the mean age of 22 patients in the ERAS group was 66.36 ± 5.31 years (p = 0.080). Although the first defecation time was shorter in the ERAS group (4.75 ± 3.21 vs. 3.73 ± 2.12 days, p = 0.179), there was no statistically significant difference. Ileus developed in 10 (20.8%) patients in the conventional group and 2 (9.1%) in the ERAS group. Use of antibiotics in the postoperative period in the conventional group (5.83 ± 3.62 vs. 3.18 ± 2.42 days, p = 0.003) and LOS (7.92 ± 3.26 vs. 5.91 ± 2, 15 days, p = 0.011) were statistically significantly longer.ConclusionIn summary, ERAS protocol is associated with short LOS, time to initiation of enteral feeding and duration of antibiotics use. There was no statistically significant difference in the rate of ileus and time to first defecation between the two groups. Randomized prospective studies on heterogeneous and larger patient groups are needed to confirm our findings.

MP64-02 THE KEY ROLE OF LEVATOR ANI THICKNESS FOR EARLY URINARY CONTINENCE RECOVERY IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL STUDY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI (MP64)1 Sep 2021MP64-02 THE KEY ROLE OF LEVATOR ANI THICKNESS FOR EARLY URINARY CONTINENCE RECOVERY IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL STUDY Manuela Tutolo, Giuseppe Rosiello, Dirk De Ridder, Davide Oreggia, Francesco Barletta, Simone Scuderi, Giovanni Tasso, Giorgio Stabile, Donato Cannoletta, Liesbeth De Wever, Antonio Esposito, Francesco De Cobelli, Wouter Everaerts, Andrea Salonia, Francesco Montorsi, Frank Van der Aa, and Alberto Briganti Manuela TutoloManuela Tutolo More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Dirk De RidderDirk De Ridder More articles by this author , Davide OreggiaDavide Oreggia More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Giovanni TassoGiovanni Tasso More articles by this author , Giorgio StabileGiorgio Stabile More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Liesbeth De WeverLiesbeth De Wever More articles by this author , Antonio EspositoAntonio Esposito More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Wouter EveraertsWouter Everaerts More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Frank Van der AaFrank Van der Aa More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002104.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary continence (UC) recovery dramatically affects quality of life of patients after radical prostatectomy (RP). Membranous urethral length (MUL) has been the most studied anatomical variable associated with UC recovery. The aim of this study is to investigate whether Levator Ani thickness (LAT), assessed with multi-parametric magnetic resonance imaging (mpMRI), correlates with UC recovery in patients undergoing robot assisted radical prostatectomy (RARP). METHODS: The study included 209 patients treated with RARP at San Raffaele Hospital - Milan, Italy and Gasthuisberg Hospital - Leuven by expert surgeons with extensive robotic experience (>100 cases AND >30 cases/year) from 2017 to 2019. All patients had complete, clinical, mpMRI, pathological and post-operative data including pelvic floor muscle training (PFMT) protocols. Two urologists (after a training with an expert radiologist) examined the images, independently. They were blinded to clinical and pathological findings as well as to postoperative continence status. On mpMRI, LAT, bladder neck (BN) shape, membranous urethral length (MUL) and apex overlapping (AO) were measured. UC recovery was defined as use of 0 or 1 safety pad at follow-up. Multivariable models were used to assess the association between the aforementioned variables, and UC recovery. RESULTS: Overall, 173 (82.8%) patients, were continent after a median follow-up of 23 months (IQR: 17-28). Of these, 98 (46.9%) recovered within 3-months after surgery, 42 (20.1%) from 3 to 6 months, and 33 (15.8%) from 6 months onwards. A significant higher rate of patients with LAT >10 mm (88.1 vs. 75.8%; p=0.03) experienced UC recovery, compared to those with LAT<10 mm. This difference was observed in the first 3 months after surgery. At multivariable analysis, LAT (OR: 1.18, 95%CI 1.02-1.37; p=0.02), pre-operative ICIQ score (OR 0,91, 95%CI 0.82-0,98, p=0.03) and PFMT (OR: 1.98, 95%CI 1.01-3.93; p=0.04) independently predict higher UC recovery within 3 months, after accounting for age, BMI, preoperative PSA, D’Amico risk group, MUL, BN shape and AO. CONCLUSIONS: This study demonstrates that LAT is an independent predictor of early UC recovery and patients with a LAT greater than 1cm seem to present a higher urinary continence rate at 3 months after RARP compared to those with LAT < 1cm. The inclusion of LAT in future predictive models could improve this accuracy and could be used in the pre-operative counselling to better inform patients about the probability of urinary continence recovery. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1110-e1110 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manuela Tutolo More articles by this author Giuseppe Rosiello More articles by this author Dirk De Ridder More articles by this author Davide Oreggia More articles by this author Francesco Barletta More articles by this author Simone Scuderi More articles by this author Giovanni Tasso More articles by this author Giorgio Stabile More articles by this author Donato Cannoletta More articles by this author Liesbeth De Wever More articles by this author Antonio Esposito More articles by this author Francesco De Cobelli More articles by this author Wouter Everaerts More articles by this author Andrea Salonia More articles by this author Francesco Montorsi More articles by this author Frank Van der Aa More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Loading ...

MP32-18 METABOLIC SYNDROME AND LONG-TERM PROSTATE CANCER OUTCOMES AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II (MP32)1 Sep 2021MP32-18 METABOLIC SYNDROME AND LONG-TERM PROSTATE CANCER OUTCOMES AFTER RADICAL PROSTATECTOMY Jennifer E. Wong, Tyler R. Erickson, Lauren E. Howard, Amanda M. De Hoedt, Christopher J. Kane, Martha K. Terris, Matthew R. Cooperberg, Christopher L. Amling, Zachary Klaassen, William J. Aronson, Stephen J. Freedland, and Adriana C. Vidal Jennifer E. WongJennifer E. Wong More articles by this author , Tyler R. EricksonTyler R. Erickson More articles by this author , Lauren E. HowardLauren E. Howard More articles by this author , Amanda M. De HoedtAmanda M. De Hoedt More articles by this author , Christopher J. KaneChristopher J. Kane More articles by this author , Martha K. TerrisMartha K. Terris More articles by this author , Matthew R. CooperbergMatthew R. Cooperberg More articles by this author , Christopher L. AmlingChristopher L. Amling More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , William J. AronsonWilliam J. Aronson More articles by this author , Stephen J. FreedlandStephen J. Freedland More articles by this author , and Adriana C. VidalAdriana C. Vidal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002036.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metabolic syndrome (MetS) has been shown to increase prostate cancer (PC) risk, but association between MetS and PC outcomes after radical prostatectomy (RP) is poorly established. We aimed to analyze associations between MetS and biochemical recurrence (BCR), metastasis, castration-resistant PC (CRPC), all-cause mortality (ACM), and PC-specific mortality (PCSM) after RP. METHODS: Men who underwent RP at 8 Veterans Affairs Medical Centers between 2000-2017 were analyzed in the SEARCH database. MetS was defined as having 3 of 5 components: hypertension (systolic blood pressure (BP) >130mmHg or diastolic BP >85mmHg), obesity (body mass index >30 kg/m2), high triglycerides (≥150mg/dL), low high-density lipoprotein (<40mg/dL), and diabetes (ICD-9 or ICD-10 code). Baseline patient characteristics stratified by MetS were compared using Wilcoxon rank sum tests for continuous variables and Chi-squared tests for categorical variables. Association between MetS and time to BCR, metastasis, CRPC, ACM, and PCSM was analyzed using Cox proportional hazards models adjusted for demographics (age, race, pre-operative PSA, year of surgery, and surgical center), clinical characteristics (biopsy grade group and clinical stage), and pathological characteristics (pathological grade group, margin status, extracapsular extension, seminal vesicle invasion, and lymph node status). RESULTS: Of 4587 men, 1605 (35%) had MetS at time of RP. During follow-up, 30% of 4587 men developed BCR, 3.6% developed metastasis, 2.4% developed CRPC, 16% died, and 1.7% died due to PC. In adjusted models, there was no association between MetS and BCR risk (HR=1.02; 95%CI: 0.91-1.14), metastasis risk (HR=1.23; 95%CI: 0.90-1.68), or ACM (HR=1.11; 95%CI: 0.96-1.30), all p ≥0.056. However, MetS was associated with increased CRPC and PCSM risk on univariable analysis (HR=1.57; 95%CI: 1.08-2.29, p=0.019, HR=2.02; 95%CI: 1.29-3.16, p=0.002 respectively), analysis adjusted for demographic and clinical characteristics (HR=1.68; 95%CI: 1.15-2.46, p=0.008, HR=2.21; 95%CI: 1.41-3.49, p=0.001 respectively), and analysis adjusted for demographic and pathological characteristics (HR=1.57; 95%CI: 1.07-2.31, p=0.022; HR=1.94; 95%CI: 1.22-3.08, p=0.005 respectively). CONCLUSIONS: Our findings suggest that following RP, MetS increases risk for CRPC and PCSM but not BCR, metastasis, and ACM. If confirmed, managing MetS components may reduce CRPC and PCSM risk in PC patients. Source of Funding: Support for this study was provided by American Cancer Society Research Scholar Grant RSG-18-018-01-CPHPS to ACV. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e573-e574 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer E. Wong More articles by this author Tyler R. Erickson More articles by this author Lauren E. Howard More articles by this author Amanda M. De Hoedt More articles by this author Christopher J. Kane More articles by this author Martha K. Terris More articles by this author Matthew R. Cooperberg More articles by this author Christopher L. Amling More articles by this author Zachary Klaassen More articles by this author William J. Aronson More articles by this author Stephen J. Freedland More articles by this author Adriana C. Vidal More articles by this author Expand All Advertisement Loading ...

MP36-01 TESTOSTERONE (T) CHALLENGE IN MEN POST-RADICAL PROSTATECTOMY (RP) WITH PROFOUNDLY LOW TESTOSTERONE

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II (MP36)1 Sep 2021MP36-01 TESTOSTERONE (T) CHALLENGE IN MEN POST-RADICAL PROSTATECTOMY (RP) WITH PROFOUNDLY LOW TESTOSTERONE John P. Mulhall, Serkan Deveci, Jose Flores, Kazuhito Matsushita, Jose Torremade, and Carolyn A. Salter John P. MulhallJohn P. Mulhall More articles by this author , Serkan DeveciSerkan Deveci More articles by this author , Jose FloresJose Flores More articles by this author , Kazuhito MatsushitaKazuhito Matsushita More articles by this author , Jose TorremadeJose Torremade More articles by this author , and Carolyn A. SalterCarolyn A. Salter More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002045.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate specific antigen is the primary marker of prostate cancer recurrence. PSA secretion is T dependent with T levels below saturation point associated with sub-optimal PSA production. Men with an undetectable PSA level after RP with very low T levels might have an artificially low PSA level. We aimed to evaluate the effects of raising T level in such men. METHODS: Study population consisted of (i) men post-RP (ii) with undetectable PSA level (iii) total T levels <200 ng/dl (two levels, LCMS) who (iv) underwent in-office intramuscular injection of 100mg of T cypionate (v) had a PSA level checked 5 days later, and if undetectable every month after that, 3 months later then every 6 months and (vi) follow-up of at least 24 months on T therapy. RESULTS: 22 men have been challenged thus far. Mean age 62±18 years. Mean preoperative PSA 6.2. Mean post-RP TT value 140±35 ng/dL 2.2. Median Gleason sum 7. 23% had GS ≥8. Mean post-RP, pre-challenge T value 140± 35 ng/dL. Mean time post-RP to challenge was 7±9 months. Mean TT value 5 days after IMT challenge 640±220 ng/dL, all with TT levels above 400. 5/22 has a PSA elevation, 2 immediately after IMT challenge (PSA values 0.07, 0.08). All other men started T therapy immediately and had PSA elevation at 9, 14 and 22 months after commencing T therapy (PSA values 0.08, 0.12, 0.11). All patients with PSA elevation had continued rise in PSA and had detectable disease on imaging. All men with PSA recurrence had either GS 7 with unfavorable pathology (2) or GS ≥8 (3). CONCLUSIONS: This T challenge approach permits the early detection of prostate cancer recurrence permitting early intervention. About 10% of such men had a PSA rise immediately after T challenge. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e636-e636 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John P. Mulhall More articles by this author Serkan Deveci More articles by this author Jose Flores More articles by this author Kazuhito Matsushita More articles by this author Jose Torremade More articles by this author Carolyn A. Salter More articles by this author Expand All Advertisement Loading ...

PD19-07 RISK FACTORS AND IMPACTS OF POSITIVE SURGICAL MARGIN IN AFRICAN AMERICAN UNDERGOING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD19)1 Sep 2021PD19-07 RISK FACTORS AND IMPACTS OF POSITIVE SURGICAL MARGIN IN AFRICAN AMERICAN UNDERGOING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY Shuo Liu, Bridget Krol, Justin Refugia, Adam Cohen, Ram Pathak, and Ashok Hemal Shuo LiuShuo Liu More articles by this author , Bridget KrolBridget Krol More articles by this author , Justin RefugiaJustin Refugia More articles by this author , Adam CohenAdam Cohen More articles by this author , Ram PathakRam Pathak More articles by this author , and Ashok HemalAshok Hemal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002008.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer disproportionately impacts African American (AA) males. Margin status remains an important measure of the quality of disease clearance by radical prostatectomy. Unfortunately, historical series have shown that AA men tend to fare worse in this metric comparing to other ethnicities. Furthermore, recent studies have reported positive surgical margin (PSM) rates of up to 34.7% in AA men undergoing robot-assisted radical prostatectomy (RARP). Our study aims to investigate the potential risk factors for PSM in this patient group and its impact on biochemical recurrence-free survival (BCRFS). METHODS: 246 AA men underwent RARP between 2009 and 2019 at our institution. Preoperative patient and disease characteristics, perioperative variables, postoperative and pathological outcomes were recorded and compared according to final margin status. Favorable PSM was defined as PSM noted on pathology with additional margins as negative or with a sub-millimeter unifocal margin. Unfavorable PSM was defined as any PSM not favorable. RESULTS: Adverse pathology (pathological stage >T3, pathological ISUP >3, or positive nodal disease) was seen in 45.1% (111). Favorable PSM status was observed in 52 (21.1%) and unfavorable PSM in 28 (11.4%). PSM was associated with reduction in BCRFS (log-rank p<0.001). Margin multifocality did not further increase disease recurrence. Patients with PSM had higher preoperative PSA (p<0.001), higher clinical risk category (p=0.007), higher pathological grade (p=0.002) and incidences of perineural invasion (PNI) (p<0.001), as well as higher percentages of clinical and pathological T3 disease. Furthermore, patients with PSM were more likely to clinically understaged on final pathological analysis (p<0.001). CONCLUSIONS: PSM rate in AA men remained high in the era of robot-assisted surgery and significantly affected BCRFS. These patients were also more likely to have other adverse pathological features. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e364-e364 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shuo Liu More articles by this author Bridget Krol More articles by this author Justin Refugia More articles by this author Adam Cohen More articles by this author Ram Pathak More articles by this author Ashok Hemal More articles by this author Expand All Advertisement Loading ...

PD61-05 RANDOMIZED TRIAL COMPARING URINARY CONTINENCE RATES BETWEEN PELVIC MUSCLES EXERCISES WITH AND WITHOUT TRANS-PELVIC MAGNETIC STIMULATION AFTER ROBOTIC ASSISTED RADICAL PROSTATECTOMY

PD61-05 RANDOMIZED TRIAL COMPARING URINARY CONTINENCE RATES BETWEEN PELVIC MUSCLES EXERCISES WITH AND WITHOUT TRANS-PELVIC MAGNETIC STIMULATION AFTER ROBOTIC ASSISTED RADICAL PROSTATECTOMY

Cribriform glands are associated with worse outcome than other pattern 4 subtypes: A study of prognostic and clinicopathological characteristics of prostate adenocarcinoma with an emphasis on Grade Groups.

Although prostate adenocarcinoma is the most common cancer in men, survival is quite high and with the help of histopathological examination using the updated classification, patient management strategies are developing. We aimed to evaluate the correlation between the histopathological features and biochemical recurrence (BCR) in patients who underwent radical prostatectomy (RP) using the new classification. A total of 285 prostate adenocarcinoma cases that underwent RP between January 2009 and December 2017 and followed up for at least 3months were included in the study. The cases were re-evaluated according to WHO-ISUP 2016 classification and the findings were recorded. The mean age was 63,4years. Gleason scores of the cases were as follows: 3+3 144 cases (50.5%), 3+4 81 cases (28.4%), 4+3 28 cases (9.8%), 4+4 7 cases (2.5%) , 3+5 6 cases (2.1%), 5+3 2 cases (0.7%), 4+5 17 cases (6%). There were 198 (69,5%) pT2, 54 (18,9%) pT3a and 33 (11,6%) pT3b cases. The mean follow-up time was 44,1months and BCR was detected in 97 cases (34%). The relationship between the Group Grades and BCR was statistically significant. BCR rate increased as the tumour volume and the percentage of pattern 4 increased (P<.001).There was a significant correlation between preoperative PSA value, extraprostatic extension, seminal vesicle invasion, surgical margin positivity, tumour volume, pattern 4 percentage, presence of cribriform glands and BCR and recurrence-free survival in both univariate and multivariate analysis and recurrence-free survival was also affected by these parameters. Among the morphological subtypes of Pattern 4, recurrence-free survival decreased as the incidence of cribriform glands increased (P<.001). Histopathological evaluation is important in predicting BCR in prostate adenocarcinoma, the Group Grade system seems to be helpful in this regard. More studies are needed to prove the relatively worse prognostic effect of cribriform glands.

High expression of Sterol-O-Acyl transferase 1 (SOAT1), an enzyme involved in cholesterol metabolism, is associated with earlier biochemical recurrence in high risk prostate cancer

BackgroundProstate cancer (PCa) is the most frequent cancer in men. The prognosis of PCa is heterogeneous with many clinically indolent tumors and rare highly aggressive cases. Reliable tissue markers of prognosis are lacking. Active cholesteryl ester synthesis has been associated with prostate cancer aggressiveness. Sterol-O-Acyl transferases (SOAT) 1 and 2 catalyze cholesterol esterification in humans.ObjectiveTo investigate the value of SOAT1 and SOAT2 tissue expression as prognostic markers in high risk PCa.Patients and methodsFormalin-fixed paraffin-embedded tissue samples from 305 high risk PCa cases treated with radical prostatectomy were analyzed for SOAT1 and SOAT2 protein expression by semi-quantitative immunohistochemistry. The Kaplan–Meier method and Cox proportional hazards modeling were used to compare outcome.Main outcome measureBiochemical recurrence (BCR) free survival.ResultsSOAT1 expression was high in 73 (25%) and low in 219 (75%; not evaluable: 13) tumors. SOAT2 was highly expressed in 40 (14%) and at low levels in 249 (86%) samples (not evaluable: 16). By Kaplan–Meier analysis, we found significantly shorter median BCR free survival of 93 months (95% confidence interval 23.6–123.1) in patients with high SOAT1 vs. 134 months (112.6–220.2, Log-rank p < 0.001) with low SOAT1. SOAT2 expression was not significantly associated with BCR. After adjustment for age, preoperative PSA, tumor stage, Gleason score, resection status, lymph node involvement and year of surgery, high SOAT1 but not SOAT2 expression was associated with shorter BCR free survival with a hazard ratio of 2.40 (95% CI 1.57–3.68, p < 0.001). Time to clinical recurrence and overall survival were not significantly associated with SOAT1 and SOAT2 expressionConclusionsSOAT1 expression is strongly associated with BCR free survival alone and after multivariable adjustment in high risk PCa. SOAT1 may serve as a histologic marker of prognosis and holds promise as a future treatment target.

Evaluation Of Erectile Function After Radical Perineal Prostatectomy

PURPOSE: Radical prostatectomy (RP) is the gold standard treatment option for localized prostate cancer (Pca) treatment. In this study, we aimed to evaluate the potance condition of patients who completed the first year after the radical prostatectomy operation with the perineal approach . PATİENTS AND METHODS: The study included 107 preoperatively potant patients who underwent RPP for localized PCA between April 2006 and September 2009. Besides to 65 patients with a preoperative International Index of Erectile Function (IIEF)- 5 score of 21 or over, 42 patients who were evaluated with their partners, even though whose preopeative IIEF-5 score was between 16-20; however, answered yes to the SEP 2 and SEP 3 questions, were considered as potant. RESULTS: The mean age of the patients was 62.4 years. The mean preoperative PSA value was 6.5 ng/dL. The mean prostate volume was 48cc (15-70). Eighty-one (75.7%) of all patients were able to continue their sexual life with or without medication at postoperative 12th month. Forty-four (54.3%) patients were normal in terms of sexual function without any need for additional treatment CONCLUSİON: We evaluated that erectile function was preserved in 81 of 107 (75.7%) patients after 1 year from surgery with or without medical therapy.

The immune checkpoint regulator PD-L1 expression are associated with clinical progression in prostate cancer

BackgroundThe programmed death 1 (PD-1)/programmed death-ligand 1 (PD-L1) have shown positive efficacy in several solid cancers due to their targeted antitumour effects. However, the frequency and clinical implication value in prostate cancer still remain unclear.MethodsThe PD-1/PD-L1 expression was detected by immunohistochemical (IHC) analysis in 96 retrospectively collected cases of prostatic cancer and 44 controls of benign prostatic hyperplasia (BPH). Its correlation with clinicopathological features including age, PSA level, Gleason score, lymph node metastasis, clinical T stage and risk factor grade in prostate cancer was also assessed.ResultsThe PD-L1-positive expression was significantly higher in cancer cases compared with benign tissues, whereas no difference in PD-1 positive expression was found. Moreover, the PD-L1 expression in tumour cells or lymphocytes was associated with Gleason score, but not related to age, preoperative PSA level, clinical T-stage, lymph node metastasis and grade of risk factors. In addition, no association between the positive expression of PD-1 and PD-L1 in tumour cells and lymphocytes was found.ConclusionsThe expression of PD-L1 not PD-1 is highly prevalent in prostate cancer. PD-L1 is closely related to Gleason score and may be a co-factor associated with the progression of prostate cancer.