Radical Prostatectomy Rates Research Articles

Robotic urologic surgery using the KangDuo-Surgical Robot-01 system: A single-center prospective analysis.

The KangDuo-Surgical Robot-01 (KD-SR-01) system is a new surgical robot recently developed in China. The aim of this study was to present our single-center experience and mid-term outcomes of urological procedures using the KD-SR-01 system. From August 2020 to April 2023, consecutive urologic procedures were performed at Peking University First Hospital using the KD-SR-01 system. The clinical features, perioperative data, and follow-up outcomes were prospectively collected and analyzed. A total of 110 consecutive patients were recruited. Among these patients, 28 underwent partial nephrectomy (PN), 41 underwent urinary tract reconstruction (26 underwent pyeloplasty, 3 underwent ureteral reconstruction and 12 underwent ureterovesical reimplantation [UR]), and 41 underwent radical prostatectomy (RP). The median operative time for PN was 112.5min, 157.0min for pyeloplasty, 151.0min for ureteral reconstruction, 142.5min for UR, and 138.0min for RP. The median intraoperative blood loss was 10mL for PN, 10mL for pyeloplasty, 30mL for ureteral reconstruction, 20mL for UR, and 50mL for RP. All procedures were successfully completed without conversion, and there were no major complications in any patient. The median warm ischemia time of PN was 17.3min, and positive surgical margin was not noted in any patient. The overall positive surgical margin rate of RP was 39% (16/41), and no biochemical recurrence was observed in any RP patient during the median follow-up of 11.0 months. The surgical success rates of pyeloplasty and UR were 96% (25/26) and 92% (11/12) during the median follow-up of 29.5 months and 11.5 months, respectively. The KD-SR-01 system appears feasible, safe, and effective for most urological procedures, based on our single-center experience.

Disease mapping: Geographic differences in population rates of interventional treatment for prostate cancer in Australia.

Treatment decisions for men diagnosed with prostate cancer depend on a range of clinical and patient characteristics such as disease stage, age, general health, risk of side effects and access. Associations between treatment patterns and area-level factors such as remoteness and socioeconomic disadvantage have been observed in many countries. To model spatial differences in interventional treatment rates for prostate cancer at high spatial resolution to inform policy and decision-making. Hospital separations data for interventional treatments for prostate cancer (radical prostatectomy, low dose rate and high dose rate brachytherapy) for men aged 40 years and over were modelled using spatial models, generalised linear mixed models, maximised excess events tests and k-means statistical clustering. Geographic differences in population rates of interventional treatments were found (p<0.001). Separation rates for radical prostatectomy were lower in remote areas (12.2 per 10 000 person-years compared with 15.0-15.9 in regional and major city areas). Rates for all treatments decreased with increasing socioeconomic disadvantage (radical prostatectomy 19.1 /10 000 person-years in the most advantaged areas compared with 12.9 in the most disadvantaged areas). Three groups of similar areas were identified: those with higher rates of radical prostatectomy, those with higher rates of low dose brachytherapy, and those with low interventional treatment rates but higher rates of excess deaths. The most disadvantaged areas and remote areas tended to be in the latter group. The geographic differences in treatment rates may partly reflect differences in patients' physical and financial access to treatments. Treatment rates also depend on diagnosis rates and thus reflect variation in investigation rates for prostate cancer and presentation of disease. Spatial variation in interventional treatments may aid identification of areas of under-treatment or over-treatment.

Androgen deprivation therapy plus apalutamide as neoadjuvant therapy prior radical prostatectomy for patients with unresectable prostate cancer.

Whether neoadjuvant therapy confers a survival benefit in advanced prostate cancer (PCa) remains uncertain. The primary endpoints of previous retrospective and phase II clinical studies that used neoadjuvant therapy, including androgen deprivation therapy combined with new-generation androgen receptor signaling inhibitors or chemotherapy, were pathological downstaging, progression-free survival, prostate-specific antigen relief, and local symptom improvement. To the best of our knowledge, no studies have explored the efficacy and safety of neoadjuvant therapy in improving the surgical resection rate in cases of unresectable primary tumors of PCa. We first designed this retrospective study to evaluate the potential value of apalutamide as neoadjuvant therapy in improving the resectability rate of radical prostatectomy (RP). We initially reported 7 patients with unresectable primary lesions who underwent neoadjuvant apalutamide treatment for a median of 4months, and all of them successfully underwent RP treatment. Our study supported apalutamide as neoadjuvant therapy, which helped improve RP's success rate and did not significantly increase perioperative complications, and the neoadjuvant therapy was controllable. Our findings' clinical value and benefit for survival still need further clinical research to confirm.

Utilization of Radical Prostatectomy vs. Radiation Therapy for Gleason Grade Group 5 Prostate Cancer before and after USPSTF Grade D Recommendation against Prostate-Specific Antigen Screening in 2012

The 2012 United States Preventive Services Task Force (USPSTF) Grade D recommendation against prostate-specific antigen (PSA) screening has resulted in a shift to higher-stage prostate cancer (PC) at diagnosis. While incidence of low-risk prostate cancer has declined, more men are diagnosed with high-risk disease, and multimodal treatment is often required. The impact of this epidemiologic shift on practice patterns, specifically radical prostatectomy (RP) versus definitive radiation therapy (RT), for men with localized PC at high risk of recurrence is unknown. Herein, we evaluate the utilization of RP versus RT in the United States for Gleason grade group 5 (GG5) prostate cancer before and after 2012. We identified 34,011 men with localized GG5 PC treated with (1) RP or (2) RT plus androgen deprivation therapy (ADT) between 2004 and 2017 in the National Cancer Database. We excluded those who were clinically node-positive, had metastatic disease, or received chemotherapy or palliative-intent treatment. Chi-square was used to compare the relative use of RP and RT before versus after January 1, 2012, corresponding to the year of USPSTF recommendation against PSA screening. Annual use of RP versus RT from 2004 to 2017 was compared in academic and non-academic centers using Cochran-Armitage test for trend. Joinpoint regression assessed if 2012 was significant for inflection of crude rates of RP. Finally, we modeled the effect of treatment year (i.e., 2012-2017 versus 2004-2011) on use of RP using multivariable logistic regression. Sensitivity analysis tested an interaction term for facility type (i.e., academic versus community). Tests were two-sided with a 0.05 level of significance. Of the eligible men, 10,745 (31.6%) had T3-T4 disease. Between 2004 and 2011, 36.5% (n = 5,483) underwent RP; between 2012 and 2017, 42.3% (n = 8,034) underwent RP (p = .02). Across all centers, use of RP increased from 31% to 41% (p for trend <.001). In academic centers, use of RP increased from 32% to 44% (p for trend <.001); in community centers, use of RP increased from 30% to 39% (p for trend <.001). 2012 was associated with significant inflection for increase in RP use in all centers. On multivariable analysis, there was an increased odds of receiving RP after 2012 (adjusted OR 1.34, 95% CI 1.28-1.40, p<.001). No differential effect by facility type was observed (p = .15). Utilization of RP for GG5 PC has significantly increased in the United States over the past decade, particularly after the USPSTF Grade D recommendation against PSA screening in 2012. It remains unknown whether oncologic or functional outcomes may be compromised in this group of high-risk men, many of whom require post-prostatectomy RT and/or ADT. While historically rare, prospective comparison of RP versus RT+ADT for GG5 PC may be helpful given the evolving epidemiology of localized PC.

Prostate cancer public health system database from Brazil: Racial disparities and heterogeneity of treatment interventions to understand evidence-based practice patterns in a large real-world database.

5025 Background: The Brazilian Public National Health System (SUS) provides an opportunity to understand epidemiologic information, treatments, discrepancies in care, and costs of men with prostate cancer (PCa) using a large real-world dataset. This analysis focuses on racial disparities and heterogeneity of specific interventions to understand evidence-based practice patterns in Brazil. Additionally, the dataset can serve as a model for other low-middle income countries (LMIC). Methods: Patients included in the database were those with a diagnosis of PCa receiving care in the SUS from 01/01/2008 to 08/31/2022. Data were analyzed using a proprietary Healthcare Data Science platform offered by TECHTRIALS and included information regarding stage, demographics, cancer-related information, treatment-related information, and resources utilized. Results: 657,609 PCa pts were diagnosed and treated at SUS during the 14.5-year study period of whom 382,263 (58%) were brown/black (non-white) and 262,820 (42%) white. Median age of the population was 72.6 years, and did not vary with race. 26.16% of the pts were diagnosed with stage IV and this was not impacted by race or localization, including state or type of city (capital or not). Rates of radical prostatectomy and radiation utilization were similar between race categories. Additionally, in patients with stage IV disease, rates of systemic therapy utilization including chemotherapy with docetaxel (7.7%), with a tendency to increase use in the last years, and androgen receptor signaling inhibitors (ARSI) with (0.6%) or enzalutamide (0.08%), were low and similar between race categories. Rates of first-generation anti-androgens and estrogens were higher (56%) The total costs of prostate cancer directed care was R$4.31 billions (US$820 millions) and race did not impact total cost of care and cost by procedure or therapy type options. Conclusions: This is one of the largest studies using public health-system databases for Prostate cancer with Real World Data ever published. Race had no impact in presenting stage, treatment received and even in the costs involved. Underutilization of chemotherapy (docetaxel) in a scenario of limiting resources and without the use of new hormonal therapies is a matter of concern, together with an overuse of agents without proven survival advantage. Our data highlights the need for increased access to life prolonging agents for patients with metastatic PCa in the SUS.

Are high-risk prostate cancer patients being treated equally? The impact of PSA.

Patients with high-risk (HR) prostate cancer (PCa) represent a heterogeneous group, however, current treatment guidelines do not consider their specific features. The objective of this study was to evaluate treatment trends and outcomes in HR patients defined by PSA alone and otherwise low-risk features. Using the National Cancer Database, we identified patients diagnosed with HR PCa between 2010 and 2016. A study group of patients defined by PSA >20 ng/ml alone and otherwise low-risk features, was compared to a group of HR patients defined by Gleason score or stage. We compared treatment rates over time, the use of concomitant androgen deprivation therapy (ADT), and overall survival (OS). Examination of treatment trends was done using a Z-test analysis. A Kaplan-Meier survival analysis was used to determine 5-year OS with the Log-rank test for comparison. Statistical analyses were completed using R Version 3.5.2. We identified 5,652 patients in the study group and 71,922 in the comparison group. Only 6.8% of the study group had disease ≥cT2, compared to 43.7% in the comparison group. In the study group, 12.5% (709), underwent active surveillance (AS), 36.4% (2,055) radiation therapy (EBRT) and 51.1% (2,888) radical prostatectomy (RP), while the rate of AS, EBRT, and RP in the comparison group were 0.3% (191), 43.0% (30,928), and 56.7% (40,803), respectively. Over the study period, adoption of AS increased from 6.2% in 2010 to 25.0% in 2016 in the study group (P< 0.001), but not in the comparison group. In patients undergoing EBRT, ADT treatment increased from 2010 to 2016 in both groups, though by 2016 only 45.3% of patients in the study group and 86.3% in the comparison group received ADT. The 5-year OS was 93.7% (95% CI 92.8-94.6) in the study group and 89.7% (95% CI 89.2-90.1) in the comparison group (P< 0.001). Men with HR PCa defined by PSA with otherwise low risk features present at an earlier stage and receive less aggressive therapy than other HR patients. Despite increased rates of AS and decreased use of ADT, these patients appear to have improved survival when compared to other HR patients. These findings suggest that not all HR patients will benefit from aggressive definitive treatment.

MP71-02 ASSESSING THE IMPACT OF HYPOGONADISM ON SURGICAL OUTCOMES FOLLOWING ARTIFICIAL URINARY SPHINCTER PLACEMENT

You have accessJournal of UrologyCME1 Apr 2023MP71-02 ASSESSING THE IMPACT OF HYPOGONADISM ON SURGICAL OUTCOMES FOLLOWING ARTIFICIAL URINARY SPHINCTER PLACEMENT Andrew Gabrielson, Logan Galansky, Una Choi, and Andrew Cohen Andrew GabrielsonAndrew Gabrielson More articles by this author , Logan GalanskyLogan Galansky More articles by this author , Una ChoiUna Choi More articles by this author , and Andrew CohenAndrew Cohen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retrospective series suggest a link between hypogonadism and complications following artificial urinary sphincter (AUS) placement. We sought to confirm this finding and evaluate whether testosterone replacement therapy (TRT) in hypogonadal patients prior to AUS placement mitigates this risk. METHODS: A retrospective cohort study was conducted using the TriNetX research network between 2006-2022. We defined 4 groups: 1) Eugonadal patients undergoing AUS, 2) Hypogonadal patients (>1 confirmatory T level <300 ng/dL) with and without TRT, 3) Hypogonadal patients who received TRT prior to AUS, 4) Hypogonadal patients who did not receive TRT prior to AUS. Propensity-score matching was used in comparing baseline differences in comorbidities of the eugonadal and hypogonadal arms. Outcomes included 5-year all-cause revision (cuff erosion, mechanical, infectious), 5-year device complication (mechanical, infectious only), and 90-day surgical site infection (SSI) rate. RESULTS: We included 4,520 eugonadal and 514 hypogonadal patients (19% with TRT, 81% without TRT) undergoing AUS (Table 1). Compared to eugonadal patients, the hypogonadal cohort had a significantly higher 5-year device complication (17% vs 13%, p=0.03) and 90-day SSI rate (2% vs 0.8%, p<0.01), but no difference in 5-year revision rate (26% vs 24%, p=0.21). When comparing hypogonadal patients who received TRT prior to AUS versus hypogonadal patients who did not receive TRT, we found no difference in 5-year revision (32% vs 26%, p=0.19), 5-year device complication (23% vs. 16%, p=0.10), or 90-day SSI (1.1% vs. 1.9%, p=0.48) rates. Hypogonadal patients receiving TRT before AUS were more likely to have pre-existing erectile dysfunction and penile implant surgery, but had similar rates of radical prostatectomy. Post-AUS, only 22 (5.3%) patients in the non-TRT arm received new TRT, suggesting minimal crossover. There was no difference in 5-year revision between eugonadal and hypogonadal patients not receiving TRT. CONCLUSIONS: Pre-existing hypogonadism may impact early SSI rates and long-term mechanical or infectious complications but was not associated with higher rates of all-cause revision likely due to similar rates of cuff erosion. TRT does not appear to impact surgical outcomes among hypogonadal patients undergoing AUS placement. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1013 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Gabrielson More articles by this author Logan Galansky More articles by this author Una Choi More articles by this author Andrew Cohen More articles by this author Expand All Advertisement PDF downloadLoading ...

Short term pathologic outcomes and biochemical recurrence rates of single port transvesical retzius-sparing radical prostatectomy as compared to multiport radical prostatectomy.

369 Background: Single port radical prostatectomy with a transvesical Retzius-sparing approach (SPRP) has shown technical feasibility and early evidence of improved time to urinary continence. How this novel approach leads to differences in pathologic outcomes and biochemical recurrence rates (BCR) as compared to multiport radical prostatectomy (MPRP) has yet to be investigated. Our goal was thus to study the pathologic and short term survival outcomes of patients undergoing SPRP as compared to those undergoing MPRP. Methods: Single center, single surgeon retrospective review of prospectively collected data on 169 patients with low and intermediate risk prostate cancer, whom either underwent SPRP or MRPR (2017-2022). Preoperative clinicopathologic and radiographic characteristics were compared. Following RP, pathologic outcomes, including T stage, grade group (GG), margin status, extraprostatic extension (EPE), seminal vesical invasion (SVI), node retrieval rates, lymph node invasion (LNI) and other adverse histopathologic features were compared between both groups. Cox proportional hazards univariate analysis was used to evaluate the impact of SPRP on biochemical recurrence free survival as compared to MPRP with a three year follow up. Results: A total of 84 patients underwent MPRP and 85 patients underwent SPRP. The SPRP cohort had a higher proportion of clinical T stage one as compared to the MPRP cohort (99% vs 85%, p=0.04), however both groups did not differ preoperatively in terms of median total PSA (6.9 MPRP vs 6.2 SPRP, p=0.24), PI-RADS score (p=0.60) or biopsy GG (p=0.52). Following RP, both groups had similar pathologic outcomes including final grade group, T stage, EPE rates, SVI and Cribriform/intraductal rates (p&gt;0.05). SPRP did yield a lower median number of nodes as compared to MPRP (2 (0-5) vs 6(4-9), p&lt;0.001), but this did not translate to differences in LNI (p=0.08). At a median of approximately 12 months of follow up, there were no differences in the biochemical recurrence-free survival rates among both groups (p=0.38). Cox proportional hazards univariate analysis did not consider SPRP to be an independent predictor of biochemical recurrence (HR 0.53, 95% CI 0.13-2.23, p=0.39). Conclusions: In well selected men, SPRP yields similar short term oncologic control as MPRP with equal rates of margin status, EPE/SVI invasion rates and rates of biochemical recurrence at 1 year. In this small, early, single surgeon experience, SPRP appears to be oncologically safe for low and intermediate risk prostate cancer patients, however longer follow up is necessary, larger numbers and multi- institutional comparisons are needed.

Contemporary Pathological Stage Distribution After Radical Prostatectomy in North American High-Risk Prostate Cancer Patients.

To investigate pathological stage at radical prostatectomy (RP) using the "Partin tables" approach in NCCN high-risk (HR) prostate cancer (PCa) patients. Within the SEER 2010 to 2016 database, we identified 7,718 NCCN HR PCa patients. Cross-tabulation was used to illustrate the distribution of organ confined disease (OC, pT2), extra-prostatic extension (EPE, pT3a), seminal vesicles invasion (SVI, pT3b), lymph node invasion (LNI, pT2N1), extra-prostatic and lymph node invasion (EPE+LNI, pT3aN1), and seminal vescicale and lymph node invasion (SVI+LNI, pT3bN1), according to preoperative criteria, which consisted in PSA, clinical T stage, biopsy Gleason Score (GS). Binomial 95%CI was constructed for the reported proportions. Median (IQR) PSA levels was 9 (6-20) ng/ml. The majority of patient harbored cT1c (51%) followed by cT2 (35%) and cT3 (14%) stage. Most patients exhibited GS 4+4 (43%). Overall, 87 vs. 15 vs. 2% of patients harbored only 1 vs. 2 vs. all 3 HR criteria. At RP, OC, EPE, SVI, and LNI rates were respectively 36%, 27%, 17%, and 19%. Highest levels of OC were recorded for cT1c, PSA <10 ng/mL and biopsy GS4+4. Conversely, EPE, SVI and LNI were the highest in patients with cT3, PSA ≥20 ng/mL and GS 5+5. After stratification according to clinical stages, OC rates decreased with increasing PSA levels and GS. Conversely, EPE, SVI and LNI rates increased with increasing PSA and GS. We provide a lookup table to illustrate the relationship between clinical and pathological characteristics in NCCN HR PCa patients.

From Cognitive MR-Targeted Fusion Prostate Biopsy to Radical Prostatectomy: Incidence and Predictors of Gleason Grade Group Upgrading in a Chinese Cohort.

Purpose To access the incidence and predictors of Gleason grade group upgrading from cognitive MR-targeted fusion prostate biopsy to radical prostatectomy in a Chinese cohort. Materials and Methods We included 199 patients in our institution between January 2016 and June 2021. Multivariable logistic regression model and nomograms were utilized to analyze the collected data. Results The concordance rate of biopsy Gleason grade group and radical prostatectomy was 50.3% (100 in 199). Upgrading occurred in 80 (40.2%) patients and 37 (68.5%) patients have an upgrading Gleason grade group when the biopsy Gleason grade group was 1. Multivariable logistic regression models were established to analyze the incidence and predictors of Gleason grade group upgrading from cognitive MR-targeted fusion prostate biopsy to radical prostatectomy. Biopsy Gleason grade group, prostate volume, and patient year were confirmed to be individual predictors of upgrading. Based on the logistic regression models, nomograms for predicting probability of prostate Gleason grade group upgrading were generated. Conclusions We established a logistic regression model to predict the accuracy of prostate biopsy GG and provide the probability of upgrading. Clinicians should be more cautious when deciding the treatment strategy especially for prostate cancer biopsy GG1 patients. Future studies should expand the sample size and include more variables to improve the accuracy of predicting upgrading and prostate cancer early screening program is urgently needed in our city in China.

Treatment patterns and outcomes in prostate cancer patients tested with Decipher in SEER.

e17006 Background: In 2021, national data between the Decipher 22-gene prognostic gene expression classifier (GC) for men with prostate cancer and the Surveillance, Epidemiology, and End Results (SEER) cancer registries were linked. The purpose of the work is to report on the linkage by characterizing national GC usage and its association with treatment decisions for men with prostate cancer. Methods: Patients in the SEER registries with primary prostate cancer diagnosis from 2010 to 2018 were included and linked to data from GC testing conducted between 2014 to 2020 (Veracyte, San Diego, CA). GC scores (range 0-1) and GC risk groups (low, intermediate, and high) were used for continuous and categorical analyses. Multivariable logistic regression was used to quantify the association between GC and active surveillance and watchful waiting (AS/WW) use and adverse pathology at radical prostatectomy (RP). Adverse pathology was defined as pathological grade group ≥3, pathological stage ≥pT3b, or lymph node invasion. Results: A total of 575,363 patients were eligible for analysis, of which 10,528 patients underwent GC testing (5,015 GC biopsy test, and 5,513 GC RP test). The median age was 67 for both tested and untested, but more white patients underwent testing (82% vs 76%, p &lt; 0.001). For GC biopsy tested patients, AS/WW was highest for those with GC low risk results (41%) as compared to those with intermediate (32%) or high (17%) GC risk (p &lt; 0.001). RP rates were lower in the tested compared to untested (25% vs. 36%, p &lt; 0.001), and among the tested patients, RP use increased by GC risk group (19% of low, 25% of intermediate, and 34% of high GC risk, p &lt; 0.001). A similar trend by GC risk group in management for radiation therapy was observed (13% of low, 19% of intermediate, and 29% of high GC risk, p &lt; 0.001). In a multivariable logistic regression adjusted for age, race, NCCN risk group, and year of diagnosis, GC tested patients were more likely to undergo AS/WW compared to untested (OR 2.9 [95% CI, 2.8-3.1], p &lt; 0.001). Within the subset of patients classified as NCCN low/favorable intermediate risk at biopsy and who were subsequently treated with RP (n = 594), GC high risk (&gt; 0.6) was associated with more than 3 times the odds of harboring adverse pathology (OR 3.2 [95% CI 1.6-6.4], p &lt; 0.001). Conclusions: Using the first ever linked SEER-Decipher data, we demonstrate that population-based treatment patterns are independently associated with GC test results. Patients with lower GC scores are independently more likely to undergo AS/WW; those with higher scores are more likely to have adverse pathology at time of RP.

MP57-18 RATE OF BLADDER NECK CONTRACTURE AFTER OPEN AND MINIMALLY INVASIVE RADICAL PROSTATECTOMY OVER 18 YEARS AT THE VETERANS HEALTH ADMINISTRATION

You have accessJournal of UrologyCME1 May 2022MP57-18 RATE OF BLADDER NECK CONTRACTURE AFTER OPEN AND MINIMALLY INVASIVE RADICAL PROSTATECTOMY OVER 18 YEARS AT THE VETERANS HEALTH ADMINISTRATION Mitch Hayes, Michael Conlin, Helen Hougen, and Ryan Kopp Mitch HayesMitch Hayes More articles by this author , Michael ConlinMichael Conlin More articles by this author , Helen HougenHelen Hougen More articles by this author , and Ryan KoppRyan Kopp More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002640.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The rate of vesicourethral anastomotic stricture (VUAS) rate is higher amongst patients who undergo open radical prostatectomy (RP) compared to robotic RP at high-volume academic centers. We sought to compare the VUAS rate between minimally invasive (MIS) and open RP cohorts amongst United States veterans. METHODS: We queried the Veterans Affairs (VA) Corporate Data Warehouse for patients who underwent retropubic RP between 2003 and 2021 by CPT code (55840, 55845, 55866) were included. Patients who did not have a biopsy at the VA. Possible selected covariates were age, preoperative prostate specific antigen (PSA), agent orange exposure, body mass index (BMI), selected comorbidities based on ICD codes, and MIS surgery defined by the CPT code 55866. The primary outcome was undergoing a transurethral incision of a postoperative bladder neck contracture (TUIBNC) within 2 years of surgery by CPT code (52640). The secondary outcome was undergoing any incontinence procedure within 2 years of RP by male sling and artificial urinary sphincter CPT codes. Multivariate logistic regression was performed on the primary and secondary outcome. Stepwise selection was used for model building and restricted cubic spline terms were used for continuous variables. All statistics were performed in R, version 4.0.5. RESULTS: 32,776 patients were included in the analysis. Median patient age was 62 years old and median PSA was 6.04. 57.8% underwent open RP, and 42.3% underwent MIS RP. Overall TUIBNC and incontinence procedure cases within 2 years of surgery were 292 (0.9%) and 725 (2.2%), respectively. Median time to TUIBNC was 8.0 months. On multivariate analysis, after adjusting for age, PSA, and a history of congestive heart failure (CHF), the risk of TUIBNC remained higher with open surgery (OR 7.1, CI 4.7-11.4 p <0.001). Figure 1 shows the rate of MIS RP, open RP, and TUIBNC over time. On multivariate analysis, after adjusting for age, BMI, a history of myocardial infarction, CHF, and diabetes, incontinence surgery within 2 years of surgery was higher after open RP (OR 1.29, CI 1.08-1.53, p 0.004). CONCLUSIONS: Compared to MIS RP, open RP was associated with a 7-fold increase in rate of VUAS and a 1.3-fold increase in the rate of incontinence requiring a procedure within 2 years of surgery at the VA. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e989 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitch Hayes More articles by this author Michael Conlin More articles by this author Helen Hougen More articles by this author Ryan Kopp More articles by this author Expand All Advertisement PDF DownloadLoading ...

Focal brachytherapy for localized prostate cancer: 5.7-year clinical outcomes and a pair-matched study with radical prostatectomy.

To report experience with focal brachytherapy (FB) and compare its clinical outcomes with those of radical prostatectomy (RP) in localized prostate cancer. Fifty-one patients with low- to intermediate-risk prostate cancer underwent low-dose-rate FB. Survival rates free from biochemical failure (BF), additional treatment (AT) including re-FB, and whole-gland or systemic salvage therapy (ST) were calculated and oncological risk factors were investigated. Patient-reported outcomes on genitourinary function were also assessed. Using propensity scoring, 51 pair-matched RP patients were selected. Oncological control, urinary continence, and ejaculation status after FB and RP were compared. During a median 5.7-year follow-up, BF, AT, and ST occurred in 12 (24%), 10 (20%), and 4 FB patients (8%), respectively. 6 of 10 AT patients were managed with re-FB alone. In the RP cohort, 3 patients (6%) underwent ST. 5-year BF-free survival rate after FB was 79%. Compared to 5-year ST-free survival rate of 94% after RP, ST-free and AT-free survival rates after FB were 93% (P = 0.813) and 87% (P = 0.049), respectively. Multivariate analyses of FB-treated patients showed that time to PSA nadir was negatively associated with BF and AT (hazard ratio 0.84 and 0.83, respectively, P <0.001 for each). The difference in oncological outcomes between low- and intermediate-risk categories was not significant. At 2 years after FB and RP, pad-free continence rates were 100% and 81%, respectively (P = 0.001). Ejaculation was preserved in 67% and 0% of patients who had been capable of ejaculation at baseline, respectively (P <0.001). In low- to intermediate-risk prostate cancer, FB-treated patients achieved superior genitourinary function compared to pair-matched RP patients. The need for ST was not substantially different between the 2 treatment cohorts. Over half of patients requiring AT could be managed by re-focal treatment rather than whole-gland ST. Early PSA nadir may predict poor oncological control after FB.

Oncologic outcomes of organ-confined Gleason grade group 4-5 prostate cancer after radical prostatectomy.

Organ-confined prostate cancer (CaP) at radical prostatectomy (RP) is associated with good long-term outcomes. However, information for aggressive Gleason organ-confined CaP is scant. To investigate the impact of Gleason grade group (GG) 4-5 on long-term oncologic outcomes after RP. Within a high-volume center database we identified patients who harbored organ-confined CaP (pT2) at RP between 1992 and 2017. Only patients with negative surgical margins, without lymph node invasion and without neo- and/or adjuvant androgen deprivation therapy and/or adjuvant radiotherapy were included. Patients with GG1 were excluded. Kaplan-Meier analyses and Cox regression models tested the effect of GG4 and GG5 on biochemical recurrence-free (BFS), metastasis-free (MFS), overall survival (OS) and cancer-specific mortality (CSM) free survival. Of 10,855 identified pT2 patients, 0.1% (n=81) and 0.1% (n=114) harbored GG4 and GG5, respectively. At 10-years after RP, BFS, MFS, OS and CSM-free rates were 80.3 vs. 68.6 vs. 55.4% (P<0.001), 96.7 vs. 89.9. vs. 83.4% (P<0.001), 93.2 vs. 78.3 vs. 72.6% (P<0.001) and 99.3 vs. 98.0 vs. 82.7% (P<0.001) for GG2 and GG3 vs. GG4 vs. GG5, respectively. In multivariable Cox regression models, GG5 represented an independent predictor for biochemical recurrence (Hazard ratio [HR] 3.00, P<0.001), metastasis (HR 5.01, P<0.001), death (HR 2.72, P<0.01) and cancer-specific death (HR 30.1, P<0.001). Conversely, GG4 represented an independent predictor for death (HR 2.10, P=0.04) and cancer-specific death (HR 6.09, P=0.01) but not for biochemical recurrence and metastasis. GG4/5 in organ-confined CaP is rare. But its associated with worse oncologic outcomes after RP, namely biochemical recurrence, metastasis, death and cancer-specific death. Patients with organ-confined GG4/5 and negative margins should be closely followed and may be candidates for risk stratification by genomic markers.

Comparison of urinary and sexual patient-reported outcomes between open radical prostatectomy and robot-assisted radical prostatectomy: a propensity score matched, population-based study in Victoria

BackgroundRobot-assisted radical prostatectomy (RARP) rates have been increasing worldwide despite a lack of evidence of superior patient-reported outcomes (PROs) compared to open radical prostatectomy (ORP).MethodsThis retrospective study included men who contributed data to the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic), underwent ORP or RARP between January 2014 and May 2018, and completed the EPIC-26 questionnaire 12 months post-surgery. Urinary and sexual bother items, the urinary incontinence domain score, the urinary irritative/obstructive domain score, the sexual domain score and the pad usage item from the EPIC-26 questionnaire were compared between the two cohorts. Unmatched and propensity score matched cohorts were used to determine if there were differences in urinary and sexual PROs between ORP and RARP after accounting for the patient case-mix and surgeon characteristics.ResultsOf 3826 patients undergoing radical prostatectomy (RP), 1047 received ORP and 2779 received RARP. Propensity score matching reduced the magnitude of the observed differences in four out of six outcomes (urinary bother, urinary incontinence domain, pad usage and sexual domain). Using a propensity score matched cohort, there were no statistically significant differences for RARP patients, compared to ORP patients, in terms of urinary bother (Rd = 0.47%, P = 0.707), urinary incontinence domain scores (Coeff = − 0.84, P = 0.506), urinary irritative/obstructive domain scores (Coeff = 1.03, P = 0.105), pad usage (Rd = − 0.75%, P = 0.771) and sexual bother (Rd = − 0.89%, P = 0.731). RARP patients had slightly higher sexual domain scores (Coeff = 3.65, P = 0.005).ConclusionThere were no differences in urinary PROs between ORP and RARP when assessed 12 months post-surgery. The sexual domain slightly favoured RARP, however this was not deemed clinically significant.

Salvage Radiotherapy versus Observation for Biochemical Recurrence following Radical Prostatectomy for Prostate Cancer: A Matched Pair Analysis.

Simple SummarySalvage radiotherapy improves oncologic outcomes in prostate cancer patients who develop biochemical recurrence after radical prostatectomy. However, the evidence on hard clinical endpoints is scarce. Within this study, we compare the long-term oncologic outcomes of patients with biochemical recurrence after prostatectomy, who were treated with either salvage radiotherapy or no radiotherapy. Our results show that patients who were treated with salvage radiotherapy after the development of biochemical recurrence following radical prostatectomy had a lower risk of developing metastasis and lower risk of death within the follow-up. These findings further underline the curative potential of salvage radiotherapy in the case of biochemical recurrence after radical prostatectomy, and should be discussed with these patients.Background: Salvage radiotherapy (SRT) improves oncologic outcomes in prostate cancer (PCa) patients who develop biochemical recurrence (BCR) after radical prostatectomy (RP). However, evidence on hard clinical endpoints is scarce. We compare long-term oncologic outcomes of SRT versus no radiotherapy (noRT) in patients with BCR after RP. Patients and methods: Within a multi-institutional database, we identified patients with BCR after RP between 1989 and 2016 for PCa. Patients with lymph node invasion, with adjuvant radiotherapy, or with additional androgen deprivation therapy at BCR were excluded. In all patients with SRT, SRT was delivered to the prostatic bed only. Propensity score matching (PSM) was performed to account for differences in pathologic tumor characteristics. Kaplan–Meier analyses and Cox regression models tested the effect of SRT versus no RT on metastasis-free (MFS) and overall survival (OS). Results: Of 1832 patients with BCR, 32.9% (n = 603) received SRT without ADT. The median follow-up was 95.9 months. Median total SRT dose was 70.2 Gy. After 1:1 PSM, at 15 years after RP, MFS and OS rates were 84.3 versus 76.9% (p < 0.001) and 85.3 versus 74.4% (p = 0.04) for SRT and noRT, respectively. In multivariable Cox regression models, SRT was an independent predictor for metastasis (HR: 0.37, p < 0.001) and OS (HR: 0.64, p = 0.03). Conclusion: This is the first matched-pair analysis investigating the impact of SRT versus observation only in post-RP recurrent PCa. After compensating for established risk factors, SRT was associated with better long-term MFS and OS. These results on clinical endpoints underline the curative potential of SRT.

Temporal Trends and Predictors in Diagnosing Pathologic Node-Positive Prostate Cancer in Clinically Node-Negative Patients.

Managing pathologically node positive (pN+) prostate cancer (PCa) is controversial. We describe temporal patterns and predictors of pN+ PCa in men with initially surgically managed clinically node negative (cN-) PCa. This observational retrospective analysis of nonmetastatic, cN- PCa uses the National Cancer Database. Multivariable logistic regression was used to identify covariates associated with pN+ disease. Cox proportional hazards modeling and Kaplan-Meier analysis were used to evaluate survival patients undergoing radical prostatectomy with or without pelvic lymph node dissection (PLND). The rates of radical prostatectomy in men with grade group (GG) 4 and GG5 increased from 47.6% to 53.1% and from 42.5% to 49.5%, respectively. The annual rate increased from 2.02% in 2010 to 5.12% in 2017 (P < .001). The annual rates of PLND increased from 54.3% to 71.7%. The most significant predictor of pN+ PCa was ISUP GG4 (odds ratio [OR] 12.5, P< .001) and GG 5 (OR 26.2, P < .001). Rates of pN+ identification increased from 5.5% to 9.4% in men with GG4 and from 13.4% to 19.5% in men with GG5 (P< .001). In GG4 and GG5, patients undergoing PLND had superior survival to those managed without PLND (P < .01). Among patients with cN- PCa, the diagnosis of pN+ PCa has become more common over time. GG4 and GG5 are the strongest independent predictors of pN+ disease. Because incidental pN+ results in upstaging these data are useful for informing discussions before radical prostatectomy.

Positive Surgical Margins Rate of Retzius-Sparing Robot-Assisted Radical Prostatectomy in a Contemporary, Unselected Cohort.

Our aim was to report the positive surgical margin (PSM) rate of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in an unselected, real-life cohort of patients treated at a fellowship-training urological department. Demographic, clinical and pathological data of 529 consecutive patients who underwent RS-RARP between January 2017 and December 2020 were collected prospectively and analyzed retrospectively in a hospital-approved audit in a European Association of Urology Robotic Urology Section (ERUS)-approved fellowship program. Overall PSM rates were reported for the entire cohort and for pT2 and pT3 patients separately. We defined clinically significant PSM as any length of >3 mm or multiple PSMs regardless of length. Median patient age was 64 years. More than 97% of the patients had intermediate or high-risk disease. The pathological stages were T2 (66.5%) and T3 (33.5%). Overall PSM was reported in 13.3% of pT2 patients and 28.9% of pT3 patients. Clinically significant PSM was reported in 43 patients (8.1%), and most of them (27 patients) had pT3 disease. Only 2.6% positive margins were reported at the apex and 0.7% on the anterior surface and bladder neck. Immediate continence (defined as no pads or 1 safety pad a day) rate was 65%. PSM rates of RS-RARP are acceptable and are higher in pT3 disease compared to pT2.

PD65-06 THE EFFECT OF PROSTATE CANCER SCREENING GUIDELINE CHANGES ON STAGE MIGRATION OF PROSTATE CANCER IN AUSTRALIA

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII (PD65)1 Sep 2021PD65-06 THE EFFECT OF PROSTATE CANCER SCREENING GUIDELINE CHANGES ON STAGE MIGRATION OF PROSTATE CANCER IN AUSTRALIA Jonathan Kam, Venu Chalasani, Ahmed Goolam, Philip Bergersen, Melanie Edwards, Warwick Delprado, and Max Dias Jonathan KamJonathan Kam More articles by this author , Venu ChalasaniVenu Chalasani More articles by this author , Ahmed GoolamAhmed Goolam More articles by this author , Philip BergersenPhilip Bergersen More articles by this author , Melanie EdwardsMelanie Edwards More articles by this author , Warwick DelpradoWarwick Delprado More articles by this author , and Max DiasMax Dias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002109.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A decrease in PSA testing and corresponding increase in diagnosis of advanced stage prostate cancer in the US has been linked to the USPSTF guidelines which recommended against prostate cancer screening in 2012. Screening guidelines by the Royal Australasian College of GPs recommended against prostate cancer screening in their 2009, 2012 and 2016 guidelines. There is no published data analysing the trends of prostate cancer testing and stage in Australia over this period. We aimed to determine if screening guidelines have resulted in decreasing PSA testing and a migration to more advanced stage prostate cancer in New South Wales (NSW), the largest state of Australia. METHODS: Patients undergoing radical prostatectomy in NSW between 2007-2018 were identified in our prospectively maintained database. PSA testing and radical prostatectomy rates were obtained from Medicare Statistics database. Population data was obtained from Australian Bureau of Statistics. Joinpoint regression analysis was performed to analyse trends. RESULTS: We identified 17,375 patients who underwent radical prostatectomy in our database, representing 69% of radical prostatectomies in NSW. The rates of non-organ confined disease (pT3) significantly increased from 31% to 55%, annual percentage change (APC) 5.36%, p<0.05. This was seen in both pT3a stage (extra-capsular extension), APC 5.41%, p<0.05 and pT3b stages (seminal vesicle invasion), APC 4.6%, p<0.05. There was a significant decrease in the rate of PSA testing being performed in NSW, APC -4.9%, p<0.05 with crude testing rates decreasing from 8342 to 4910 per 100,000 males. CONCLUSIONS: A significant decrease in PSA testing in NSW has been observed from 2007 to 2018 corresponding to a significant increase in more advanced disease being found at time of radical prostatectomy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1154-e1154 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Kam More articles by this author Venu Chalasani More articles by this author Ahmed Goolam More articles by this author Philip Bergersen More articles by this author Melanie Edwards More articles by this author Warwick Delprado More articles by this author Max Dias More articles by this author Expand All Advertisement Loading ...

Abstract 2627: Socioeconomic status and utilization of major surgical procedures in the United States, Canada, and Australia

Abstract Purpose: This study aimed to compare the utilization rates of three organ resection surgeries, predominantly indicated for the treatment of cancer, in the US, Canada, and Australia, and compare rates between residents of lower- and higher-income neighborhoods. Methods: We used population-based administrative data to identify all adults aged ≥18 years hospitalized for pancreatectomy (PX), radical prostatectomy (RP) and nephrectomy (NX) between 2011-2016 (New York, USA), 2011-2018 (Ontario, Canada), and 2013-2018 (New South Wales, Australia). We linked each patient's zip-code of residence to 2016 census data to ascertain neighborhood income. We compared utilization rates for each procedure in each jurisdiction in aggregate and by neighborhood income quintile. Primary outcomes were: 1) each jurisdictions' per-capita overall, age-, and sex-standardized utilization rates for each procedure; and 2) utilization rates amongst residents of lower- and higher-income neighborhoods. Results: Sociodemographics were similar across jurisdictions; patients in New South Wales were older for all procedures. New York hospitals were significantly likelier to perform each of the three procedures compared to Ontario and New South Wales (all P&amp;lt;0.001); New York and New South Wales hospitals tended to have lower volumes than Ontario hospitals. Overall utilization rate was highest in New York for NX (28.93 procedures per-100,000 per-year) while New South Wales had the highest utilization of PX (6.94) and RP (94.37); overall utilization of all three procedures was lowest in Ontario (PX 6.18; RP 49.24; NX 21.40; all P&amp;lt;0.001). Utilization of PX and NX was significantly higher for men than women in all jurisdictions (all P&amp;lt;0.05). Utilization of all three procedures increased until age 70-79, before declining at age ≥80 (all P&amp;lt;0.001). With the exception of NX in Ontario, residents of lowest income neighborhoods (quintile 1 [Q1]) had lower surgical utilization rates than residents of highest income neighborhoods (quintile 5 [Q5]). The Q5-Q1 utilization rate difference was largest in New South Wales for PX and RP (Q5-Q1 PX +4.65 procedures per-100,000 per-year; RP +73.46; NX +6.23), largest in New York for NX and smallest for RP (PX +3.05; RP +19.70; NX +8.43) and smallest in Ontario for PX and NX (PX +1.15; RP +27.94; NX -1.10) (all P&amp;lt;0.05). Conclusions: Utilization rates of PX, RP, and NX were significantly higher in New York and New South Wales than in Ontario. Rich-poor surgical utilization differences were significantly larger in New York and New South Wales and significantly smaller in Ontario. These findings suggest that income-based disparities are larger in US and Australian jurisdictions than those Canadian, and highlight the possible trade-offs of equity and access in cancer care of different countries. Citation Format: Hilary Pang, Kelsey Chalmers, Bruce Landon, Adam Elshaug, John Matelski, Vicki Ling, Monika K. Krzyzanowska, Girish Kulkarni, Bradley A. Erickson, Peter Cram. Socioeconomic status and utilization of major surgical procedures in the United States, Canada, and Australia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2627.