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Transrectal ultrasound (US) imaging is paramount to the successful completion of prostate biopsies. Certain US features have been associated with prostate cancer (PCa), but their utility remains controversial. We explored the role of multiparametric US (mpUS) in the detection of clinically significant PCa.We performed a retrospective cohort study to contrast the findings of prostate MRI and mpUS. Patients who underwent MRI, US and biopsy between 2015 and 2021 were included. Biopsies were performed using a systematic approach (12 cores), as well as with MRI (4 cores/lesion) and US (1 core/lesion) targeting. The US features analyzed consisted of: calcifications, hypoechoic lesions and power or color Doppler positivity. Gleason 3 + 4 or higher was used as to define true positives. Measures of diagnostic accuracy were calculated for the different imaging modalities.The final cohort included 74 patients, of which 24 (32.4%) had clinically significant PCa. The concordance between MRI and US was 63.5%. Seven individuals with discordant results had clinically significant PCa. MRI alone was more sensitive (87.5% vs 75%) but less specific (28% vs 32%) than US alone. An all-inclusive approach considering any suspicious US or MRI finding had a sensitivity of 95.8%. A more restrictive approach, targeting lesions noted in both US and MRI, yielded the highest specificity (50.0%) and accuracy (55.4%).Biopsy targeting based on US findings can provide additional diagnostic information that may increase sensitivity or specificity. Additional research into this topic could open the door to a more personalized approach to prostate biopsy.

INTRODUCTION AND OBJECTIVE:The COVID-19 pandemic has affected all aspects of healthcare including surgical training. The impact on resident and fellow education has yet to be measured. Urologic onc...

INTRODUCTION AND OBJECTIVE:Current guidelines recommend neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) for muscle invasive bladder cancer (MIBC). NAC has been shown to confer a sur...

e16530 Background: National Comprehensive Cancer Network (NCCN) guidelines state partial cystectomy (PC) may be offered in select patients with clinical T2 (cT2) muscle invasive bladder cancer (MIBC) utilizing neoadjuvant chemotherapy (NAC) and pelvic lymphadenectomy (PLND). Our objective was to investigate utilization and survival outcomes of PC in a large contemporary cohort. Methods: Propensity matching was used to compare pathological and surgical outcomes in non-metastatic MIBC patients in the National Cancer Database undergoing PC or radical cystectomy (RC). Multivariate logistic regression was used to determine predictors of NAC, LND, peri-operative morbidity and mortality outcomes. This analysis was repeated in the subset with cT2 MIBC. Results: Of 31,306 T2-T4N0M0 patients, 1543 (4.9%) underwent PC. PC use was higher in older patients and most often (85%) performed for cT2 disease. The PC group was less likely to receive standard of care including NAC (11.4 vs 27.9%, p

4536 Background: Current guidelines recommend neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) for muscle invasive bladder cancer (MIBC). NAC has been shown to confer a survival benefit across all ages. Yet, many elderly patients are not offered NAC due to concern regarding physiologic reserve and postoperative complications. Our objective was to evaluate age-based disparity in treatment and outcomes of MIBC. Methods: Using the National Cancer Database, we identified patients with MIBC from 2006-2017. First, use of different treatments, RC, RC and adjuvant chemotherapy, RC with NAC (“optimal treatment”), chemo-radiation, and no treatment, was compared between age groups. A second analysis was performed in the cohort of elderly patients, ≥70, undergoing cystectomy. Propensity weighting was used to compare peri-operative and mortality outcomes in those who received NAC vs. no NAC. Results: In 70,911 patients with non-metastatic MIBC, use of RC with NAC was lower in patients ≥70, 7.2 vs. 20.9%, p

e17514 Background: National Comprehensive Cancer Network (NCCN) guidelines recommend definitive treatment for high risk prostate cancer (HRPCa). This study aims to assess treatment trends for men with HRPCa, focusing on men deemed high risk on the basis of an elevated PSA alone with otherwise low risk features. Our hypothesis is that this group is treated differently than other patients with high risk disease. Methods: The National Cancer Database (NCDB) prostate cancer (PCa) participant use file was queried for high risk patients ages 18-75 with biopsy proven PCa from 2010-2016. The NCDB represents approximately 55% of men treated for PCa in the United States. Patients were divided into two groups: the study group with PSA > 20 and otherwise low risk features, and a comparison group comprised of high-risk patients due to cT stage ≥T3a or Gleason Grade Group ≥4. Patients with nodal or metastatic disease were excluded. Rates of treatment by modality were compared over the years studied. Survival was modeled using Kaplan Meier analysis. Results: 91,565 patients met eligibility criteria with 12,156 in the study group and 79,409 in the comparison group (Table). In the study group, a significantly higher number of patients underwent surveillance (10.2%) versus the comparison group (0.3%)(p < 0.001). Furthermore, there was an upward trend in use of surveillance in the study group, with a surveillance rate of 18.9% in 2016. Amongst patients receiving radiation, only 26.1% received androgen deprivation therapy (ADT) in the study group versus 82.8% in the comparison group. Despite these findings, survival analysis demonstrated significantly higher 5-year overall survival in the study group (95.1%) vs the comparison group (87.8%) (HR = 0.41, p < 0.001). Conclusions: Men categorized as HRPCa by PSA alone with otherwise low risk features are treated less aggressively than other high-risk patients with significantly higher rates of surveillance and radiation without ADT. However, these men appear to have better survival outcomes than other high-risk patients at 5-year follow-up. [Table: see text]

e17518 Background: The treatment options for low risk PCa are active surveillance (AS), radiation therapy (RT), and radical prostatectomy (RP). HRQoL studies with long term follow up are lacking. We evaluated HRQoL of initial active surveillance vs initial treatment. Methods: The Center for Prostate Disease Research (CPDR) database was used. HRQoL data was collected for 5 years with the Expanded Prostate Cancer Index Composite (EPIC) and the 36-item Medical Outcomes Study Short Form (SF-36). Patients had low risk PCa, age less than 75, and follow up data of at least 1 year. AS was defined as no definitive treatment within 12 months of diagnosis and repeat biopsy or PSA within 18 months of diagnosis. Results: Patient characteristics are located in the table. Baseline HRQoL scores were comparable across treatment groups for all HRQoL domains, except for sexual function and bother, and physical health where RT were worse than RP. Of the 68 patients classified as AS, 4 had brachytherapy, 9 had hormone therapy, 38 had RP, and 17 had XRT as a first treatment after terminating their AS. In the Generalized Estimating Equations (GEE) model, the HRQoL scores were compared. Multivariate analysis was done accounting for baseline differences. Urinary function (p = 0.0017), urinary bother (p = 0.0028), hormone function (p = 0.035), bowel bother (p = 0.0122), sexual function (p < 0.01), sexual bother (p < 0.01), and physical health (p = 0.0457) were significantly different. For urinary function and bother, XRT had the best HRQoL scores at most time points, with AS getting worse over time as patients went on to receive treatment. AS had worse scores with hormone function and sexual function. RP had the best scores for bowel bother over the course of the study, but had the worst initial scores in sexual bother, which got better over time. Hormone bother (p = 0.5574), Bowel function (p = 0.098), mental health (p = 0.7231) were not statistically different between groups. Conclusions: Initially AS results in improved HRQoL. For those patients who undergo treatment after AS, HRQoL is no worse than those who got treatment initially. [Table: see text]

INTRODUCTION AND OBJECTIVE:The National Comprehensive Cancer Network (NCCN) guidelines recommend active surveillance (AS) as the preferred management of low risk (LR) prostate cancer (PCa) and an o...

37 Background: This study compared 5-year health-related quality of life (HRQoL) outcomes among prostate cancer (PCa) patients who underwent a robotic-assisted radical prostatectomy (RARP) versus a radical retropubic prostatectomy (RRP), with a focus on race-specific outcomes for Caucasian American (CA) compared to African American (AA) men. RARPs have almost replaced RRPs in recent years, with few long-term studies focused on HRQoL and race. Methods: A prospective cohort study of HRQoL was conducted on patients diagnosed with PCa from 2007 to 2017 and enrolled in the Center for Prostate Disease Research (CPDR) Multicenter National Database. HRQoL was assessed with the EPIC instrument. Temporal changes in urinary and sexual-related quality of life domain scores were compared across surgery type (RARP versus RRP) at pre-treatment (“baseline”), 1-, 2-, 3-, 4-, and 5 years post-baseline. Longitudinal HRQoL patterns were modeled using generalized estimating equations (GEE), adjusting for baseline HRQoL and key clinical characteristics. Results: Of 497 PCa patients who met study inclusion criteria, 68% had RARP and 32% had RRP, with 22% AA men and 88% CA men. Baseline HRQoL domains were comparable across race and surgery type. In adjusted GEE analysis, no differences were noted between AA and CA patients. However, treatment-related differences were observed over time in urinary function (UF) and incontinence (UI) (p=0.02 and p=0.03, respectively), with lower HRQoL scores in RARP vs. RRP patients. Upon dual stratification by surgery type and race, the differences for UF and UI persisted (p=0.01 and p=0.03, respectively) with poorest outcomes observed, and similar trajectories of decline, for AA patients who received RARP. Conclusions: In this 10+ year prospective cohort study, AA patients receiving RARP had the poorest UF and UI outcomes which continued to decline for 5 years post treatment. In light of these findings, AA men considering RARP might benefit from discussions with their providers to set expectations regarding long-term urinary outcomes; though these decrements in HRQoL may be overshadowed by the minimally invasive nature of RARP.

Indications for superficial inguinal lymph node (ILN) dissection in melanoma include fine needle aspiration or clinically positive ILN and sentinel lymph nodes (SLN). Open inguinal lymphadenectomy may be complicated by poor wound healing, deep vein thrombosis, and lymphedema. Technical considerations and case series of a novel surgical approach, robotic inguinal lymphadenectomy, are presented. This is a case series of four robotic ILN dissections for melanoma at a tertiary care facility. Each patient had previously diagnosed melanoma by lymph node biopsy. Physician and patient jointly decided on robotic procedure after disclosure of this novel approach. Demographic, complication, pathological outcome, estimated blood loss (EBL), operative time, and length of stay (LOS) data were collected. No cases were aborted due to technical difficulty. The median patient age was 44.5 years (range 22–53 years) and median BMI was 27.5 (range 20.4–40.2). Operative time range was 120–231 min and EBL from 0 to 100 mL. Median nodal count was 5.5 (range 1–14 nodes). Patient LOS ranged from 0 (discharged from post anesthesia care unit) to 96 h. There was one complication of port site cellulitis, one seroma formation, and no instances of lymphedema. To date, there have been no deaths or melanoma recurrences in this population. Recent data suggest a minimum node count of six to seven for inguinal dissection. Of our four dissections, two were above this threshold and there were minimal postoperative complications. Given our limited sample size, future focus should be on increasing the data on this approach to optimize surgical outcomes and oncologic results.

Malignant paratesticular tumors are rare. We describe the first documented case of a paratesticular serous ovarian type epithelial tumor (OTET) associated with abdominal metastasis and its treatment.

Cotyledonoid dissecting leiomyoma was originally described in 1975 in a case report by David et al. as a “grape-like leiomyoma of the uterus”.1 In 1996, Roth et al. coined the name “cotyledonoid dissecting leiomyoma”, based on the tumor's resemblance to cotyledons of the placenta and the accompanying dissecting myometrial component.2 To the best of our knowledge, this is the first case presented of cotyledonoid dissecting leiomyoma (CDL) occurring after a hysterectomy and originating from an extrauterine site. CDL consists of an exophytic component of smooth muscle which is rich in blood supply and has a multinodular gross appearance, suggestive of placental tissue. It typically protrudes from the lateral surface of the uterine cornu into the broad ligament and pelvic cavity. This exophytic component is in continuity with intramural dissecting components, which consist of sinuous processes of neoplastic smooth muscle extending between normal myometrial smooth muscle.2 CDL is a benign process, as histologically there is no nuclear atypia, mitotic activity, or coagulative tumor necrosis, which are suggestive of leiomyosarcoma.4

We report on a case of a 38-year-old female who presented with metastatic malignant melanoma of her right kidney with Level II tumor thrombus. This is the first ever presented case of a renal melanoma IVC tumor thrombus. Furthermore, in an effort to expand the surgical scope of minimally invasive and robotic surgery, we report management of this lesion as the first case of non-renal cell carcinoma IVC tumor thrombus treated with a robotic thrombectomy.