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Context.--Prostatic ductal adenocarcinoma (PDA) has historically been considered to be an aggressive subtype of prostate cancer. Objective.--To investigate if PDA is independently associated with worse biochemical recurrence (BCR)-free survival after radical prostatectomy. Design.--A review of 1584 radical prostatectomies was performed to grade, stage, and assess margin status in each tumor nodule. Radical prostatectomies with localized PDA (ie, those lacking metastasis) in the tumor nodule with the highest grade and stage and worst margin status were matched with prostatic acinar adenocarcinoma according to grade, stage, and margin status. The effect of PDA on BCR was assessed by multivariable Cox regression and Kaplan-Meier analyses. Results.--Prostatic ductal adenocarcinoma was present in 171 cases. We excluded 24 cases because of lymph node metastasis (n = 13), PDA not in the highest-grade tumor nodule (n = 9), and positive surgical margin in a lower-grade tumor nodule (n = 2). The remaining 147 cases included 26 Grade Group (GG) 2, 44 GG3, 6 GG4, and 71 GG5 cancers. Seventy-six cases had extraprostatic extension, 33 had seminal vesicle invasion, and 65 had positive margins. Follow-up was available for 113 PDA and 109 prostatic acinar adenocarcinoma cases. Prostate-specific antigen density (odds ratio, 3.7; P = .001), cancer grade (odds ratio, 3.3-4.3; P = .02), positive surgical margin (odds ratio, 1.7; P = .02), and tumor volume (odds ratio, 1.3; P = .02) were associated with BCR in multivariable analysis. Prostatic ductal adenocarcinoma, its percentage, intraductal carcinoma, and cribriform Gleason pattern 4 were not significant independent predictors of BCR. Conclusions.--Advanced locoregional stage, higher tumor grade, and positive surgical margin status rather than the mere presence of PDA are more predictive of worse BCR-free survival outcomes following radical prostatectomy in men with a component of PDA. (Arch Pathol Lab Med. 2022;146:1012-1017; doi: 10.5858/arpa.2021-0048-OA), Melicow and Pachter (1) first described prostatic ductal adenocarcinoma (PDA) in 1967 as an 'endometrial carcinoma of prostatic utricle (uterus masculinus),' and in so doing suggested it had a Mullerian [...]

Introduction: The majority of staghorn classifications do not incorporate volumetric stone burden assessment. Accurate volumetric data can easily be acquired with the ever-increasingly available computerized tomography (CT) scan. This manuscript reviews the available staghorn stone classifications and rationalizes the morphometry-based classification. Materials and Methods: A Pubmed search was performed for articles concerning staghorn classification and morphometry. Twenty abstracts were shortlisted from a total of 43 published abstracts. In view of the paucity of manuscripts on staghorn morphometry (4), older staghorn classifications were analyzed with the aim to determine the most optimum one having relevance to the percutaneous nephrolithotomy (PCNL) monotherapy outcome. Results: All available staghorn classifications are limited with non-widespread applicability. The traditional partial and complete staghorn are limited due to non-descript stone volumetric data and considerable overlap of the intermediate ones in either group. A lack of standardized definition limits intergroup comparison as well. Staghorn morphometry is a recent addition to the clinical classification profiling of a staghorn calculus. It comprises extensive CT volumetric stone distribution assessment of a staghorn in a given pelvi-calyceal anatomy. It allows meaningful clinical classification of staghorn stones from a contemporary PCNL monotherapy perspective. Conclusions: Morphometry-based classification affords clinically relevant nomenclature in predicting the outcome of PCNL for staghorn stones. Further research is required to reduce the complexity associated with measuring the volumetric stone distribution in a given calyceal system. [ABSTRACT FROM AUTHOR]

Robotic radical cystectomy with urinary diversion has become increasingly utilized for the surgical management of bladder cancer. Orthotopic neobladder reconstruction is still performed worldwide primarily via an extracorporeal approach because of the difficulty associated with robotic intracorporeal reconstruction. The objective of this article is to demonstrate a stepwise approach for robotic intracorporeal neobladder in a standardized manner that adheres to the principles of open surgery.