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BACKGROUND A 2-gene urine-based molecular test that targets messenger RNAs known to be overexpressed in aggressive prostate cancer (PCa) has been described as a helpful method for detecting clinically significant prostate cancer (grade group [GG] ≥2). We performed an external validation of this test in men undergoing initial prostate biopsy (Bx) within a Spanish opportunistic screening scenario. METHODS We analyzed archived samples from 492 men who underwent prostate Bx in an opportunistic screening scenario, with prostate-specific antigen (PSA) 3 to 10 ng/mL and/or suspicious digital rectal exploration (DRE) and without previous multi-parametric magnetic resonance imaging (mpMRI). Urinary biomarker measurements were combined with clinical risk factors to determine a risk score, and accuracy for GG ≥ 2 PCa detection was compared with PCA3, European randomized screening in prostate cancer (ERSPC), and prostate biopsy collaborative group (PBCG) risk calculators in a validation workup that included calibration, discrimination, and clinical utility analysis. RESULTS In our cohort, the detection rates for GG1 and GG ≥ 2 PCa were 20.3% and 14.0%, respectively. The median PSA level was 3.9 ng/mL and 13.4% of subjects had suspicious DRE findings. The median risk score for men with GG ≥ 2 PCa was 21 (interquartile range: 14-28), significantly higher than benign+GG1 PCa (10, 6-18), P

Extended Pelvic Lymph Node Dissection (ePLND) remains the most accurate technique for the detection of occult lymph node metastases (LNMs) in prostate cancer (CaP) patients. Here we aim to examine whether free-Indocyanine Green (F-ICG) could accurately assess the pathological nodal (pN) status in CaP patients during real-time lymphangiography as a potential replacement for ePLND.219 consecutive patients undergoing F-ICG-guided PLND, ePLND and radical prostatectomy (RP) for clinical-localized CaPwere included in this prospective single-center study. The pathological outcomes of F-ICG-guided PLND were compared to confirmatory ePLND. Parameters of a binary diagnostic test for the proper classification of the pN status of patients ('per-patient' analysis) and for the probability of detecting all the metastatic LNs ('per-node' analysis) were calculated. Outcome measures were prevalence, accuracy (Acc), sensitivity (Se), negative predictive value (NPV), and likelihood ratio of a negative F-ICG-guided PLND test result [LR(-)].F-ICG-guided PLND successfully visualized LNs in all procedures with no adverse events. The overall per-patient F-ICG staging Acc was 97.7%, Se was 91.4%, with a NPV of 97.0%, and LR(-) of 8.6%. At the overall per-node level, 4,780 LNs were removed and 1,535 (32.1%) were fluorescent in vivo. F-ICG-guided PLND identified LNMs with a Se of 63.4%.This study confirms that F-ICG-guided lymphangiography correctly staged almost 98% of patients. The high per-patient NPV suggested that avoiding ePLND is safe for most patients when F-ICG stained nodes were pN0. Thus, more conservative approaches might minimise perioperative morbidity during LNMs diagnosis in selected patients.

Prostate cancer (PCa) is the second most common cancer in men and the fifth leading cause of death from cancer. The possibility of sarcopenia being a prognostic factor in advanced PCa patients has recently become a subject of interest. The aim of the present study was to evaluate the prognostic value of sarcopenia in advanced prostate carcinoma. A systematic review was conducted in Medline, EMBASE, and Web of Science (March, 2021). The quality of studies was assessed using the Quality in Prognosis Studies tool. Meta-analyses for overall, cancer-specific, and progression-free survival were performed. Nine studies (n = 1659) were included. Sarcopenia was borderline associated with a shorter overall survival (HR = 1.20, 95% CI: 1.01, 1.44, P = 0.04, I2 = 43%) but was significantly associated with progression-free survival (HR = 1.61, 95% CI: 1.26, 2.06, P < 0.01; k = 3; n = 588). Available evidence supports sarcopenia as an important prognostic factor of progression-free survival in patients with advanced PCa. However, sarcopenia has a weak association with a shorter overall survival. The evidence on the role of sarcopenia in prostate-cancer-specific survival is insufficient and supports the need for further research. Patient summary: The literature was reviewed to determine whether the loss of muscle mass (sarcopenia) affects the survival in patients with advanced PCa. Patients with advanced PCa and sarcopenia were found to have a shorter progression-free survival (the length of time during and after treatment of a cancer that the patient lives with the disease but it does not get worse), but sarcopenia did not have much influence on the overall survival and cancer-specific survival (the length of time from either the date of diagnosis or the start of treatment to the date of death due to the cancer).

INTRODUCTION AND OBJECTIVE:Current standard imaging procedures have limited ability to predict lymph node metastases (LNMs) in clinically localized prostate cancer (PCa) and extended pelvic lymph n...

Purpose To systematically review the relevant literature that evaluates the LN topographical distribution and propose a uniform template. Methods A bibliographic search of PubMed/Medline, Embase and SCOPUS was performed for studies reporting data of LN imaging and/or nodal resection. Results 101 and 26 articles met the inclusion criteria for PCa and BCa, respectively. In PCa, the most common locations of positive LNs for surgical and imaging studies were external iliac (both 38 studies), followed by obturator (38 and 37, respectively). Similarly, in BCa, the most common location of positive nodes for surgical and imaging studies were external iliac (19 and 4, respectively), followed by obturator (15 and 3 studies, respectively). In PCa, median percentages of positive external iliac nodes/patient were 12.2% and 11.6% for surgical and imaging studies, respectively while corresponding rates for BCa were 3.9% and 17.6%. There were high risks of bias across studies as well as high heterogeneity in the definition of the anatomic boundaries of lymphadenectomy templates. ConclusionsThis review highlights the lack of detailed information on exact LN templates and metastases location, which in turn hinders generation of high-quality evidence on optimal lymphadenectomy templates. Our proposed template is applicable for both imaging and surgical description and could facilitate the translation of anatomical location from imaging to surgical resection.

OBJECTIVES: To evaluate whether indocyanine green guidance can improve the quality of extended pelvic lymph node dissection in patients undergoing radical prostatectomy. METHODS: A total of 214 patients underwent laparoscopic radical prostatectomy with indocyanine green-guided lymph node dissection plus extended pelvic lymph node dissection. These patients (group A) were matched 1:1 for clinical risk groups according to the National Comprehensive Cancer Network classification with patients who underwent the same procedure without fluorescence guidance (group B). Biochemical recurrence was defined as two consecutive prostate-specific antigen rises of at least 0.2 ng/mL. The Kaplan-Meier method and Cox regression models were used to identify predictors of biochemical recurrence. RESULTS: The median number of retrieved nodes was significantly higher in group A (22 vs 14, P < 0.001). The rate of lymph node metastases was higher in group A (65.9% vs 34.1%, P = 0.01). Increasing the yield of lymph node dissection was independently and negatively correlated with the biochemical recurrence risk in both overall and pN-positive patients (hazard ratio 0.97, P = 0.03; and hazard ratio 0.95, P = 0.02). The 5-year biochemical recurrence-free survival rates were (75.8% vs 65.9, P = 0.09) and (54.1% vs 24.9%, P = 0.023) for group A and group B in the overall cohort and pN-positive cohort, respectively. CONCLUSION: Indocyanine green-guided lymph node dissection plus extended pelvic lymph node dissection improves identification of lymphatic drainage, resulting in a higher number of lymph nodes and retrieved lymph node metastases, and allowing a more accurate local staging and a prolonged biochemical recurrence-free survival.

INTRODUCTION AND OBJECTIVE: Despite several improvements in surgical technique, radical cystectomy (RC) remains an highly morbid operation and even in contemporary series the combined surgical, medical and disease morbidity results in a low 5-years overall survival (OS). Furthermore, the age of patients undergoing RC has increased and the ability to predict perioperative morbidity is crucial in the preoperative workup of RC. The controlling nutritional status (CONUT), a score based on the serum albumin concentration, lymphocyte count and total cholesterol concentration, is a comprehensive index that could provide an immune response status and long-term nutritional effect of the host. Recently, its prognostic value has been reported in many types of malignancies but it’s never tested in bladder cancer (BC). The aim of the study is to evaluate the role of preoperative CONUT score in the assessment of both oncological outcomes and perioperative morbidity in patients underwent RC for non-metastatic BC. METHODS: We retrospectively evaluated data from 347 patients who underwent RC for BC at ve european high-volume centers between January 2002 and December 2018. Patients were divided into two groups according to the optimal cut-off value of CONUT score. Relationships of CONUT score with clinicopathological characteristics, perioperative complications (according to the Calvien-Dindo system), 30-days readmission, 90-days mortality, cancer-specific mortality (CSM), overall mortality (OM) and progression-free survival (PFS) were analyzed. RESULTS: Cut-off value to discriminate between high and low CONUT score was determined calculating the ROC curve: the area under the curve was 0.72 with an optimal cut-off of 3 points. High preoperative CONUT score was significantly correlated with older age, worse ASA score, advanced pT stage, high grade and node-positive disease, higher median length of stay and 30-days readmission (all p

To evaluate the efficacy of the Advance® and AdvanceXP® slings in men with stress urinary incontinence (SUI) post-radical prostatectomy and to identify predictive factors for outcome. Included were male patients with SUI following radical prostatectomy who had a positive “repositioning test”, 24 h-pad weight (PW) test

Introduction and objective There is growing interest in the use of more aggressive therapeutic modalities for treating metastatic prostate cancer. In this study, we examine the use of stereotactic body radiation therapy (SBRT) for patients with oligorecurrent prostate cancer. We analyzed the biochemical response and toxicity of patients who underwent this therapy at our centre. Material and method We selected patients who experienced oligorecurrence between January 2015 and December 2016 and were administered SBRT. The association of androgen deprivation (AD) was left in each case to the decision of the tumor committee. We describe the clinical situation at diagnosis of oligorecurrence, the treatment administered and the biochemical response. We considered a biochemical response to be a 50% reduction in the absolute prostate-specific antigen (PSA) readings. Results SBRT was administered to 11 patients with bone (82%) and/or lymph node oligometastasis (18%). The treatment regimen for bone oligometastasis was 27 Gy divided into 3 sessions, while the treatment for lymph node oligometastasis reached 70 Gy. Seven patients had no treatment at the time of diagnosis, 2 were in the castration-resistant phase, 1 patient was in the off phase of intermittent AD, and 1 patient had adjuvant AD for pN1. Seven patients presented a biochemical response with a PSA reduction of 75-100%. The response was not assessable in 4 patients due to the continuing adjuvant AD. With a mean follow-up of 10.5 months, only 2 patients had progressed. Grade 1 gastrointestinal toxicity was detected in only 1 patient. Conclusion Our data suggest that the use of SBRT in carefully selected patients with metastatic oligorecurrence of prostate cancer can achieve biochemical response and potentially delay progression and the use of systemic treatments.

INTRODUCTION AND OBJECTIVE: Current standard imaging procedures have limited ability to predict lymph node (LN) involvement in clinically localized prostate cancer (PCa) and extended pelvic lymph node dissection (ePLND) during radical prostatectomy (RP) remains the most accurate staging procedure. However, meticulous ePLND is time-consuming and associated with an increased risk of morbidity. In order to improve these aspects, sentinel LN mapping with different guided techniques has been proposed over the years. The primary aim of this study is to evaluate the effectiveness of indocyanine green (ICG)-guided ePLND to assess regional LN status in patients who underwent RP. Secondary objective is to evaluate the potential role of a selective ICG lymph node dissection (LND) in patients with ≤ 2 LN metastasis which according to the literature are those who may more benefit from ePLND. METHODS: Data about 226 consecutive patients underwent laparoscopic RP with ICG-guided ePLND at our Department were prospectively evaluated. A solution of 25 mg ICG in 5 ml sterile water was transperineally injected. PLND started with the ICG stained nodes followed by extended template. Primary outcome measures were sensitivity (S), negative predictive value (NPV) and likelihood ratio of a negative test (LRn) of ICG-guided procedure. To our knowledge this study shows data about the largest cohort of patients underwent ICG-guided ePLND. RESULTS: Overall, median age of patients was 64.8 years with a median PSA of 6.6 ng/ml. Extracapsular disease occurred in 50.9% of patients, Gleason score ≥ 8 was reported in 11.9% cases and positive surgical margins rate was 24.3%. Median number of nodes retrieved was 22 (IQR 16-27) and median number of ICG stained per patient nodes was 6 (IQR 4-9). Overall 4939 nodes were removed and 1599 (32.4%) were fluorescent in vivo. Node-positive disease was found in 58 (25.7%), of which 53 (91.4%) had some of the metastatic LNs stained by ICG, while 5 (8.6%) were false negative. Therefore 97.8% of the sample was properly classified by ICG-guided ePNLD (S: 91.4%, NPV: 97.1% and LRn: 8.6%). Considering 209 (92.5%) patients with 0, 1 or 2 metastatic LNs, 39 (18.7%) had a node-positive disease of which 34 (87.2%) had metastatic ICG stained LNs. Again, 97.6% were properly classified by ICG approach (S: 87.2%, NPV: 97.1% and LRn: 12.8%). These 39 node-positive patients had a total of 48 metastatic LNs and all except 9 (18.8%) were fluorescent in vivo (S: 81.2%). CONCLUSIONS: ICG guidance correctly stage 97% of cases. Furthermore, its high NPV will allow to avoid ePLND as soon as an accurate intraoperative analysis is available. Among those patients in whom the LND may have a potentially curative role, ICG alone would have lost only 9 metastatic LNs. This suggest that maybe there is a place for selective LND in patients with limited LN metastatic burden.

ICG navigation in cancer surgery may help during pelvic lymphadenectomy.We performed a systematic review combining the terms: bladder cancer or radical cystectomy and ICG, and prostate cancer or radical prostatectomy and ICG. We used the PRISMA guidelines recommendations. We describe the populations studied in each work, the pathological results, as well as the parameters specificity, sensitivity and predictive values.In muscle-invasive bladder cancer, 4 case series analyzed the performance of lymphography with ICG. The most accepted injection method is under endoscopic vision. Several punctures are done in the submucosa and the detrusor surrounding the scar. Sentinel nodes were found in up to 92% of patients with a technique sensitivity to find metastases of 88% in the series with largest casuistry. In prostate cancer, we collected data from 11 case series. Nine of them apply transrectal or transperineal dilution immediately before surgery. Sensitivity in the detection of all adenopathies ranged between 44% and 100%. The sensitivity of the technique to know the lymph node stage ranges between 67% and 100%.There is little experience of ICG-guided lymph node dissedction in bladder tumors. Endoscopic fluorophore injection allows us to find the nodes that drain the infiltrated area. However, the use of this technique is not widespread. In prostate cancer, it is a reproducible and efficient technique for staging patients with prostate cancer.La principal aplicación del ICG en cirugía oncológica es la navegación intraoperatoria durante la linfadenectomía. Revisamos la literatura para conocer el uso de ICG durante la linfadenectomía pélvica en el cáncer de próstata y cáncer de vejiga.MATERIAL Y MÉTODO: Hacemos una revisión sistemática con los términos cáncer de vejiga o cistectomía radical, cáncer de próstata o prostatectomía radical. Utilizamos las recomendaciones de las guías PRISMA. Describimos las poblaciones a estudio en cada trabajo, los resultados patológicos así como los parámetros sensibilidad especificidad y valores predictivos.En tumor vesical musculo invasivo 4 series de casos analizan el rendimiento de la linfografia con ICG. El método de inyección más aceptado es la inyección de la dilución -bajo visión endoscópica- en la submucosa y en el detrusor, peri tumoral o pericicatrical. Se encontraron ganglios centinela hasta en el 92% de los pacientes con una sensibilidad de la técnica para encontrar las metástasis del 88% en la serie de mayor casuística. En cáncer de próstata recopilamos datos de 11 series. De entre ellas 9 aplican la dilución vía transrectal o transperineal inmediatamente antes de la cirugía. La sensibilidad en la detección de todas las adenopatías oscila entre el 44 y el 100%. En cuanto la sensibilidad de la técnica para conocer el estadio ganglionar oscila entre el 67% y el 100%.Existe poca experiencia de la linfadenectomía guiada por ICG en tumor de vejiga. La inyección endoscópica del fluoróforo permite encontrar los ganglios que drenan el área infiltrada, sin embargo no se populariza el uso de esta técnica. El cáncer de próstata es una técnica reproducible y eficiente para estadiar a los pacientes con cáncer de próstata.

Suburethral male slings are an alternative option for mild stress urinary incontinence. Our purpose is to evaluate the long-term functional outcomes, efficacy and worsening continence of male suburethral slings.The functional outcomes of realignment/anatomical slings were evaluated with AdVance ®, and the outcomes of compressive slings were evaluated with InVance®. We considered 55 patients fulfilling 5 years of complete follow-up. We included patients with a 24-hour pad weight test400 grams. Night-continent patients who also had positive "repositioning tests" were considered for AdVance®, whereas patients without sphincter contraction or previous pelvic radiotherapy were considered for InVance®.Between February 2006 and September 2010, 24 AdVance® and 31 InVance® slings were implanted. The median follow-up times from sling insertion were 75 months in the AdVance® group (range: 64-97) and 86 months in the InVance® group (range: 61-108). At three months of follow-up, 43 of 55 patients were considered to be cured (pad-free) (78.1%), 79.1% in the AdVance® group and 77.4% in the InVance® group. Postoperatively, 16.6% of patients with AdVance® and 22.5% of patients with InVance® presented "de novo" urgency. At 5 years of follow-up, we observed 10 cases of some deterioration of continence, 3 patients in the AdVance® group and 7 in the InVance® group (15.8% and 29.1% of the initially cured, respectively). To date, there have been no reports of urethral sling erosion.Male slings are safe and effective. Although we observed an increase in "de novo" urgency, in our experience, slings seemed to maintain their efficacy during long-term follow-up, and the risks of urethral erosion are low.Los cabestrillos suburetrales masculinos son una opción alternativa para la incontinencia urinaria de esfuerzo leve. El objetivo del trabajo es evaluar los resultados funcionales a largo plazo, la eficacia y el empeoramiento de la continencia en los cabestrillos suburetrales masculinos. METODOS: Se evaluaron los resultados funcionales de los cabestrillos de realineamiento/anatómicos con Ad- Vance® y compresivos con InVance®. Se incluyeron 55 pacientes que cumplían con los 5 años de seguimiento completo. Incluimos pacientes con un peso en el test de la compresa de 24 h menor de 400 gramos. Los pacientes con continencia nocturna que tenían también positivas las pruebas de reposicionamiento se consideraron para AdVance®, mientras que los pacientes sin contracción esfinteriana o con radioterapia pélvica previa fueron considerados para InVance®. RESULTADOS: Entre febrero 2006 y septiembre 2010 se implantaron 24 cabestrillos AdVance® y 31 InVance ®. La mediana de seguimiento fue de 75 meses desde la inserción del cabestrillo en el grupo de AdVance® (rango 64-97) y 86 meses en el grupo de InVance® (rango: 61-108). A los tres meses de seguimiento, 43 de los 55 pacientes fueron considerados curados (sin compresa) (78,1%), 79,1% en el grupo de AdVance® y 77,4% en el de InVance®. En el postoperatorio, el 16,6% de los pacientes con AdVance® y el 22,5% de los InVance® presentaron urgencia “de novo”. A los 5 años de seguimiento, observamos 10 casos con algún deterioro de la continencia, 3 pacientes en el grupo de AdVance® y 7 en el de InVance® (15,8% y 29,1% de los pacientes inicialmente curados, respectivamente). Hasta la fecha, no se han presentado casos de erosión del cabestrillo. CONCLUSIONES: Los cabestrillos masculinos son seguros y eficaces. Aunque observamos un incremento de la urgencia “de novo”, en nuestra experiencia, los cabestrillos parecen mantener su eficacia durante el seguimiento a largo plazo, y los riesgos de erosión uretral son bajos.

5024 Background: PSA value is widely used for the monitoring of treatment outcome in mCRPC in the clinical real-world setting. Early PSA changes are not considered in the definition of PSAProg due to the potential for spurious “flare” reactions. We aimed to evaluate the significance of an early PSA increase in mCRPC patients (pts) treated with enzalutamide or abiraterone (Enz/Abi). Methods: We retrospectively evaluated Enz/Abi-treated mCRPC pts from 11 hospitals between 2011-2020. Early PSAProg was defined as a 25% increase in PSA from baseline at 4 (PSAProg4) or 8 (PSAProg8) weeks after treatment initiation. PSA progression at 12 weeks (PSAProg12) was confirmed by a second reading. Uni- and multivariable (MV) Cox regression models were conducted to explore the association of PSAProg and overall survival (OS) in chemotherapy naïve patients treated with Abi or Enz. Interaction tests were conducted to explore differences in the impact of PSA progression on OS in Abi or Enz-treated pts. Results: We analyzed 511 chemotherapy-naïve mCRPC pts treated with Abi (N=391; 76.5%) or Enz (N=120; 23.5%). Median follow-up: 30.2 months. OS was longer in Enz-treated pts (38.1 vs 29m; HR 1.4; p=0.027). 59 (15.1%), 70 (17.9%) and 48 (12.3%) of Abi-treated and 9 (7.5%), 11 (9.2%) and 10 (8.3%) of Enz-treated pts experienced PSAProg4, PSAProg8 and PSAProg12, respectively, although differences were not statistically significant. PSAProg was associated with worse OS at all 3 timepoints only in Abi-treated pts. In Enz-treated pts, PSAProg4 had a large impact on OS, not observed in PSAProg8 or PSAProg12. We observed no significant interaction between agent (Enz/Abi) and PSA progression (Table). Conclusions: PSA progression at 4 weeks after Enz/Abi is significantly associated with shorter OS and may help identify pts not benefitting from Abi/Enz before clinical or radiographic progression. PSA pattern progression and its association with OS might differ depending on the drug used (Enz/Abi). Prospective validation studies are needed.[Table: see text]

We evaluated the effectiveness of indocyanine green guided pelvic lymph node dissection for the optimal staging of prostate cancer and analyzed whether the technique could replace extended pelvic lymph node dissection.A solution of 25 mg indocyanine green in 5 ml sterile water was transperineally injected. Pelvic lymph node dissection was started with the indocyanine green stained nodes followed by extended pelvic lymph node dissection. Primary outcome measures were sensitivity, specificity, predictive value and likelihood ratio of a negative test of indocyanine green guided pelvic lymph node dissection.A total of 84 patients with a median age of 63.55 years and a median prostate specific antigen of 8.48 ng/ml were included in the study. Of these patients 60.7% had intermediate risk disease and 25% had high or very high risk disease. A median of 7 indocyanine green stained nodes per patient was detected (range 2 to 18) with a median of 22 nodes excised during extended pelvic lymph node dissection. Lymph node metastasis was identified in 25 patients, 23 of whom had disease properly classified by indocyanine green guided pelvic lymph node dissection. The most frequent location of indocyanine green stained nodes was the proximal internal iliac artery followed by the fossa of Marcille. The negative predictive value was 96.7% and the likelihood ratio of a negative test was 8%. Overall 1,856 nodes were removed and 603 were stained indocyanine green. Pathological examination revealed 82 metastatic nodes, of which 60% were indocyanine green stained. The negative predictive value was 97.4% but the likelihood ratio of a negative test was 58.5%.Indocyanine green guided pelvic lymph node dissection correctly staged 97% of cases. However, according to our data it cannot replace extended pelvic lymph node dissection. Nevertheless, its high negative predictive value could allow us to avoid extended pelvic lymph node dissection if we had an accurate intraoperative lymph fluorescent analysis.

Objective To assess the relationship between prostate cancer (PC) and the presence of metabolic syndrome and late-onset hypogonadism (LOH) syndrome. Material and method A retrospective study was conducted on 686 patients who underwent prostate biopsy. We analyzed the demographic variables, clinical data and biopsy results. To diagnose metabolic syndrome, we employed the criteria of the American Heart Association. For the diagnosis of LOH syndrome, we employed the Androgen Deficiency in the Aging Male questionnaire and testosterone levels (TT). We evaluated the relationship between free testosterone (FT) and bioavailable testosterone (BT) on one hand and PC and its aggressiveness on the other, as well as the usefulness of the TT to prostate specific antigen (TT/PSA) ratio in the PC diagnosis. Results The patient's median age was 65 years. Metabolic syndrome is not associated with PC (39.4% vs. 35%; p = 0.1) but is associated with a PC Gleason score > 7 (50.4% vs. 29.44%; p = 0.002). LOH, low FT and low BT are associated with an increased presence of PC (51% vs. 35%, p = 0.02; 44.86% vs. 33.33%, p = 0.03; and 46.46% vs. 33.08%, p = 0.01, respectively) and with an increased probability of a PC Gleason score > 7 (61.54% vs. 37.5%, p = 0.02; 54.17% vs. 34.12%, p = 0.02; 54.35% vs. 34.48%, p = 0.02, respectively). Additionally, the median TT/PSA ratio was significantly lower in patients with positive biopsies ( p = 0.022). Conclusions Metabolic syndrome was not associated with the probability of having PC but was associated with a PC Gleason score > 7. Moreover, LOH syndrome had a higher percentage of PC and a greater presence of PC Gleason score > 7, as did low levels of FT and low levels of BT.

5511 Background: Germline BRCA1/2 (g BRCA1/2) mutations are associated with poor clinical outcomes in PC. Previous studies showed that g BRCA2 carriers present more CNV in several genes associated with more aggressive disease. These aberrations may explain the poor clinical outcomes of these patients, but larger studies are needed to confirm these findings. Methods: PROREPAIR-A is a multicenter case-control study in which g BRCA2 carriers with available diagnostic timor-tissue were matched 1:2 by Gleason and stage at diagnosis (M0 vs M1) with known non-carriers (NC). A minimum of 120 controls-60 cases were required to prove a 5yr Cause Specific Survival (CSS)-rate of 85% vs 60%. The primary endpoint was to confirm the independent prognostic value of g BRCA2 in PC CSS. In addition, we explored the prognostic role of g BRCA1 and somatic events in BRCA2, RB1, MYC, PTEN and TMPRSS2-ERG by FISH. Χ2, Kaplan-Meier, log-rank and cox-regression models were carried out to identify associations with baseline characteristics and outcomes: Metastases Free Survival (MFS), Time to Castration-Resistance (TTCR) and CSS. Results: A total of 80:160 matched cases-controls were initially included, but tumor tissue and clinical data were only available in 73 g BRCA2 and 127 NC. 14 g BRCA1 were also included. At diagnosis, g BRCA2 were younger (median 62.6 vs 64.5, p = 0.02) and had cT3-4 disease more often than NC (31.5% vs 9.4%, p < 0.01), but no other significant differences were found. Somatic BRCA2-RB1 codeletion (40.8% vs 11.8%, p < 0.01) and MYC amplification (51.4% vs 22.8%, p < 0.01) were more frequent in g BRCA2 compared to NC, but no significant differences in PTEN and TMPRSS2-ERG were observed. g BRCA2 mutations as well as somatic BRCA2-RB1 codel and MYC amplif were significantly associated with shorter CSS, MFS and TTCR (Table). MVA model confirmed the independent prognostic value of g BRCA2 (HR 1.94, p = 0.03), BRCA2-RB1 codel (HR 3.16, p < 0.01), MYC amplif (HR 2.36, p < 0.01), Gleason ≥8 (p < 0.01) and M1 at diagnosis (p < 0.01) for CSS. Conclusions: PROREPAIR-A confirmed the independent prognostic value of g BRCA2 for CSS. Somatic BRCA2, RB1 and MYC aberrations were more frequent in g BRCA2 carriers. Those alterations are associated with shorter CSS, MFS and TTCR, and may contribute to poor clinical outcomes in g BRCA2 and NC. [Table: see text]

Objective: To compare the outcomes of robotic radical nephrectomy (RRN) to those of laparoscopic radical nephrectomy (LRN) for large renal masses. Methods: This was a retrospective analysis of RRN and LRN cases performed for large (≥ cT2) renal masses from 2004 to 2017 and collected in the multi-institutional international database (ROSULA: RObotic SUrgery for LArge renal masses). Peri-operative, functional, and oncologic outcomes were compared between each approach. Descriptive analyses were performed and presented as medians with interquartile ranges. Inverse probability of treatment weighting-adjusted multivariable analyses were used to identify predictors of peri-operative complications. Kaplan–Meier analysis and Cox regression models were used to assess survival outcomes. Results: A total of 941 patients (RRN = 404, LRN = 537) were identified. There was no difference in terms of gender, age, and clinical tumor size. Over the study period, RRN had an annual increase of 11.75% (95% CI [7.34, 17.01] p < 0.001) and LRN had an annual decline of 5.39% (95% CI [−6.94, −3.86] p < 0.001). Patients undergoing RRN had higher BMI (27.6 [IQR 24.8–31.1] vs. 26.5 [24.1–30.0] kg/m 2 , p < 0.01). Operative duration was longer for RRN (185.0 [150.0–237.2] vs. 126 [90.8–180.0] min, p < 0.001). Length of stay was shorter for RRN (3.0 [2.0–4.0] vs. 5.0 [4.0–7.0] days, p < 0.001). RRN cases presented more advanced disease (higher pathologic staging [pT3–4 52.5 vs. 24.2%, p < 0.001], histologic grade [high grade 49.3 vs. 30.4%, p < 0.001], and rate of nodal disease [pN1 5.4 vs. 1.9%, p < 0.01]). Surgical approach did not represent an independent risk factor for peri-operative complications (OR 1.81 95% CI [0.97–3.39], adjusted p = 0.2). The main study limitation is the retrospective design. Conclusions: This study represents the largest known multi-center comparison between RRN and LRN. The two procedures seem to offer similar peri-operative outcomes. Notably, RRN has been increasingly utilized, especially in the setting of more advanced and surgically challenging disease without increasing the risk of peri-operative complications.

Objective To compare outcomes of laparoscopic radical prostatectomy (LRP) performed in live surgery versus daily routine LRP. Methods From January 2014 to June 2017, data from LRP performed at our Institution in live broadcasting by 3 experienced laparoscopic surgeons during educational events were collected. A 1:2 matching (according to BMI, comorbidities, NCCN risk groups, and operating surgeon) was performed with the routine LRP patients collected in our prospectively-maintained database. Chosen procedures were performed within the same time span by the same surgeons. Data of interest were compared. Results Twenty-three live surgery LRPs were analyzed (Group A). Forty-six matched patients were the controls (Group B). Groups were comparable at baseline. No differences were found in perioperative data (operative time, blood loss, and intraoperative complications, 4.3% in both Groups) and postoperative complications. Particularly, 10 (43.5%) and 22 patients (47.8%) did not report complications (Group A vs B, respectively, P = .54). The majority of complications were Clavien 1-2, with 2 patients per Group requiring blood transfusion. Overall positive surgical margins rate was 26.1%. It was significantly higher in Group A (43.5% vs 17.4%; P = .02), but no differences were found in the number of patients who relapsed, who needed radiotherapy or androgen deprivation therapy within a median follow-up of 25 months in both Groups. No differences were found regarding functional data. Limitations include a low sample size and limited follow-up. Conclusion LRP has similar perioperative outcomes when performed in either live surgery or daily routine setting. We underline the higher positive surgical margins rate after live surgeries that should increase the awareness before embarking on it.

Introduction Life expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks. Objective To outline the complications and survival in surgical patients 80 years and over undergoing radical cystectomy for bladder cancer. Patients and Methods A review of a radical cystectomy in elderly recorded in four different institutional prospective databases during the period between 1991 and 2014. Clinical and pathologic features, complications and survival were evaluated. Results A total of 111 patients were available. Median (range) age 82.2 (80–89) years. Seventeen women and 94 men. Regarding the ASA score, 6 patients were ASA I, 47 patients were ASA II, 49 patients ASA III and 9 ASA IV. Prior to surgery, 48 patients had hydronephrosis. The median (range) creatinine series was 1.1 (0.71–11.1) ng/dL. In 88 cases an ileal conduit was performed, 17 a cutaneous ureterostomy diversion, 5 neobladders and 1 ureterosigmoidostomy case. The median (range) operative time was 230 (120–420) min and a total of 97 patients required blood transfusion. The median (range) hospital stay was 14 (7–126) days. The early and late complication rates were 50.4% and 32%, respectively. A total of 14 patients (12.6%) required surgical reintervention. Eight patients (7.2%) died in the immediate postoperative period. The readmission rate of the series was 27.2%. The mean follow-up of the series was 18 (0.27–134.73) months. During this period 66 patients died, 52 of them due to the tumor. Twelve month tumour progression free survival was 83.9% for ≤pT1, 70.2% for pT2 and 36% for ≥pT3, respectively. Twelve month cancer specific survival was 85.6% for ≤pT1, 75.1% for pT2 and 42.5% for ≥pT3, respectively. Conclusion Radical cystectomy in elderly population is an aggressive surgical treatment with a significant complication rate, hospital readmission and perioperative mortality rate. Careful selection of patients is essential in order to minimize the complications of this surgery and balance benefits against risks in the elderly population. Tumour progression and cancer specific survival are poor for patients with ≥pT3 disease. Alternatives such as tri-modality therapy need to be considered within a multi-disciplinary approach. More data is required to determine which sub-groups of elderly patients would benefit from a complication, survival and quality of life perspective.

Introduction and objective We estimate that more tan 63,000 prostate biopsies are performed in our country each year. There are no functional status data of those patients and if there is a relationship between biopsy result and functional status. In order to solve that question we have performed this study. Material and method 1128 prostate biopsies were included. Patients fill in the IPSS, IIEF-5 and ICIQ-SF questionnaires before the prostate biopsy was performed. A prospective data collection of clinical, pathological and questionnaires results was done. A descriptive analysis was carried out. IPSS and IIEF-5 results were categorized. Results were compared depending on the biopsy result. In the subgroup of patients with prostate cancer, questionnaires results were stratify according to the clinical risk group. Results The mean age of the sample was 65. Prostate cancer detection rate was 32.71%, 52.2% of the sample had mild lower urinary tract symptoms (LUTS) and 13.4% had severe LUTS at the time of the biopsy. Regarding the impact of LUTS on quality of life (QOL), only 12.6% showed a perfect QOL. More than 50 percent of patients suffered from some degree of erectile dysfunction at the time of the biopsy. According to ICIQ-SF, 24% of the sample experienced some kind of urinary incontinence, although it is true that most of them classified it as small amount. Patients with a positive biopsy had a lower IPSS and IIEF-5 average score. There were no differences in the prostate cancer detection rate stratified by the severity of LUTS. Conclusions Patients undergoing prostate biopsy have, with a high probability, LUTS. Approximately 50% suffer from some degree of erectile dysfunction and 24% had some kind of urinary leakage.

Aims Speckle-type POZ protein (SPOP) is an E3 ubiquitin ligase adaptor recently described to be mutated in prostate cancer (PCa). Hence, studying the gene expression profile and the presence of SPOP mutations in PCa and understanding its clinico-pathological significance as prognostic and therapeutic biomarker are important to further understand its role in PCa development. Patients and methods A cohort of 265 paraffin-embedded PCa samples from patients with more than 5years of follow-up and treated with radical prostatectomy were collected at our institution for SPOP evaluation. RT-qPCR analysis was performed for expression studies while mutations were assessed by next generation sequencing. Relationship with prognosis was analysed using log-rank analysis and multivariable Cox regression. Results SPOP was found to be strongly down-regulated in PCa (median=0.24; range=0.04–9.98) and its expression was associated with both, biochemical ( p =0.003) and clinical progression free survival ( p =0.023), the very low SPOP expression levels being associated to the worst prognosis. Multivariate analysis demonstrated that low levels of SPOP independently predicted a worse prognosis for both, biochemical (Hazard ratio (HR)=0.5; confidence interval (CI) 95% [0.4–0.9], p =0.011) and clinical progression (HR=0.6; IC 95% [0.4–1], p =0.046). SPOP mutations were found in 10% of TMPRSS2-ERG (T2E)-negative cases. Log-rank tests showed that mutations were significantly associated with biochemical progression free survival (BPFS) ( p =0.009) and also were significant in the multivariable analysis (HR=3.4; IC 95% [1.5–7.6], p =0.004). Conclusions The present study demonstrates that prognosis varies depending on SPOP expression and mutational status, hence, defining a new biotype of PCa associated with a worse prognosis.

Objectives To validate the relation of the nephrometry scores in a series of patients who underwent partial nephrectomy with perioperative parameters and the urologist–radiologist reproducibility. Materials and methods A retrospective study of open and laparoscopic partial nephrectomy patients performed between 2005 and 2012 registered in prospective filled out database. An urologist and a radiologist calculated the RENAL, PADUA and C-index for 86 patients. We carried out a comparative study of the results using the Spearman and Pearson correlation indexes. Results Distribution according to the complexity of the tumors with the RENAL calculation was: 42 (49%) low, 35 (41%) moderated and 9 (11%) high complexity. According to PADUA: 35 (41%) low complexity, 32 (37%) intermediate and 19 (22%) high. No statistically significant correlation was found for the appearance of operative complications and the pathology results in case of RENAL and PADUA. A correlation was found in the case of PADUA in relation to the warm ischemia time. Positive correlation according to Spearman's index was found in RENAL, PADUA and C-index between urologist and radiologist evaluations. Conclusions Nephrometry scores can be a useful tool to plan the surgical technique or approach. However, it is not clear if they are really predictors of surgical or pathologic parameters. The correlation between the urologist and radiologist seems to be sufficient to recommend their use by both specialties.

Objectives To reduce unnecessary biopsies (Bx) in an opportunistic screening programme of prostate cancer. Material and methods We performed a prospective evaluation of PCA3 as a second-line biomarker in an opportunistic screening for prostate cancer (PCa). From September 2010 until September 2012, 2,366 men, aged 40–74 years and with >10 years life expectancy, were initially screened with PSA/digital rectal examination (DRE). Men with previous Bx or with recent urine infections were excluded. Men with abnormal DRE and/or PSA > 3 ng/ml were submitted for PCA3. All men with PCA3 ≥ 35 underwent an initial biopsy (IBx) —12cores—. Men with PCA3 .5 ng/ml at 4-6months or PSAv > .75 ng/ml/year. Results With a median follow-up (FU) of 10.1 months, PCA3 was performed in 321/2366 men (13.57%), 289 at first visit and 32 during FU. All 110 PCA3+ men (34.3%) were biopsied and PCa was identified in 43 men in IBx (39.1%). In the randomized arm, 110 were observed and 101 underwent biopsy, finding 12 PCa (11.9%), showing a statistically significant reduction of PCa detection rate in this cohort (p Conclusions PCA3 as a second-line biomarker within an opportunistic dual screening protocol can potentially avoid 65.7% and 50.1% biopsies at first round and at median FU of 10.1 months, respectively, just missing around 3.2% of high grade PCa.

Resumen Objetivos Reducir el numero de biopsias (Bx) innecesarias en un programa de cribado oportunista en cancer de prostata (CaP). Material y metodos Estudio prospectivo y aleatorizado evaluando el PCA3 como biomarcador de segunda linea. De septiembre de 2010 a septiembre de 2012 2.366 hombres con edad en rango 40-74 anos, y mas de 10 anos de expectativa de vida, fueron estudiados mediante PSA y tacto rectal (TR), excluyendo los biopsiados previamente o con infeccion urinaria reciente. Ante un TR sospechoso y/o PSA > 3 ng/ml se les realizo un PCA3. A todos aquellos con PCA3 ≥ 35 se les realizo una Bx inicial (IBx) —12 cilindros—. Con PCA3 0,5 ng/ml a 6 meses o PSAv > 0,75 ng/ml/ano. Resultados Con un seguimiento medio de 10,1 meses se testo el PCA3 en 321/2.366 hombres (13,57%), 289 en la primera visita y 32 durante el seguimiento. Entre los 110 hombres con PCA3+ (34,3%) se identifico CaP en 43 en IBx (39,1%). En el brazo aleatorizado 110 se observaron y 101 se biopsiaron, encontrando 12 CaP (11,9%), mostrando un reduccion en la deteccion de CaP estadisticamente significativa en esta cohorte (p Conclusiones El PCA3 como biomarcador de segunda linea en un programa de cribado oportunista podria potencialmente evitar un 65,7% de IBx y 50,1% a 10 meses de seguimiento, dejando de diagnosticar 3,2% de CaP de alto grado.

e16530 Background: Changes in PSA are widely used as a biomarker for the monitoring of treatment outcome in Metastatic Castration-Resistant Prostate Cancer (mCRPC) in the clinical real-world setting. Early PSA changes (before 12 weeks) are not considered in the definition of PSA Progression (PSAProg) due to the potential for spurious “flare” reactions. We aimed to evaluate the significance of an early PSA increase in Abiraterone/Enzalutamide (Abi/Enz)-treated mCRPC patients (pts). Methods: We retrospectively evaluated Abi/Enz-treated mCRPC pts from 11 hospitals between 2011-2018. Early PSAProg was defined as a 25% increase in PSA from baseline at 4 (PSAProg4) or 8 (PSAProg8) weeks after treatment initiation. PSA progression at 12 weeks (PSAProg12) was confirmed by a second reading. Uni- and multivariable (MV) Cox regression models were conducted to explore the association of PSAProg and overall (OS) and radiographic progression-free (rPFS) survival. Sensitivity (Se), specificity (Sp) and predictive values (PPV, NPV) for the association of early PSAProg with PSAProg12 were calculated. Results: We analyzed 581 mCRPC pts; median follow-up: 19.1 months. 96 (17.1%); 105 (21.6%) and 85 (16.9%) pts had PSAprog at 4, 8 and 12 wks. PSAProg4 and PSAProg8 were significantly associated with confirmed PSAProg12. 55.3% of pts with PSAProg4 and 66.7% of pts with PSAProg8 had a confirmed PSAProg12. Only 9% of pts with no PSA prog at 4 wks and 4.1% of pts with no PSAProg8 had a confirmed PSAProg12. PSAProg4 had Se: 56.6%, Sp: 90.5%, PPV: 55.2%, NPV: 91% for the detection of PSAProg12. PSAProg8 had Se: 81.9%, Sp: 91.2%, PPV: 66.7%, NPV: 95.9% for the detection of PSAProg12. PSAprog at 4, 8 and 12 wks was significantly associated with OS and rPFS in uni- and MV Cox models (Table). Conclusions: Early PSAProg after Abi/Enz is significantly associated with both confirmed PSA Prog at 12 wks and outcome, and may help identify pts not benefitting from Abi/Enz before clinical or radiographic progression. Prospective validation studies are needed. [Table: see text]

Objectives To implement the use of nomograms in clinical practice showing how to choose thresholds in nomograms’ predictions to select risk groups. To validate and compare the predictive ability and clinical utility of the Hospital Universitario ‘Miguel Servet’ (HUMS) and the updated Partin Tables 2012 (PT-2012) nomograms to predict organ-confined disease (OCD) after radical prostatectomy (RP). Patients and Methods Cohort of 1285 patients with prostate cancer treated with RP at Instituto Valenciano de Oncologia (IVO) between 1986 and 2011. The predictive value of the nomograms was assessed by means of calibration curves, discrimination ability (area under the receiver operating characteristic (ROC) curve (AUC) and probability density functions). The clinical utility was evaluated through Vickers’ decision curves and thresholds were chosen through probability density functions. Results The calibration curves showed a minimal underestimation in low probabilities ( 50%) in the HUMS nomogram and a regular minimal overestimation in the PT-2012. Their AUC of 0.7285 (95% confidence interval [CI] 0.7010–0.7559) and 0.7288 (95%CI 0.7013–0.7562) respectively, show an adequate discrimination ability for both predictive models in the IVO cohort. The decision curves show similar net benefits for both models. In this study we advocate for a threshold of 53% for the identification of OCD. Conclusions The HUMS-nomogram and the PT-2012 predictions of OCD confirm their utility in a contemporary cohort of patients. Patients with a probability of OCD >53% should be classified as OCD, helping physicians to better counsel their patients. A selection of adequate thresholds, as presented in this paper, makes nomograms more accessible tools.

Resumen Objetivo Comparar la naturaleza tumoral y la evolucion oncologica de los pacientes intervenidos mediante prostatectomia radical en 3 grupos de edad. Material y metodo De la base de datos de cumplimentacion prospectiva de nuestro Servicio, analizamos 1.012 pacientes intervenidos entre los anos 1986 y diciembre de 2009. Se excluyeron los pacientes con tratamiento neo o adyuvante y aquellos con PSA preoperatorio mayor de 50. Se dividio la muestra en 3 grupos: menores de 60, de 61 a 69 y los de 70 y mayores. Se analizaron las variables clinicas, patologicas, la evolucion bioquimica y la necesidad de rescate. Consideramos recidiva bioquimica cuando los valores de PSA alcanzan cifras mayores de 0,4 en 2 mediciones consecutivas. Se definio rescate como la necesidad de tratamiento hormonal o de la administracion de radioterapia. Procedimos a un estudio comparativo, un analisis de supervivencia univariante mediante curvas de Kaplan y Meyer y multivariante mediante regresion de Cox. Resultados La mediana de seguimiento fue de 55,1 meses. De los 1.012 pacientes incluidos en el estudio 317 pacientes (31,3%) experimentaron progresion bioquimica y 259 (25,6%) necesitaron rescate. Observamos que los grupos de mayor edad tenian un PSA significativamente mas alto y mayores estadios que el resto. No se objetivaron diferencias en el Gleason de la pieza quirurgica ni en el estado de los margenes quirurgicos. La supervivencia libre de recidiva bioquimica a los 5 anos fue del 72,3% (IC 95%: 66,4-78,2) en los pacientes menores de 60 anos, del 65,3% (IC 95%: 60,6-70,0) para los pacientes menores de 70 y del 62,2% (IC 95%: 53,2–71,1) para los pacientes con 70 o mas anos; p Conclusiones En el presente estudio se objetivo una peor evolucion bioquimica de los pacientes mayores de 70 anos, sin embargo esta peor evolucion bioquimica estuvo condicionada por tumores clinicamente mas agresivos, lo que a nuestro juicio justifica la decision tomada en cuanto a la actitud quirurgica para con estos pacientes.

To compare the tumor nature and oncological course of patients operated on by radical prostatectomy in three age groups.From the prospective completion of the data base of our department, we analyzed 1012 patients operated on between 1986 and December 2009. Patients with neo- or adjuvant treatment and those with pre-operative PSA over 50 were excluded. The sample was divided into three groups: younger than 60, 60 to 69 and over 70. The clinical, pathological variables, biochemical course and need for rescue treatment were analyzed. We consider biochemical relapse as when the PSA values reached values greater than 0.4 in two consecutive measurements. Rescue was defined as the need for hormone treatment or radiotherapy. We then made a comparative study, a univariate survival analysis by Kaplan and Meyer Curves and multivariate by Cox's regression.The median follow-up was 55.1 months. Of the 1012 patients included in the study, 317 patients (31.3%) had biochemical progression and 259 (25.6%) required rescue treatment. We observed that the groups with the older age had a significantly higher PSA and higher stages than the rest. No differences were observed in the Gleason score of the surgical specimen or in the state of the surgical margins. Biochemical relapse free survival at 5 years was 72.3% (CI 66.4-78.2) in patients under 60 years, 65.3% (CI 60.6-70.0) for patients under 70 and 62.2% (CI 53.2-71.1) for patients of 70 years or older; P.05. In the univariate study, age was a factor that was significantly associated to biochemical relapse. However, it loses interest in the multivariate study and PSA, pathological state and Gleason score regain interest. Rescue treatment free survival did not differ by age groups.In the current study, worse biochemical evolution of patients over 70 was observed. However, this worse biochemical course was conditioned by clinically more aggressive tumors that, in our opinion, justifies the decision made in regards to the surgical approach taken with these patients.

Objective Despite early diagnosis of prostate cancer, seminal vesicle invasion is still a common clinical scenario nowadays. The objective of this study is to evaluate clinical and pathological prognostic factors in that subgroup of patients. Material and methods After approval of our Ethical Committee, we selected all pT3b prostate cancer patients operated between 1987 and 2010. Neoadjuvant treatment patients were excluded. The biochemical free survival periods BFS and the period free of complementary treatment were calculated with the Kaplan Meier method. Cox regression model was used to select those variables associated with biochemical failure and the need for complementary treatment. We considered complementary treatment when radiotherapy or hormone therapy in an adjuvant or salvage scheme was required. Results 101 patients were selected from 1470 procedures. Among these, 28 patients died (27.7%), 18 due to tumor, and 74 showed biochemical relapse (73.3%). The median follow up was of 4 years and 4 months. The five years BFS was 30.2% (IC 95%: 20.2–40.1), whereas the 5-year period free of complementary treatment was 16.9% (IC 95%: 8.1–25.8%). In the multivariate analysis, margin status (R) was independently and significantly associated with biochemical relapse and the need for complementary treatment. Likewise, the preoperative PSA was associated to biochemical relapse and N1 tumors were clearly associated to complementary treatment. Conclusion pT3b prostate cancer patients with R1 disease have a worse biochemical prognosis and higher probability of complementary treatment.

Bladder cancer is the most common malignancy of the urinary tract. About 75%-85% of patients present with non-muscle-invasive bladder cancer (NMIBC). However, patients with pT1 tumors, as well as all those with high-grade disease, make up a subset with a high-risk of recurrence and disease progression. Although still regarded as the gold standard, clinical evidence from contemporary published series clearly demonstrates that transurethral resection of tumor (TUR) is a procedure far from optimal, highlighting its limitations and the need for further diagnostic accuracy. Routine use of a restaging TUR (re-TUR), supported by the American Urological Association and European Association of Urology guidelines, detects residual tumor in a significant number of cases after initial TUR. It provides a more accurate staging of the disease and, consequently, helps to guide its treatment. Recent years have seen rapid development of novel optical techniques aimed to optimize resection. Routine implementation of these novel techniques in the context of re-TUR is promising and may potentially result in more tumors being identified and completely resected, leading to significantly lower residual tumor rates than with the standard white-light TUR. This article will focus on re-TUR in the management of high-risk NMIBC, with an up-to-date review of the available literature and detailed analysis of the published series.

Resumen Introduccion La enuresis nocturna es un trastorno con un interes historico mantenido, no solo en cuanto a su patogenia, probablemente multifactorial pero todavia hoy desconocida, sino tambien en cuanto a su frecuencia. Objetivo Nos planteamos revisar la literatura medica al respecto para conocer la problematica en el calculo de su casuistica. Material y metodo Realizamos una busqueda en la base de datos PubMed, mediante los terminos Mesh «enuresis», «nocturnal enuresis» y «bedwetting», e incluimos en el cuadro de busqueda los terminos «epidemiology OR prevalence». Incluimos todos los trabajos en lengua inglesa o espanola. Seleccionamos los trabajos con una muestra mayor de 1.000 pacientes, e incluimos estos y los articulos de revision. Procedemos al analisis de la metodologia empleada por los grupos mas relevantes, asi como los resultados globales de frecuencia; ademas, cuando es posible, estratificamos los resultados por edad, sexo y frecuencia de los escapes. Resultados La metodologia de los trabajos analizados es heterogenea y las comparaciones se hacen, por tanto, dificiles. La prevalencia global es dificil de estimar y dar resultados globales carece de interes pues para interpretarlos es necesario pormenorizar la metodologia, la muestra y los criterios diagnosticos. Conclusiones Se hace necesario un estudio epidemiologico propio que resuelva nuestra problematica.

Objectives: Prostate biopsy grade is a key factor when deciding whether to perform pelvic lymph node dissection (PLND) at laparoscopic radical prostatectomy. In common with many laparoscopic radical prostatectomy centers, we perform PLND in patients found to have intermediate and high-risk prostate cancer based upon preoperative PSA, prostate biopsy and imaging. We assessed the feasibility of performing a secondary laparoscopic PLND 6 weeks postoperatively in the presence of postoperative upgrading in patients who did not have PLND. Methods: A prospective study recording the pathological results and operative outcomes prospectively over a 10-month period during which 24 patients underwent a secondary PLND. All patients had a preoperative PSA level Results: During the 10-month period, 377 prostatectomies were carried out in our department in which 54 (18.3%) had an upgrading in the prostatectomy specimen. 24 patients (mean age 60 and mean PSA 6.7 ng/ml) agreed to a secondary PLND. No lymph nodes metastases were observed. One patient who was sexually potent following a nerve-sparing prostatectomy was impotent after the secondary PLND. Conclusions: Upgrading of prostate Gleason score is seen in up to a third of cases in many large published series that is reflected in our experience. A laparoscopic secondary lymphadenectomy is feasible with low morbidity and yields valuable pathological clinical staging for subsequent surveillance and therapy for these high-risk patients.

Introducción y objetivo: En la mayoría de los casos el aprendizaje de la prostatectomía radical laparoscópica no se completa durante la residencia. Ante esta problemática internacional surgen las becas o "fellowships" de los centros de excelencia europeos y norteamericanos. El objetivo del presente trabajo es evaluar la eficiencia de la beca de formación propuesta por el grupo alemán. Material y método: Describimos la evolución de un becario durante el entrenamiento progresivo, tutorizado por módulos descrito por el grupo de Leipzig, evaluamos la eficiencia del modelo describiendo los resultados de las primeras 30 prostatectomías radicales del becario como cirujano autónomo, comparamos los resultados con la serie histórica del centro, con la curva de aprendizaje de residentes del mismo centro y de otros centros. Resultados: El becario cumplimentó el entrenamiento por módulos en 7 meses posteriormente se le asignaron 30 prostatectomías radicales sin la obligatoriedad de ser ayudado por un cirujano experto. En el 46,67% de los pacientes se aplicó una técnica intrafascial. El tiempo quirúrgico medio fue de 2h y 27 minutos, incluida la linfadenectomía (realizada en 20/30 pacientes). Dos pacientes presentaron márgenes positivos, todas las anastomosis, menos un paciente, fueron estancas. La sonda se retiró al quinto día (mediana). No se detectaron complicaciones intraoperatorias ni en el posoperatorio tardío. Los resultados de éstas, se superponen a la de los residentes del mismo centro y a la de otros urólogos que siguen un entrenamiento tutelado de larga duración. Conclusiones: El aprendizaje de la prostatectomía radical laparoscópica debe seguir un modelo tutorizado progresivo de larga duración. Hasta la expansión definitiva de la técnica, el programa de formación tipo "fellow" que imparte el grupo de Leipzig es un modelo de formación completo y efectivo.

Objetivo: Evaluar la eficacia de la analgesia intravenosa con meperidina frente a la infiltración del plexo periprostático con lidocaína,y seguridad de la anestesia local periprostática. Material y métodos: Estudio prospectivo aleatorizado con 100 pacientes sometidos a primera o segunda biopsia de próstata. Distribuimos a los pacientes en dos grupos; grupo A (50 pacientes) al que se le administra 50 mg de meperidina intravenosa y grupo B (50 pacientes) que reciben 5 mL de lidocaína al 2% en el ángulo prostatoseminal. El dolor fue evaluado mediante la Escala Analógico Visual (VAS) y un cuestionario a cerca del impacto emocional de la prueba. La seguridad del procedimiento se obtuvo mediante cuestionario telefónico sobre las complicaciones aparecidas tras la biopsia. Para el análisis estadístico se uso el test de chi cuadrado, la t de Student y test no paramétrico de Kruskal-Wallis. Resultados: La mediana de edad fue 66 años (47-80) siendo ambos grupos homogéneos respecto a: PSA, volumen prostático, número de cilindros y nivel de estudios, sin diferencias significativas. Se trató de una primera biopsia en 74 pacientes (74%) y 26 (26%) de una segunda. El número medio de cilindros fue de 10,9±2. La puntuación media del VAS para el grupo A fue 3,6±1,8 frente a 3,2±2 del grupo B sin diferencias significativas (p0,05). Si comparamos el dolor con la introducción del transductor (grupo A 3,9±1,9 / grupo B 4,3±2,2) frente a la toma de cilindro (grupo A 3,6±1,8/grupo B 3,2±22) sí encontramos diferencias significativas (p0,05). Aparecieron complicaciones en 12 pacientes (12%); 5 en el grupo de meperidina frente a 7 en el de lidocaína sin observar diferencias entre ambos. Conclusión: El bloqueo del plexo periprostático con lidocaína no ofrece ventajas analgésicas respecto a la meperidina, a pesar de que se trata de un método seguro que no aumenta el número de complicaciones. El paso del transductor transrrectal produce más dolor que la propia toma de los cilindros.

To review the evidence about frozen sections during radical prostatectomy (RP) and its ability to decrease the incidence of positive margins, the impact on PSA postoperatively and the significance of residual benign prostatic cells after prostatectomy.The information for this review was compiled by searching the Pubmed database. We used Mesh Terms "Prostatectomy" and "Prostatic Neoplasms" and we added "frozen sections" and/or "hyperplasic cells" and/or "benign cells" and/or "positive margins". Furthermore, we review the articles referenced in those studies and editorials letters.Several groups have studied the performance of frozen section during RP to try and assess the risk of positive margins intraoperatively. The controversial sites where they should be performed are the apex, the dorsolateral zones and the bladder neck. They have been performed routinely or when the surgeon decides it, depending on the preoperative or intraoperative findings.At the present time there is no standardisation in the number, the site and the type of patient where this procedure should be done. The improvement in functional outcomes and biochemical control is not proven.

Resumen Introduccion La Prostatectomia radical es el tratamiento estandar para el cancer de prostata organoconfinado. Clasicamente se presta atencion a los margenes positivos para celulas tumorales, pero no a la presencia de celulas hiperplasicas residuales a la cirugia capaces de generar antigeno prostatico especifico (PSA) y dificultar el seguimiento de los pacientes intervenidos. Esta situacion nos lleva a plantear una revision de la literatura, donde evaluemos la frecuencia de esta presencia, las posibles causas que lo justifiquen y la influencia de estas celulas en la evolucion bioquimica de la enfermedad. Material y metodo Realizamos una busqueda bibliografica a traves de la base de datos “Pubmed” utilizando los terminos “Mesh” “Prostatectomy” y “Prostatic Neoplasms” y “Prostate-Specific Antigen” a los que anadimos los terminos “biochemical failure” y/o “hyperplasic cells” y/o “benign cells”. Asimismo, seleccionamos los trabajos en lengua inglesa, espanola y alemana, revisamos los articulos que dichos trabajos referencian e incluimos las series con mas de 50 pacientes, cartas al editor, editoriales y revisiones de conjunto. Conclusiones La presencia de celulas hiperplasicas microscopicas residuales a la cirugia prostatica radical, es un hecho frecuente que probablemente este infra-evaluado. Los margenes positivos para celulas benignas procederan del apex o del cuello vesical donde la capsula prostatica no esta bien definida, en ningun caso de la zona dorsolateral de la prostata, lo que traduciria un defecto de la tecnica quirurgica. La capacidad de estas celulas para generar PSA en cantidad suficiente para interferir en el seguimiento de los pacientes operados es controvertida. Recomendamos la inspeccion macroscopica de la pieza por el cirujano, tras la prostatectomia, para evaluar la integridad del apex, zona craneal y capsula dorsolateral.

Background: PCA3 has been included in a nomogram outperforming previous clinical models for the prediction of any prostate cancer (PCa) and high grade PCa (HGPCa) at the initial prostate biopsy (IBx). Our objective is to validate such IBx-specific PCA3-based nomogram. We also aim to optimize the use of this nomogram in clinical practice through the definition of risk groups. Methods: Independent external validation. Clinical and biopsy data from a contemporary cohort of 401 men with the same inclusion criteria to those used to build up the reference’s nomogram in IBx. The predictive value of the nomogram was assessed by means of calibration curves and discrimination ability through the area under the curve (AUC). Clinical utility of the nomogram was analyzed by choosing thresholds points that minimize the overlapping between probability density functions (PDF) in PCa and no PCa and HGPCa and no HGPCa groups, and net benefit was assessed by decision curves. Results: We detect 28 % of PCa and 11 % of HGPCa in IBx, contrasting to the 46 and 20 % at the reference series. Due to this, there is an overestimation of the nomogram probabilities shown in the calibration curve for PCa. The AUC values are 0.736 for PCa (C.I.95 %:0.68–0.79) and 0.786 for HGPCa (C.I.95 %:0.71–0.87) showing an adequate discrimination ability. PDF show differences in the distributions of nomogram probabilities in PCa and not PCa patient groups. A minimization of the overlapping between these curves confirms the threshold probability of harboring PCa >30 % proposed by Hansen is useful to indicate a IBx, but a cut-off > 40 % could be better in series of opportunistic screening like ours. Similar results appear in HGPCa analysis. The decision curve also shows a net benefit of 6.31 % for the threshold probability of 40 %. Conclusions: PCA3 is an useful tool to select patients for IBx. Patients with a calculated probability of having PCa over 40 % should be counseled to undergo an IBx if opportunistic screening is required.