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BACKGROUND: Adverse events induced by intravesical bacillus Calmette-Guérin (BCG) to treat high-grade non-muscle-invasive bladder cancer (NMIBC) often lead to treatment discontinuation. The EAU-RF NIMBUS trial found a reduced number of standard-dose BCG instillations to be inferior with the standard regimen. Nonetheless, it remains important to evaluate whether patients in the reduced BCG treatment arm had better quality of life (QoL) due to a possible reduction in toxicity or burden. OBJECTIVE: To evaluate whether patients in the EAU-RF NIMBUS trial experienced better QoL after a reduced BCG instillation frequency. DESIGN SETTING AND PARTICIPANTS: A total of 359 patients from 51 European sites were randomized to one of two treatment arms between December 2013 and July 2019. The standard frequency arm (n = 182) was 6 weeks of BCG induction followed by 3 weeks of maintenance at months 3, 6, and 12. The reduced frequency arm (n = 177) was BCG induction at weeks 1, 2, and 6, followed by maintenance instillations at weeks 1 and 3 of months 3, 6, and 12. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Analyses were performed using an intention-to-treat analysis and a per-protocol analysis. QoL was measured using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 version 3.0 (QLQ-C30 v.03) prior to the first and last instillations of each BCG cycle. Group differences were determined using linear regression corrected for QoL at baseline. Differences in QoL over time were tested for significance using a linear mixed model. Side effects were recorded by the treating physician using a standardized form. Chi-square tests were used to compare the side-effect frequency between the arms. RESULTS AND LIMITATIONS: There were no significant differences in the means of each QoL scale between the two arms. There were also no significant changes over time in all QoL domains for both arms. However, differences in the incidence of general malaise at T1 (before the last induction instillation), frequency, urgency, and dysuria at T7 (before the last maintenance instillation) were detected in favor of the reduced frequency arm. CONCLUSIONS: Reducing the BCG instillation frequency does not improve the QoL in NMIBC patients despite lower storage symptoms. PATIENT SUMMARY: In this study, we evaluated whether a reduction in the number of received bacillus Calmette-Guérin instillations led to better quality of life in patients with high-grade non-muscle-invasive bladder cancer. We found no difference in the quality of life between the standard and the reduced bacillus Calmette-Guérin instillation frequency. We conclude that reducing the number of instillations does not lead to better quality of life in patients with high-grade non-muscle-invasive bladder cancer.

BackgroundInnovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but there are still many aspects of management that lack high-level evidence to inform clinical practice. The Advanced Prostate Cancer Consensus Conference (APCCC) 2019 addressed some of these topics to supplement guidelines that are based on level 1 evidence.ObjectiveTo present the results from the APCCC 2019.Design, setting, and participantsSimilar to prior conferences, experts identified 10 important areas of controversy regarding the management of advanced prostate cancer: locally advanced disease, biochemical recurrence after local therapy, treating the primary tumour in the metastatic setting, metastatic hormone-sensitive/naïve prostate cancer, nonmetastatic castration-resistant prostate cancer, metastatic castration-resistant prostate cancer, bone health and bone metastases, molecular characterisation of tissue and blood, inter- and intrapatient heterogeneity, and adverse effects of hormonal therapy and their management. A panel of 72 international prostate cancer experts developed the programme and the consensus questions.Outcome measurements and statistical analysisThe panel voted publicly but anonymously on 123 predefined questions, which were developed by both voting and nonvoting panel members prior to the conference following a modified Delphi process.Results and limitationsPanellists voted based on their opinions rather than a standard literature review or formal meta-analysis. The answer options for the consensus questions had varying degrees of support by the panel, as reflected in this article and the detailed voting results reported in the Supplementary material.ConclusionsThese voting results from a panel of prostate cancer experts can help clinicians and patients navigate controversial areas of advanced prostate management for which high-level evidence is sparse. However, diagnostic and treatment decisions should always be individualised based on patient-specific factors, such as disease extent and location, prior lines of therapy, comorbidities, and treatment preferences, together with current and emerging clinical evidence and logistic and economic constraints. Clinical trial enrolment for men with advanced prostate cancer should be strongly encouraged. Importantly, APCCC 2019 once again identified important questions that merit assessment in specifically designed trials.Patient summaryThe Advanced Prostate Cancer Consensus Conference provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference, which has been held three times since 2015, aims to share the knowledge of world experts in prostate cancer management with health care providers worldwide. At the end of the conference, an expert panel discusses and votes on predefined consensus questions that target the most clinically relevant areas of advanced prostate cancer treatment. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients as part of shared and multidisciplinary decision making.

The Asian Prostate Cancer (A-CaP) study is an Asia-wide initiative that was launched in December 2015 in Tokyo, Japan, with the objective of surveying information about patients who have received a histopathological diagnosis of prostate cancer (PCa) and are undergoing treatment and clarifying distribution of staging, the actual status of treatment choices, and treatment outcomes. The study aims to clarify the clinical situation for PCa in Asia and use the outcomes for the purposes of international comparison. Following the first meeting in Tokyo in December 2015, the second A-CaP meeting was held in Seoul, Korea, in September 2016. This, the third A-CaP meeting, was held on October 14, 2017, in Chiang Mai, Thailand, with the participation of members and collaborators from 12 countries and regions. In the meeting, participating countries and regions presented the current status of data collection, and the A-CaP office presented a preliminary analysis of the registered cases received from each country and region. Participants discussed ongoing challenges relating to data input and collection, institutional, and legislative issues that may present barriers to data sharing, and the outlook for further patient registrations through to the end of the registration period in December 2018. In addition to A-CaP-specific discussions, a series of special lectures were also delivered on the situation for health insurance in the United States, the correlation between insurance coverage and PCa outcomes, and the outlook for robotic surgery in the Asia-Pacific region. Members also confirmed the principles of authorship in collaborative studies, with a view to publishing original articles based on A-CaP data in the future.

Background/aim: This study aims to compare the success rates of rigid registration (RR) and elastic registration (ER) systems in diagnosing all cancers and clinically significant prostate cancer (csPC) in software-based targeted prostate biopsies (TPBs) by performing matching analysis. Materials and methods: The data of 2061 patients from six centers where software-based TPB is performed were used. All cancer and csPC detection rates of the RR and ER systems were compared following Mahalanobis distance matching with the propensity score caliper method. Logistic regression analysis was applied to identify factors predicting clinically insignificant prostate cancer (ciPC) and csPC diagnoses. Additionally, the International Society of Urological Pathology Grade Group (ISUP GG) upgrade rates of RR and ER systems were compared between biopsy and radical prostatectomy pathologies. Results: The matched sample included 157 RR and 157 ER patients. No statistically significant difference was found between ER and RR in terms of csPC detection rate (28.0% vs. 22.3% respectively, p = 0.242). The detection rate of all cancers by ER compared to RR was found to be significantly higher (54.8% vs. 35.7% respectively p < 0.001,). No statistically significant difference was found between the ER and RR groups regarding pathological upgrade (39.7% vs. 24.2% respectively, p = 0.130). In the logistic regression analysis performed to determine the factors predicting ciPC, decreased prostate volume and ER system use were found to be independent predictive factors. Conclusion: While the detection rate of csPC was similar for the RR and ER systems, the detection rate of all cancers and ciPC was significantly higher with the ER systems. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of surgical delay in localized prostate cancer (PCa) on adverse pathological features and oncological outcomes. Materials and Methods: Patients who underwent surgery for localized PCa were included from the Turkish Urooncology Association PCa database. History of previous treatment or active surveillance was considered an exclusion criterion. Patients were divided into two groups according to the time period between the diagnosis and surgery; less than or equal to 90 days (group 1) or longer than 90 days (group 2). Surgical pathology results and oncological outcomes were compared between the groups. Results: In total, 2454 out of 3646 patients were assessed. Pathological findings of radical prostatectomy specimens were similar between the two groups. However, there was slightly more seminal vesicle invasion in the final surgical pathology in group 1 (12.9% vs. 9.3%, respectively p=0.042). The 5-year biochemical recurrence-free survival times were similar across all D'Amico risk categories between the two groups. The regression analysis demonstrated seminal vesicle invasion as the only factor affecting the time to prostate-specific antigen progression in high-risk patients (p<0.001 HR=2.51 confidence interval=1.58-4.45). Conclusion: In conclusion, our results in this large cohort suggest that surgical delay does not cause a deterioration in PCa surgical outcomes, even in high-risk patients. These findings may be helpful for planning limited healthcare resources especially in conditions like the coronavirus disease-2019 pandemic where the availability and optimal use of healthcare system resources are crucial. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the International Society of Urological Pathology (ISUP) grade group 4 (GG4) and ISUP GG5 subgroups according to prostate biopsy on biochemical recurrence (BCR). Materials and Methods: Patients who underwent radical prostatectomy (RP) after being diagnosed with GG4 and GG5 prostate cancer according to prostate biopsy and who had follow-up data were retrospectively evaluated. Patient data were obtained from the Urologic Cancer Database-Prostate of the Turkish Urooncology Association. GG4 and GG5 pathologies were evaluated using Gleason subgroups. The effect of clinicopathological parameters on BCR after RP was investigated separately in the GG4 and GG5 patient groups. Results: In GG4, 73 of 188 patients developed BCR. When GG4 patients were evaluated for BCR, only lymphovascular invasion was significant for BCR (p=0.004). In addition, seminal vesicle invasion (SVI) and high ISUP grade according to RP pathology were significant in patients with BCR (p=0.004 and p=0.005). In the follow-up of 145 patients with GG5, 80 patients developed BCR. When GG5 patients were evaluated for BCR, no predictive factor was found for developing BCR. However, surgical margin positivity, extraprostatic extension, and SVI after RP were found to be significant in patients with BCR (p=0.031, p=0.011 and p=0.007). Conclusion: According to our results, the ISUP GG system, which does not include Gleason subgroups, is an appropriate classification system for GG4 and GG5 patients for the prediction of BCR in the Turkish patient population, in parallel with the current literature. [ABSTRACT FROM AUTHOR]

To assess the incidence, risk factors, and timing of specific causes of reoperations following PVP. A retrospective analysis of data on men who underwent GreenLight PVP between 2004 and 2019 in a single center and required surgical intervention for bladder neck contracture (BNC), urethral stricture (US), or persistent/recurrent prostate adenoma. The overall rate of reoperations was 13.8% during a 61-month median follow-up of 377 patients. Reoperations were due to BNC, US, and adenoma in 7.7%, 5.6%, and 4.8% of cases, respectively. The median interval until reoperation for US (11 months) was significantly shorter. None of the risk factors had any relevance to US. In patients who underwent reoperation for BNC, lasing time and energy were significantly lower, and the prostate volume was smaller; however, the multivariate analysis only identified shorter lasing time as a predictor. In patients who had reoperation for persistent/recurrent adenoma, the PSA was increased, while the prostate volume was non-significantly high, and performance by less-experienced surgeons was associated with a higher rate of reoperations (p < 0.05). A longer lasing time predicted an increased risk of reoperation for adenoma in multivariate analysis. An unselective utilization of PVP may result in a relatively high rate of reoperations. The correlation of BNC with shorter lasing time may imply a higher risk after PVP of smaller prostates. A longer lasing time predicts an increased risk of reoperation due to persistent/recurrent adenoma, which may be related to higher prostate volumes and inefficient PVP by less-experienced surgeons. [ABSTRACT FROM AUTHOR]

Objective: To evaluate clinicopathological features of patients with serum prostate-specific antigen (PSA) level of ≤3 ng/mL and diagnosed with prostate cancer (PCa). Materials and Methods: A total of 34 male patients diagnosed with PCa by either prostate needle biopsy (PNB) or transurethral resection of the prostate (TUR-P) were included in this study between January 2010 and June 2021. Patients whose preoperative serum PSA level was >3 ng/mL and those with missing clinical data were excluded. Preoperative clinical characteristics of the patients and pathological findings of PNB, TUR-P, and radical prostatectomy (RP) specimens were evaluated. Results: The median age of the patients was 65 (60-69) years. The median preoperative serum PSA level was 1.98 (1.45-2.64) ng/mL. PCa was detected by "systematic prostate biopsy (SBx) only", combined prostate biopsy [SBx following multiparametric magnetic resonance imaging-targeted prostate biopsy (TBx)], and "TUR-P" in 6 (17.6%), 17 (50.0%), and 11 (32.4%) patients, respectively. In combination of both biopsy, PCa was detected in "SBx specimens only", "TBx specimens only", and "both TBx and SBx specimens" in 3 (8.8%), 5 (14.7%), and 9 (26.5%) patients, respectively. Clinically significant (cs) PCa was in 52.9% of the TBx (9/17) and 60.9% of the SBx (14/23) specimen. Twenty (58.8%) patients treated with RP. csPCa in RP specimens was observed in 17/20 (85.0%) patients. Upgrading in RP specimens compared with PNB specimens was observed in 5/11 (45.5%) of the TBx and 9/17 (52.9%) of the SBx specimen. At the final RP pathology, International Society of Urologic Pathology-grade group >3 or non-organ confined disease were observed in 8 (40%) and 8 (40.0%) patients, respectively. Conclusions: Adverse pathological outcomes in RP specimens are frequent in patients with PCa with a serum PSA level of ≤3 ng/mL at the time of diagnosis, and physicians should be aware of the limitations of pre-set PSA cut-off levels. [ABSTRACT FROM AUTHOR]

Objective: In this study, we investigated the correlation between prostate imaging reporting and data scoring system (PIRADS) grades of patients' prostate lesions detected by multiparametric prostate magnetic resonance imaging (MpMRI) and prostate specific antigen (PSA) values obtained before prostate biopsy and its role in predicting clinically significant cancer in prostatectomy specimens. Materials and Methods: Patients who underwent biopsy and were diagnosed with prostate cancer (PCa) because of positive or negative MpMRI were evaluated. Histopathological factors were recorded, and the relationship between the PIRADS grading system and PSA values was analyzed in patients who underwent radical prostatectomy and preoperative MpMRI. PSA cut-off values predicting clinically significant PCa (CSPCa) in MpMRI were calculated. Results: A total of 1,319 patients were included in the study. MR-fusion biopsy was performed in 58% of the patients, and malignant histopathology was detected in 49% of the patients. While 87% of the patients had CSPCa, 13% had clinically insignificant PCa. The sensitivity and specificity of the PSA 4 ng/mL cut-off value were 88.6% and 15.1% in all patient groups, respectively. In predicting CSPCa, sensitivity was 88.9% and specificity was 18.8% for PSA 4 ng/mL cut-off value in MpMRI-negative patients. If PSA >4 ng/mL in MpMRI-negative patients, there is a >45% PCa detection rate in biopsy, but biopsy is more appropriate for PSA >10 ng/mL for CSPCa. In MpMRI-positive patients, if PSA is >2.5 ng/mL, biopsy provides a >50% PCa and >30% CSPCa diagnosis. If there are PIRADS 5 lesions and PSA is >2.5 ng/mL, biopsy has a >70% PCa and >60% CSPCa detection rate. Conclusions: It may be appropriate to consider higher PSA cut-off values (PSA >10 ng/mL) to make a biopsy decision in patients with negative MpMRI, whereas it may be possible to detect CSPCa at lower PSA values in patients with positive MpMRI findings and high PIRADS grade. [ABSTRACT FROM AUTHOR]

Objective: Testicular tumors can be seen bilaterally in 2-3% of cases as synchronous or metachronous. The long cancer-specific survival in early-stage testicular cancer requires consideration for fertility and quality of life issues because of organ loss in these patients. In the present case series, the surgical outcome and histopathological features of testis-sparing surgery were evaluated using bench work after a standard radical orchiectomy in testicular tumor patients with normal contralateral testis. Materials and Methods: Patients with a testicular mass confirmed by ultrasonography and/or magnetic resonance imaging and normal contralateral testis were included in the study. All patients underwent standard radical orchiectomy. Partial orchiectomy was performed on a separate operating table (bench) following radical orchiectomy. After visual evaluation of the removed tumor mass, seven biopsies were taken from the tumor bed for frozen section examination (FSE). If a residual tumor was found in the tumor bed because of FSE, parenchymal resection was performed until a negative margin was achieved. The patients' age, tumor marker levels, tumor type, tumor diameter, rete testis invasion, epididymis and spermatic cord invasion, necrosis, and presence of lymphatic-vascular invasion were recorded. Results: Sixteen patients were included in the study. The mean age of the patients was 31.6±11.6 years. The mean tumor diameter was 26.9±15.3 mm, and the mean tumor-testicular-volume ratio was 33.2±24.9 percentage. The surgical margin was positive in 12.5% (n=2/16) patients in the FSE. In these two patients, the tumor-testicular volume ratio was above 50%, the tumor diameter was greater than 50 mm, and necrosis and invasion of the tunica albuginea were observed in the final histopathology. The tumor histopathology of patients was pure seminoma, non-seminomatous germ cell tumors, mixed germ cell tumor, sex cord stromal tumor, and fibrosis in 50% (n=8/16), 12.5% (n=2/16), 25% (n=4/16) 6.5% (n=1/16) and 6.5% (n=1/16) of the cases, respectively. Histopathological examination revealed 37.5% (n=6/16) intratubular germ cell neoplasia in the adjacent testicular tissue. Conclusion: Our experience in the present case series shows that testis-sparing surgery is technically straightforward. Surgical margin positivity can be detected in patients with a large tumor or a high tumor-testicular-volume ratio. FSE is useful for detecting surgical margin positivity. [ABSTRACT FROM AUTHOR]

Objective: This report examined the approaches to low-risk patients using the data from the Urologic Cancer Database - Prostate, Urooncology Association. Materials and Methods: In this study, there were 920 patients with low-risk prostate cancer according to the current guidelines of the European Urology Association. Patient data were obtained from the Urological Cancer Database - Prostate, the Turkish Urooncology Association (UroCaD-P) from records of the years 1995-2021. Ethics committee approval was obtained for this study to publish in the form of a database report. Results: Our study was conducted with 920 patients with low-risk prostate cancer. Therefore, at the time of diagnosis, all patients in the study were ISUP 1, had a prostate specific antigen (PSA) level lower than 10 ng/mL, and clinically T1-T2a. Surgical treatment was used in 750 (81.5%) of the patients. At the time patients were retrieved from the database for the study, 140 patients (15.2%) were in the active surveillance (AS) process. Thirty patients (3.2%) in the study received their local treatment as radiotherapy (RT). The mean age value at cancer detection in the study was 61.9. The mean ages of the patients who were under AS and who underwent radical prostatectomy (RP) were 61.3 and 61.7 years, respectively. In the RT group, the mean age was 66.7 years. The mean PSA value of the whole group was 5.81 ng/mL. While it was 5.94 in AS patients, it was calculated as 5.89 in patients who underwent radical surgery. The mean PSA value of the RT group was 5.40. The pathological upgrade was detected in 225 patients (30%) after surgery. Surgical margin positivity was in 160 of the patients (21.3%) who underwent surgery. In addition, 100 patients (13.3%) had extracapsular disease. The seminal vesicle invasion was detected in 25 patients (3.3%) after surgery. Conclusion: We predict that the incidence of low-risk prostate cancer will increase over time due to the aging of the population, the use of PSA, advances in imaging modalities, and increasing biopsy success rates. Therefore, the importance of the existence of multicentric databases containing this patient group is undeniable. More studies are needed with these databases, including both patient demographics and treatment outcomes. Hopefully, this database report will be an important step in this direction. [ABSTRACT FROM AUTHOR]