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178 Abstracts

  • Introduction & Objectives

    The cut-off level of prostate-specific antigen (PSA) at 4.0 ng/ml has been the most important and widely used value in the screening, detection and monitoring of prostate cancer. The aim of this study is to assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0 ng/ml.

    Material & Methods

    Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0 ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml.

    Results

    The detection rate of prostate cancer was 23, 8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/ 32 cases (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml, respectively.

    Conclusions

    The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0 ng/ml.

  • Introduction & Objectives

    We have developed a “prostatocrit” logistic regression model using the differing zones of the gland and their asymmetry of acini to significantly better predict cancer from the benign gland on TRUS biopsy. This model using acinal bulk and PSA and outperforms all conventional forms of PSA densities. We now apply it to suspected differences in growth of prostatic zones, for benign or malignant processes schematic diagram of prostate growth with variation in zones and acinal density.

      BPH All PC RP WGv 1.16 1.16 0.82 WGav 0.81 0.81 0.57 WGsv 0.35 0.35 0.24 TZv 0.89 0.82 0.47 TZav 0.6 0.54 0.29 TZsv 0.29 0.28 0.17 PZv 0.26 0.34 0.34 PZav 0.21 0.27 0.27 PZsv 0.05 0.06 0.06

     

      BPH All PC RP
    PSA 0.23 0.433 0.15
    IPSS 0.03 0.03?  

     

      BPH All PC
    IPSS WGv 0.02 0.02?
    IPSS TZv 0.05 ?
    IPSS PZv 0.03 ?

     
    Slopes densities ng/ml/cc/year

      BPH All PC RP
    WGd 0.0015 0.0065 0.0007
    WGad 0.00218 0.0093 0.0010
    TZd -0.0024 -0.0087 -0.0077
    TZad 0.00233 0.0068 0.0015
    PZd 0.0077 0.01879 0.0031
    PZad -0.00015 0.0093 0.0010

     
     
     
    Slopes ratio

      BPH All PC RP
    PZv/WGv -0.0052 -0.006 -0.0041
    PZav/WGav -0.0060 -0.007 -0.00473
    PZsv/WGsv -0.0035 -0.004 -0.00276
    TZv/WGv 0.8984 0.006 0.0041
    TZav/WGav 0.0060 0.007 0.0047
    TZsv/WGsv 0.0035 0.004 0.00275

    Conclusions

    Benign patients are younger with bigger transition zones. PZ same size in all three groups. Once the PZ reaches its mature volume it does not grow much more after this.  
    PZ/TZ increases with cancer and great PZ acini growth and less TZ stroma growth.
    TZ stroma increases with benign tissue and this was the sole predictor of PSA on multivariate analysis along with age. 
    The IPSS score increases more with TZ growth than with PZ growth.
    Ratio of volumes reflects large positive increases in TZ volumes, acinal/stromal, relative to whole gland with benign glands. Negative ratios with the peripheral zone being outgrown by transition zone in all three groups.
    This offers useful insight into the different growth rates of benign and cancerous glands.

  • Introduction & Objectives

    Peyronie's disease is characterized by formation of hardened scar and fibrous tissue in the tunica albuginea, septum and corpora cavernosa of the penis. Its typical symptoms are the painful bend during erection, which makes sexual intercourse difficult and palpable plaque or tough "cord"  on the dorsal side of the penis. Proper evaluation of the plaque's location and size is important in the choice of treatment method and in the evaluation of the effects of instituted treatment.
    3D ultrasound transducers enable to obtain three-dimensional images and make the evaluation of the examined organ more accurate.
    The aim of this study was to present the examination methods, indications and advantages of three-dimensional ultrasound in the diagnosis of induratio penis plastica (Peironie' s disease) and assessment of the effects of treatment.

    Material & Methods

    3D ultrasound scanning was performed in twelve patients with Peyronie's disease with palpable plaques in the tunica albuginea of the penis. The scanning was carried out with a linear transducer (ultrasonic wave frequency of 12 MHz) positioned transversely to the long axis of the penis and then moved from the root of the penis towards the glans penis. During movement of the transducer, single ultrasound images are obtained and arranged to give an appearance of a three-dimensional image.

    Results

    We obtained the ultrasound images, encoded as "volumetric units", or voxels, and arranged to form a cube, which was later computer-processed, using a specially designed computer program. In addition to traditional longitudinal and transverse views, it enabled to obtain also a coronal view. In patients with Peyronie's disease, this third view is of great importance since it allows for visualization of the whole plaque. Careful image analysis performed after the examination (not in the patient's presence) allowed to identify other, smaller plaques which were not observed prior to examination.

    Conclusions

    l. 3D ultrasound diagnosis allows for more accurate evaluation of pathologic changes in the tunica albuginea of the penis in Peyronie's disease.
    2. Final evaluation involving analysis of obtained images is done after the examination and not in the patient's presence.
    3. Examination time is shortened when compared with two-dimensional ultrasound.

  • Introduction & Objectives

    To evaluate a possible role for prophylactic irradiation of the pelvic lymph-nodal area (WPRT) in the postoperative setting for prostate cancer (PCa) in increasing the risk of potentially radiation-induced second malignancies (SM).

    Material & Methods

    From 1993 to 2011, 1109 patients (pts) (median age=65 years) were treated with postoperative ADV (n=739) or SALV (n=370) non conformal RT (n=169), 3DCRT (n=670) or static-fields IMRT (SS-IMRT, n=57) at 1.80 Gy/fr (median dose=70.2Gy), with moderately hypofractionated regimens (median dose=2.35Gy/fr) with Tomotherapy (n=213) at a median 2Gy equivalent (EQD2, α/β=3) dose of 70Gy. WPRT was delivered to 336 pts at a median EQD2 dose of 50 Gy. 510 pts received adjuvant hormonal therapy for a median of 21 months. The median follow-up (FU) was 124 months.

    Results

    139 pts developed SM, including 73 in-field (IN) and 66 out-field (OUT), after a median of 65, 80 and 56 months, respectively. At univariate analysis, there was no statistical difference of 10-year risk SM/IN/OUT for pts receiving prostatic bed (PB) only or PB+WPRT (Figure 1a). No role emerged for RT dose, technique or fractionation. A borderline predictive role of the 10-year risk of SM was found in patients experiencing any (acute/late) GU+GE Grade≥2 (p=0.12), while GE and GU G≥2 showed a correlation with the risk of IN (p=0.21) and OUT (p=0.12), respectively. Age showed a statistically significant correlation with the risk of SM (p≤0.05). Of note, only for patients treated with WPRT, a slight correlation between IMRT techniques and increased risk of OUT (p= 0.26, HR= 1.78) emerged (Figure 1b). Multivariable analysis, including all variables with p65 years in all subgroups.

    Conclusions

    Though preliminary, this study does not indicate any additive risk of SM arising from the use of prophylactic WPRT in the postoperative setting for PCa. Overall, the risk of SM development appeared fundamentally as a function of aging. Nevertheless, in the sole pts treated with WPRT a slight correlation, absolutely to be confirmed, between IMRT techniques and risk of OUT emerged. An analysis focused on tumours arose at least 5 years after RT has been precluded owing  the low number of events (n=47, 4%).

  • Introduction & Objectives

    Open radical cystectomy (ORC) with extended pelvic node dissection remains as the gold standard treatment for patients with localized muscle invasive bladder cancer (MIBC) and for those with high-risk recurrent noninvasive disease. Laparoscopic radical cystectomy (LRC) was first reported in 1992 and since then is an alternative to ORC. However, according to the EAU guidelinesthis technique is still experimental because of the limited number of cases reported, an absence of long-term oncological and functional outcome data, and a possible selection bias. The aim of the present study is to evaluate the short and midterm oncologic outcomes of patients who underwent LRC in the last 10 years.

    Material & Methods

    From January 2005 to December 2012, a total of 218 LRC with lymph node dissection and ileal conduit or ileal neobladder were performed in our institution. Data have been analysed at the biostatistics section. Descriptive results are shown in terms of absolute values, mean, median, range, and percentages. Analysis for overall survival (OS), cancer specific survival (CSS) and recurrence-free survival (RFS) was performed with Kaplan-Maier.

    Results

    The descriptive and surgical data of the series is summarized in table 1. Most of the tumours were transitional cell carcinomas. Follow up time was 66 months. Local recurrence was diagnosed in 8 patients (3.6%) and distant recurrence in 28 (12.8%). The estimated 5-yr OS, CSS and RFT rates were 63,91%, 70,59% y 71,14% respectively.

    Table 1.
    Age 66 years *
    Gender Male:  85 %                 Female: 15 %
    Pathological stage  
    ≤ pT1 17 %
    pT2 19 %
    pT3 39 %
    pT4 25 %
    Lymph nodes 15
    pNx / pN- / pN+ pNx: 17% / pN-:51% / pN+: 32%
    Time to surgery 60 days *
    Heterotopic urinary diversion 76 %
    Orthotropic urinary diversion 24 %
    Surgical time Heterotopic urinary diversion: 312 mins. *
    Orthotropic urinary diversion: 422 mins. *
    Surgical Margins  
    ≤ pT1 0 %
    pT2 0 %
    pT3 5,8 %
    pT4 13,5 %
    Total 5,2 %
    Hospital stay 13 days
    Complications (Clavien-Dindo)  
    I and II 49 %
    III 7 %
    IV 2 %
    V 0.4 %
    Perioperative chemotherapy 35,7 %

    Conclusions

    LRC may be the technique of choice for all cases of MIBC and for those with high-risk recurrent noninvasive disease in specialized centers as shown in our results. Further investigation should analyses risk factors for oncological outcomes after LRC.

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