The forum focused on talks and presentations with discussions covering almost all areas of prostatic diseases, including both benign prostatic conditions and prostate cancer, their diagnosis, ...imaging, multidisciplinary treatment, and preventive care. There were six sessions on benign prostatic hyperplasia (BPH) and chronic prostatitis, screening and imaging for prostate cancer, molecular markers and pathology of prostate cancer, localized prostate cancer, metastatic prostate cancer, and challenging cases in prostate cancer. The topics discussed during this meeting were NIH perspective on benign prostatic disease, innovations in medical and surgical treatment of BPH, prostate biopsy, prebiopsy imaging in prostate cancer, prevention and early detection of prostate cancer, new molecular markers in prostate cancer, genomic classifiers in prostate cancer, Gleason scoring to prognostic grade grouping, circulating tumor cells and their role in prostate cancer, update on histopathological evaluation of lymphadenectomy specimens from prostate cancer patients, androgen deprivation therapy in localized prostate cancer, radical prostatectomy in patients older than 75 years, focal treatment in prostate cancer, role of open radical prostatectomy, continence increasing measures at radical prostatectomy, surgery for high-risk prostate cancer, role of chemotherapy in advanced prostate cancer, how to handle surgical margin positivity, timing of antiandrogens in metastatic prostate cancer, current concepts of treatment of bone metastasis in prostate cancer, mechanisms and treatment of castration resistance in prostate cancer, multimodal treatment in prostate cancer, immunotherapy in prostate cancer, and who should treat castration-resistant prostate cancer: urologist or medical oncologist?
In this study, we evaluated the role of the Prostate Imaging–Reporting and Data System (PI‐RADS) classification of multiparametric magnetic resonance imaging (mpMRI) to determine the likelihood of ...prostate cancer (PCa) in patients with haemospermia. Fifty‐one patients presenting with haemospermia between 2018 and 2020 were included in this retrospective study. Forty‐two of the patients (82.4%) were over 40 years, and the median prostate‐specific antigen (PSA) level was 1.4 ng/ml. Fourteen of the patients (27.5%) had recurrent haemospermia. All patients underwent mpMRI, and assessments were classified according to PI‐RADS v2. The mpMRI revealed PI‐RADS one to four lesions in 10 (19.6%), 30 (58.8%), 6 (11.8%) and 5 (9.8%) patients respectively. One patient with PI‐RADS 3 and five with PI‐RADS 4 lesions underwent cognitive fusion prostate biopsy depending on MRI findings, and two patients with PI‐RADS 4 lesions were diagnosed with PCa. Patients with haemospermia and risk factors, that is aged over 40 years, a high PSA level or familial history of PCa, need a more thorough evaluation with mpMRI.
Objective
After radical prostatectomy, prostate‐specific antigen(PSA) value measuring ≥0.1 ng/mL is defined as persistent PSA(pPSA) and in many studies, it was found to be associated with aggressive ...disease and poor prognosis. Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot‐assisted radical prostatectomy(RARP) in an experienced academic centre and to make a useful risk grouping algorithm that can predict pPSA value based on operative data.
Methods
We examined records of 1273 patients who underwent RARP retrospectively. Preoperative, operative and postoperative data were collected. Based on the PSA values (ng/mL) measured after 4‐to‐8 weeks of RARP, patients were divided into two groups as pPSA group (Group1)(n = 97) with PSA values ≥0.1 ng/mL and undetectable PSA group (Group2)(n = 778) with PSA values <0.1 ng/mL. Later on, Group1 was further divided into Group1a (PSA:0.1‐0.2 ng/mL) and Group 1b (PSA≥0.2 ng/mL) to evaluate biochemical recurrence(BCR).
Results
Multivariate logistic regression analyses of the collected data revealed that preoperative PSA≥20 ng/mL, operation time, a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3‐4 and pN were independently associated with pPSA. Based on these results, a risk grouping algorithm predicting pPSA was developed. By looking at the risk grouping algorithm pPSA was found in 98.9% of the cases with a preoperative PSA value of ≥20 ng/mL, an operation time of 150 min, a postoperative ISUP grade of 4‐5, a positive lymphovascular invasion (LVI) status, pT3‐T4, and pN+; while pPSA was found in 25.5% of the cases with a preoperative PSA value of <20 ng/mL, an operation time of 100 min, a postoperative ISUP grade of <4‐5, a negative LVI status, pT<3‐4 and pN‐. The estimated BCR‐free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (P < .001). Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (P < .001).
Conclusion
For the patients who underwent RARP, factors associated with aggressive disease can predict the PSA persistence. To plan our treatment modalities accurately, an applicable risk grouping algorithm in daily practice would be useful.
To evaluate the influence of previous experience as bedside assistants on patient selection, perioperative and pathological results in robot assisted laparoscopic radical prostatectomy.
The first 50 ...cases of two robotic surgeons were reviewed retrospectively. Group 1 consisted of the first 50 cases of the surgeon with previous experience as a robotic bedside assistant between September 2016-July 2018, while group 2 included the first 50 cases of the surgeon with no bedside assistant experience between February 2009-December 2009. Groups were examined in terms of demographics, prostate volume, presence of median lobe, prostate specific antigen (PSA), preoperative Gleason score, positive core number, clinical stage, console surgery time, estimated blood loss, postoperative Gleason score, pathological stage, positive surgical margin rate, postoperative complications, length of hospital stay and biochemical recurrence rate.
Previous abdominal surgery and the presence of median lobe hypertrophy rates were higher in Group 1 than in Group 2 (20% vs. 4%, p=0.014; 24% vs. 6%, p=0.012; respectively). In addition, patients in Group 1 were in a higher clinical stage than those in Group 2 (cT2: 70% vs. 28%, p=0.001). Median console surgery time and median length of hospital stay was significantly shorter in Group 1 than in Group 2 (170 min vs. 240 min, p=0.001; 3 vs. 4, p=0.022; respectively). Clavien grade 3 complication rate was higher in Group 2 but was statistically insignificant.
Our findings might reflect that previous bedside assistant experience led to an increase in self-confidence and the ability to manage troubleshooting and made it more likely for surgeons to start with more difficult cases with more challenging patients. It is recommended that novice surgeons serve as bedside assistants before moving on to consoles.
Objective: This study aimed to assess the urethrovesical anastomotic leakage (UAL) and associated factors in patients who underwent robot-assisted radical prostatectomy (RARP) and its effect on early ...continence. Material and Methods: The data of 81 patients who underwent RARP between February 2017 and June 2022 were evaluated in this retrospective analysis. On the seventh postoperative day, we performed a cystography to determine whether the patients had UAL. Uni- and multivariate analyses were done to investigate the factors that could lead to UAL. Continence rates were recorded in patients at 6-12 weeks after surgery. Results: Overall 25 patients (31%) had UAL; of them 12 (15%) were mild, eight (10%) were moderate, and five (6%) were extensive. A drain/ serum creatinine ratio >1.5 and a prostate volume >53 cm3 were determined to be significant in predicting UAL in both the uni- and multivariate analyses (p=0.017 and p=0.046, respectively). On the postoperative second or third day, of the 36 patients who had drain output greater than 100 ml, eight (22%) had a high drain/serum creatinine ratio (>1.5), seven (88%) of which had UAL. According to the early period follow-up data, incontinence was prevalent in 9 (36%) of the patients with UAL and 20 (%37) of the patients without UAL (p=0.959). Conclusion: Cystography is an effective method for detecting leakage after RARP. A large prostate volume (>53 cm3) and a high postoperative drain/serum creatinine ratio (>1.5) were found to be associated with UAL. UAL had no effect on early continence. Keywords: anastomotic leak, cystography, prostatectomy, robot-assisted, urinary incontinence
Around 20%-30% of patients diagnosed with prostate cancer (PCa) still have high-risk PCa disease (HRPC) that requires aggressive treatment. Treatment of HRPC is controversial, and multimodality ...therapy combining surgery, radiation therapy, and androgen deprivation therapy have been suggested. There has been a trend toward performing radical prostatectomy (RP) in HRPC and currently, robot-assisted laparoscopic RP (RARP) has become the most common approach. Number of publications related to robotic surgery in HRPC is limited in the literature. Tissue and Tumor characteristics might be different in HRPC patients compared to low-risk group and increased surgical experience for RARP is needed. Due to the current literature, RARP seems to have similar oncologic outcomes including surgical margin positivity, biochemical recurrence and recurrence-free survival rates, additional cancer therapy needs and lymph node (LN) yields with similar complication rates compared to open surgery in HRPC. In addition, decreased blood loss, lower rates of blood transfusion and shorter duration of hospital stay seem to be the advantages of robotic surgery in this particular patient group. RARP in HRPC patients seems to be safe and technically feasible with good intermediate-term oncologic results, acceptable morbidities, excellent short-term surgical and pathological outcomes and satisfactory functional results.
To compare the patients who underwent robot assisted radical cystectomy (RARC) and extended pelvic lymph node dissection (EPLND) and whose pathology result was reported as micropapillary variant ...(MV), plasmacytoid variant (PV) and pure urothelial carcinoma (PUC).
The data of 133 patients who underwent RARC and EPLND with the postoperative pathology results reported as MV, PV and PUC were analyzed. According to the postoperative pathology results, patients were divided into two groups in initial analyses as variant pathologies group (n=14) and PUC group (n=119). In secondary analyses, patients were divided into three groups as MV group (n=7), PV group (n=7) and PUC group (n=119). The operative data, oncologic outcomes and complications were compared between the groups.
Median operation time and estimated blood loss were significantly increased in variant pathologies group (P <0.001 and P = .001, respectively). The postoperative pathological T stage, positive surgical margin rate and lymph node involvement were also significantly increased in variant pathologies (P = .001, P = 0.004, P <0.001, respectively). Kaplan-Meier analysis revealed significant decrease in OS and CSS times in PV group compared to PUC group (P = .048 and P = .016, respectively).
MV and PV are rarely seen variant pathologies with higher pathological T stages. RARC is a minimally invasive surgical technique that can be performed successfully by an experienced surgical team with low morbidity rates and similar oncological results, even in challenging cases.
We present operative, postoperative, oncologic and functional outcomes of genital tract sparing robot-assisted laparoscopic radical cystectomy, bilateral extended pelvic lymph node (LN) dissection ...and intracorporeal Studer pouch construction on five female patients with bladder cancer. One of the cases had concomitant nephroureterectomy performed due to a non-functioning kidney. Median patient age, mean operation time, median estimated blood loss and mean duration of hospital stay were 59 (39-78), 462 ± 25, 400 (50-970), 8.8 ± 2.5, respectively. Pathologic stages were pTis (n=1), pT1 (n=1), pT3 (n=1), pT4a (n=1) and pT4b (n=1). Mean LN yield was 32.4 ± 8.9. Positive surgical margins were detected in 2 patients with pT4 diseases. Only minor complications developed that were resolved with medical treatment. Two patients had no, 1 patient had mild, and 2 patients had moderate daytime incontinence. One patient had good, 3 patients had fair, and 1 had poor night-time incontinence. This complex robotic surgery can be performed safely with acceptable short-term surgical, oncological and functional outcomes.
OBJECTIVEThe aim of this study is to compare systematic, cognitive fusion, in-bore, and software fusion prostate biopsies regarding rates of and risk factors for pathological upgrading. MATERIAL AND ...METHODSCharts of 291 patients with systematic biopsy (n = 105), magnetic resonance imaging- targeted cognitive fusion (n = 58), in-bore (n = 68), and software fusion biopsy (n = 60), and who subsequently underwent radical prostatectomy were retrospectively evaluated. The degree of similarity between the grade groups reported in the biopsy and radical prostatectomy pathology results was recorded. Analyses of the associated factors for concordance and discordance were performed with univariate and multivariate methods. RESULTSThe concordance rates were as follows: systematic biopsy = 42.8%, cognitive fusion-targeted biopsy = 50%, in-bore fusion-targeted biopsy = 61.8, and software fusion biopsy = 58.4%. The upgrade rate of systematic biopsy (46.6%) was higher than cognitive fusion-targeted biopsy (27.6%), in-bore fusiontargeted biopsy (26.4%), and software fusion-targeted biopsy (18.3%). The number of positive cores was significantly associated with grade group concordance for the systematic biopsy group (P = .040). Within the cognitive fusion-targeted biopsy cohort, number of positive cores was the only parameter that exhibited a significant association with grade group concordance in multivariate analysis (P = .044). Considering the in-bore fusion-targeted biopsy group, maximum tumor length was statistically significant (P = .021). In the software fusion-targeted biopsy group, low prostate volume was found to be the only significant predictor for grade group accordance (P = .021). CONCLUSIONMagnetic resonance imaging-targeted biopsy techniques showed higher concordance and lower upgrade rates compared to systematic biopsy. For systematic biopsy and cognitive fusion-targeted biopsy, the number of positive cores was associated with grade group concordance, while maximum tumor length in in-bore fusion-targeted biopsy and low prostate volume for in-bore fusion-targeted biopsy were associated with grade group concordance. Among the MRI-targeted biopsy methods, in-bore fusion-targeted biopsy and software fusion-targeted biopsy were more accurate than cognitive fusion-targeted biopsy in terms of grade group.
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