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MP17-16 URETHRA-SPARING TREATMENT WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR LOCALIZED PROSTATE CANCER
THE JOURNAL OF UROLOGYâ
e182
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
histology was 56%. Statistical evaluation of sensitivity, specificity and PPV in comparison to the experience levels showed significant difference between the groups (gp1: Sens.: 0.90, spec.: 0.23, PPV: 0.70; gp2: 0.81, 0.36, 0.67; gp3: 0.79, 0.41, 0.76; gp4: 0.91, 0.45, 0.83) (p<0.05). CONCLUSIONS: Overall these results show a high sensitivity for organ-confined tumors but a low sensitivity in T3 stage and low specificity in organconfined tumors due to the results of the unexperienced groups. The evaluation showed a significant correlation between the staging quality and the experience level of the physicians. Education and training in TRUS is highly recommended as long as the optimal preoperative staging is still under debate. Source of Funding: none Source of Funding: none
MP17-16 URETHRA-SPARING TREATMENT WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR LOCALIZED PROSTATE CANCER Sunao Shoji*, Mayura Nakano, Tetsuro Tomonaga, Hiroshi Fujikawa, Kazuyuki Endo, Akio Hashimoto, Toshiro Terachi, Toyoaki Uchida, Hachioji, Japan INTRODUCTION AND OBJECTIVES: To evaluate the oncological outcomes and the longitudinal change in quality of life (QOL) of patients treated with urethra-sparing high-intensity focused ultrasound (HIFU), compared with whole-gland HIFU for localized prostate cancer. METHODS: Patients receiving urethra-sparing or whole-gland HIFU (Sonablateâ) as the primary therapy for localized prostate cancer without transurethral resection of the prostate were included in the study. Patients with negative findings of the transition zone biopsies and magnetic resonance imaging received urethra-sparing HIFU. Oncological and functional outcomes, along with longitudinal changes in QOL were analyzed. RESULTS: Comparing the patients treated with urethrasparing (n¼54) (Fig.1a) with those treated with whole-gland HIFU (n¼254), there were no significant differences in negative biopsy rates upon follow-up (83% vs. 87%; p¼0.4) or biochemical disease-free survival rates (BDFS) (81% vs. 77%; p¼0.5) (Fig.1b). In functional outcomes, there were significant differences in International Prostate Symptom Score (IPSS) (11 vs. 14, p¼0.022) at 3 months, IPSS QOL (3 vs. 4, p¼0.038) at 3 months, maximum urinary flow rate (mL/s) (12.8 vs. 9.4 at 3 months, p¼0.014; 13.2 vs. 11.2 at 6 months, p¼0.048), and residual urine volume (mL) (32 vs. 58 at 3 months, p<0.0001; 30 vs. 38 at 6 months, p¼0.010; at 12 months, p¼0.038). In QOL, there were significant differences in Functional Assessment of Cancer Therapy - General (FACT-G) (90 vs. 80 at 3 months, p¼0.020) and FACT-Prostate (P) (36 vs. 30 at 3 months, p¼0.030; 37 vs. 32 at 6 months, p¼0.044), but no significant difference in International Index of Erectile Function (IIEF) -5. In complication rates, there was a significant difference in the rate of urethral stricture at 6 months (5.6% vs. 16% within 3 months, p¼0.044; 3.7% vs. 10% from 4 to 6 months, p¼0.048), but no significant difference in erectile function at 24 months (63% vs. 65%, p¼0.8). CONCLUSIONS: There was no significant difference in the oncological outcomes between urethra-sparing and whole-gland HIFU patients in this study. However, the urinary function of patients treated with urethra-sparing HIFU was superior to patients treated with whole gland HIFU within 6 months post-treatment.
MP17-17 SIGNIFICANCE OF URETHRAL FIBROSIS EVALUATED BY PREOPERATIVE MAGNETIC RESONANCE IMAGING AS A PREDICTOR OF CONTINENCE STATUS AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Hiroyuki Momozono*, Hideaki Miyake, Akira Miyazaki, Masato Fujisawa, Kobe, Japan INTRODUCTION AND OBJECTIVES: The urethra is shown to be susceptible to fibrotic changes associated with several factors, including inflammation and aging, which could exert a negative impact on the urethral function; however, no data have been reported with respect to the significance of the presence of urethral fibrosis as a demographic risk factor for predicting the postoperative continence status in patients undergoing radical prostatectomy (RP). The objective of this study was to assess the impact of urethral fibrosis on the continence status following robot-assisted RP (RARP). METHODS: This study included a total of 185 consecutive patients with prostate cancer who underwent RARP. The findings of fibrosis of the urethral wall and periurethral tissue were each divided into grade 0 to 3 (grade 0, no fibrosis; grade 1: fibrosis involving onethird of the circumference; grade 2: fibrosis involving two-thirds of the circumference and grade 3: circumferential fibrosis) based on preoperatively performed T2-weighted 3-Tesla magnetic resonance imaging (MRI) as previously described (Paparel et al, Eur Urol 2009; 55: 629). Urethral fibrosis was defined as the sum of the fibrotic grades in both areas, and a score 2 and that 3 were considered as mild and severe fibrosis, respectively. Postoperative urinary continence was defined as the absence of pad use. RESULTS: Of the 185 patients, 135 (73.0%) and 50 (27.0%) were judged to be mild and severe fibrosis, respectively, and there were no significant differences in several parameters between these two groups. In this series, at 1, 3, 6 and 12 months after RARP, 166 (89.7%), 118 (63.8%), 67 (36.2%) and 50 (27.0%) were judged to be incontinent. Despite the lack of a significant difference in the continence status at 1 month after RARP between the mild and severe fibrosis groups, the incidences of urinary continence in patients with mild fibrosis were significantly higher at 3, 6 and 12 months after RARP than those in patients with severe fibrosis. Logistic regression analyses of several factors identified significant predictors of the postoperative continence status, as follows: age at 12 months after RARP, and urethral fibrosis at 3, 6 and 12 months after RARP. CONCLUSIONS: These findings suggest that semiquantitative assessment of urethral fibrosis based on the preoperative findings of MRI could be a significant predictor of recovery of the urinary continence status in patients with prostate cancer after RARP. Source of Funding: none
e182
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
histology was 56%. Statistical evaluation of sensitivity, specificity and PPV in comparison to the experience levels showed significant difference between the groups (gp1: Sens.: 0.90, spec.: 0.23, PPV: 0.70; gp2: 0.81, 0.36, 0.67; gp3: 0.79, 0.41, 0.76; gp4: 0.91, 0.45, 0.83) (p<0.05). CONCLUSIONS: Overall these results show a high sensitivity for organ-confined tumors but a low sensitivity in T3 stage and low specificity in organconfined tumors due to the results of the unexperienced groups. The evaluation showed a significant correlation between the staging quality and the experience level of the physicians. Education and training in TRUS is highly recommended as long as the optimal preoperative staging is still under debate. Source of Funding: none Source of Funding: none
MP17-16 URETHRA-SPARING TREATMENT WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR LOCALIZED PROSTATE CANCER Sunao Shoji*, Mayura Nakano, Tetsuro Tomonaga, Hiroshi Fujikawa, Kazuyuki Endo, Akio Hashimoto, Toshiro Terachi, Toyoaki Uchida, Hachioji, Japan INTRODUCTION AND OBJECTIVES: To evaluate the oncological outcomes and the longitudinal change in quality of life (QOL) of patients treated with urethra-sparing high-intensity focused ultrasound (HIFU), compared with whole-gland HIFU for localized prostate cancer. METHODS: Patients receiving urethra-sparing or whole-gland HIFU (Sonablateâ) as the primary therapy for localized prostate cancer without transurethral resection of the prostate were included in the study. Patients with negative findings of the transition zone biopsies and magnetic resonance imaging received urethra-sparing HIFU. Oncological and functional outcomes, along with longitudinal changes in QOL were analyzed. RESULTS: Comparing the patients treated with urethrasparing (n¼54) (Fig.1a) with those treated with whole-gland HIFU (n¼254), there were no significant differences in negative biopsy rates upon follow-up (83% vs. 87%; p¼0.4) or biochemical disease-free survival rates (BDFS) (81% vs. 77%; p¼0.5) (Fig.1b). In functional outcomes, there were significant differences in International Prostate Symptom Score (IPSS) (11 vs. 14, p¼0.022) at 3 months, IPSS QOL (3 vs. 4, p¼0.038) at 3 months, maximum urinary flow rate (mL/s) (12.8 vs. 9.4 at 3 months, p¼0.014; 13.2 vs. 11.2 at 6 months, p¼0.048), and residual urine volume (mL) (32 vs. 58 at 3 months, p<0.0001; 30 vs. 38 at 6 months, p¼0.010; at 12 months, p¼0.038). In QOL, there were significant differences in Functional Assessment of Cancer Therapy - General (FACT-G) (90 vs. 80 at 3 months, p¼0.020) and FACT-Prostate (P) (36 vs. 30 at 3 months, p¼0.030; 37 vs. 32 at 6 months, p¼0.044), but no significant difference in International Index of Erectile Function (IIEF) -5. In complication rates, there was a significant difference in the rate of urethral stricture at 6 months (5.6% vs. 16% within 3 months, p¼0.044; 3.7% vs. 10% from 4 to 6 months, p¼0.048), but no significant difference in erectile function at 24 months (63% vs. 65%, p¼0.8). CONCLUSIONS: There was no significant difference in the oncological outcomes between urethra-sparing and whole-gland HIFU patients in this study. However, the urinary function of patients treated with urethra-sparing HIFU was superior to patients treated with whole gland HIFU within 6 months post-treatment.
MP17-17 SIGNIFICANCE OF URETHRAL FIBROSIS EVALUATED BY PREOPERATIVE MAGNETIC RESONANCE IMAGING AS A PREDICTOR OF CONTINENCE STATUS AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Hiroyuki Momozono*, Hideaki Miyake, Akira Miyazaki, Masato Fujisawa, Kobe, Japan INTRODUCTION AND OBJECTIVES: The urethra is shown to be susceptible to fibrotic changes associated with several factors, including inflammation and aging, which could exert a negative impact on the urethral function; however, no data have been reported with respect to the significance of the presence of urethral fibrosis as a demographic risk factor for predicting the postoperative continence status in patients undergoing radical prostatectomy (RP). The objective of this study was to assess the impact of urethral fibrosis on the continence status following robot-assisted RP (RARP). METHODS: This study included a total of 185 consecutive patients with prostate cancer who underwent RARP. The findings of fibrosis of the urethral wall and periurethral tissue were each divided into grade 0 to 3 (grade 0, no fibrosis; grade 1: fibrosis involving onethird of the circumference; grade 2: fibrosis involving two-thirds of the circumference and grade 3: circumferential fibrosis) based on preoperatively performed T2-weighted 3-Tesla magnetic resonance imaging (MRI) as previously described (Paparel et al, Eur Urol 2009; 55: 629). Urethral fibrosis was defined as the sum of the fibrotic grades in both areas, and a score 2 and that 3 were considered as mild and severe fibrosis, respectively. Postoperative urinary continence was defined as the absence of pad use. RESULTS: Of the 185 patients, 135 (73.0%) and 50 (27.0%) were judged to be mild and severe fibrosis, respectively, and there were no significant differences in several parameters between these two groups. In this series, at 1, 3, 6 and 12 months after RARP, 166 (89.7%), 118 (63.8%), 67 (36.2%) and 50 (27.0%) were judged to be incontinent. Despite the lack of a significant difference in the continence status at 1 month after RARP between the mild and severe fibrosis groups, the incidences of urinary continence in patients with mild fibrosis were significantly higher at 3, 6 and 12 months after RARP than those in patients with severe fibrosis. Logistic regression analyses of several factors identified significant predictors of the postoperative continence status, as follows: age at 12 months after RARP, and urethral fibrosis at 3, 6 and 12 months after RARP. CONCLUSIONS: These findings suggest that semiquantitative assessment of urethral fibrosis based on the preoperative findings of MRI could be a significant predictor of recovery of the urinary continence status in patients with prostate cancer after RARP. Source of Funding: none