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MP3-19 DEEPGREEN: PROSPECTIVE MRI EVALUATION OF TISSULAR EFFECTS AFTER PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE WITH GREENLIGHT AMS XPS-180W
THE JOURNAL OF UROLOGYâ
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Source of Funding: none
MP3-19 DEEPGREEN: PROSPECTIVE MRI EVALUATION OF TISSULAR EFFECTS AFTER PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE WITH GREENLIGHT AMS XPS-180W Romain Huet*, Romain Mathieu, Tanguy Rohou, Gregory Verhoest, bastien Vincendeau, Rennes, France Karim Bensalah, Se INTRODUCTION AND OBJECTIVES: Photoselective vaporization of the prostate (PVP) is an alternative to transurethral resection of the prostate (TURP). PVP could provide a better hemostatic effect due to a coagulation depth of several millimeters. The objective of the study was to prospectively evaluate tissular consequences of PVP on MRI. METHODS: We prospectively collected the data of ten patients who underwent PVP with the Greenlightâ laser 180-W XPS by a single surgeon from december 2013 to february 2014. A multiparametric MRI of the prostate (Siemens 3T Verio) was performed the day before surgery and during postoperative period two days, seven days, three and six months after the procedure. Inflammation and depth of necrosis in the prostatic and periprostatic tissues were evaluated in six different areas. Inflammation was evaluated using a score from 0 to 3 based on MRI signal in diffusion sequences. RESULTS: Mean age and prostatic volume were 69 y (64e76) and 53mL (22e76), respectively. Mean Qmax and postvoid residual volume were 6.1ml/s (4.6-10) and 84ml (0e200), respectively. Mean energy delivered was 3.13 KJ/ml of prostate (0.93-5.38) and mean total laser time was 28.9 min (7e49). None postoperative complication was reported. Two days after procedure, mean depth of necrosis was 1.2 mm (0e4) and mean periprostatic oedema was 1.2 (0 to 3). Results were similar on seven day MRI. No necrosis or inflammation was reported three and six months after procedure. CONCLUSIONS: We demonstrated depth of necrosis after PVP with Greenlight XPS 180W is low and homogeneous. Risk for injuries of noble adjacent structures is limited Source of Funding: none
MP3-20 PREDICTORS OF PERIOPERATIVE COMPLICATIONS AND REOPERATION IN PATIENTS TREATED WITH PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE € ller, Gernot Bonkat, Jan Ebbing, Malte Rieken*, Sanwei Guo, Georg Mu Thomas Gasser, Alexander Bachmann, Basel, Switzerland INTRODUCTION AND OBJECTIVES: We aimed to characterize predictors of perioperative complications and surgical reintervention within the first two years after photoselective vaporization of the prostate (PVP) for symptomatic prostate enlargement (BPE). METHODS: Retrospective analysis of a single center cohort of 771 patients who underwent PVP with the 80-W KTP, 120-W HPS, and
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
180-W XPS GreenLight laser between 2002 and 2013. Binominal logistic regression analyses addressed factors associated with intra- and perioperative complications. Uni- and multivariable Cox regression analyses assessed the association of various clinical and surgical parameters with reoperation. RESULTS: Of 771 patients, 370 (48.0%), 187 (24.3) and 214 (27.8%) underwent PVP with the 80-W KTP, 120-W HPS, and 180-W XPS-laser, respectively. Median age was 68 years (Interquartile range (IQR): 12), median PSA 2.5 ng/ml (IQR: 3.4), and median prostate volume 45 ml (IQR: 25). Of the patients, 199 (25.8%) were in retention at time of surgery. Intraoperative bleeding was noted in 70 (9.1%) patients. Use of the 120-W laser (OR: 6.65, 95% CI 3.48-12.70, p<0.0001) and 180-W laser (OR: 2.19, 95% CI 1.04-4.63, p¼0.04) was associated with increased risk of intraoperative bleeding compared to the 80-W laser. Ongoing platelet aggregation therapy or oral anticoagulation was not associated with increased risk of intraoperative bleeding (p>0.05). Retention during hospitalization with the need for catheterization occurred in 67 (8.7%) patients. Preoperative catheterization (OR: 2.34, 95% CI 1.37-4.01, p¼0.002) was associated with increased risk of postoperative retention. During 2-years follow-up, 49 (6.4%), 10 (1.3%), and 17 (2.2) patients has to undergo reoperation due to persistent or recurrent adenoma, urethral stricture, and bladder neck stricture, respectively. No significant association of clinical and surgical parameters or laser generation with risk of reoperation due to recurrent or persistent adenoma or urethral stricture could be detected. In contrast, incidence of bladder neck sclerosis was significantly associated with prostate volume < 40 ml (HR 3.65, 95% CI 1.41-9.47, p¼0.008). CONCLUSIONS: Reoperation within the first 2 years after PVP does not seem to be associated with laser type. Prostate volume < 40 ml is significantly associated with increased risk of reoperation due to bladder neck sclerosis. Our results may help patients counseling and treatment decision-making regarding the choice of technique for BPE surgery. Source of Funding: none
Prostate Cancer: Epidemiology & Natural History I Moderated Poster 4 Friday, May 15, 2015
10:30 AM-12:30 PM
MP4-01 DEVELOPMENT OF INTERMEDIATE AND HIGH-RISK PROSTATE CANCER AFTER TESTICULAR CANCER Andrew Riggin*, M. Minhaj Siddiqui, Baltimore, MD INTRODUCTION AND OBJECTIVES: A history of testicular cancer has been suggested to have an association with an increased risk of developing prostate cancer (PCa) in epidemiology studies. We hypothesized that there may be an increased risk of developing intermediate to high-risk PCa as well. METHODS: This is a retrospective case-control study. The Surveillance, Epidemiology and End Results (SEER) registry was queried to identify men with a history of testicular cancer (case group) and men with a history of melanoma (controls). Melanoma was used as a control group because, to our knowledge, there is no association of melanoma and PCa. Men were excluded if they were not 40 years of age or older to allow for sufficient age for PCa diagnosis. PCa incidence was only counted if it occurred at least 5 years after the diagnosis of their primary cancer to allow for possible temporal effect of the primary malignancy. Incidence of total and intermediate to high-risk PCa(Gleason score 7) was compared using Kaplan-Meier (KM) curves. Cox proportional hazards models were utilized to assess for associations of PCa (JMP 10, SAS Inc).
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Source of Funding: none
MP3-19 DEEPGREEN: PROSPECTIVE MRI EVALUATION OF TISSULAR EFFECTS AFTER PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE WITH GREENLIGHT AMS XPS-180W Romain Huet*, Romain Mathieu, Tanguy Rohou, Gregory Verhoest, bastien Vincendeau, Rennes, France Karim Bensalah, Se INTRODUCTION AND OBJECTIVES: Photoselective vaporization of the prostate (PVP) is an alternative to transurethral resection of the prostate (TURP). PVP could provide a better hemostatic effect due to a coagulation depth of several millimeters. The objective of the study was to prospectively evaluate tissular consequences of PVP on MRI. METHODS: We prospectively collected the data of ten patients who underwent PVP with the Greenlightâ laser 180-W XPS by a single surgeon from december 2013 to february 2014. A multiparametric MRI of the prostate (Siemens 3T Verio) was performed the day before surgery and during postoperative period two days, seven days, three and six months after the procedure. Inflammation and depth of necrosis in the prostatic and periprostatic tissues were evaluated in six different areas. Inflammation was evaluated using a score from 0 to 3 based on MRI signal in diffusion sequences. RESULTS: Mean age and prostatic volume were 69 y (64e76) and 53mL (22e76), respectively. Mean Qmax and postvoid residual volume were 6.1ml/s (4.6-10) and 84ml (0e200), respectively. Mean energy delivered was 3.13 KJ/ml of prostate (0.93-5.38) and mean total laser time was 28.9 min (7e49). None postoperative complication was reported. Two days after procedure, mean depth of necrosis was 1.2 mm (0e4) and mean periprostatic oedema was 1.2 (0 to 3). Results were similar on seven day MRI. No necrosis or inflammation was reported three and six months after procedure. CONCLUSIONS: We demonstrated depth of necrosis after PVP with Greenlight XPS 180W is low and homogeneous. Risk for injuries of noble adjacent structures is limited Source of Funding: none
MP3-20 PREDICTORS OF PERIOPERATIVE COMPLICATIONS AND REOPERATION IN PATIENTS TREATED WITH PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE € ller, Gernot Bonkat, Jan Ebbing, Malte Rieken*, Sanwei Guo, Georg Mu Thomas Gasser, Alexander Bachmann, Basel, Switzerland INTRODUCTION AND OBJECTIVES: We aimed to characterize predictors of perioperative complications and surgical reintervention within the first two years after photoselective vaporization of the prostate (PVP) for symptomatic prostate enlargement (BPE). METHODS: Retrospective analysis of a single center cohort of 771 patients who underwent PVP with the 80-W KTP, 120-W HPS, and
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
180-W XPS GreenLight laser between 2002 and 2013. Binominal logistic regression analyses addressed factors associated with intra- and perioperative complications. Uni- and multivariable Cox regression analyses assessed the association of various clinical and surgical parameters with reoperation. RESULTS: Of 771 patients, 370 (48.0%), 187 (24.3) and 214 (27.8%) underwent PVP with the 80-W KTP, 120-W HPS, and 180-W XPS-laser, respectively. Median age was 68 years (Interquartile range (IQR): 12), median PSA 2.5 ng/ml (IQR: 3.4), and median prostate volume 45 ml (IQR: 25). Of the patients, 199 (25.8%) were in retention at time of surgery. Intraoperative bleeding was noted in 70 (9.1%) patients. Use of the 120-W laser (OR: 6.65, 95% CI 3.48-12.70, p<0.0001) and 180-W laser (OR: 2.19, 95% CI 1.04-4.63, p¼0.04) was associated with increased risk of intraoperative bleeding compared to the 80-W laser. Ongoing platelet aggregation therapy or oral anticoagulation was not associated with increased risk of intraoperative bleeding (p>0.05). Retention during hospitalization with the need for catheterization occurred in 67 (8.7%) patients. Preoperative catheterization (OR: 2.34, 95% CI 1.37-4.01, p¼0.002) was associated with increased risk of postoperative retention. During 2-years follow-up, 49 (6.4%), 10 (1.3%), and 17 (2.2) patients has to undergo reoperation due to persistent or recurrent adenoma, urethral stricture, and bladder neck stricture, respectively. No significant association of clinical and surgical parameters or laser generation with risk of reoperation due to recurrent or persistent adenoma or urethral stricture could be detected. In contrast, incidence of bladder neck sclerosis was significantly associated with prostate volume < 40 ml (HR 3.65, 95% CI 1.41-9.47, p¼0.008). CONCLUSIONS: Reoperation within the first 2 years after PVP does not seem to be associated with laser type. Prostate volume < 40 ml is significantly associated with increased risk of reoperation due to bladder neck sclerosis. Our results may help patients counseling and treatment decision-making regarding the choice of technique for BPE surgery. Source of Funding: none
Prostate Cancer: Epidemiology & Natural History I Moderated Poster 4 Friday, May 15, 2015
10:30 AM-12:30 PM
MP4-01 DEVELOPMENT OF INTERMEDIATE AND HIGH-RISK PROSTATE CANCER AFTER TESTICULAR CANCER Andrew Riggin*, M. Minhaj Siddiqui, Baltimore, MD INTRODUCTION AND OBJECTIVES: A history of testicular cancer has been suggested to have an association with an increased risk of developing prostate cancer (PCa) in epidemiology studies. We hypothesized that there may be an increased risk of developing intermediate to high-risk PCa as well. METHODS: This is a retrospective case-control study. The Surveillance, Epidemiology and End Results (SEER) registry was queried to identify men with a history of testicular cancer (case group) and men with a history of melanoma (controls). Melanoma was used as a control group because, to our knowledge, there is no association of melanoma and PCa. Men were excluded if they were not 40 years of age or older to allow for sufficient age for PCa diagnosis. PCa incidence was only counted if it occurred at least 5 years after the diagnosis of their primary cancer to allow for possible temporal effect of the primary malignancy. Incidence of total and intermediate to high-risk PCa(Gleason score 7) was compared using Kaplan-Meier (KM) curves. Cox proportional hazards models were utilized to assess for associations of PCa (JMP 10, SAS Inc).