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POS-03.82: Malignant phyllodes tumor of the prostate (report of 2 cases and review of literature)
UNMODERATED POSTER SESSIONS
POS-03.82 Malignant phyllodes tumor of the prostate (report of 2 cases and review of literature) Chen R, Xu Y, Zhang X Department of Urology, Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China Objectives: Study the clinical and histological features and the treatment of malignant phyllodes tumor (PT) of the prostate. Materials & Methods: Clinical and pathological features of two cases with malignant phyllodes tumor of the prostate were evaluated. A review of the reported cases of PT of the prostate was done. Results: The first patient underwent surgical resection of the prostatic mass and Bricher’s operation. Intraoperatively 䊐resected prostatic tumor was measured 22 cm⫻16 cm⫻11cm. Postoperative pathology showed malignant PT of the prostate. Routine follow up by CT showed distant metastases to the lung at 4th year. Patient succumbed to his disease and died six moths later. In the second patient, radical prostatectomy was performed. The tumor was 400g and 16 cm⫻10 cm⫻8cm. Histological examination demonstrated low grade malignant PT. At 15-month postoperative follow up 䊐the patient remained well with no evidence of disease. Conclusion: PT of the prostate is extremely rare. The final diagnosis depends on its specific clinical behavior and histological findings. Local control may be achieved by radical surgery and radiotherapy may be also valuable.
POS-03.83 Using the Vienna nomogram to determine the number of prostate biopsy cores to be taken, does not seem to have statistical advantage: an ongoing, prospective, randomised study Lecuona AT, Naidoo A, Heyns CF University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa Objectives: 1. To compare prostate cancer detection rates at first and repeat biopsies using a standard 8-core biopsy protocol versus the Vienna nomogram for determining the number of biopsy cores; 2. To compare the side-effect profile of a standard 8-core versus the Vienna nomogram biopsy protocol. Patients & Methods: Men with a serum PSA ⬎2.5 ng/ml or suspicion of prostate
298
Table 1. POS-03.83: Vienna Nomogram: Number of biopsy cores based on patient age and prostate volume Age (years) Prostate size (ml) 0-30 31-40 41-50 51-60 61-70 ⬎71
Younger than 50 8 12 14 16 18 18
51-60 8 10 12 14 16 18
cancer on digital rectal examination were stratified according to serum PSA into low, intermediate and high risk groups (I ⫽ PSA 2.5-10; II ⫽ PSA 10.1-30; III ⫽ PSA 30.1-50 ng/ml) and were then randomised into two arms. Group A underwent a standard 8 core TRUS guided prostate biopsy and Group B underwent TRUS guided prostate biopsy with the number of cores determined according to the Vienna nomogram, based on the patient’s age and prostate volume as measured by TRUS. Biopsies were performed under local anesthesia using periprostatic infiltration of 2% lignocaine. The study was approved by our institutional review board, and written informed consent was obtained from all study subjects. Results: In the period August 206 to March 2007 we randomised 109 patients to standard 8-core biopsy (Group A n⫽59) or biopsy with the number of cores determined according to the Vienna nomogram (Group B n⫽50). The mean (range) serum PSA was 9,99 (3,238,7) in Group A and 9,51(2,8-32,9) in Group B subjects. The mean (range) patient age was 63,1 (40-81) in Group A and 66,3 (47-81) in Group B. The mean (range) prostate volume was 46,28ml (16-129ml) in Group A and 53,47ml (11142ml) in Group B patients. The mean (range) number of biopsy cores was 10,6 (6-16) in Group B, versus 8 in Group A subjects. Prostate cancer was detected in 17/59 (29%) of men in Group A and in 13/50 (26%) in Group B (Fisher’s exact test p⫽0.82). The two groups are statistically comparable. Conclusion: Although the number of patients is relatively small, there does not appear to be a significant advantage in using the Vienna nomogram to determine the number of prostate biopsy cores when compared to a standard 8-core biopsy protocol. The study is ongoing and we aim to include 190 patients before the end of August 2007.
61-70 8 8 10 12 14 16
Older than 70 6 6 8 10 12 14
POS-03.84 Robotic assisted transperineal saturation prostate biopsy in men with previous negative biopsy: comparison with transrectal approach Ho H, Mohan P2, Li DL2, Yuen J1, Ng WS2, Lau W1, Cheng C1 1 Department of Urology, Singapore General Hospital, Singapore; 2Computer Medical Intervention Laboratory, Nanyang Technological University, Singapore Introduction: In men with rising serum prostate specific antigen despite of previous negative prostate biopsy, there is a clinical need for more accurate biopsy without compromising on safety. Materials & Methods: We developed a robotic device that allowed accurate biopsy in the peripheral zone of the prostate. Between September 2006 and December 2006, we conducted a prospective trial in men with rising PSA with previous negative prostate biopsy. With the ethic committee’s approval, we used the device for transperineal saturation prostate biopsy (TPB) under general anesthesia (GA). Post-operative information on hematuria, pain and infection were collected. The historical control group included patients who had tranrectal saturation prostate biopsy (TRB) under GA between April 2002 and August 2006. Patients’ demographics, serum PSA, prostate volume and histopathological results were recorded. Endpoints were the number of prostate cancer detected and complications encountered. Results: In the TPB arm and TRB arm, there were 25 and 24 men respectively. They were similar in characteristics in both groups. There was a higher mean number biopsies taken from the TPB. (20.3 vs 22.4) There were 3 cases of prostate cancer detected in the TRB arm and 4 cases were detected in the other group. In the transrectal approach, we had 2 retention of urine that needed temporary
UROLOGY 70 (Supplment 3A), September 2007
POS-03.82 Malignant phyllodes tumor of the prostate (report of 2 cases and review of literature) Chen R, Xu Y, Zhang X Department of Urology, Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China Objectives: Study the clinical and histological features and the treatment of malignant phyllodes tumor (PT) of the prostate. Materials & Methods: Clinical and pathological features of two cases with malignant phyllodes tumor of the prostate were evaluated. A review of the reported cases of PT of the prostate was done. Results: The first patient underwent surgical resection of the prostatic mass and Bricher’s operation. Intraoperatively 䊐resected prostatic tumor was measured 22 cm⫻16 cm⫻11cm. Postoperative pathology showed malignant PT of the prostate. Routine follow up by CT showed distant metastases to the lung at 4th year. Patient succumbed to his disease and died six moths later. In the second patient, radical prostatectomy was performed. The tumor was 400g and 16 cm⫻10 cm⫻8cm. Histological examination demonstrated low grade malignant PT. At 15-month postoperative follow up 䊐the patient remained well with no evidence of disease. Conclusion: PT of the prostate is extremely rare. The final diagnosis depends on its specific clinical behavior and histological findings. Local control may be achieved by radical surgery and radiotherapy may be also valuable.
POS-03.83 Using the Vienna nomogram to determine the number of prostate biopsy cores to be taken, does not seem to have statistical advantage: an ongoing, prospective, randomised study Lecuona AT, Naidoo A, Heyns CF University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa Objectives: 1. To compare prostate cancer detection rates at first and repeat biopsies using a standard 8-core biopsy protocol versus the Vienna nomogram for determining the number of biopsy cores; 2. To compare the side-effect profile of a standard 8-core versus the Vienna nomogram biopsy protocol. Patients & Methods: Men with a serum PSA ⬎2.5 ng/ml or suspicion of prostate
298
Table 1. POS-03.83: Vienna Nomogram: Number of biopsy cores based on patient age and prostate volume Age (years) Prostate size (ml) 0-30 31-40 41-50 51-60 61-70 ⬎71
Younger than 50 8 12 14 16 18 18
51-60 8 10 12 14 16 18
cancer on digital rectal examination were stratified according to serum PSA into low, intermediate and high risk groups (I ⫽ PSA 2.5-10; II ⫽ PSA 10.1-30; III ⫽ PSA 30.1-50 ng/ml) and were then randomised into two arms. Group A underwent a standard 8 core TRUS guided prostate biopsy and Group B underwent TRUS guided prostate biopsy with the number of cores determined according to the Vienna nomogram, based on the patient’s age and prostate volume as measured by TRUS. Biopsies were performed under local anesthesia using periprostatic infiltration of 2% lignocaine. The study was approved by our institutional review board, and written informed consent was obtained from all study subjects. Results: In the period August 206 to March 2007 we randomised 109 patients to standard 8-core biopsy (Group A n⫽59) or biopsy with the number of cores determined according to the Vienna nomogram (Group B n⫽50). The mean (range) serum PSA was 9,99 (3,238,7) in Group A and 9,51(2,8-32,9) in Group B subjects. The mean (range) patient age was 63,1 (40-81) in Group A and 66,3 (47-81) in Group B. The mean (range) prostate volume was 46,28ml (16-129ml) in Group A and 53,47ml (11142ml) in Group B patients. The mean (range) number of biopsy cores was 10,6 (6-16) in Group B, versus 8 in Group A subjects. Prostate cancer was detected in 17/59 (29%) of men in Group A and in 13/50 (26%) in Group B (Fisher’s exact test p⫽0.82). The two groups are statistically comparable. Conclusion: Although the number of patients is relatively small, there does not appear to be a significant advantage in using the Vienna nomogram to determine the number of prostate biopsy cores when compared to a standard 8-core biopsy protocol. The study is ongoing and we aim to include 190 patients before the end of August 2007.
61-70 8 8 10 12 14 16
Older than 70 6 6 8 10 12 14
POS-03.84 Robotic assisted transperineal saturation prostate biopsy in men with previous negative biopsy: comparison with transrectal approach Ho H, Mohan P2, Li DL2, Yuen J1, Ng WS2, Lau W1, Cheng C1 1 Department of Urology, Singapore General Hospital, Singapore; 2Computer Medical Intervention Laboratory, Nanyang Technological University, Singapore Introduction: In men with rising serum prostate specific antigen despite of previous negative prostate biopsy, there is a clinical need for more accurate biopsy without compromising on safety. Materials & Methods: We developed a robotic device that allowed accurate biopsy in the peripheral zone of the prostate. Between September 2006 and December 2006, we conducted a prospective trial in men with rising PSA with previous negative prostate biopsy. With the ethic committee’s approval, we used the device for transperineal saturation prostate biopsy (TPB) under general anesthesia (GA). Post-operative information on hematuria, pain and infection were collected. The historical control group included patients who had tranrectal saturation prostate biopsy (TRB) under GA between April 2002 and August 2006. Patients’ demographics, serum PSA, prostate volume and histopathological results were recorded. Endpoints were the number of prostate cancer detected and complications encountered. Results: In the TPB arm and TRB arm, there were 25 and 24 men respectively. They were similar in characteristics in both groups. There was a higher mean number biopsies taken from the TPB. (20.3 vs 22.4) There were 3 cases of prostate cancer detected in the TRB arm and 4 cases were detected in the other group. In the transrectal approach, we had 2 retention of urine that needed temporary
UROLOGY 70 (Supplment 3A), September 2007