UP-02.173 Robotic Radical Prostatectomy: Evaluation of the Learning Curve

UP-02.173 Robotic Radical Prostatectomy: Evaluation of the Learning Curve

UNMODERATED POSTER SESSIONS the vesico-urethral anastomosis is a wellknown complication after radical prostatectomy. Correlations between anastomotic...

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UNMODERATED POSTER SESSIONS

the vesico-urethral anastomosis is a wellknown complication after radical prostatectomy. Correlations between anastomotic stricture formation and tumour stage, positive surgical margins, previous prostatic surgery (TURP or open surgery due to BPH), number of anastomotic sutures, bladder neck preservation, catheter removal time and urine leakage is possible. Urethral dilatation, internal urethrotomy, transurethral resection or laser therapy have been reported as the treatment for this complication. Material & Methods: We retrospectively analysed the incidence and management of anastomotic strictures at 150 patients with prostate cancer, who underwent a radical retropubic prostatectomy. Vesicourethral strictures was treated by dilatation, internal urethrotomy and transurethral resection of scar tissue in all the patients. Results: Anastomotic stricture was found in 22(14.66%) patients, requiring some kind of treatment. In 16(72.72%) patients stricture occurred within 3 months after surgery, in 3 (13.63%) patients at the period of 4-12 months after surgery and in 3(13.63%) more than 12 months after surgery. Anastomotic stricture was associated with positive margins at 9(40.9%) patients, intraoperative blood loss at 5(22.72%) patients and urine leakage at 2(9.09%) patients. Only 1(4.54%) patients whose catheter was removed on 7. postoperative day developed uretral strictura, whereas 4(18.5%) and 9(40.9%) patients whose catheter were removed on 14 or 21 postoperative day developed stricturas. The stricture was treated by dilatation in 7 (53.9%) cases, by internal urethrotomy in 4 (30.7%) cases and by TUR in 2 (15.4%) cases. Cure was achieved in 11(84.7%) patients without incontinence. Conclusions: Dilatation and endoscopic procedure of the vesico-urethral stricture showed a high cure rate without incontinence.

UP-02.172 The Appropriateness of Active Surveillance and the Impact of Prostate Cancer Gene 3 (PCA3) in Low Risk Prostate Cancer: An Analysis of Expert Opinion Speakman M1, Ameye F2, de la Taille A3, de Reijke T4, Gontero P5, Haese A6, Kil P7, Perrin P8, Remzi M9, Schröder J10, Stoevelaar H11, Volpe A12 1 Taunton and Somerset Hospital, Taunton, UK; 2UZ Gasthuisberg, Leuven, Belgium; 3Hôpital Henri Mondor, Créteil, France; 4Academic Medical Center,

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UP-02.172, Table 1. Variable Life expectancy (yrs) Clinical stage % positive cores PSA (ng/mL) PCA3 Score

Total

Value ⱖ 10 ⬍ 10 T1c T2a ⱕ 20 ⬎ 20 ⬍3 3-10 NP ⬍ 20 20-50 ⬎ 50

% Inappropriate 56 3 25 34 19 40 25 34 19 6 38 56 30

% uncertain 38 59 47 50 53 44 50 47 56 31 62 44 48

% Appropriate 6 38 28 16 28 16 25 19 25 63 0 0 22

Np: not performed

Amsterdam, The Netherlands; 5Ospedale Molinette, Università di Torino, Turin, Italy; 6Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany; 7St. Elisabeth Ziekenhuis, Tilburg, The Netherlands; 8 Hôpital Henry Gabrielle, Lyon, France; 9 Medical University of Vienna, Vienna, Austria; 10ATURO Uroonkologische Gemeinschaftspraxis, Berlin, Germany; 11 Ismar Healthcare, Lier, Belgium; 12 Maggiore Della Carità Hospital, Novara, Italy Introduction and Objectives: The prostate cancer gene 3 (PCA3) may be suggestive of prostate cancer (PCa) significance and aid in identifying men with insignificant PCa in whom active surveillance (AS) would be appropriate. Material and Methods: Using the RAND/UCLA Appropriateness Method (RAM), 12 European experts assessed the appropriateness of AS and the impact of the PCA3 Score on AS decisions for 64 different profiles of low-risk PCa patients (PSA ⬍ 10 ng/mL, stage T1c-T2a, Gleason sum ⬍ 7). Profiles were combinations of life expectancy (LE), clinical stage,% of positive cores, PSA level and PCA3 Score. Panellists scored the appropriateness of AS with and without the PCA3 Score for all profiles, using a scale from 9⫽appropriate to 1⫽inappropriate. Based on the median score and extent of agreement between the experts, the appropriateness of AS for each of the profiles was calculated. Results: AS was considered appropriate for 22% of cases, particularly in men with a LE ⬍ 10 yrs, T1c PCa, ⱕ 20% positive cores and PSA ⬍ 3 ng/mL (Table). A PCA3 Score ⬍ 20 supported the decision for AS in men with a LE ⬍ 10 yrs, T2a PCa, ⬎ 20% positive cores and/or a PSA 3-10 ng/mL and also in men with a LE ⱖ

10 yrs, T1c PCa and ⱕ 20% positive cores. A PCA3 Score ⬎ 20 (and in particular ⬎ 50) advocated against AS in men with a LE ⱖ 10 years with T1c PCa and ⬎ 20% positive cores or T2a PCa and ⱕ 20% positive cores. Conclusions: In men at low risk of significant cancer, PCA3 could provide additional information to guide AS decisions and is considered useful for patient counselling. This should be further evaluated in well designed trials. Note that that this study concerned hypothetical patient cases.

UP-02.173 Robotic Radical Prostatectomy: Evaluation of the Learning Curve Schraml J1, Strbavy M2, Bocan M3 1 Krajska Zdravotni A.S., Masaryk Hospital, Usti nad Labem, 2Krajska Zdravotni a.s., Masaryk Hospital, Usti nad Labem, 3Krajska Zdravotni a.s., Hospital Most, Most, Czech Republic Introduction and Objective: The learning curve of a new technique is always a matter of debate, especially during the initial phases. Some open surgery-experienced urologists in our Centre jumped over laparoscopy and quickly adopted robotic radical prostatectomy. In poster we would like to evaluate our learnig curve by presentation surgery and pathology outcomes. Our objective was to see the surgical and pathological results correlation between the first (initial) and second (advanced) period of using the daVinci surgical system in our Robotic Centre. Materials and Methods: a retrospective data evaluation of the initial group of 100 patients (group A) and the following group of 200 patients (group B) who underwent robotic radical prostatectomy over the 1-years period each. A transperitoneal five-port approach and da Vinci

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UNMODERATED POSTER SESSIONS

system was used by 2 surgeons. Data collection included basic demographics, PSA levels, clinical and pathological stage, Gleason grade, operative duration, blood loss, complications, hospital stay, positive marins rate, relative positive margins rate and complications. Results: mean age was A. 65 (41-79), B. 55 (47-80) years, mean preoperative PSA level was A. 9,6 (1,09 – 51,00) B. 8,7 (0,10 – 66,67) ng/ml, Clinical stage with distribution: A. cT1(a,c) 26%, cT2(a,b) 46%, cT2c 25% and cT3(a,b) 3% B. cT1(a,c) 37%, cT2(a,b) 49%, cT2c 12% and cT3(a,b) 2%. Pathological stage was: A. T0 1%, T2a 20%, T2b 4%, T2c 39%, T3a 26% and T3b 10%, B. T0 2%, T2a 13%, T2b 7%, T2c 51%, T3a 21% and T3b 6%. Mean operative duration was A. 180 (120 – 240) min. B. 127 (65 – 210) min, the mean EBL was A. 210 (20-1000) ml, B. 185 (35-1200) ml. Mean hospital stay was A.5 (3-21), B. 3.5 (3-13). Positive margin rate was A.16%, B. 14%. Relative positive margin rate was A. pT2a and pT2b 0%, pT2c 20.51%, pT3a 19.23%, pT3b 40.0%.B. pT2a nad pT2b 0%, pT2c 12.74%, pT3a 23.80%, pT3b 41.66%. Conclusion: The second year of robotic activity in our Centre has proved significant impovement in surgical and oncological results. We doubled the number of operated patients and confirmed the quick learning curve of the method. The mean operative time was notably reduced as well as the EBL. We recorded the movement to the lower stages in oncological results, which is the most valuated fact.

UP-02.174 The Effects of Neoadjuvant Hormonal Therapy on Vascular Endothelial Growth Factor and Microvessel Density in Prostate Cancer Sul C, Na Y, Song K, Lim J, Shin J, Oh T, Hwang E Chungnam National University Hospital, Daejon, South Korea Objectives: The effect of neoadjuvant hormonal therapy (NHT) for prostate cancer is various and remains a controversy for urologists. We conducted this study to comparatively evaluate whether NHT before radical prostatectomy is indicated and beneficial in the aspects of neovascularization and postoperative parameters. Methods: During a 3-year period, 69 patients were scheduled for radical retropubic prostatectomy (RRP) as a treatment for prostate cancer and were divided into two groups. Group 1 (n⫽31, 44.9%) was treated with RRP only, and group 2

(n⫽38, 55.1%) was performed RRP with preoperative NHT. Their medical records were retrospectively reviewed, and data, including perioperative parameters, tumor vascularity in surgical specimens and postoperative parameters, were analyzed. Results: There were no statistical differences in age, body mass index (BMI), preoperative biopsy Gleason score, initial serum prostate-specific antigen (PSA) levels, international prostate symptom score (IPSS), or quality of life (QoL) between the two groups (p⬎0.05). There were significant difference between the groups in Intensity of vascular endothelial growth factor (VEGF) expression and microvessel density (MVD) (p⬍0.05). We also observed no differences in the transfusion rate, mean catheterization time, or positive margin rate (p⬎0.05). However, the mean operative time was significantly higher in the RRP with preoperative NHT group than in the other group (p⫽0.034). Conclusions: These results suggest that there were clinical benefits to the administration of NHT before RRP from the viewpoint of neovascularization. But, there were no clinical benefits to support the administration of NHT from the viewpoint of postoperative parameters.

UP-02.175 Non-invasive Therapy of Incidental Prostate Cancer by Robotic High Intensity Focused Ultrasound: 65 Patients Followed 9 Years Thüroff S1,2, Chaussy C1,3 1 Krebshilfe Harlaching E.V., 2Dept. of Urology, Klinikum München Harlaching, 3 Dept. of Urology, University of Regensburg, Regensburg, Germany Objective: Up to 8% of patients who undergo TUR or adenomectomy for BPH show in histology unexpected PCa. These patients might deserve or wish a cancer therapy. We perform a prospective, monocentric study, treating these patients with HIFU as a local/focal therapy, analyzing oncological efficacy and therapy induced side effects. Material and Methods: Since 2000, 65 patients with incidental PCa were treated by robotic HIFU. Median(*) age was 70(57-87), *PSAi was 4.9(1-32), *prostatic volume 39cc(16-130), *20 gr(1-95) had been resected by TUR. Histology showed *5%(5-50%) positive chips with a Gleason of 5 (3-9). We used robotic Ablatherm® integrated imaging, EDAP-TMS, Lyon in spinal anesthesia in a single session–as monotherapy without ADT– by a non invasive transrectal approach.

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Results: *PSA nadir of 0.07 (0-3.67) was measured after *1.8(0.7-5.9) months, including 62% ⬍0.1 / 81% ⬍0.5 ng/ml). *PSA of 0.13(0-8.3) equivalent to a *PSA velocity of 0.01ng/ml/year was found after a mean follow up of 48 months(3-110). Intra-and postoperative side effects were minimal: (Clavien: ⬍ 15% I-III). But longterm follow-up showed 45% of secondary obstructions caused by necrotic tissue or bladder neck stenosis. Other long—term side effects were mild: intermediate urinary stress incontinence Grade I (11%) and UTI (14%). *disease free survival was 31 months in a *33-month follow-up. Conclusion: *PSA Nadir of 0.07ng/ml as well as the *PSA velocity of 0.01ng/ml/ year indicate that HIFU is a curative therapy for patients with incidental PCa, because both are most valid oncological surrogate parameters. The psychological burden of the patients who are confronted either with untreated cancer disease in cases of “wait and see” or with fear of significant side effects in cases of radical surgery or radiation, can be avoided by this non-invasive, transrectal, single session therapy.

UP-02.176 PSA Nadir After TUR and Robotic High Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer: 677 Monocentric Cases Followed 15 Years Thüroff S1,2, Chaussy C1,3 1 Krebshilfe Harlaching E.V., 2Dept. of Urology, Klinikum München Harlaching, 3 Depy. of Urology, University of Regensburg, Regensburg, Germany Introduction: PSA Nadir is a strong surrogat parameter for a successfull PCa therapy. We wanted to know, how strong the individual input of TUR and of HIFU on the individual PSA Nadir in a combined therapy of localized PCa (T1-2,N0,Mo,PSAi ⬎ 20ng/ml) is. Three therapeutic options, “HIFU only”, “TUR and HIFU in one session” and “TUR one month before HIFU” were analyzed. Material and Methods: Prospective Harlaching HIFU Database (n⬎2.300, since 96) served as data source for analysis. 3 patient cohorts (T1-2, N0, M0): are analyzed: A) ‘98-00 (-HIFU only-), B) ‘01-04: (TUR&HIFU), C) ‘05-10: (TUR 1 month before HIFU), all without any PCa/PSA influencing therapy, treated completely by Ablatherm ® (robotic HIFU at 3 MHz, EDAP-Lyon-France). Analysis of diagnostic and resulting prostate volume and PSA, before TUR/HIFU and at PSA nadir. Results: See table.

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