311 Can We Predict Extraprostatic Extension (EPE) Prior To Radical Prostatectomy? – A Single Institution Comparison of Pre-Operative Biopsy Histology and Multiparametric MRI (mpMRI) With Radical Prostatectomy Specimen Histology

Introduction

Prostate biopsies and mpMRI play an integral role in diagnosis of prostate cancer. The aim of our study was to assess the ability to predict EPE based on pre-operative histology and mpMRI.

Method

We retrospectively analysed 235 patients who underwent radical prostatectomy between January 2015 and April 2017. All patients underwent pre-biopsy mpMRI scans and prostate biopsies. All mpMRIs were reported by dedicated uro-radiologists and all histology was reported by dedicated uro-pathologists.

Results

17/25 patients showing EPE on mpMRI had it confirmed on final histology.

a53/210 patients showing organ-confirmed disease on mpMRI had EPE on final histology.

40/49 patients who had Gleason 6 adenocarcinoma were organ-confined.

61/186 patients with > Gleason 7 adenocarcinoma had EPE.

Sensitivity of mpMRI was 25% with a specificity of 95%. The positive predictive value (PPV) was 68% and negative predictive value (NPV) was 75%.

The specificity of pre-biopsy Gleason score > 7 to predict EPE was 81% and sensitivity was 33% with a PPV of 87%.

Conclusions

Our data suggests that by using > Gleason 7 and mpMRI as a combination, we can reliably predict EPE on final histology which in turn will help counsel patients appropriately for treatment options. Further data collection is ongoing at our institution.

Nurse-led renal cancer follow-up is safe and associated with high patient satisfaction-an audit from the East of England

Background

With more people diagnosed and dying from renal cancers in England than ever before, treatment and follow-up post-surgery is of paramount importance. We have instituted a nurse-led follow-up service for renal cancers as a way to improve efficiency and make better use of clinic time. This is our first attempt to audit our service.

Objectives

One of the main objectives of this project was to measure compliance of a nurse-led renal surveillance clinic against an established institutional follow-up protocol which was based on current European Association of Urology guidelines. We also aimed to assess patient satisfaction with nurse-led care.

Patients and Methods

A total of 89 patients with low/intermediate-risk kidney cancers who were on the nurse-led renal surveillance database following nephrectomy or partial nephrectomy were placed on a database. This was then audited for adherence to the clinic protocol. These same patients were subsequently sent patient satisfaction questionnaires.

Results

The audit revealed high levels of compliance against the renal clinic protocol as well as positive feedback from the patient satisfaction questionnaire. Ninety-five percent said they felt either at ease or very at ease speaking to the nurse specialist. No one was dissatisfied with their consultations with 86% being very satisfied and 14% fairly satisfied. This was reinforced further by 100% of patients feeling that they could discuss all aspects of their condition with the Uro-oncology Clinical Nurse Specialist (UOCNS). Ninety-seven percent felt that they had adequate time with the nurse.

Conclusion

Nurse-led follow-up, in our setting, was noted to be safe and effective and was associated with high levels of patient satisfaction. This study adds to the growing body of work on the efficacy of nurse-led care.

Nurse-led active surveillance for prostate cancer is safe, effective and associated with high rates of patient satisfaction-results of an audit in the East of England

Introduction

Active surveillance (AS) is an option in the management of men with low-stage, low-risk prostate cancer. These patients, who often require prolonged follow-up, can put a strain on outpatient resources. Nurses are ideally placed to develop advanced roles to help meet this increased demand—a model we have utilised since 2014. We set about to comprehensively evaluate our nurse-led AS (NLAS) programme.

Patients and methods

An audit of patient notes was carried out to assess compliance with trust and national guidelines. A questionnaire was designed to capture patients’ experiences of NLAS. This was piloted and then distributed to all patients in our NLAS programme. A second questionnaire was designed to assess the views of stakeholders within the department.

Results

Compliance with various aspects of local guidelines ranged from 88.8% to 100%. 143 patients are currently in the programme with a mean duration of AS of 37.03 months. 104 questionnaires were returned. Most of the patients were aware of the role of the nurse prior to their visit, and all were happy to meet with a nurse. All of the patients indicated their confidence in the nurse monitoring their prostate-specific antigen. Among those requiring further investigations, 85.3% were happy with the information they received prior to their tests. Overall, 96.2% were either very satisfied or satisfied with NLAS. All stakeholders held positive views about NLAS.

Conclusions

NLAS is safe and effective. Patients and stakeholders alike held positive views of the programme.

A single United Kingdom center experience of open partial nephrectomy using regional ischemia

INTRODUCTION

Different techniques are used in open partial nephrectomy (OPN) for localized renal cancer, with variable impact on renal function. Regional renal ischemia technique by using different clamps and without the need to occlude renal vessels is gaining popularity. In our study, we present the largest international series; and the first in the United Kingdom; describing OPN using soft bowel clamp. We study the impact of this regional ischemia innovative technique on renal function, postoperative complications and oncological outcomes.

MATERIALS AND METHODS

We retrospectively analyzed the first 100 OPN cases done between 2001 and 2011. All available data on the hospital databases were analyzed; recording patient demographics, tumor characteristics, operative procedure details, histopathology results and long term follow up.

RESULTS

A direct comparison with other studies that have used different clamps to achieve regional ischemia was performed. Our technique has the advantage of being used for interpolar and hilar/central tumors. Our mean tumor size was higher at 4.1 cm. Our positive margin rate for malignant tumors was comparable with other studies, same for mean operative time and hospital stay. None had significant deterioration in renal function that required renal replacement therapy. Median blood loss was 400 mL. Our series has the advantage of showing the long term follow up data.

CONCLUSION

We believe the technique we have developed using soft bowel clamp to produce regional renal ischemia is practical and successful. It can be applied safely in all OPN cases, with excellent oncological outcome and clinically acceptable renal function preservation.

Expression of the cancer-testis antigen BORIS correlates with prostate cancer

BACKGROUND

BORIS, a paralogue of the transcription factor CTCF, is a member of the cancer-testis antigen (CT) family. BORIS is normally present at high levels in the testis; however it is aberrantly expressed in various tumors and cancer cell lines. The main objectives of this study were to investigate BORIS expression together with sub-cellular localization in both prostate cell lines and tumor tissues, and assess correlations between BORIS and clinical/pathological characteristics.

METHODS

We examined BORIS mRNA expression, protein levels and cellular localization in a panel of human prostate tissues, cancer and benign, together with a panel prostate cell lines. We also compared BORIS levels and localization with clinical/pathological characteristics in prostate tumors.

RESULTS

BORIS was detected in all inspected prostate cancer cell lines and tumors, but was absent in benign prostatic hyperplasia. Increased levels of BORIS protein positively correlated with Gleason score, T-stage and androgen receptor (AR) protein levels in prostate tumors. The relationship between BORIS and AR was further highlighted in prostate cell lines by the ability of ectopically expressed BORIS to activate the endogenous AR mRNA and protein. BORIS localization in the nucleus plus cytoplasm was also associated with higher BORIS levels and Gleason score.

CONCLUSIONS

Detection of BORIS in prostate tumors suggests potential applications of BORIS as a biomarker for prostate cancer diagnosis, as an immunotherapy target and, potentially, a prognostic marker of more aggressive prostate cancer. The ability of BORIS to activate the AR gene indicates BORIS involvement in the growth and development of prostate tumors.

An unusual groin mass. Seminal vesicle abscess: a case report

The rare pathology of seminal vesicle abscess is usually diagnosed with computerised tomography scan and confirmed with transrectal ultrasound. We report a recently encountered case where diagnosis proved difficult owing to the non-specific clinical presentation.

Spinal dysraphism at MR urography: initial experience

PURPOSE

To prospectively evaluate the role of magnetic resonance (MR) urography in the radiologic assessment of patients with spinal dysraphism.

MATERIALS AND METHODS

Fourteen patients with spinal dysraphism were referred for MR urography with half-Fourier rapid acquisition with relaxation enhancement (RARE) (repetition time msec/echo time msec = 11.9/95) and RARE (2,800/1,100) sequences on a 1.5-T MR machine. Six patients did not tolerate MR urography owing to claustrophobia (n = 4) or flexion deformities (n = 2), giving a final success rate of 57% (eight patients). Two patients had a single kidney (one after nephrectomy, one with a crossed-fused ectopic kidney). Images were jointly assessed by two radiologists and compared with excretory urographic studies. The signal intensity ratio and contrast-to-noise ratio were also calculated.

RESULTS

Visualization of the kidneys, pelvicaliceal system, and ureters was better with half-Fourier RARE than with RARE imaging, whereas visualization of the bladder was comparable with both sequences. The mean signal intensity ratios for half-Fourier RARE and RARE sequences, respectively, were 16.2 +/- 3.65 and 19.2 +/- 3.65 (P =. 58, factorial analysis of variance model), whereas the mean contrast-to-noise ratios were 55.4 +/- 5.16 and 47.8 +/- 5.16 (P =. 34). Cortical scarring was depicted more clearly at MR urography than at excretory urography, whereas a renal calculus seen at excretory urography was not detected at MR urography.

CONCLUSION

MR urography was feasible in 57% of patients with spinal dysraphism and is a safe, accurate method of evaluating the upper urinary tract.

Prognostic factors in squamous cell carcinoma of the penis and implications for management

OBJECTIVE

To determine the clinical and pathological features, methods and outcome of management in squamous cell carcinoma of the penis (SCCP).

PATIENTS AND METHODS

A retrospective study was carried out of 42 patients (mean age 63 years, range 28-86) with a histological diagnosis of SCCP. The disease stage, grade, treatment of primary tumour, lymph node disease and survival were recorded; the mean follow-up was 4 years (range 1.5-25).

RESULTS

The disease stage was T1 in 24 patients (57%), T2 in 14 (33%), T3 in three (7%) and T4 in one (2%); the tumour grade was well differentiated in 20 (47%), moderately differentiated in 14 (33%) and poorly differentiated in three (7%). Eight patients had histologically confirmed inguinal node disease at presentation, six of whom underwent lymph node dissection, while two underwent radiotherapy. Five patients developed inguinal node disease during follow-up (mean 10 months, range 4-21). Three of these patients were irradiated and two underwent lymph node dissection. Six patients (14%) had local recurrence, five of whom were managed surgically. One patient developed a local recurrence 11 years after initial surgery. Seven patients died from their disease (17%); four died within 2 years, being patients with high-stage and/or high-grade disease.

CONCLUSIONS

Modern management should include a standard staging classification and treatment protocols to maximize survival.

Urological complications of pancreatic transplantation

PURPOSE

Pancreas transplantation is increasingly being used in the treatment of type I insulin-dependent diabetes mellitus. Because bladder drainage of the exocrine pancreatic secretion is the procedure of choice, urological complications are frequent. As the number of these procedures increases the urologist will have an extended role in the management of the postoperative complications, the majority of which are urological.

MATERIALS AND METHODS

The literature from 1985 on the complications related to pancreas transplants was reviewed.

RESULTS

Approximately 50 to 60% of bladder drained pancreas transplant recipients will have a urological complication postoperatively.

CONCLUSIONS

The increasing application of bladder drained pancreas transplantation in the treatment of type I insulin-dependent diabetes mellitus necessitates that the clinical urologist is familiar with the management of complications related to this procedure.

Fournier's gangrene of scrotum in a patient with AIDS

Fournier's gangrene of the scrotum, a form of necrotising fasciitis, is a rare but potentially fatal disorder. Predisposing conditions include chronic alcoholism and diabetes mellitus, possibly as a result of impaired immunity. Fournier's syndrome, occurring in a patient with AIDS, is described.