Prostate volume index and prostatic chronic inflammation have an effect on tumor load at baseline random biopsies in patients with normal DRE and PSA values less than 10\u2009ng/ml: results of 564 consecutive cases

Background: To assess the association of prostate volume index (PVI), defined as the ratio of the central transition zone volume (CTZV) to the peripheral zone volume (PZV), and prostatic chronic inflammation (PCI) as predictors of prostate cancer (PCA) load in patients presenting with normal digital rectal exam (DRE) and prostate-specific antigen (PSA) <= 10 ng/ml at baseline random biopsies. Methods: Parameters evaluated included age, PSA, total prostate volume (TPV), PSA density (PSAD), PVI and PCI. All patients underwent 14 core transperineal randomized biopsies. We considered small and high PCA load patients with no more than three (limited tumor load) and greater than three (extensive tumor load) positive biopsy cores, respectively. The association of factors with the risk of PCA was evaluated by logistic regression analysis, utilizing different multivariate models. Results: 564 Caucasian patients were included. PCA and PCI were detected in 242 (42.9%) and 129 (22.9%) cases, respectively. On multivariate analysis, PVI and PCI were independent predictors of the risk of detecting limited or extensive tumor load. The risk of detecting extensive tumor load at baseline biopsies was increased by PSAD above the median and third quartile as well as PVI <= 1 [odds ratio (OR)=1.971] but decreased by PCI (OR=0.185; 95% CI: 0.088-0.388). Conclusions: Higher PVI and the presence of PCI predicted decreased PCA risk in patients presenting with normal DRE, and a PSA <= 10 ng/ml at baseline random biopsy. In this subset of patients, a PVI <= or >1 is able to differentiate patients with PCA or PCI

High surgeon volume and positive surgical margins can predict the risk of biochemical recurrence after robot-assisted radical prostatectomy

Background: The aim of this study was to determine whether any clinical factors are independent predictors of positive surgical margins (PSM), and to assess the association of PSM and biochemical recurrence (BR) after robot-assisted radical prostatectomy (RARP). Methods: The population included cases with negative surgical margins (control group) and patients with PSM (study group). Tumor grade was evaluated according to the International Society of Urologic Pathology (ISUP) system. A logistic regression model assessed the independent association of factors with the risk of PSM. The risk of BR was assessed by Cox\u2019s multivariate proportional hazards. Results: A total of 732 consecutive patients were evaluated. Extend pelvic lymph node dissection (ePLND) was performed in 342 cases (46.7%). Overall, 192 cases (26.3%) had PSM. The risk of PSM was positively associated with the percentage of biopsy positive cores (BPC; odds ratio, OR = 1.012; p = 0.004), extracapsular extension (pT3a; OR=2.702; p < 0.0001), invasion of seminal vesicle (pT3b; OR = 2.889; p < 0.0001), but inversely with body mass index (OR = 0.936; p = 0.021), and high surgeon volume (OR = 0.607; p = 0.006). Independent clinical factors associated with the risk of BR were baseline prostate-specific antigen (PSA; hazard ratio, HR = 1.064; p = 0.004), BPC (HR = 1.015; p = 0.027), ISUP biopsy grade group (BGG) 2/3 (HR = 2.966; p = 0.003), and BGG 4/5 (HR = 3.122; p = 0.022). Pathologic factors associated with the risk of BR were ISUP group 4/5 (HR = 3.257; p = 0.001), pT3b (HR = 2.900; p = 0.003), and PSM (HR = 2.096; p = 0.045). Conclusions: In our cohort, features related to host, tumor, and surgeon volume are associated with the risk of PSM, which is also an independent parameter predicting BR after RARP. The surgical volume of the operating surgeon is an independent factor that decreases the risk of PSM, and, as such, the risk of BR

Visualization of peri-prostatic neurovascular fibers before and after radical prostatectomy by means of diffusion tensor imaging (DTI) with clinical correlations: preliminary report

To evaluate if diffusion tensor imaging (DTI) is able to detect morphological changes of peri-prostatic neurovascular fibers (PNF) before and after robot-assisted radical prostatectomy (RARP) and if these changes are related to urinary incontinence (UI) and erectile dysfunction (ED). From October 2014 and August 2017, 26 patients with biopsy-proven prostate cancer underwent prostatic multiparametric magnetic resonance imaging (mp-MRI) including DTI sequencing before, and 6 months after, RARP. Images were analyzed by placing six regions of interest (ROI), respectively, at base, mid gland, and apex, one for each side, to obtain tractographic reconstruction of the PNF. Patients were asked to complete International Consultation Incontinence Questionnaire-Short Form (ICIQ-SF) and International Index of Erectile Function (IIEF-5) questionnaires before RARP and 6 months post-operatively. Fractional anisotropy (FA), number (N), and length (L) of PNF before and after RARP were compared by means of Student's t test; Spearman's test was used to evaluate correlation between DTI parameters and questionnaires' scores. We observed a significant difference in N values before and after RARP (p < 0.001) and a negative correlation between IIEF-5 score and post-operative FA values at both the right (rho = - 0.42; p = 0.0456) and left (rho = - 0.66; p = 0.0006) base of the prostate. DTI with tractography of PNF is able to detect quantitative changes in N, L, and FA values in PNF after RARP. In particular, we observed an inverse correlation between FA of PNF and ED at 6 months after RARP. Further investigations are needed to confirm this trend

43rd Annual Congress of the Italian Urodynamic Society, Rome, Italy, 13th-15th June 2019: Influence of emotional condition on uroflowmetry

Introduction and aim of the study: The emotional condition of patients before uroflowmetry (UF) may affect the micturition and consequently the results of the examination. Limited literature data are available on the correlation between anxiety levels and uroflowmetry1. Aim of this study was to assess the correlation between emotional condition of the patients at UF and whether anxiety/embarrassment may affect patient\u2019s micturition. Materials and methods: This is a prospective multicenter ongoing study started on July 2018. Patients were enrolled during an office uroflowmetry. Data recorded were: demographics (sex, age, educational level), urological history (therapy, surgical urological treatment), International Prostate Symptoms Score (IPSS) questionnaire in males, and ICIQ\u2010FLUTS questionnaire in females. General anxiety level of the patient was evaluated by the General Anxiety Disorder \u2010 7 (GAD \u2010 7) questionnaire2 considering the levels of severity as following: score <5 no anxiety, 5 to 9 mild anxiety, 10 to 14 moderate anxiety, 15 to 21 severe anxiety. Moreover, to better understand the anxiety level related to UF we applied questions #4 to 6 of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).3 Levels of severity were considered as follow: 3 to 6 no anxiety, 7 to 10 moderate anxiety, 11 to 15 severe anxiety. Specific linker\u2010type scales assessed the subjective micturition satisfaction/reproducibility and the discomfort. A dedicated nurse measured post\u2010void residual (PVR) urine by bladder\u2010scan immediately after the examination. Statistical analysis was performed using one\u2010way ANOVA test, and Mann\u2010Whitney test. Results: Patients enrolled in the study were 125 (mean age 65+13 years): 85 men (68%) and 40 women (32%). Voided volumes, Qmax, PVR, and discomforts did not correlate with higher level of anxiety. However, greater anxiety negatively influenced the subjectivesatisfaction and the UF reproducibility. Patients with higher anxiety levels showed greater symptomatology questionnaires (Table 1\u20102). A general high level of anxiety was assessed by GAD in 41,6% (52/125) of the cohort, while a high level of UF\u2010related anxiety was recorded by APAIS in 42,4% (53/125). Women reported GAD score >5 in the 87.5% (35/40), and APAIS score >6 in the 70% (28/40). GAD score >5 and APAIS modified score >6 were documented in males in 44,7% (38/85) and 29% (25/85) respectively. The relation between GAD \u2010 APAIS levels and satisfaction/reproducibility and discomforts of the patient are reported in Tables 3 to 4. A low satisfaction/reproducibility of the examination was reported by 31.2% of the patients (39/ 125): 38.5% males and 45% females. High discomforts were recorded in 51.2% (74/125) of the population: 56.5% men and 65% women. Interpretation of results: Most factors may influence UF outcomes, but the level of anxiety has been poorly investigated. In our study a high levels of general, and UF\u2010related anxiety was found in 4/10 patients. Surprisingly, we found a severe discrepancy of anxiety levels between genders. Women were mostly affected by high general and UF\u2010related high anxiety. Quite the reverse, in men an impaired emotional condition was documented in less than a half of the cases. Moreover, the higher levels of anxiety mainly influenced the subjective satisfaction/reproducibility of the UF. However, no significant differences were found among the objective outcomes (VV/Qmax/PVR). Patients with higher anxiety levels showed worst results at the symptomatology questionnaires. The emotional condition poorly influenced the UF discomforts.Conclusions: A relevant rate of patients showed high anxiety levels. This study demonstrated that UF, although is a simple and not invasive test, has an important impact on the emotional condition of the patients, mostly in women. This issue should be considered in the counseling of the patients. Anxiety influenced the subjectivity of the patients leading to the sensation of not having reproduced the normal urinary pattern. Therefore, a proper counseling may lower anxiety levels obtaining more physiological results at UF

The Influence of Endogenous Testosterone on Incidental Prostate Cancer after Transurethral Prostate Resection

The aim of the study was to test the hypothesis that endogenous total testosterone (TT) may relate to incidental prostate cancer (iPCA) in patients with lower urinary tract symptoms (LUTS) associated with prostate enlargement undergoing transurethral resection of the prostate (TURP)

Incidental prostate cancer after transurethral resection of the prostate: analysis of incidence and risk factors in 458 patients

Background: The aim of this study is to evaluate the incidence and risk factors of incidental prostate cancer (IPCA) in a contemporary cohort of lower urinary tract symptoms (LUTS) patients who underwent trans-urethral resection of the prostate (TURP). Methods: A series of 458 consecutive patients who underwent TURP were evaluated between January 2016 to June 2018. Evaluated factors included age (years), Body Mass Index (BMI; kg/square meters), treatment with inhibitors of 5-alpha reductase, previous prostate biopsies, basal prostate specific antigen (PSA) levels (ng/mL), serum leukocyte count (×109/L), weight of resected prostate tissue (grams), grade and stage of IPCA. The multivariate logistic regression model evaluated associations of significant clinical factors with the risk of IPCA. Results: Overall, IPCA was detected in 30 of 454 patients (6.6%). A mean of 21.8 g of tissue was resected. The mean number of positive chips was 5.6 (mean percentage 3.9%) with tumor grade group 1 in 22 cases (73.4%) and tumor stage cT1a in 23 patients (76.7%). On multivariate analysis, independent factors that were positively associated with the risk of IPCA were BMI (odds ratio, OR=1.121; P=0.017) and leukocyte count (OR=1.144; P=0.027). Conclusions: In a contemporary cohort of patients undergoing TURP for the treatment of LUTS, the risk of IPCA was not negligible with a rate of being 6.6%. BMI and serum leukocyte count were found to be independent factors that were positively associated with the risk of IPCA

Positive Association between Basal Total Testosterone Circulating Levels and Tumor Grade Groups at the Time of Diagnosis of Prostate Cancer

Introduction: To test the hypothesis that basal total testosterone (TT) levels are associated with International Society of Urologic Pathology (ISUP) tumor grade groups at the time of diagnosis of prostate cancer (PCA). Methods: From November 2014 to March 2018, preoperative TT and PSA were measured in 601 consecutive patients who were not under androgen deprivation and undergoing surgery for PCA. Patients were classified into low (ISUP 1; reference group), intermediate (ISUP 2/3), and high (ISUP 4/5) tumor grade groups. The association of TT and other clinical factors with tumor groups was evaluated by multinomial multivariate regression analysis. Results: 218 patients (36.3%) were biopsy low grade (ISUP 1), 297 (49.4%) intermediate grade (ISUP 2/3), and 86 (14.3) high grade (ISUP 4/5). Median basal circulating TT levels progressively increased as tumor grade groups increased. On multivariate models, TT, among other clinical factors, was positively associated with the risk of intermediate (OR 1.001; p = 0.023) and high tumor grades (OR 1.002, p = 0.022) compared to low-grade cancers. Conclusions: Increased endogenous circulating basal TT levels were positively associated with ISUP tumor grade groups at the time of diagnosis indicating a close association with tumor biology. Basal TT levels may reflect the heterogeneity of the cancer population

Endogenous testosterone as a predictor of prostate growing disorders in the aging male

To investigate the associations of endogenous testosterone with prostate growing disorders (PGD) including benign prostatic hyperplasia (BPH) and prostate cancer (PCA)

Open approach, extended pelvic lymph node dissection and seminal vesicle invasion are independent predictors of hospital readmission after prostate cancer surgery: a large retrospective study

To evaluate factors (clinical, pathological and perioperative) associated with the risk of hospital readmission after radical prostatectomy (RP) over the long term in a single tertiary referral center where both open RP (ORP) and robot assisted RP (RARP) are performed

Linear extent of positive surgical margin impacts biochemical recurrence after robot-assisted radical prostatectomy in a high-volume center

The objective of this study is to evaluate if surgeon volume and stratifying positive surgical margins (PSM) into focal and non-focal may differentially impact the risk of biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). Between January 2013 and December 2017, 732 consecutive patients were evaluated. The population included negative cases (control group) and PSM subjects (study group). PSMs were stratified as focal ( 64\u20091 mm) or non-focal (>\u20091 mm). A logistic regression model assessed the independent association of factors with the risk of PSM. The risk of BCR of PSM and other factors was assessed by Cox's multivariate proportional hazards. Overall, 192 (26.3%) patients had PSM focal in 133 patients; non-focal in 59 cases. Focal PSM was associated with the percentage of biopsy positive cores (BPC; OR 1.011; p\u2009=\u20090.015), extra-capsular extension (pT3a stage; OR 2.064; p\u2009=\u20090.016), seminal vesicle invasion (pT3b; OR 2.150; p\u2009=\u20090.010), body mass index (odds ratio, OR 0.914; p\u2009=\u20090.006), and high surgeon volume (OR 0.574; p\u2009=\u20090.006). BPC (OR 1.013; p\u2009=\u20090.044), pT3a (OR 4.832; p\u2009<\u20090.0001) and pT3b stage (OR 5.153; p\u2009=\u20090.001) were independent predictors of the risk of non-focal PSM. Surgeon volume was not a predictor of non-focal PSM (p\u2009=\u20090.224). Independent factors associated with the risk of BCR were baseline PSA (hazard ratio, HR 1.064; p\u2009=\u20090.004), BPC (HR 1.015; p\u2009=\u20090.027), ISUP biopsy grade group (BGG) 2/3 (HR 2.966; p 0.003) and BGG 4/5 (HR 3.122; p\u2009=\u20090.022) pathologic grade group 4/5 (HR 3.257; p\u2009=\u20090.001), pT3b (HR 2.900; p\u2009=\u20090.003), and non-focal PSM (HR 2.287; p\u2009=\u20090.012). Surgeon volume was not a predictor of BCR (p\u2009=\u20090.253). High surgeon volume is an independent factor that lowers the risk of focal PSM. Surgeon volume does not affect non-focal PSM and BCR. Negative as well as focal PSM are not associated with BCR