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The best surgical template for salvage pelvic lymph node dissection (sLND) in patients with nodal recurrence from prostate cancer (PCa) after radical prostatectomy (RP) is currently unknown. We analyzed data of 189 patients with a unilateral positive positron emission tomography (PET) scan of the pelvic lymph node areas, who were treated with bilateral pelvic sLND after RP at 11 high-volume centers. The primary endpoint was missed contralateral disease at final pathology, defined as lymph node positive for PCa in the side opposite to the positive spot(s) at the PET scan. Overall, 93 (49%) and 96 (51%) patients received a 11C-choline and a 68Ga prostate-specific membrane antigen (PSMA) PET scan, respectively, and 171 (90%) and 18 (10%) men had one and two positive spots, respectively. The rate of missed contralateral PCa was 18% (34/189), with the rates being 17% (29/171) and 28% (5/18) in men with one and two positive spots, respectively. While the rate of contralateral disease did not differ between 68Ga-PSMA and 11C-choline (29% and 27%, respectively) among men with two positive spots, the rate of contralateral PCa was only 6% with 68Ga-PSMA versus 28% with 11C-choline in patients with a single positive spot. This finding was confirmed at multivariable logistic regression analysis predicting missed disease at final pathology after accounting for confounders (odds ratio: 0.24; p = 0.001). However, in men with a single positive spot at 68Ga-PSMA PET/computed tomography, the rate of single confirmed lymph node metastasis at final pathology was only 33%, suggesting the need for extended template even if unilateral dissection is performed. Awaiting confirmatory studies, patients diagnosed with a single positive spot at the 68Ga-PSMA PET scan might be considered for unilateral extended pelvic sLND. Patient summary We assessed the risk of missing contralateral disease in patients with a positron emission tomography (PET) scan suggestive of unilateral nodal recurrence from prostate cancer (PCa) after radical prostatectomy and who were treated with bilateral salvage lymph node dissection (sLND). Variability exists according to the number of positive spots and PET tracer, with the lowest rate of missed PCa in men diagnosed with a single positive spot at a 68Ga prostate-specific membrane antigen PET scan (6%). If replicated, our data suggest that these patients might be considered for unilateral extended pelvic sLND.

Background: The optimal definition and prognostic significance of persistently elevated prostate-specific antigen (PSA) after salvage lymph node dissection (sLND) for node-only recurrent prostate cancer (PCa) remain unknown. Objective: To assess the definition and clinical implications of persistently elevated PSA after sLND for node-only recurrent PCa after radical prostatectomy. Design, setting, and participants: The study included 579 patients treated with sLND at 11 high-volume centers between 2000 and 2016. Outcome measurements and statistical analysis: We assessed the linear relationship between the first PSA after sLND and death from PCa. Different definitions of PSA persistence were included in a multivariable model predicting cancer-specific mortality (CSM) after surgery to identify the best cutoff value. We investigated the association between PSA persistence and oncologic outcomes using multivariable regression models. Moreover, the effect of early androgen deprivation therapy (ADT) after sLND was tested according to PSA persistence status and estimated risk of CSM. Results and limitations: We found an inverse relationship between the first PSA after sLND and the probability of cancer-specific survival. PSA persistence defined as first postoperative PSA ≥0.3 ng/ml provided the best discrimination accuracy (C index 0.757). According to this cutoff, 331 patients (57%) experienced PSA persistence. The median follow-up for survivors was 48 mo (interquartile range 27-74). After adjusting for confounders, men with persistently elevated PSA had higher risk of clinical recurrence (hazard ratio [HR] 1.61), overall mortality (HR 2.20), and CSM (HR 2.59; all p 10%. Conclusions: PSA persistence after sLND independently predicts adverse prognosis, with the best discrimination accuracy for CSM provided by a definition of PSA ≥ 0.3 ng/ml. We showed that when stratifying patients by final pathology results and PSA persistence status, early ADT use after sLND was beneficial only for patients with PSA persistence or with a calculated 5-yr risk of CSM of >10%, which could be useful as we await results from ongoing prospective trials. Patient summary: We found that for patients with prostate cancer who had lymph nodes removed after their cancer recurred, persistently elevated prostate-specific antigen (PSA) levels predict poorer prognosis. We showed that a PSA level of ≥0.3 ng/ml provides the best accuracy in identifying patients with worse prognosis. This may help to improve risk stratification after lymph node removal and allow physicians to optimize treatment strategies after surgery.

Purpose The oncological benefit of postchemotherapy residual tumor resection (PC-RTR) in patients with germ cell tumors and elevated serum tumor markers (STMs) remains unclear. This analysis was performed to better define patients who benefit from surgery in this setting. Patients and methods Of 575 PC-RTR procedures (07/2008 - 07/2019), 153 were performed in patients with elevated STMs (human chorionic gonadotropin (s-HCG) >2.0 mIU/ml, alpha-fetoprotein (AFP) >7.0 µg/l), including 55 after first-line and 98 after second- or later-line chemotherapy. Results Viable cancer in the resected specimen was significantly more common in the salvage group than in the first-line group (48.98% vs. 16.36%, p=0.0001988) and was a predictor of survival in both groups. A preoperative serum level of AFP ≥30 µg/l was a significant predictor of viable cancer in the first-line and salvage groups (55.56% [p=0.0157] and 66.67% [p=0.0017], respectively). The overall relapse-free survival rate (22.7% and 50%, p=0.00032) and overall survival rate (37.8% and 65%, p=0.0059) were significantly worse in the salvage group than in the first-line group. A preoperative serum level of AFP ≥30 µg/l and viable cancer/teratoma found in the histological examination of the RTR specimens were significant predictors of relapse after first-line chemotherapy. Serum AFP ≥30 µg/l and HCG ≥20 mIU/ml were significant factors affecting survival in the first-line group. Conclusion Patients with AFP serum levels>30 µg/l and HCG ≥20 mIU/ml after first-line chemotherapy should receive salvage chemotherapy instead of surgery. After second- or later-line therapy, the prognosis of patients with elevated markers and surgery is poor regardless of the tumor marker levels. However, 38% of these patients are long-term survivors, which justifies PC-RTR in this setting.

Background One cycle of adjuvant chemotherapy with bleomycin, etoposide and cisplatin (BEP) has shown superiority in recurrence-free survival over retroperitoneal lymph node dissection (RPLND) in patients with clinical stage (CS) I non-seminomatous germ cell tumours (NSGCTs) of the testis in the setting of a phase III trial. We report the recurrences and late toxicities of this study after 13 years of follow-up. Methods Questionnaires from 382 patients with CS I NSGCT treated with 1 cycle of adjuvant BEP (arm A) or RPLND + two cycles of adjuvant BEP in cases of pathological stage II disease (arm B) were evaluated regarding recurrences and late toxicity. Overall, information on recurrence status was available in 337 patients, and 170 questionnaires were evaluable for toxicity (arm A: 95; arm B: 75). Results With a median follow-up of 13.8 years (0–22), 3 patients (1.6%) in arm A and 16 patients (8.4%) in arm B experienced recurrence. The 15-year PFS in arm A/B was 99% (CI 96–100%)/92% (CI 89–99%) (p = 0.0049). The 15-year OS in arm A/B was 93% (CI 87–97%)/93% (CI 86–97%) (p = 0.83). Eight patients (4.2%) in arm A and four patients (2.1%) in arm B showed metachronous secondary testicular cancer (p = 0.26). Five patients (2.6%) in arm A and four patients (2.1%) in arm B developed other malignancies. Toxicities were not significantly different apart from retrograde ejaculation, which occurred more frequently after RPLND (10% versus 24%, p = 0.01). Conclusions With long-term observation, one cycle of BEP remains superior to RPLND in preventing recurrence and was tolerated without any clinically relevant long-term toxicities.

PURPOSE To evaluate the probability to correctly predict major vascular surgery (MVS) in patients undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for testicular cancer. METHODS From a database of 504 RPLNDs performed in 434 patients (2008-2018), 78 patients submitted to PC-RPLND for non-seminoma germ-cell cancer after cisplatin-based chemotherapy with available preoperative CT scans were identified. Second PC-PLNDs (Re-Dos), salvage RPLNDs, or RPLNDs for late-relapse were excluded as well as thoraco-abdominal approaches. Preoperative imaging was reviewed by a urologist and a radiologist blinded to operative details. RESULTS Of 78 patients, 16 (20.5%) underwent MVS (caval and/or aortic replacement or reconstruction). On univariable analyses, transversal diameter, sagittal diameter, tumor volume, aorta- and cava-tumor contact angle, poor IGCCCG score, clinical stage III and preoperative positive markers were predictors of MVS (all p values ≤ 0.01). At multivariable analyses aorta- (cut-off 64°) and cava-tumor contact angle (cut-off 98°) and poor IGCCCG score represented the three most important predictors of MVS (all p values ≤ 0.05). The model constructed has a PPV 100%, NPV 87% and an accuracy of 88%. CONCLUSIONS Presence of aorta-tumor contact angle ≥ 64°, cava-tumor contact angle ≥ 98° and poor IGCCCG score identify correctly 9 out of 10 patients requiring MVS at the time of first PC-RPLND.

Among young men between the ages of 15 and 40 years, germ cell cancer is the most common solid tumor [1]. The worldwide incidence of germ cell cancer is 70 000 cases. Compared to all solid tumors of men, germ cell cancer accounts for 1% of all male tumors. Nevertheless, the mortality of this rare tumor entity is about 13% since 9507 patients died worldwide of germ cell cancer. The improvement in survival of germ cell cancer patients is due to a multimodal treatment of germ cell cancer including cisplatin-based chemotherapy and surgery leading to higher cure-rates even in advanced stages [1], whereas the increasing incidence of germ cell cancers cannot be thoroughly explained. In this article we review the current indications for surgery in metastatic germ cell cancers, highlight the strength and weaknesses of techniques and indications and raise the question how to improve surgical treatment in metastatic germ cell cancer.

Germ cell cancers are the most common solid tumors among men between 15 and 40 years. Non-seminomatous germ cell tumors (NSGCTs) represent a unique and exclusive cohort of germ cell tumor patients. Non-seminoma can harbor different histologic components. The most commonly found histologies are embryonal cell cancer, teratoma, yolk sack tumor and choriocarcinoma, as well as teratocarcinoma and seminoma, in combination with non-seminomatous germ cell tumors histologic types. The clinical definition of stage I non-seminoma is the absence of metastatic lesions on imaging and normal tumor markers. The cure rate for clinical stage I NSGCT is 99% and this can be achieved by three therapeutic strategies: Active surveillance with treatment at the time of relapse, retroperitoneal lymph node dissection or adjuvant chemotherapy. The balancing of these various strategies should always be based on an individual risk profile of NGSCG patient depending on the lymphovascular invasion of the tumor.

Die Diagnose des Growing-Teratoma-Syndroms (GTS) ist komplex und in den Behandlungsmoglichkeiten aufgrund der geringen Fallzahl schwierig zu bewerten. Ein besseres Verstandnis zu der Entstehung des GTS sowie die Sensibilisierung fur das paradoxe klinische Bild, ist masgeblich fur eine erfolgreiche Behandlungsstrategie. Ziel dieser Studie ist es, die aktuelle Literatur zu der Entwicklung und den Behandlungsmoglichkeiten des GTS zusammenzufassen. Darauf basierend wird ein molekulares Modell zur Entstehung des GTS erortert und eine evidenzbasierte Behandlungsstrategie empfohlen. Es wurde eine selektive Literaturrecherche uber PubMed durchgefuhrt. Das GTS ist durch proliferierende und metastasierende postpubertare Teratome ohne weitere nichtseminomatose Komponente sowie unter Chemotherapie regredienten oder sich normalisierenden Serum-Tumormarkern humanes Choriongonadotropin (β-hCG), α‑Fetoprotein (AFP) und Laktatdehydrogenase (LDH) gekennzeichnet. Die Autoren postulieren, dass wahrend der Chemotherapie embryonale Karzinomzellen zu einer sich transient vermehrenden Gewebe-Stammzellpopulation differenzieren. Diese Population hat das Potenzial, sich selbst zu erneuern oder in alle 3 Keimblatter (Mesoderm/Endoderm/Ektoderm) zu differenzieren, wodurch das Wachstum eines Teratoms gefordert wird. Als Therapieoption ist daher eine vollstandige Resektion des gesamten Teratoms notwendig. Aufgrund der hohen Inzidenz gemeinsamer Resektionen von zusatzlichen Strukturen wird die Behandlung in multidisziplinaren und spezialisierten Zentren empfohlen.

Die Behandlung von Patienten mit fortgeschrittenen, rezidivierten und chemotherapieresistenten Keimzelltumoren stellt eine besondere Herausforderung dar. Die multidisziplinare Behandlung der Patienten mit Chemotherapie und operativer Resektion von Residualtumorgewebe resultiert in insgesamt exzellenten Uberlebenschancen. In den seltenen Fallen von Keimzelltumorrezidiven, seltenen Rezidivlokalisationen, einer erworbenen oder angeborenen Chemotherapieresistenz kommt der operativen Resektion eine besondere Bedeutung zu. In diesem Ubersichtsartikel wird der Stellenwert der operativen Resektion von Residualtumorgewebe bei fortgeschrittenen Keimzelltumoren nach First-Line-Therapie sowie in der Salvage-Situation als auch im Sonderfall der „desperation surgery“ bei steigenden Tumormarkern unter oder nach Letztlinien-Chemotherapie beschrieben. Es wurde eine selektive Literaturrecherche uber PubMed durchgefuhrt. Die operative Resektion von Residualtumorgewebe von >1 cm nach Chemotherapie ist integraler Bestandteil der leitliniengerechten Therapie bei nichtseminomatosen Keimzelltumoren und senkt die Rezidivrate. Bei fortgeschrittenen Seminomen stellt die primare Residualtumorresektion eine Ausnahme dar. Nach erfolgter Salvage-Chemotherapie ist die Residualtumorresektion unabhangig von der Residualtumorgrose durchzufuhren. Mit einem Langzeituberleben von etwa 50 % stellt die „desperation surgery“ einen operativen Therapieansatz bei chemotherapieresistenten Keimzelltumoren dar. Komplette Resektabilitat ist hier jedoch zentrale Voraussetzung fur den onkologischen Erfolg.

Robotic assisted retroperitoneal lymph node dissection in patients with testicular cancer is controversial. Lately, unusual recurrence patterns with adverse outcomes after robotic assisted retroperitoneal lymph node dissection have been published. In this report we determine the feasibility, safety and early oncologic outcome of robotic assisted retroperitoneal lymph node dissection in patients with small volume metastatic testicular cancer.We retrospectively evaluated 27 consecutive patients with small volume metastatic testicular cancer (October 2010 to November 2019) who underwent robotic assisted retroperitoneal lymph node dissection (unilateral modified template). Intraoperative and postoperative complications as well as early oncologic outcomes are reported. Surgery was performed in the primary metastatic setting in 22 (81%), post-chemotherapy in 4 (15%) and for late relapse in 1 patient (4%). Initial clinical stage was IIA for 14 (52%), IIB for 12 (43%) and III for 1 (4%) patient.Median operative time, blood loss and length of hospital stay were 175 minutes, 50 ml and 4 days, respectively. Expectedly, viable tumor was found in 21/27 patients (78%) and 6 patients (22%) showed fibrosis, necrosis or no tumor. Overall 3 (11%) patients experienced intraoperative (Satava II) and 1 (4%) postoperative (Clavien-Dindo IIIb) complications, respectively. Median followup was 16.5 months (3-69), and 3 (11%) patients experienced relapse outside of the surgical field after 12, 22 and 36 months.In highly selected patients with low volume metastatic testicular cancer robotic assisted retroperitoneal lymph node dissection may be indicated, and appears to be technically feasible and comparable with open surgery in terms of complications and early oncologic safety. Prospective data collection in larger series is necessary to clarify the role and specific indications of this approach.

Thoracic growing teratoma syndrome (TGTS) is a rare disease in patients with germ cell tumors. Other than a few case reports and a limited number of case series, studies of this topic are not available. We retrospectively analyzed the data from our patients who received surgery for TGTS between 1999 and 2016. Descriptive statistical analyses were performed to analyze the characteristics of the patients, tumors, and short-term outcomes. Furthermore, the long-term outcomes and survival curves were analyzed using the Kaplan–Meier method. Twenty-nine patients underwent surgery for TGTS. The median age was 32 years (range: 19–50 years). All patients received cisplatin-based chemotherapy. Many of the patients had multilocalized TGTS (n = 10). The median tumor size was 64.5 mm (range 10-210 mm). In all cases, R0 resection was achieved. The minor morbidity, major morbidity, and mortality rates were 3.4%, 6.9%, and 0%, respectively. Altogether, 28 patients were included in the long-term follow-up analysis, with a median follow-up time of 94 months (13–237 months). The 5-, 10-, and 15-year survival rates were 93%, 93%, and 84%, respectively. TGTS may occur in multiple localizations and grow to a large tumor size. The resection of TGTS can be performed with low morbidity and mortality rates and is associated with good overall survival after complete resection. Important are an early detection and knowledge of the systemic treatment options by the oncologist and urologist, as well as a thoracic surgeon with a large experience in extended thoracic resections.

Zusammenfassung Hintergrund Bei mehr als 80 % aller Patienten mit einem Seminom wird die Diagnose im Stadium I–IIB gestellt. In den letzten Jahrzehnten wurden Therapiealgorithmen anhand von klinischen Studien definiert und mögliche Toxizitäten anhand von Langzeitbeobachtungen untersucht. Fragestellung Therapieoptionen werden unter Berücksichtigung der Langzeittoxizitäten dargelegt. Material und Methoden Es erfolgte eine Literaturrecherche sowie die kritische Auseinandersetzung mit Leitlinienempfehlungen und laufenden Studien. Ergebnisse Die präferierte Option im Stadium I ist die aktive Überwachung. Eine adjuvante Carboplatintherapie oder Strahlentherapie können das Rezidivrisiko senken. Im Stadium IIA/B wird eine primäre Strahlentherapie oder eine Polychemotherapie empfohlen. Experimentelle Ansätze testen die Lymphadenektomie und die deeskalierte Radio‑/Chemotherapie. Das Toxizitätsprofil von Radio- und Chemotherapie unterscheidet sich markant. Individuelle Nachsorgepläne nach Risikoprofil werden empfohlen. Schlussfolgerung Patienten mit Risikofaktoren im Stadium I haben ein relevantes Rezidivrisiko, sodass eine adjuvante Therapie gegenüber der aktiven Überwachung abgewogen werden kann. Die Wahl der Therapie im Stadium IIA/B sollte sich an der Tumorlast und den möglichen Spättoxizitäten orientieren. Strategien zur Therapiedeeskalation sind in Erarbeitung – mit ermutigenden ersten Resultaten.

Purpose:We compared the use of 11C-choline and 68Ga-prostate specific membrane antigen in men undergoing salvage lymph node dissection for nodal recurrent prostate cancer.Materials and Methods:The ...

Die retroperitoneale Lymphadenektomie ist integraler Bestandteil der stadienadaptierten Therapie von testikularen Keimzelltumoren. Verschiedene Ansatze der retroperitonealen Lymphadenektomie werden auf Basis unterschiedlicher Indikationen durchgefuhrt. Die nervschonende retroperitoneale Lymphadenektomie als primare Therapieoption bei nicht seminomatosen Keimzelltumoren im klinischen Stadium I sollte risikoadaptiert erfolgen. Geringfugige perioperative Komplikationen wie Wundinfekte, Lymphozelen und paralytischer Ileus treten bei in etwa 14 % der Patienten auf. Schwerwiegendere Komplikationen wie chylarer Aszites und Lungenarterienembolien treten bei ca. 5,4 % der Patienten auf. Die haufigste Langzeitkomplikation ist hierbei das Auftreten einer Retrograden Ejakulation. Der Erhalt der antegraden Ejakulation kann jedoch bei weit uber 90 % der Patienten erreicht werden. Die postchemotherapeutische retroperitoneale Lymphadenektomie ist integraler Bestandteil der multimodalen Therapie bei retroperitonealen Residualbefunden. Bei residuellen Befunden > 3 cm beim fortgeschrittenen Seminom dient das FDG PET als zuverlassige Entscheidungshilfe zur Durchfuhrung einer retroperitonealen Lymphadenektomie. Bei ca. 30 % der Patienten mit nicht seminomatosen Keimzelltumoren finden sich residuelle retroperitoneale Tumorbefunde. Diese sollten unabhangig von der Grose der Befunde bei negativen Serumtumormarkern oder Serumtumormarkern im Plateau komplett reseziert werden. Die postchemotherapeutische retroperitoneale Lymphadenektomie stellt einen herausfordernden Eingriff dar und sollte primar an ausgewiesenen Zentren durchgefuhrt werden. Bei bis zu 25 % der Patienten ist im Rahmen der postchemotherapeutischen retroperitonealen Lymphadenektomie die Resektion umgebender Strukturen indiziert. Eine Beteiligung der aorta abdominalis liegt in 6 – 10 % der Falle vor, eine Beteiligung der vena cava in ca. 2 % der Falle. Komplikationsraten liegen bei der postchemotherapeutischen retroperitonealen Lymphadenektomie hoher als bei der primaren nervschonenenden Lymphadenektomie mit signifikant hoherem intraoperativen Blutverlust und signifikant hoherer Transfusionsrate. Mit einer Wahrscheinlichkeit von 2 – 7 % tritt chylarer Aszites nach postchemotherapeutischer retroperitonealer Lymphadenektomie haufiger auf. Jedoch kann auch im Rahmen der postchemotherapeutischen Lymphadenektomie bei bis zu 85 % der Erhalt der antegraden Ejakulation erreicht werden. Entscheidend fur den Erhalt der antegraden Ejakulation und einer Verbesserung der Morbiditat insgesamt ist auch hier das nach Moglichkeit das Anstreben eines nervsparenden Vorgehens durch Anpassung der Felder. Retroperitoneal lymph node dissection is an integral part of the stage-adapted therapy of germ cell tumours. Different approaches of retroperitoneal lymph node dissection are performed based on various indications. Nerve-sparing retroperitoneal lymph node dissection as a primary therapy option in non-seminomatous germ cell tumours in clinical stage I disease should be performed using a risk-adapted approach. Minor complications like infections of operative wounds, lymphoceles and paralytic ileus are described in about 14 % of patients, major complications like chylous ascites and pulmonary artery embolism in 5,4 % of patients. The most common long-term complication is retrograde ejaculation. Antegrade ejaculation rates of over 90 % can be achieved with a nerve-sparing attempt. Post-chemotherapy retroperitoneal lymph node dissection is an integral part of the multimodality treatment of retroperitoneal residual masses after chemotherapy. For residual masses with a diameter of > 3 cm in advanced seminoma patients, FDG-PET is a reliable indicator for decision-making on retroperitoneal lymph node dissection. Residual retroperitoneal tumour masses appear in about 30 % of patients with non-seminomatous germ cell tumours. These masses should be resected completely, irrespectively of their size, in patients with negative tumour markers or plateauing tumour markers. Post-chemotherapy lymph node dissection is a challenging procedure and should be performed at referral centres. In 25 % of patients, resection of adjunctive organs is necessary in post-chemo lymph node dissection. Affection of abdominal aorta is described in 6 – 10 % of all cases, affection of inferior vena cava in about 2 % of cases. Post-chemo lymph node dissection is associated with a higher complication rate than nerve-sparing primary retroperitoneal lymph node dissection, including a significantly higher intraoperative blood loss and a significantly higher transfusion rate. With rates of 2 – 7 %, chylous ascites occurs more often in post-chemo retroperitoneal lymph node dissection. Antegrade ejaculation can be preserved in up to 85 % of patients. To preserve antegrade ejaculation and reduce morbidity, a nerve-sparing approach and template reduction in post-chemo retroperitoneal lymph node dissection is crucial and should be performed when possible.

Objectives To assess the ability of multiparametric MRI (mp-MRI) of the prostate to exclude prostate cancer (PCa) progression during monitoring patients on active surveillance (AS). Methods One hundred forty-seven consecutive patients on AS with mp-MRI (T2WI, DWI, DCE-MRI) at 3T were initially enrolled. Fifty-five received follow-up mp-MRI after a minimum interval of 12 months and subsequent targeted MR/US fusion-guided biopsy (FUS-GB) plus concurrent systematic transrectal ultrasound-guided (TRUS-GB) biopsy as reference standard. Primary endpoint was the negative predictive value (NPV) of the follow-up mp-MRI to exclude histopathologic tumor progression using PRECISE recommendations. Secondary endpoints were the positive predictive value (PPV), sensitivity, specificity, Gleason score (GS) upgrades, and comparison of biopsy method. Results Of 55 patients, 29 (53%) had a GS upgrade on re-biopsy. All 29 patients showed a tumor progression on follow-up mp-MRI. Fifteen of 55 patients (27%) displayed signs of tumor progression, but had stable GS on re-biopsy. None of the 11 patients (20%) without signs of progression on follow-up mp-MRI had a GS upgrade on re-biopsy. The NPV was 100%, PPV was 66%, sensitivity was 100%, and specificity 42%. FUS-GB resulted in GS upgrade significantly more often (n = 28; 51%) compared with TRUS-GB (n = 12; 22%; p < 0.001). Conclusions (Follow-up) Mp-MRI can reliably exclude PCa progression in patients on AS. Standard serial re-biopsies might be waived if follow-up mp-MRIs are stable. Over 60% of patients with signs of tumor progression on mp-MRI during AS had a GS upgrade on re-biopsy. Targeted re-biopsies should be performed if cancer progression or higher-grade PCa is suspected on mp-MRI. Key Points • None of the patients with unsuspicious mp-MRI had a GS upgrade in re-biopsy and mp-MRI might replace serial biopsies in these cases • More than 60% of patients with mp-MRI signs of tumor progression had subsequent Gleason score (GS) upgrades • Targeted re-biopsies should be performed in case of higher GS cancer suspicion on mp-MRI

ZusammenfassungDas zunehmende Wissen um den Einfluss des Immunsystems auf Tumorentstehung und -progression haben unser Verständnis von Tumorbiologie in den letzten Jahren grundlegend verändert. Während sich die zur Verfügung stehenden Therapieoptionen für Patienten mit metastasiertem Urothelkarzinom der Harnblase über Jahrzehnte hinweg kaum verbessert haben, hat der Einzug von Immuncheckpoint-Inhibitoren in kurzer Zeit zu einer starken Wandlung der Behandlungslandschaft geführt. Zwar bildet die Cisplatin-basierte Kombinationstherapie auch weiterhin die Hauptsäule, darüber hinaus bestehen aber nun zusätzliche wirkungsvolle Behandlungsoptionen mit den in Europa zugelassenen PD-(L)-1-Inhibitoren Atezolizumab, Pembrolizumab und Nivolumab. Einem bemerkenswerten Langzeitansprechen stehen hier das Auftreten teils schwerster immun-vermittelter Nebenwirkungen sowie eine insgesamt nur geringe Ansprechrate von etwa 25 % gegenüber. Eine Vielzahl aktueller klinischer Studien beschäftigt sich daher besonders mit möglichen Kombinationsansätzen und sinnvollen Therapiesequenzen, um mögliche Synergismen sowie additive Effekte der bisher zur Verfügung stehenden Substanzen unter Berücksichtigung eines vertretbaren Nebenwirkungsprofils optimal auszunutzen. Darüber hinaus werden viele neue Therapieansätze in klinischen Studien erprobt. In diesem Zusammenhang sind besonders die Entwicklungen auf dem Gebiet der Antikörper-Wirkstoff-Konjugate und FGFR-Inhibitoren vor dem Hintergrund der erst kürzlich erfolgten FDA-Zulassung hervorzuheben.Der hier vorliegende Review gibt einen Überblick über die aktuell zur Verfügung stehenden Therapieoptionen im metastasierten Urothelkarzinom der Harnblase und behandelt darüber hinaus schwerpunktmäßig zukünftige Therapieansätze anhand gegenwärtiger Studien.

Purpose Clinical stage I (CSI) testicular germ cell tumors (TGCT) represents disease confined to the testis without metastasis and CSIS is defined as persistently elevated tumor markers (TM) after orchiectomy, indicating subclinical metastatic disease. This study aims at assessing clinical characteristics and oncological outcome in CSIS. Methods Data from five tertiary referring centers in Germany were screened. We defined correct classification of CSIS according to EAU guidelines. TM levels, treatment and relapse-free survival were assessed and differences between predefined groups (chemotherapy, correct/incorrect CSIS) were analyzed with Fisher’s exact and Chi-square test. Results Out of 2616 TGCT patients, 43 (1.6%) were CSIS. Thereof, 27 were correctly classified (cCSIS, 1.03%) and 16 incorrectly classified (iCSIS). TMs that defined cCSIS were in 12 (44.4%), 10 (37%), 3 (11.1%) and 2 (7.4%) patients AFP, ß-HCG, AFP plus ß-HCG and LDH, respectively. In the cCSIS group, six patients were seminoma and 21 non-seminoma. Treatment consisted of active surveillance, carboplatin-mono AUC7 and BEP (bleomycin, etoposide and cisplatin). No difference between cCSIS and iCSIS with respect to applied chemotherapy was found (p = 0.830). 5-year relapse-free survival was 88.9% and three patients (11%) in the cCSIS group relapsed. All underwent salvage treatment (3xBEP) with no documented death. Conclusion Around 1% of all TGCT were classified as cCSIS patients. Identification of cCSIS is of critical importance to avoid disease progression and relapses by adequate treatment. We report a high heterogeneity of treatment patterns, associated with excellent long-term survival irrespective of the initial treatment approach.

Background: Long-term outcomes of patients treated with salvage lymph node dissection (sLND) for nodal recurrence of prostate cancer (PCa) remain unknown. Objective: To investigate long-term oncological outcomes after sLND in a large multi-institutional series. Design, setting, and participants: The study included 189 patients who experienced prostate-specific antigen (PSA) rise and nodal-only recurrence after radical prostatectomy (RP) and underwent sLND at 11 tertiary referral centers between 2002 and 2011. Lymph node recurrence was documented by positron emission tomography/computed tomography (PET/CT) scan using either 11C-choline or 68Ga prostate-specific membrane antigen ligand. Outcome measurements and statistical analysis: The primary outcome of the study was cancer-specific mortality (CSM). The secondary outcomes were overall mortality, clinical recurrence (CR), biochemical recurrence (BCR), and androgen deprivation therapy (ADT)-free survival after sLND. The probability of freedom from each outcome was calculated using Kaplan-Meier analyses. Cox regression analysis was used to predict the risk of prostate CSM after accounting for several parameters, including the use of additional treatments after sLND. Results and limitations: At long term, 110 and 163 patients experienced CR and BCR, respectively, with CR-free and BCR-free survival at 10 yr of 31% and 11%, respectively. After sLND, a total of 145 patients received ADT, with a median time to ADT of 41 mo. At a median (interquartile range) follow-up for survivors of 87 (51, 104) mo, 48 patients died. Of them, 45 died from PCa. The probabilities of freedom from cancer-specific and all-cause death at 10 yr were 66% and 64%, respectively. Similar results were obtained in sensitivity analyses in patients with pelvic-only positive PET/CT scan, as well as after excluding men on ADT at PET/CT scan and patients with PSA level at sLND higher than the 75th percentile. At multivariable analyses, patients who had PSA response after sLND (hazard ratio [HR]: 0.45; p = 0.001), and those receiving ADT within 6 mo from sLND (HR: 0.51; p = 0.010) had lower risk of death from PCa. Conclusions: A third of men treated with sLND for PET-detected nodal recurrence of PCa died at long term, with PCa being the main cause of death. Salvage LND alone was associated with durable long-term outcomes in a minority of men who significantly benefited from additional treatments after surgery. Taken together, all these data argue against the use of metastasis-directed therapy alone for patients with node-only recurrent PCa. These men should instead be considered at high risk of systemic dissemination already at the time of sLND. Patient summary: We assessed long-term outcomes of patients treated with salvage lymph node dissection (sLND) for node-recurrent prostate cancer (PCa). In contrast with prior evidence, we found that the majority of these men recurred after sLND and eventually died from PCa. A significant survival benefit associated with the administration of androgen deprivation therapy after sLND suggests that sLND should be considered part of a multimodal approach rather than an exclusive treatment strategy. At long-term follow-up, the majority of patients treated with salvage lymph node dissection (sLND) for node-recurrent prostate cancer (PCa) recurred and eventually died from PCa. We found a significant survival benefit associated with the administration of androgen deprivation therapy after sLND, suggesting that sLND should be considered part of a multimodal approach rather than an exclusive treatment strategy.

Purpose Late relapsing germ cell tumors (LR-GCT) are considered a rare distinct biologic entity as their clinical presentation and response to treatment is different to early recurrences. While serum tumor markers (AFP and ß-HCG) play an important role at the time of first diagnosis to correctly classify prognosis and treatment of germ cell tumors, they may not have the same significance in a late relapse situation. Patients and methods Thirty-seven patients with LR-GCT with elevated serum tumor markers were identified in our database. Twenty-six patients underwent primary surgical resection of the late relapsing tumor. Eleven patients received salvage chemotherapy and a post-chemotherapy residual tumor resection. Serum tumor markers, histological findings and oncological outcome were analyzed. Results In the histopathological specimen, viable cancer was found in 20 cases (54%) and teratoma was found in 16 cases (43%). In nine cases (24%), a somatic-type malignant transformation was present. In 19 of 37 patients (51.4%), the late relapse specimen presented a histological type of GCT, which was not present in the primary histology. Twenty-two patients (59.5%) were included in follow-up analysis. Mean and median follow-up time was 62.2 and 53 months, respectively. Seventeen patients (77.3%) suffered a relapse or had progressive disease after LR therapy. Five patients (22.7%) have been relapse-free after LR therapy (mean FU 61.6 months). Ten patients died of disease during follow-up (45.5%) and had a mean time from LR to death of 66.4 months. Eleven patients were alive at last follow-up (mean FU 62.2 months). Relapse and survival rate were similar between patients who received primary resection of LR tumor and patients who received salvage chemotherapy followed by surgery. Conclusion Patients with a late relapsing germ cell tumor and elevated markers have a poor prognosis and a high risk for another relapse independent on primary treatment. The histological type and aggressiveness of a late relapsing tumor cannot be predicted with serum tumor marker levels at the time of diagnosis of LR. In up to 54% of cases, primary histology did not coincide with LR histology. Therefore, we propose primary surgical resection of a late relapsing tumor if a complete resection is feasible in order to gain exact histology and tailor further treatment.

Growing teratoma syndrome (GTS) is a rare clinical phenomenon in patients with nonseminomatous germ cell cancer defined by growing metastatic mass during ongoing or directly after completed chemotherapy with timely decreasing tumor markers and postpubertal teratoma exclusively after resection. GTS was first described in 1982, and few reports have been published. The limited number of studies and the resulting lack of exact knowledge about development, differentiation, and treatment of GTS leaves several clinical problems regarding treatment and follow-up unsolved. This review provides an overview of clinical diagnosis and disease management and an approach to explain the molecular development of GTS.

For multiparametric magnetic resonance imaging/ultrasound fusion prostate biopsy the number of biopsy cores obtained is arbitrarily established by urologists. Moreover, a general consensus is lacking on the number of biopsy cores to be obtained from a single magnetic resonance imaging lesion. Therefore, we evaluated the feasibility of obtaining only 1 biopsy core per magnetic resonance imaging lesion.We retrospectively evaluated a total of 2,128 biopsy cores of 1,064 prostatic lesions (2 cores per lesion) in 418 patients in regard to prostate cancer detection (histology) and the Gleason score of the first biopsy core compared to the second biopsy core. Two analyses were performed, including patient level analysis based on prostate cancer detection per patient and lesion level analysis based exclusively on the histology of each lesion regardless of the overall histological outcome of the case.The overall prostate cancer detection rate was 45.7% (191 of 418 patients). The first biopsy core detected 170 of all 191 prostate cancers (89%). In 17 of these 170 prostate cancers (10%) the second biopsy core revealed Gleason score upgrading. Nine of the 21 prostate cancers (43%) missed by the first biopsy core had a Gleason score of 6. Altogether 537 of the 2,128 biopsy cores were positive, including 283 first (26.6%) and 254 second (24%) biopsy cores (p ≤0.001). The concordance between the first and second biopsy cores was 89% (κ = 0.71). There was a discrepancy with Gleason score upgrading in 28 of 212 lesions (13.2%) with positive first and second biopsy cores.Our study shows that obtaining more than 1 biopsy core per magnetic resonance imaging lesion only slightly improves the prostate cancer detection rate and Gleason grading.

Objectives This study evaluates cases with clinically significant prostate cancer (csPCa) missed by targeted biopsy (TB) and analyzes the diagnostic impact of an additional systematic biopsy (SB) in a large patient collective. Methods Consecutive patients with a 3 T multiparametric prostate MRI (mpMRI) and a subsequent MRI/US fusion-guided TB plus 12-core US-guided SB from 01/2014 to 04/2019 were included in this study. Primary study endpoint was the analysis of cases with a csPCa missed by TB and detected by SB. Secondary study objectives were the PCa detection and the correlation with clinical and MRI parameters. Results In total 785 patients met the inclusion criteria. 342 patients had a csPCa (median PSAD 0.29 ng/mL/cm3). In 42 patients (13 %), a csPCa was detected only by SB. In 36 of these cases, the localization of the positive SB cores matched with the cancer suspicious region described on mpMRI (mCSR). Cases with a csPCA missed by TB showed either an insufficient MRI segmentation (prostate boundary correlation) (31 %) and/or insufficient lesion registration (lesion transfer, tracking, and/or matching) (48 %), a missed small lesion (14 %), or a failed center of a large lesion (10 %). Median PSAD of patients with non-significant PCa detected by SB was 0.15 ng/mL/cm3. Conclusions Main reasons for missing a csPCa by TB were insufficient prostate segmentation or imprecise lesion registration within MRI/US fusion-guided biopsy. Consequently, verification of MRI quality, exact mCSR assessment, and advanced biopsy experience may improve accuracy. Altogether, an additional SB adds limited clinical benefit in men with PSAD ≤ 0.15 ng/mL/cm3.

BackgroundDeletion or mutations ofSHANK3lead to Phelan–McDermid syndrome and monogenic forms of autism spectrum disorder (ASD).SHANK3encodes its eponymous scaffolding protein at excitatory glutamatergic synapses. Altered morphology of dendrites and spines in the hippocampus, cerebellum, and striatum have been associated with behavioral impairments in Shank3-deficient animal models. Given the attentional deficit in these animals, our study explored whether deficiency ofShank3in a rat model alters neuron morphology and synaptic ultrastructure in the medial prefrontal cortex (mPFC).MethodsWe assessed dendrite and spine morphology and spine density in mPFC layer III neurons inShank3-homozygous knockout (Shank3-KO), heterozygous (Shank3-Het), and wild-type (WT) rats. We used electron microscopy to determine the density of asymmetric synapses in mPFC layer III excitatory neurons in these rats. We measured postsynaptic density (PSD) length, PSD area, and head diameter (HD) of spines at these synapses.ResultsBasal dendritic morphology was similar among the three genotypes. Spine density and morphology were comparable, but more thin and mushroom spines had larger head volumes inShank3-Het compared to WT andShank3-KO. All three groups had comparable synapse density and PSD length. Spine HD of total and non-perforated synapses inShank3-Het rats, but notShank3-KO rats, was significantly larger than in WT rats. The total and non-perforated PSD area was significantly larger inShank3-Het rats compared toShank3-KO rats. These findings represent preliminary evidence for synaptic ultrastructural alterations in the mPFC of rats that lack one copy ofShank3and mimic the heterozygous loss ofSHANK3in Phelan–McDermid syndrome.LimitationsTheShank3deletion in the rat model we used does not affect all isoforms of the protein and would only model the effect of mutations resulting in loss of the N-terminus of the protein. Given the higher prevalence of ASD in males, the ultrastructural study focused only on synaptic structure in maleShank3-deficient rats.ConclusionsWe observed increased HD and PSD area inShank3-Het rats. These observations suggest the occurrence of altered synaptic ultrastructure in this animal model, further pointing to a key role of defective expression of the Shank3 protein in ASD and Phelan–McDermid syndrome.

INTRODUCTION AND OBJECTIVE:To provide a complete resection of residual tumor in testicular cancer patients, major vascular surgery (MVS) is necessary and requires multidisciplinary planning and ade...

INTRODUCTION AND OBJECTIVE:Salvage lymph node dissection (SLND) is among possible treatment options for patients with node-recurrent prostate cancer (PCa). It is well known that preoperative imagin...

We systematically analyzed the records of patients with PI-RADS™ (Prostate Imaging Reporting and Data System) 3 lesions, which are called equivocal according to PI-RADS version 2, using prostate multiparametric magnetic resonance imaging and magnetic resonance imaging targeted biopsies. Systematic transrectal ultrasound guided biopsies served as the reference standard.A total of 120 consecutive patients were retrospectively included in the study. In these patients the overall PI-RADS score was 3 after 3 Tesla T2-weighted imaging, diffusion weighted imaging and dynamic contrast enhanced multiparametric magnetic resonance imaging as well as subsequent targeted magnetic resonance imaging/ultrasound fusion guided biopsies plus systematic 12-core transrectal ultrasound guided biopsies. The study end points were the prostate cancer detection rate, the Gleason score distribution, the prostate cancer location and risk stratification by subgroup analyses.Prostate cancer was detected in 13 of 118 patients for a detection rate of 11%, including 5 patients (4.2%) with a Gleason score of 3 + 4 = 7 or greater. Three of the 212 lesions (1.4%) in the transition zone and 6 of the 64 (9.4%) in the peripheral zone were positive for prostate cancer. Multiparametric magnetic resonance imaging revealed patterns of peripheral prostatitis combined with diffuse stromal hyperplasia in 54% of the patients with prostate cancer. Prostate volume was significantly lower in patients with prostate cancer (p = 0.015) but differences in prostate specific antigen levels were not statistically significant (p = 0.87). Prostate specific antigen density was higher in patients with prostate cancer (0.19 vs 0.12 ng/ml/ml).Low grade prostate cancer (Gleason score 3 + 3 = 6) can develop in patients with an overall PI-RADS score of 3. Prostate cancer with a Gleason score of 3 + 4 = 7 or greater can be detected by multiparametric magnetic resonance imaging with a high degree of certainty. Gleason score 4 + 3 = 7 or greater prostate cancer is unlikely in PI-RADS 3 lesions. Therefore, these patients should primarily undergo followup multiparametric magnetic resonance imaging. In patients with a combination of multiparametric magnetic resonance imaging aspects of extensive prostatitis and diffuse stromal hyperplasia low prostate volume and/or high prostate specific antigen density biopsy might be considered.

Schadstoffe wie chlorierte, aromatische oder polyzyklische aromatische Kohlenwasserstoffe (CKW, BTEX, PAK) oder Mineralolkohlenwasserstoffe (MKW) stellen fur viele Wasserressourcen eine erhebliche Gefahrdung dar. Die Schadstoffe kontaminieren Geringleiter aufgrund deren betrachtlichen Speicherpotenzials meist langfristig. Thermische In-situ-Sanierungen (TISS) haben sich zur Sanierung kontaminierter Geringleiter bewahrt, wobei sich die Anwendungsbereiche in den letzten 10 Jahren stetig erweitert haben. Abhangig von den hydrogeologischen und geologischen Randbedingungen und den zu sanierenden Schadstoffen konnen sich die dominierenden Prozesse bei der Sanierung jedoch stark voneinander unterscheiden. Der Beitrag fasst die Anwendungsbereiche thermischer Sanierungen zur Reinigung kontaminierter Geringleiter und die hierbei sanierungsrelevanten Prozesse bei der Boden- und Grundwasserreinigung zusammen. Der Sanierungsverlauf bei der Beseitigung von Leichtfluchtern (CKW-Schaden) bzw. der Forderung residualer Olphase wird anhand von Projektbeispielen verdeutlicht.

Background A frequent complication post cesarean section (C-section) is surgical site infections (SSI) which are associated with heightened maternal morbidity and mortality, decreased patient satisfaction, prolonged hospitalization, and increased costs. In Calendar Year 2019, our Infection Control Committee identified an increase in the incidence of post-operative C-section SSI rates over an 8 month period from January through August of 2019.. The purpose of this study was to develop, implement and measure the compliance and efficacy of a novel pre-operative bundle (POB) for patients undergoing C-section. Calendar Year 2019 Jan. through Aug. C-Section Infections Raw Numbers Methods In October 2019, our multidisciplinary team consisting of Infection Control, Pharmacy, Nursing, and Physicians developed and implemented POB for patients undergoing C-section. The POB included the following: 1. Mandatory interventions of vaginal cleansing using povidone iodine 2. Chlorhexidine (CHG) 2% wipes to abdomen 3. Addition of Azithromycin 500mg x 1 dose as pre-operative antibiotic. Primary endpoint of the study was to measure the overall C-section SSI incidence for 8 months period pre and 8 months post implementation of the POB. This Secondary endpoint of the study included POB compliance and efficacy of real-time prospective audit and feedback for non-compliance. Novel Preoperative Bundle Auditing Compliance Results There were total of 212 patients who received C-section in Pre-POB group and 182 in Post-POB group. Baseline characteristics between the groups were similar. Overall C-section rates Pre-POB was 3.8 % vs 0% in Post-POB group. We noted a bundle compliance of 97.9% since implementation of POB. Real time prospective audit and feedback was provided to total of 122 cases after implementation of POB. Comparison of C-Section Raw Numbers Calendar Year 2019 Pre and Post Novel Bundle Implementation Conclusion With implementation of POB, we noticed a significant drop in our C-section SSI. We observed a very high bundle compliance with implementation of prospective audit and feedback approach. This is the first study evaluating implementing a novel pre-operative bundle for patients undergoing C-section. Continued auditing and real time feed back of novel bundle will ensure continued success. Disclosures All Authors: No reported disclosures

To assess the impact of dynamic contrast-enhanced imaging (DCE) in mp-MRI on prostate cancer (PCa) detection in a large patient cohort assigned to PI-RADS category 4. This retrospective, single center cohort study includes 193 consecutive patients with PI-RADS assessment category 4 in mp-MRI (T2WI, DWI, DCE) at 3 T with targeted plus systematic biopsy combined as the reference standard. The detection of prostate cancer with and without the use of DCE was compared. Overall, the PCa detection rate in PI-RADS-4 patients was 62 % (119/193) with DCE and 52 % (101/193) without the inclusion of lesions upgraded on the basis of DCE. 48 % (92/193) had clinically significant PCa (csPCa; Gleason score ≥ 3 + 4 = 7) and 40 % (78/193) without use of DCE. 38 of the 193 patients (20 %) had peripheral lesions upgraded from PI-RADS category 3 to an overall PI-RADS category 4 due to focal positive DCE findings. Of these 38 patients, 18 had PCa including 14 with csPCa. Thus, 15 % (18/119) of the patients with PCa and 15 % (14/92) of the patients with csPCa were detected only based on additional DCE information. DCE prevents underestimation and misclassification of a significant number of cases of peripheral csPCa and might improve detection rates in PI-RADS-4 patients. The current PI-RADS decision rules regarding upgrading PI-RADS-3 lesions to category 4 due to positive DCE imaging are useful for PCa detection. · Positive peripheral DCE upgraded 20 % of patients in PI-RADS category 4 from category 3.. · Clinically significant PCa was found in almost 40 % of upgraded, peripheral PIRADS-3-lesions.. · 15 % of all csPCa in PI-RADS-4-patients was detected in DCE-upgraded lesions.. · In 7 % of all PI-RADS-4-cases csPCa would had been underestimated without DCE upgrade..· Ullrich T, Quentin M, Arsov C et al. Value of Dynamic Contrast-Enhanced (DCE) MR Imaging in Peripheral Lesions in PI-RADS-4 Patients. Fortschr Röntgenstr 2020; 192: 441 - 447.ZIEL: Ziel der Studie war die Evaluation des Mehrwerts der dynamischen kontrastmittelgestützten Sequenzen (DCE) in der multiparametrischen MRT (mp-MRT) bezüglich der Prostatakarzinomdetektion in einer großen Kohorte von Patienten mit PI-RADS-4-Befund. 193 Patienten mit einer MR-Gesamtklassifikation von PI-RADS 4 nach mp-MRT der Prostata bei 3 T (T2WI, DWI, DCE) und anschließend kombiniert gezielter plus systematischer Biopsie als Referenzstandard wurden retrospektiv in diese unizentrische Kohortenstudie eingeschlossen. Es wurde die Prostatakarzinomdetektion mit und ohne die Hilfe kontrastmittelgestützter Sequenzen verglichen. Die Gesamtkarzinomdetektionsrate in den PI-RADS-4-Patienten war 62 % (119/193). Ohne Einschluss von Läsionen, die mithilfe der DCE von Kategorie PI-RADS 3 auf PI-RADS 4 aufgewertet wurden, lag die Detektionsrate bei 52 % (101/193). Mit DCE wurden 48 % (92/193) klinisch signifikante Prostatakarzinome (Gleason-Score ≥ 3 + 4 = 7) detektiert und 40 % (78/193) ohne DCE-Verwendung. 38 der 193 Patienten (20 %) hatten periphere Läsionen, die durch auffällige Kontrastmittelanreicherung von PI-RADS Kategorie 3 auf 4 aufgewertet wurden. Von diesen 38 Patienten hatten 18 ein Prostatakarzinom, einschließlich 14 mit einem klinisch signifikanten Karzinom. Somit wurden 15 % (18/119) mit jeglichem Prostatakarzinom und 15 % (14/92) mit einem klinisch relevanten Karzinom nur durch zusätzliche Informationen aus kontrastmittelgestützten Sequenzen detektiert. Kontrastmittelgestützte, dynamische Sequenzen können eine zu niedrige PI-RADS-Fehlklassifizierung einer relevanten Anzahl von Prostatakarzinomen verhindern und die Detektionsraten bei PI-RADS-4-Patienten verbessern. Die aktuellen PI-RADS-Kriterien zur Aufwertung von PI-RADS-3-Läsionen in die Gesamtkategorie 4 durch auffällige Kontrastmittelanreicherung scheinen sinnvoll. · 20 % der PI-RADS-4-Patienten wurden durch auffällige, periphere Kontrastmittelanreicherung aus Kategorie 3 aufgewertet.. · Klinisch signifikante Prostatakarzinome wurden in fast 40 % der aufgewerteten, peripheren PI-RADS-3-Läsionen gefunden.. · 15 % aller signifikanten Karzinome bei PI-RADS-4-Patienten wurden in durch DCE aufgewerteten Läsionen detektiert.. · In 7 % aller PI-RADS-4-Befunde wären klinisch signifikante Prostatakarzinome ohne DCE unterschätzt worden..

INTRODUCTION AND OBJECTIVES:Despite high specificity, PET/CT scan is limited by relatively low sensitivity at a lesion-based analysis in the context of recurrent prostate cancer (PCa). Moreover, un...

INTRODUCTION AND OBJECTIVES:Salvage lymph node dissection (SLND) represents a possible treatment approach for patients affected by nodal recurrence of prostate cancer (PCa). However, its oncologica...

To evaluate different analgesic techniques in MRI-guided in-bore prostate biopsy (IB-GB) regarding the influence on patient procedural experience of pain. Two hundred fifty-two consecutive patients who had received an IB-GB either with intrarectal instillation of 2% lidocaine gel (n = 126, group A) or with periprostatic nerve block (PPNB) with 2% mepivacaine (n = 126, group B) were retrospectively included in this study. Pain scores were measured on a visual analog scale, the operating room time (ORT) was recorded for each biopsy and correlations between the parameters were analysed. Pain scores for IB-GB were slightly lower in group B compared with group A (2.0 ± 1.9; 2.4 ± 1.7; p = 0.02). In group A, significantly more targeted biopsy cores were acquired (group B: 5.2 ± 1.1; group A: 5.6 ± 0.8; p

Background: Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) plays a crucial role in treatment of metastatic non-seminomatous germ cell cancer.Objective: To evaluate the functional outcome regarding the preservation of ejaculatory function comparing a bilateral vs. unilateral template resection in PC-RPLND patients. In addition, oncological safety and perioperative complications of the unilateral template resection was compared to the full bilateral one.Design/Setting/Participants: Between 2003 and 2018, 504 RPLNDs have been performed in 434 patients. The database of consecutive patients was queried to identify 171 patients with PC-RPLND after 1st line chemotherapy for a non-seminoma with or without bilateral template resection. Re-Do's, late relapse, salvage patients, and thoraco-abdominal approaches were excluded. Indication for a template resection was a unilateral residual mass mainly

Objectives To compare prostate specific membrane antigen (PSMA) Positron Emission Tomography/Computed Tomography (PET/CT) and computed tomography (CT) alone for the detection of biochemical recurrence of prostate cancer (PCa) and effect on treatment. Methods This retrospective study included 59 patients with recently recorded biochemical recurrence of PCa (mean PSA 1.96 ± 1.64 ng/mL) after radical prostatectomy. Patients received PET/CT with either 68Ga-PSMA-11 (n = 36) or 18F-PSMA-1007 (n = 23). PET/CT and CT images were evaluated separately in regard to PCa lesion count, type, and localisation by two physicians. Histopathology, follow-up imaging and PSA levels after salvage irradiation served as reference standard. A McNemar test was used to compare detection rates. Changes in therapeutic approaches based on staging differences between CT alone and PET/CT were assessed in a virtual multidisciplinary tumour board. Results There were 142 lesions in 50 of 59 patients. PSMA PET/CT detected 141 lesions (99.3 %) in 50 patients (84.7 %), while CT detected 72 lesions (50.7 %) in 29 patients (49.2 %). A significantly higher detection rate of PSMA PET/CT was observed on a lesion-based analysis (p Conclusion PSMA PET/CT is superior to CT alone in detecting biochemical recurrence in PCa patients after radical prostatectomy and offered additional therapeutic options in a substantial number of patients.

Pennsylvania’s Board of Probation & Parole recently developed a reentry program that provides intensive supervision and oversight to offenders during their reintegration back into the community. The present analysis examined findings gathered from 261 surveys and 226 interviews with program participants across four counties in Pennsylvania. Participants discussed topics related to substance abuse, program characteristics, and perceptions of program staff. Findings highlight program benefits and recidivism outcomes. Results indicate short-term effectiveness with diminished returns overtime. Improvements to the program are needed to ensure better long-term outcomes. Policy implications for offender reentry in Pennsylvania will be discussed.