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We evaluated the diagnostic accuracy of multiparametric magnetic resonance imaging and multiparametric magnetic resonance imaging/transrectal ultrasound fusion guided targeted biopsy against that of transperineal template saturation prostate biopsy to detect prostate cancer.We retrospectively analyzed the records of 415 men who consecutively presented for prostate biopsy between November 2014 and September 2016 at our tertiary care center. Multiparametric magnetic resonance imaging was performed using a 3 Tesla device without an endorectal coil, followed by transperineal template saturation prostate biopsy with the BiopSee® fusion system. Additional fusion guided targeted biopsy was done in men with a suspicious lesion on multiparametric magnetic resonance imaging, defined as Likert score 3 to 5. Any Gleason pattern 4 or greater was defined as clinically significant prostate cancer. The detection rates of multiparametric magnetic resonance imaging and fusion guided targeted biopsy were compared with the detection rate of transperineal template saturation prostate biopsy using the McNemar test.We obtained a median of 40 (range 30 to 55) and 3 (range 2 to 4) transperineal template saturation prostate biopsy and fusion guided targeted biopsy cores, respectively. Of the 124 patients (29.9%) without a suspicious lesion on multiparametric magnetic resonance imaging 32 (25.8%) were found to have clinically significant prostate cancer on transperineal template saturation prostate biopsy. Of the 291 patients (70.1%) with a Likert score of 3 to 5 clinically significant prostate cancer was detected in 129 (44.3%) by multiparametric magnetic resonance imaging fusion guided targeted biopsy, in 176 (60.5%) by transperineal template saturation prostate biopsy and in 187 (64.3%) by the combined approach. Overall 58 cases (19.9%) of clinically significant prostate cancer would have been missed if fusion guided targeted biopsy had been performed exclusively. The sensitivity of multiparametric magnetic resonance imaging and fusion guided targeted biopsy for clinically significant prostate cancer was 84.6% and 56.7% with a negative likelihood ratio of 0.35 and 0.46, respectively.Multiparametric magnetic resonance imaging alone should not be performed as a triage test due to a substantial number of false-negative cases with clinically significant prostate cancer. Systematic biopsy outperformed fusion guided targeted biopsy. Therefore, it will remain crucial in the diagnostic pathway of prostate cancer.

Background: We sought to determine which parsimonious combination of complete blood count (CBC)-based biomarkers most efficiently predicts oncologic outcomes in patients undergoing radical cystectomy (RC) for bladder cancer (BC). Methods: Using our institutional RC database (1992–2012), nine CBC-based markers (including both absolute cell counts and ratios) were evaluated based on pre-treatment measurements. The outcome measures were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Time-dependent receiver-operating characteristics curves were used to characterise each biomarker. The CBC-based biomarkers, along with several clinical predictors, were then considered for inclusion in predictive multivariable Cox models based on the Akaike Information Criterion. Results: Our cohort included 418 patients. Neutrophil–lymphocyte ratio (NLR) was the only biomarker satisfying criteria for inclusion into all models, independently predicting RFS (HR per 1-log unit=1.52, 95% CI=1.17–1.98, P=0.002), CSS (HR=1.47, 95% CI=1.20–1.80, P

Objectives To externally validate and compare the two novel versions of the European Randomised Study for Screening of Prostate Cancer (ERSPC)-prostate cancer risk calculator (RC) and Prostate Cancer Prevention Trial (PCPT)-RC. Patients and Methods All men who underwent a transrectal prostate biopsy in a European tertiary care centre between 2004 and 2012 were retrospectively identified. The probability of detecting prostate cancer and significant cancer (Gleason score ≥7) was calculated for each man using the novel versions of the ERSPC-RC (DRE-based version 3/4) and the PCPT-RC (version 2.0) and compared with biopsy results. Calibration and discrimination were assessed using the calibration slope method and the area under the receiver operating characteristic curve (AUC), respectively. Additionally, decision curve analyses were performed. Results Of 1 996 men, 483 (24%) were diagnosed with prostate cancer and 226 (11%) with significant prostate cancer. Calibration of the two RCs was comparable, although the PCPT-RC was slightly superior in the higher risk prediction range for any and significant prostate cancer. Discrimination of the ERSPC- and PCPT-RC was comparable for any prostate cancer (AUCs 0.65 vs 0.66), while the ERSPC-RC was somewhat better for significant prostate cancer (AUCs 0.73 vs 0.70). Decision curve analyses revealed a comparable net benefit for any prostate cancer and a slightly greater net benefit for significant prostate cancer using the ERSPC-RC. Conclusions In our independent external validation, both updated RCs showed less optimistic performance compared with their original reports, particularly for the prediction of any prostate cancer. Risk prediction of significant prostate cancer, which is important to avoid unnecessary biopsies and reduce over-diagnosis and overtreatment, was better for both RCs and slightly superior using the ERSPC-RC.

The prognostic role of preoperative serum lipid levels in patients undergoing radical prostatectomy (RP) for clinically localized prostate cancer (PCa) is unclear. The aim of the present study was to investigate preoperative serum lipid levels in patients with clinically localized PCa undergoing RP and their association with clinicopathological features and oncological outcome.Preoperative lipid levels (total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides) and statin use from consecutive patients with clinically localized PCa undergoing RP in a tertiary referral center between 2008 and 2015 were recorded and patients were followed prospectively. Logistic regression analysis was used to test the association between lipid levels and clinicopathological parameters. Lipid values were analyzed both as continuous and dichotomized variables. Univariable and multivariable Cox regression analyses were performed to identify predictors for recurrence-free survival (RFS). Recurrence was defined as rising and verified PSA levels0.1 ng/ml.Our cohort consisted of 371 men with a median age of 63 years (range 41-78 years) and a median preoperative PSA value of 6.79 ng/ml (0.43-81.4 ng/ml). Median follow-up was 28 months (1-64). No association was found between lipid levels and adverse pathological characteristics such as ≥pT3, Gleason score ≥8, positive nodal status and positive surgical margins. Recurrence occurred in 49 patients (15.4%) at a median time of 18 months (2-51 month). Compared to low LDL cholesterol, high LDL cholesterol was associated with longer RFS in univariable analysis (continuous: Hazard Ratio (HR): 0.67, 95%-Confidence Interval (CI): 0.47-0.96, P = 0.03; 3 mM cut-point: HR: 0.44, 95%-CI: 0.24-0.79, P = 0.006). Neither levels of other lipids, nor statin use were associated with RFS. Preoperative LDL cholesterol remained an independent predictor for PCa recurrence in a multivariable model adjusted for age, preoperative PSA, statin use, tumor stage, Gleason score, nodal status and surgical margin status (continuous: HR: 0.66, 95%-CI: 0.44-0.99, P = 0.04; 3 mM cut-point: HR: 0.41, 95%-CI: 0.21-0.78, P = 0.007).This is the first prospective study showing the potential adverse and independent prognostic role of low preoperative LDL cholesterol levels in patients with localized PCa undergoing RP. Prostate 77:549-556, 2017. © 2017 Wiley Periodicals, Inc.

INTRODUCTION AND OBJECTIVES: Prostate volume reduction has been shown to be less extensive after 120W greenlight laser vaporization (LV) than after conventional transurethral resection. Higher power and a larger beam area are the main features of the novel 180 W greenlight laser and the new MoxyTM laser fibre. LV using the 180W laser results in faster tissue ablation. However, whether 180W LV also results in more extensive tissue ablation is unknown. The aim of this study was to compare volume changes after 120W and 180W greenlight LV of the prostate. METHODS: A total of 144 patients were investigated in this prospective, non-randomized study. The 120W group consisted of 96 consecutive patients who underwent routine 120W LV between 04/2008 and 03/2012 and the 180W group of 48 consecutive patients who underwent 180W LV between 11/2012 and 11/2014. Planimetric volumetry after transrectal 3D ultrasound of the prostate was performed preoperatively, after catheter removal and after 6 weeks, 6 and 12 months. Clinical outcome parameters were recorded preoperatively and at the respective follow-up visits. Student t-test and Mann-Whitney U test were used for statistical analysis. RESULTS: The median initial prostate volume (120W: 46.6ml, 180W: 39.4ml; p1⁄40.15) and the investigated baseline parameters (IPSS, QoL, Residual volume, Qmax, PSA) were not significantly different between the two groups. The operative time was significantly lower in the 180W group (120W: 82min, 180W: 70min; p

Aims. CD73 is a membrane associated 5′-ectonucleotidase that has been proposed as prognostic biomarker in various solid tumors. The aim of this study is to evaluate CD73 expression in a cohort of patients with primary bladder cancer in regard to its association with clinicopathological features and disease course. Methods. Tissue samples from 174 patients with a primary urothelial carcinoma were immunohistochemically assessed on a tissue microarray. Associations between CD73 expression and retrospectively obtained clinicopathological data were evaluated by contingency analysis. Survival analysis was performed to investigate the predictive value of CD73 within the subgroup of pTa and pT1 tumors in regard to progression-free survival (PFS). Results. High CD73 expression was found in 46 (26.4%) patients and was significantly associated with lower stage, lower grade, less adjacent carcinoma in situ and with lower Ki-67 proliferation index. High CD73 immunoreactivity in the subgroup of pTa and pT1 tumors was significantly associated with longer PFS (HR: 0.228; ) in univariable Cox regression analysis. Conclusion. High CD73 immunoreactivity was associated with favorable clinicopathological features. Furthermore, it predicts better outcome in the subgroup of pTa and pT1 tumors and may thus serve as additional tool for the selection of patients with favorable prognosis., Disease Markers, 2015, ISSN:0278-0240, ISSN:1875-8630

Absorption of irrigation fluid was not detected during GreenLight™ laser vaporization of the prostate using the first generation 80 W laser. However, data are lacking on intraoperative irrigation fluid absorption using the second generation 120 W high power laser. We assessed whether fluid absorption occurs during high power laser vaporization of the prostate.We performed this prospective investigation at a tertiary referral center in patients undergoing 120 W laser vaporization for prostatic bladder outlet obstruction. Normal saline containing 1% ethanol was used for intraoperative irrigation. The expired breath ethanol concentration was measured periodically during the operation using an alcometer. The volume of saline absorption was calculated from these concentrations. Intraoperative changes in hematological and biochemical blood parameters were also recorded.Of 50 investigated patients 22 (44%) had a positive breath ethanol test. Median absorption volume in the absorber group was 725 ml (range 138 to 3,452). Ten patients absorbed more than 1,000 ml. Absorbers had a smaller prostate, more capsular perforation, higher bleeding intensity and more laser energy applied during the operation. Three patients (13%) had symptoms potentially related to fluid absorption. Hemoglobin, hematocrit and serum chloride were the only blood parameters that changed significantly in the absorber group. The changes were significantly different than those in nonabsorbers.Fluid absorption occurs frequently during high power laser vaporization of the prostate. This should be considered in patients who present with cardiopulmonary or neurological symptoms during or after the procedure.

INTRODUCTION AND OBJECTIVES: The objective was to measure the penetration depth after PhotoVaporization of the Prostate (PVP) by Enhanced Contrat UltraSonography (ECUS). METHODS: It is a forward-looking study about twelve patients operated by a PVP performed by the GREENLIGHT XPS laser. Ethical committee gave its aproval (EUDRACT N : 2012-001451-39). ECUS was performed (B-mode then contrast mode after injection of 2,4mL of suphur hexafluoride micro bubbles) preoperatively and immediately after the PVP and at 1 month. With ultrasound were measured: width, prostatic volume and diameter of the cavity of vaporization (DC) with the B-mode; then in contrast mode MicroFlow Imaging (MFI): the prostatic width and the NonVascularized cavity diameter (DD). The necrotic depth was measured using the formula: NC 1⁄4 (DD-DC)/2) (Figure 1). RESULTS: The characteristics of the patients were : a median age of 70 years old [57-81], median prostatic volume of 65 cc [40-110], median maximal urinary flow of 7,2 mL/s [2, 9-15,2], median post mictional residual volume of 90 cc [0-213], median IPSS score of 19 [8-24] and a median PSA rate of 4 ng/mL [1,6-7,9]. The results found with ultrasound performed pre and post operatively are summarized in table 1. All the patients had their bladder catheter removed and then discharged the hospital at day 1, except one patient who had an acute retention treated at day 8 by an indwelling catheter. CONCLUSIONS: The use of ECUS showed an unexpected necrotic depth up to 16,5 mm in the immediate post-operative ultrasound. This necrotic depth persisted at 1 month and was measured up to 13 mm. At one month we measured a 26% decrease of the prostatic volume and a 23% of the necrotic depth. These results are to be considered to performe securely PVP without any rectal complication. The continuing follow-up at 6 and 12 months will probably precize the necrotic depth evolution and the potential correlation with the occurrence of irritative voiding dysfunction. Table 1 : Ultrasonography results

INTRODUCTION AND OBJECTIVES: Laser vaporization (LV) of the prostate using the 532-nm laser is a recommended treatment option for patients with prostatic bladder outlet obstruction and particularly for those with significant cardiovascular comorbidities. Despite the excellent coagulation properties of the laser, fluid absorption was frequently detectable during 120W LV of the prostate. For the nextgeneration 180W laser, a better coagulation technology has been announced. If fluid absorption occurs during LV using this improved but also more powerful laser is unknown. METHODS: Intraoperative fluid absorption was investigated during routine LV using the 180W Greenlight XPS laser (AMS, USA) in 32 consecutive patients. For this purpose intraoperative irrigation was performed using saline containing 1% ethanol. Measurements of breath ethanol were performed every 10 minutes during the operation with a conventional alcometer. The volume of fluid absorption was calculated from these results. Intraoperative changes in hemoglobin (Hb), hematocrit (Hct), venous pH and serum Na, K, Cl, HCO3 were also recorded. Statistical analysis was done using Mann Whitney U test and Wilcoxon signed-rank test. RESULTS: Median age was 73 y (range: 56 85 y), median prostate volume 50 ml (20 99 ml). The median operative time was 60 min (30-150 min), the intraoperative irrigation volume 21 L (6 42 L), and the applied laser energy 175 kJ (70 e 544 kJ). 17 patients (53%) had a positive ethanol test. The median calculated absorption volume in these patients was 827 ml (138 e 4808 ml). In the absorber group, a significant decrease in Hb, Hct, HCO3, pH (p1⁄40.001, 0.004, 0.002 and 0.02, respectively), and a significant increase in serum Cl (p1⁄40.007) were detectable. The changes in Hb, Hct, Cl and HCO3 were significantly greater compared to the non-absorber group (p1⁄40.005, 0.02, 0.001 and 2000ml) were prolonged metabolic acidosis and somnolence, hypothermia, jugular venous distension and significant postoperative weight gain. CONCLUSIONS: Intraoperative fluid absorption occurs in a significant proportion of patients during 180W LV of the prostate. Fluid absorption can be excessive and thus clinically relevant. Early identification of fluid absorption using the ethanol breath test enables timely interventions. If ethanol monitoring is not available, changes in Hb, Hct, pH, HCO3 and Cl can be used to detect potentially dangerous fluid absorption.

Bipolar plasma vaporization (BPV) has been introduced as an alternative to transurethral resection of the prostate (TURP). Promising short-term results, but inferior mid-term results compared to TURP have been reported following first-generation bipolar electrovaporization. Outcome data following second-generation BPV are still scarce. The aim of this investigation was to evaluate the intra- and postoperative outcomes of contemporary BPV in a center with long-standing expertise on laser vaporization of the prostate.A consecutive series of 83 patients undergoing BPV in a tertiary referral center was prospectively evaluated. The investigated outcome parameters included the maximum flow rate (Qmax), postvoid residual volume, International Prostate Symptom Score (IPSS)/quality of life (Qol), and prostate-specific antigen (PSA) tests. Follow-up investigations took place after 6 weeks, 6 months, and 12 months. The Wilcoxon signed-rank test was used to compare pre- and post-treatment parameters.The median (range) preoperative prostate volume was 41 mL (17-111 mL). The preoperative IPSS, Qol, Qmax, and residual volume were 16 (2-35), 4 (0-6), 10.1 mL/s (3-29.3 mL/s), and 87 mL (0-1000 mL), respectively. One third of the patients were undergoing platelet aggregation inhibition (PAI). No intraoperative complications occurred. Postoperatively, 13 patients (15.7%) had to be recatheterized. Three patients (3.6%) had clot retention and 28 patients (34%) reported any grade of dysuria. After 6 weeks, all outcome parameters improved significantly and remained improved over the 12-month observation period [IPSS: 3 (0-2); Qol: 1 (0-4); Qmax: 17.2 mL/s (3.2-56 mL/s); residual volume 11 mL (0-190 mL)]. The PSA reduction was 60% at study conclusion. Three patients (3.6%) developed a urethral stricture and four patients (4.8%) bladder neck sclerosis. Re-resections were not necessary.Contemporary BPV is a safe and efficacious treatment option even for patients undergoing PAI. Early urinary retention and temporary dysuria seem to be specific side effects of the treatment. Bleeding complications are rare. Long-term follow-up is needed to confirm these promising short-term results.

INTRODUCTION AND OBJECTIVES: Greenlight laser vaporisation (LV) of the prostate has been shown to be a safe procedure even for high-risk patients with lower urinary tract symptoms caused by prostate enlargement. Intra-operative fluid absorption was not detectable during LV using the first generation 80W greenlight laser. For the more powerful 120W greenlight laser, a different spectrum of adverse events, including a higher rate of capsular perforations and more bleeding complications, has been reported. The aim of the present investigation was to assess if fluid absorption occurs during LV using the more powerful 120W laser. METHODS: A total of 50 consecutive patients was investigated during 120W greenlight LV of the prostate. Intra-operative irrigation was performed using isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min throughout the procedure with a conventional alcometer. The volume of fluid absorption was calculated from the results of these measurements. Intraoperative changes of haemoglobin, haematocrit, venous pH and serum electrolytes were also recorded. RESULTS: The median patients’ age was 69 y (range: 49-84) and the median prostate volume 41 mL (23-118). 25 patients (50%) were operated under thrombocyte aggregation inhibition and 8 (16 %) under anti-coagulation therapy. The median operation time was 70 min (30-170), the median irrigation volume 18 L (8-45) and the median applied laser energy 230 kJ (65-400). 22 patients (44 %) had a positive ethanol breath test. The median amount of fluid absorption in these patients was 1249 mL (138-3452). The surgeons reported intra-operative events in form of opened venous sinuses (n 2), capsular perforation (n 3) or a deep bladder neck incision (n 5) In 10 of these patients (45%). In the group of patients with a positive ethanol test, a significant decrease of the haemoglobin, haematocrit and venous pH and a significant increase of the serum chloride were detectable. CONCLUSIONS: Intra-operative fluid absorption was detectable in 44% of the patients undergoing 120W greenlight LV of the prostate. Absorption of isotonic saline does not result in a classical TUR-syndrome. However, care must be taken in cardiovascular highrisk patients because absorption of up to 3.5 liters of saline can result in serious complications in these patients. Intra-operative monitoring with venous pH or serum chloride might help to detect potentially dangerous fluid absorption if ethanol breath ethanol measurements are not performed.