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Prostate cancer (PC) etiology is up to 57% heritable, with the remainder attributed to environmental exposures. There are limited studies regarding national level environmental exposures and PC aggressiveness, which was the focus of this study METHODS: SEER was queried to identify PC cases between 2010 and 2014. The environmental quality index (EQI) is a county-level metric for 2000-2005 combining data from 18 sources and reports an overall ambient environmental quality index, as well as 5 environmental quality sub-domains (air, water, land, built, and sociodemographic) with higher values representing lower environmental quality. PC stage at diagnosis was determined and, multivariable logistic regression models which adjusted for age at diagnosis (years) and self-reported race (White, Black, Other, Unknown) were used to test associations between quintiles of EQI scores and advanced PC stage at diagnosis.The study cohort included 252,164 PC cases, of which 92% were localized and 8% metastatic at diagnosis. In the adjusted regression models, overall environmental quality EQI (OR 1.20, CI 1.15-1.26), water EQI (OR: 1.34, CI: 1.27-1.40), land EQI (OR: 1.35, CI: 1.29-1.42) and sociodemographic EQI (OR: 1.29, CI: 1.23-1.35) were associated with metastatic PC at diagnosis. For these domains there was a dose response increase in the OR from the lowest to the highest quintiles of EQI. Black race was found to be an independent predictor of metastatic PC at diagnosis (OR: 1.36, CI: 1.30-1.42) and in stratified analysis by race; overall EQI was more strongly associated with metastatic PC in Black men (OR: 1.53, CI: 1.35-1.72) compared to White men (OR: 1.18, CI: 1.12-1.24).Lower environmental quality was associated with advanced stage PC at diagnosis. The water, land and sociodemographic domains showed the strongest associations. More work should be done to elucidate specific modifiable environmental factors associated with aggressive PC.

Objectives To demonstrate the feasibility, surgical technique and initial outcomes of robotic vaginoplasty with peritoneal flap (Davydov) technique for vaginal reconstruction. Methods Following appropriate preoperative patient counseling, 11 consecutive patients underwent robotic vaginoplasty with the da Vinci (Intuitive Surgical, Sunnyvale CA) multi-port Xi and single port (SP) robotic platforms. Perioperative and postoperative outcomes of interest were retrospectively collected. Results Between March 2019 and October 2019, a total of 11 patients have undergone robotic vaginoplasty with peritoneal flap technique at our institution – 9 using the da Vinci SP platform and 2 using the da Vinci Xi platform. Reasons for vaginoplasty included primary gender-affirming genital reconstruction, vaginal stenosis after gender confirmation surgery, and vaginal hypoplasia secondary to disorders of sexual development. Mean operative time was 267.2 +/- 85.9 minutes. Initial post-operative mean vaginal depth was 13.9 +/- 0.5 cm. Mean estimated blood loss was 131.8 +/- 92.9 ml. Mean length of stay was 5.2 +/- 0.6 days and time to return of bowel function was 1.7 +/- 0.9 days. Thirty-day readmission rate was 18% (N = 2/11) with 1 patient (9%) requiring surgical revision of the neovagina. Conclusions Robotic-assisted Davydov technique is a potentially applicable, efficacious and safe method of vaginal reconstruction in cis-gender and transgender individuals.

Objective To describe the design and build of a novel phantom for magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy and present pilot testing results from a multicenter urology resident training session. Methods We cast our phantom from polyvinylchloride-plastisol that features 10 mm and 5 mm blue clay tumors, a urethral lumen, and an echogenic capsule. T2-weighted images were acquired with a 3T MR750 scanner (GE Healthcare, Boston, MA). Fusion testing was performed on the bkFusion system (BK ultrasound, Peabody, MA) with MIM Symphony software (MIM, Cleveland, OH) and an 18-gauge Bard Monopty disposable gun (Bard, Murray Hill, NJ). Twenty residents from 6 urology programs in Chicago performed proctored user testing. Results The per phantom material cost was $12. The phantom was compatible with all necessary equipment to create a MRI/US fusion data set. MRI and US imaging characteristics were excellent with hypointense lesions. Image fusion was achieved through both end and side fire ultrasound probes. The phantom allowed for biopsies to be performed, and target lesion hits were confirmed by visual inspection of core samples. 38% (8/21) of urology resident pilot testing participants had previously performed a fusion biopsy. The mean postsession survey scores were (1-10 [best]): realism 9.0, usefulness 9.4, ease of use 9.1, ease of orientation 8.9, and overall experience 9.3. Conclusion This simple and inexpensive phantom allows for training and accuracy testing of MRI/US fusion biopsy hardware and software platforms.

Hormonal influences such as androgens and estrogens are known contributors in the development and progression of prostate cancer (CaP). While much of the research to the hormonal nature of CaP has focused on androgens, estrogens also have critical roles in CaP development, physiology as well as a potential therapeutic intervention. In this review, we provide a critical literature review of the current basic science and clinical evidence for the interaction between estrogens and CaP. Estrogenic influences in CaP include synthetic, endogenous, fungi and plant-derived compounds, and represent a family of sex hormones, which cross hydrophobic cell membranes and bind to membrane-associated receptors and estrogen receptors that localize to the nucleus triggering changes in gene expression in various organ systems. Estrogens represent a under-recognized contributor in CaP development and progression. Further research in this topic may provide opportunities for identification of environmental influencers as well as providing novel therapeutic targets in the treatment of CaP.

Prostate cancer (PC) is one of the most common cancer types in the United States (US). Cumulative environmental exposures have been associated with PC incidence. However, the impact of cumulative e...

Varicocelectomy is the surgical excision of dilated and/or incompetent veins that drain blood from the testicle. It is the most common operation for male infertility, and has been shown to halt further testicular damage leading to improved spermatogenesis and testosterone production. There have been several described techniques, from open to laparoscopic to microsurgical. The adoption of the new technology, especially the operating microscope, has led to improved outcomes with fewer adverse effects.

Prostate imaging with F-labeled 1-amino-3-fluorocyclobutane-1-carboxylic acid (FACBC, F-fluciclovine) PET/CT scan (Axumin) was recently approved by the US Food and Drug Administration for men with suspected prostate cancer recurrence based on elevated blood prostate-specific antigen levels following prior treatment. We present a rare case of a 77-year-old man with suspected recurrent prostate cancer with an incidental finding of advanced-stage breast cancer showing different degrees of F-fluciclovine uptake.

21 Background: Treatment of ISUP Grade Group 1 (Gleason 3+3 = 6) disease continues to evolve in the modern era. We examined our surgical database to investigate patterns of behavior in this pathologic subset. Methods: We reviewed the results of 1127 consecutive radical prostatectomies performed by our surgeons from 2012−2015 at various community and academic medical centers in Chicagoland. Specifically, we examined the ISUP Grade Group 1 (Gleason 3+3 = 6) patients in our database, 314 patients overall. Results: A review of our database revealed that of ISUP Grade Group 1 (Gleason 3+3 = 6) patients (n = 314), only 3.82% had pT3 disease (11 patients stage pT3a and 1 stage pT3b). The only patient of these 12 to have lymphovascular invasion (LVI) was the singular pT3b patient. Overall, ISUP Grade Group 1 (Gleason 3+3 = 6) pT3 disease represents only 1.06% of all prostatectomies in our database. Conclusions: In our large prostatectomy cohort, ISUP Grade Group 1 (Gleason 3+3 = 6) prostate cancer was rarely associated with extra−prostatic extension (pT3) or lymphovascular invasion (LVI), suggesting that it has very low metastatic potential. These findings give further support to the trend of increased utilization of active surveillance for low risk prostate cancer.