Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 Outcomes of Primary Cryotherapy for Localized Prostate Cancer - 14-year Single Institution Experience A. Wang; G. Mansour; R. Given Eastern Virginia Medical School Department of Urology, Virginia Beach, VA, USA Introduction: Cryoablation is recommended as an alternative treatment for localized prostate cancer (PCa) given its favorable side effect profiles on bladder and bowel function. Long termoutcomes are not well characterized in the literature. We aim to report our experience with procedure at our center. Materials & Methods: We retrospectively reviewed all men who underwent primary whole-gland cryoablation for localized prostate cancer at our institution from 2005 through 2019. Functional and oncologic outcomes were assessed. Recurrence-free survival was studied based on Kaplan-Meier results. Results: Of the 276 patients, 80% had D’Amico high- (22.8%) or intermediate- (57.6%) risk disease. Median follow-upwas 4.7 years. Majority of the patients (83%) reached prostate-specific antigen (PSA) nadir < 0.4 ng/ml. This was associated with improved disease-free survival (p < 0.00001). De novo incontinence (2%) and De novo ED rates (12%) were relatively low, and complications such as urethral stricture (n = 1) and rectal urethral fistula (n = 0) were extremely rare. 5 year clinical recurrence-free survival was 70% overall and 94% for low-, 86% for intermediate-, and 63% for high-risk PCa in our cohort. Conclusions: Primary whole-gland cryoablation is a safe and durable medium- term alternative for radiation therapy and radical prostatectomy. A 5-Item Frailty Index Predicting Morbidity and Mortality in Radical Prostatectomy: Result from the ACS NSQIP Database M. Shahait 1 ; M. Labban 2 ; J. Cheaib 3 ; D. Lee 1 ; A. El Hajj 2 1 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2 American University of Beirut Medical Center, Beirut, Lebanon; 3 Johns Hopkins Medicine, Baltimore, MD, USA Introduction: Frailty limits a patient’s ability to recover from surgery. Current preoperative evaluation methods fail to assess difference in physiological reserves of patients with the same chronological age. We sought to assess the ability of a simple 5-item frailty index (5-IF) to predict outcomes in patients undergoing radical prostatectomy (RP). Materials &Methods: TheAmerican College of SurgeonNational Surgical Quality Improvement Program (ACS NSQIP) was queried for patients who underwent RP without concurrent procedures from 2008-2017. We calculated the 5-IF score for each patient by assigning a point for each of the following conditions: chronic obstructive pulmonary disease, congestive heart failure, dependent functional status, hypertension, and diabetes. Multivariable backward logistic regression was used for the following outcomes: Clavien-Dindo grade (CDG) ≥ 3 and ≥ 4, extended length of hospital stay (LOS > 1 day), operative time > 240 minutes, return to operating room, and early mortality. The model was adjusted for age, race, American Society of Anesthesiology (ASA) class, and whether laparoscopy/ robotics were used. Results: Atotal of 29,723 patients were included. Patients older than 65, non-white, and with ASA ≥ 3 were more likely to have higher 5-IF scores (≥ 2) (p < 0.0001). A higher 5-IF score correlated with higher CDG complications (p < 0.0001). A 5-IF score ≥ 2 had 1.69 (1.34-2.13) and 1.91 (1.44-2.54) times the odds of CDG ≥ 3 and ≥ 4 adverse events, respectively, as well as a 29% increased risk of extended LOS (p < 0.0001) and increased mortality [OR: 3.83 (1.23-11.84)]. No effect on operative time or return to the operating room was demonstrated. When the 5-IF score was ≥ 2, the tool had 89.3% specificity and 97.8% and 98.3% negative predictive value to predict CDG ≥ 3 and ≥ 4 complications, respectively. Conclusions: Frailty, measured by a simple 5-point frailty index, is an independent predictor of adverse outcomes in patients undergoing RP. This index is a useful tool to counsel patients before surgery. PDB-01 PDA-11 10 Podium Session B PDA-12 PDB-03 TheEffectofPeritonealInterpositionFlaponLymphoceleRatesfollowingRobotic Assisted Radical Prostatectomy with Bilateral Pelvic Lymph Node Dissection C. Mehta; M. Lee; D. Eun; A. Reese Temple University, Philadelphia, PA, USA Introduction: During robotic assisted laparoscopic prostatectomy (RALP) with bilateral pelvic lymph node dissection (BPNLD), creation of a peritoneal interposition flap has been proposed as a technique to reduce the rate of post-operative pelvic lymphocele formation. We aimed to investigate the effect of this technique on the rate of symptomatic lymphocele formation after RALP with BPLND. Materials & Methods: Two surgeons at our institution began performing the peritoneal interposition flap in August 2018. The flap is created after BPLND by rotating and advancing the peritoneum around the lateral surface of the bladder to the dependent portion of the pelvis and fixing it to the bladder itself. To study the effect of the peritoneal flap on development of post-operative lymphoceles, a retrospectivechartreviewwasconductedinwhich191patientswhounderwentRALP with BPLND prior to performance of the flap (pre-flap group) were compared to 124 patients who underwent RALPwith PLNDwith a peritoneal flap (post-flap group). Results: The table shows a comparison of demographic and disease-specific characteristics between the pre- and post-flap groups, as well as the rates of post- operative symptomatic lymphocele formation. More lymph nodes were removed in the post-flap compared to the pre-flap group. Significantly fewer symptomatic lymphoceles occurred in the post-flap group compared to the pre-flap group (4.03% vs. 18.3% p < 0.01). Conclusions: In this single institution series, performance of a relatively simple peritoneal flap significantly decreased the rate of symptomatic lymphocele formation after RALP with PLND. The decreased lymphocele rate in the interposition flap group was observed despite more extensive lymph node dissections being performed in this group. This promising technique warrants additional study in larger multi-institutional series to confirm its potential benefits. Tracking MRI invisible Tumors and Their Pathologic Outcomes in Prostate Cancer S. Gurram 1 ; M. Ahdoot 1 ; A. Lebastchi 1 ; L. O’Connor 1 ; A. Wang 1 ; N. Yerram 1 ; B. Wood 1,2 ; B. Turkbey 1 ; P. Pinto 1 1 National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; 2 Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA Introduction: Magnetic resonance imaging (MRI) invisible tumors are a diagnostic challenge in prostate cancer due to the lack of ability to reliably monitor these lesions radiographically or pathologically. The progression and natural history of these lesions are unknown. Materials & Methods: Men with multiparametric MRI of the prostate and MRI/ Transrectal ultrasound (TRUS) fusion guided biopsy were assessed for the presence of MRI invisible tumors (MIT). An MIT is defined as cancer detected only on extended sextant biopsy and not visible on MRI. All men first underwent an MRI/ TRUS fusion biopsywith tracked extended sextant biopsywhich originally detected the MIT. The original biopsy needle course sampling these MITs were tracked and set as future targets using the MRI/TRUS fusion platform. Men were followed and subsequently underwent a combined MRI/TRUS fusion biopsy, systematic extended sextant biopsy, and a Targeted Tracked biopsy of the MIT (TT-MIT) that was recorded and tracked from the original biopsy. Results: 446MITs were identified, 364 (82%) of whichwere originallyGleason grade group 1 tumors. The median time between biopsies was 17.2 months. 198 tumors were detected on rebiopsy with TT-MIT compared to 151 tumors on systematic biopsy sampling the same corresponding sextant location. TT-MIT demonstrated a 23.7% increased rate of detecting any grade of cancer (p = 0.0003) and a 28.4% increase in detecting GG ≥ 2 tumors (p = .01) compared to corresponding systematic biopsy. Of the 152 rebiopsies in which a GG ≥ 2 tumor was discovered, 23 (15.1%) were found only due to the addition of TT-MIT biopsy and would otherwise have been undetected. GG1 MITs have a 12.5% and 28.8% rate of upgrading to GG ≥ 2 after a single or subsequent rebiopsy, respectively. Conclusions: TrackingMRI invisible tumors with TT-MIT biopsy increases cancer detection rate compared to systematic biopsy and more accurately samples these MITs, unveiling a more aggressive pathology.