UROFAIR Virtual 2020

UROFAIR Virtual 2020 Abstracts The Role of a Multidisciplinary MRI Prostate Review Meeting in Reducing the Number of Targeted Biopsies of PIRADS 3 Lesions Found on Multiparametric Prostate MRI Zhen Wei Choo (1) (1) Tan Tock Seng Hospital Introduction and Objectives: Literature has reported detection rates of 12-20% for clinically significant cancer in PIRADS 3 lesions on MRI prostate (1-3). In our monthly MRI prostate review meeting, all PIRADS 3 lesions are re-read by one of two dedicated uro-radiologists and combined with clinical data, and in discussion with urologists, a decision on biopsy is made. Also, the results of the previous months targeted biopsies are reviewed. Methods: Aretrospective review of 352 consecutive patients with PIRADS 3 lesions discussed at the review meeting between January 2017 to September 2019. A decision is made on whether to proceed with targeted biopsy based on radiological features, laboratory results (PSA/PHI levels and PSAdensity), prior biopsy, and clinical status. Results: The meeting recommended 49% (171/352) of PIRADS 3 cases not to proceed with targeted biopsy. Within this, 137/171 (80%) patients had their PIRADS score downgraded, and 34/171 (20%) were not recommended for targeted biopsy due to other clinical or radiological considerations. Overall, 36/352 (10%) had MRI lesions upgraded, and 141/352 (40%) were downgraded to PIRADS 1 or 2. Among patients with PIRADS 3 lesions after the meeting, who proceeded, 27/114 (24%) had prostate cancer, of which 16/114 (14%) were clinically significant (? Gleason grade group 2). Conclusions: Nearly half of patients with PIRADS 3 lesions reviewed were recommended not to proceed with biopsy, with clinically significant cancer detection rates similar to known literature. This meeting streamlines the number of targeted biopsies for PIRADS 3 lesions and provides feedback and educational opportunities for both urologists and radiologists. AMultiphotonMicroscopicStudyoftheRenalCellCarcinomaPseudocapsule Reveals its Heterogeneity Yi Quan Tan (1) (1) National University Hospital Introduction and Objectives: Renal cell carcinoma tumor enucleation has gained popularity as a nephron-sparing surgery technique. This involves dissection along the fibrous pseudocapsule, which remains poorly understood. Multiphotonmicroscopy combines second harmonic generation and two photon excitation fluorescence to image extracellular matrix architecture. This study aimed to utilise MPM as a novel imaging technique to characterize and quantify collagen at the pseudocapsule, and assess for both intra-tumoral and inter-tumoral variation. Methods: 20 partial nephrectomy specimen tissues were retrieved, cut into 5 -micron sections, mounted on slides and deparaffinized. The PCs were imaged with 2X and 20X objective at selected regions of interest. Corresponding clinical information was retrieved. PC thickness was determined. Collagen was quantified by collagen area ratio, and qualitativelymeasured by collagen fibre density and collagen reticulation index. Results: The boundaries between tumour, PC and normal renal parenchyma were distinguished bymultiphotonmicroscopywithout the need for staining. In the thickest areas of the pseudocapsule, collagen content and density were quantitatively higher compared to the thinnest areas. Median collagen area ratio was higher in the thickest compared to the thinnest areas of the PC (p=0.01). Clear cell RCC specimens had a consistently higher collagen fibre density in both the thickest and thinnest areas compared to non-clear cell RCC specimens (p=0.02). Conclusions: In this study, we demonstrated the ability of multiphoton microscopy to quantify collagen characteristics of pseudocapsules without fluorescent labelling. Evenwith a complete and intact pseudocapsule, it is not a homogenous structure, andvaries in its thickness and its collagen characteristics within and between tumours. C-10076 C-10070 Optimal Prostate-Specific Antigen (PSA) Cut-off Value and Transrectal Ultrasound Guided Prostate Biopsy for the Diagnosis of Prostate Cancer at Ramathibodi Hospital: The First Study in Southeast Asia Kun Sirisopana (1) (1) Ramathibodi Hospital, Mahidol University, Thailand Introduction andObjectives: To create an optimumprostate specific antigen (PSA) cut-off level for performing prostate biopsy in the Thai population. Methods: Excluding patients with missing data, 1486 transrectal ultrasound guided prostate biopsies were performed at Ramathibodi Hospital from January 2011 to January 2017. Patient data, such as age, PSAlevel and prostate biopsy findings, were collected. Sensitivities, specificities, positive predictive value and negative predictive value of the PSA cut-off were assessed by retrospective analysis. Results: Of the 1486 transrectal ultrasound guided prostate biopsies evaluated, patients with PCa had a significantly higher mean age (69.34 vs. 67.71 years for PCa and non-PCa, p < 0.001) and had a higher median PSA level (17.11 vs. 7.89 ng/mL for PCa and non-PCa, p < 0.001) than non-PCa patients. Sensitivity, specificity and positive predictive value of the PSAcut-off levels of 4 and 10 ng/ml were 97.3%, 8.4% and 33.3% and 68.0%, 66.4% and 48.7%, respectively. While the sensitivity, specificity and positive predictive value of PSA cut-off levels of 5.5 and 11 ng/ml were 91.8%, 23.3% and 33.3% and 64.0%, 72.5% and 52.2%, respectively. Conclusions: The PSAcut-off should be increased to a level with an optimum trade-off between sensitivities and specificity. New PSA cut-off levels of 5.5 and 11 ng/mLwould still detect 91.8% and 64% of cancers and refrain 23.3% and 72.5% of Thai men, respectively, from having unnecessary biopsies. Furthermore, this cut-off may be adopted for use in other Southeast Asian countries since they share similar environmental and genetic factors. More studies still need to validate these findings. Cost-Impact Analysis of Shifting Benign Prostate Hyperplasia (BPH) Patients Undergoing TURP or TUVP from Inpatient to Ambulatory Day Surgery Centre Zhen Wei Choo (1) (1) Tan Tock Seng Hospital Introduction and Objectives: Outpatient TURP has been reported as early as 1994 with excellent clinical outcomes without compromising quality of care while freeing up inpatient beds, even in Singapore (1,2). Achange in care design was proposed to reduce the average length of stay (ALOS) at Tan Tock Seng Hospital by shifting patients who had undergone TURP or TUVP from the inpatient wards to ambulatory settings at our Day Surgery Centre (DSC). We aim to analyze the cost-impact to our institution and patient between pre and post-implementation. Methods: Patients were chosen for DSC based on our institutions selection criteria by the primary surgeon on listing day. A total of 513 patients bill profiles were manually retrieved and analyzed for the period from April 2014 to March 2015 and fromApril 2016 to March 2017 as well as fromApril 2017 to March 2018. The following key performance indexes were evaluated as results below. Results: Total of 94 bed days saved for every 100 patients; S$199,584 ward charges saved over 2 years, S$56,244 ward charges saved for every 100 patients and average length of stay (ALOS) lessened from 2.6 days in the pre-implementation year (April 2014 to March 2015) to 1.4 (April 2016 to March 2017) and 1.36 (April 2017 to March 2018). Readmission rates within 30 days are similar to pre-implementation. Conclusions: The care redesign helped to reduce the ALOS which translated to cost savings for both the patient and the hospital ward charges saved over 2 years. C-10071 C-10066 7