UROFAIR Virtual 2020

UROFAIR Virtual 2020 Abstracts C-10207 A Rare Case of Zinner Syndrome Soon Hock Koh (1) , Siying Yeow (1) (1) Khoo Teck Puat Hospital Introduction andObjectives: Zinner syndrome is a rare condition comprising a triad of unilateral renal agenesis, ipsilateral seminal vesicle obstruction and ipsilateral ejaculatory duct obstruction. It was first described in 1914 and to date, about 200 cases have been reported in literature. Most of them remain asymptomatic and typically present during the second to fourth decade of life, the age when they become sexually active. Methods: We report a 24-year old male who was diagnosed with Zinner syndrome in our hospital. Results: The patient is a 24-year old single male who was referred for investigation of urinary tract infection. Bedside ultrasound of the kidneys and bladder showed a large, tubular cystic mass posterior to the bladder; the left kidneywas absent.Acomputed tomography urogram showed agenesis of left kidney and a large left seminal vesicle cyst, confirming the diagnosis of Zinner syndrome. Semen analysis showed hypospermia and teratozoospermia. He remains asymptomatic and is still on active follow-up for future symptom development and/or potential fertility issues. Conclusions: A high index of suspicion for Zinner syndrome should be present for young males presenting with urinary tract infection, infertility, or non-specific pelvic symptoms with concomitant renal agenesis. Cross-sectional imaging should be performed to confirm the diagnosis. Asymptomatic patients can be managed conservatively with follow-up and treatment for associated fertility issues; whereas definitive treatment will be required for those who are symptomatic. Utility of MRI Fusion Targeted Prostate Biopsy in Biopsy-Naïve Men in Singapore Jeffrey Leow (1) , Soon Hock Koh (1) , Rolando Salada (1) , Seok Kwan Hong (1) , Teck Wei Tan (1) (1) Tan Tock Seng Hospital Introduction and Objectives: Current guidelines recommend performing upfront magnetic resonance imaging (MRI) prostate in biopsy-naïve men. A systematic and targeted biopsy is commonly offered to those with a suspicious lesion graded by the Prostate Imaging Reporting and Data System (PIRADS) as ≥ 3. We aim to evaluate our series of biopsy-naïve men who underwent concurrent systematic and targeted biopsy. Methods: From our prospectively-maintained MRI-fusion biopsy database, we identified all biopsy-naïve patients who underwent systematic and/or fusion targeted biopsies from May 2016 to Dec 2019. We defined clinically significant prostate cancer (csPCa) as any Gleason grade group ≥ 2 cancer. Results: The 190 patients had a median age of 69 years (interquartile range [IQR 65-74]), with a median prostate-specific antigen of 9.0 ng/ml (IQR 6.2-13.5) and median Prostate Health Index (PHI) level of 35 (IQR 26-44). PCa and csPCA detection rates were 62.1% (n = 118) and 52.6% (n = 100) respectively. More csPCA was found in those with higher PIRADS score [84.4% (PIRADS-5), 49.4% (PIRADS-4) and 26% (PIRADS-3)]. One csPCa (0.5%) was missed by targeted biopsy but found on systematic biopsy alone. 16 csPCA(8.4%) were found on targeted biopsy but not on systematic biopsy. Multivariable regression found PSA density ≥ 0.10 (OR 6.76, p < 0.001), PHI ≥ 27 (OR 3.02, p = 0.03), higher PIRADS (vs. PIRADS-3: OR 4.21 for PIRADS-4; OR 11.4 for PIRADS-5, both p < 0.001) and target lesion volume-to-prostate volume ratio ≥ 0.10 (OR 6.11, p = 0.007) were significantly associated with csPCa detection on targeted biopsy. Conclusions: Biopsy-naïve men who have a suspicious lesion on MRI benefited from MRI-fusion targeted and systematic biopsy for the detection of csPCa. C-10204 Can We Omit Systematic Biopsies in Patients Undergoing MRI-Fusion Targeted Prostate Biopsies? Jeffrey Leow (1) , Soon Hock Koh (1) , Rolando Salada (1) , Seok Kwan Hong (1) , Teck Wei Tan (1) (1) Tan Tock Seng Hospital Introduction and Objectives: Magnetic resonance imaging (MRI)-targeted prostate biopsy is the recommended investigation in patients with a suspicious lesion found on MRI prostate. The role of concurrent systematic biopsies in addition to targeted biopsies is currently unclear. Methods: We queried our prospectively maintained MRI fusion-targeted biopsy database at our institution, identifying all patients who underwent biopsy from May 2016 to Dec 2019. Inclusion criteria for our study were patients with at least one Prostate Imaging Reporting and Data System (PI- RADS) ≥ 3 lesion, and who underwent targeted and/or systematic biopsies. We defined clinically significant prostate cancer (csPCa) as any Gleason grade group ≥ 2 cancer. Results: Among the total of 500 patients, 190 (30%) were biopsy-naïve, 237 (47.4%) had previous negative systematic biopsy, and 73 (14.6%) had previous biopsy-proven D’Amico low-risk prostate cancer on active surveillance. Rates of csPCA detection were 53.2%, 24.1% and 39.7% respectively. Expectedly, there was a higher rate of detecting csPCA with higher PIRADS score. Of the 189 patients diagnosed with csPCa, 32 (16.9%) would have been missed if only targeted prostate biopsy had been performed (i.e. they were detected on systematic biopsy only). The rate of csPCAdetection on systematic biopsy was 3.2% (n = 1) and 0% among patients with previous 2 and 3 negative biopsies prior, respectively. Conclusions: We found that concurrent systematic together withMRI-fusion targeted biopsy was of value only in patients who were biopsy-naïve or had 1 prior negative systematic biopsy. MRI Fusion Targeted Confirmatory Prostate Biopsy Improves the Selection of Men with Prostate Cancer for Active Surveillance Jeffrey Leow (1) , Soon Hock Koh (1) , Rolando Salada (1) , Seok Kwan Hong (1) , Yuyi Yeow (1) , Teck Wei Tan (1) (1) Tan Tock Seng Hospital Introduction andObjectives: Men on active surveillance for low-risk prostate cancer are recommended to undergo confirmatory biopsy within a year of diagnosis. The only randomised trial (ASIST trial) in this population failed to show an improvement in upgrading rates with targeted biopsy compared to systematic biopsy at the first confirmatory biopsy. We aim to evaluate our series of men on active surveillance who underwent concurrent systematic and MRI fusion targeted confirmatory biopsy. Methods: From our prospectively maintained MRI fusion targeted biopsy database at our institution, we identified patients on active surveillance who underwent biopsy fromMay 2016 to Dec 2019. Inclusion criteria for our study were patients with at least one Prostate Imaging Reporting and Data System (PI-RADS) ≥ 3 lesion, and who underwent targeted and systematic biopsies. Upgrading was defined as any newly detected clinically significant prostate cancer (csPCa) of Gleason grade group ≥ 2. Results: A total of 61 patients were identified, with a median age of 71 years (interquartile range [IQR] 67-75), median prostate-specific antigen of 7.26 ng/ml (IQR 5-10) and median Prostate Health Index (PHI) level of 34.5 (IQR 18-44). Upgrading to csPCa was found in 41% (n = 25) of patients. Targeted biopsies upgraded 9 (14.8%) patients who did not have csPCa with systematic confirmatory biopsy alone. Conclusions: MRI fusion targeted confirmatory biopsy upgrades a significant proportion of men with previous low-risk prostate cancer and improves the selection of patients suitable for active surveillance. C-10205 C-10203 23