UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 Should Patients with Lower PSA(< 10) be Offered Up-Front Multi- Parametric MRI (mpMRI) Scan and Trans-Perineal MRI-Fusion Targeted and Saturation Biopsies? Yufei Qiao (1) , Woon Tsang (1) , Karthik Thandapani (1) , QingHui Wu (1) , Lincoln Tan (2) , Edmund Chiong (1) (1) National University Hospital, (2) Tan Urology Introduction andObjectives: EAUguidelines recommendedmpMRI scan for prior negative biopsy and was expanded to include biopsy-naive and active surveillance patients. Our aimwere to review local patients who underwent TP-fusion-biopsy, and to determine CSPC detection rate, compared to US guided systemic TRUS-biopsy and TP-biopsy and complications. Methods: Sept 2015-Sept 2019, 241 patients with elevated PSA and mpMRI scan were recruited into prospective study for TP MRI-fusion targeted and saturation biopsies using a robotic-assisted iSRobot Mona Lisa TM biopsy platform. MRI lesions were classified according to PIRADv2. Results: For 241 TP-fusion-biopsy patients, 116 (84%) biopsy-naive, 72 (30%) prior negative biopsy, 52 (22%) of active surveillance; 80 (33%) PSA < 10, 27 (11%) PSA 10-20, 9 (4%) PSA > 20. patient mean age 65 years, median PSA 7.32 ng/dL, mean target cores 7.444.83, mean saturation cores 29.8010.78 (IQR 12-56 cores). For 178 TRUS-biopsy patients, median PSA 10.76 ng/dL (IQR 0.93-4679), mean cores 11.142.92 (IQR 2-18 cores). 87 (49%) PSA < 10, 26 (15%) PSA 10-20, 64 (36%) PSA > 20. For 117 TP-biopsy patients, median PSA 12.51 ng/dL (IQR 0.30-1000), mean cores 12.993.68 (IQR 12-18 cores). 44 (38%) PSA < 10, 32(27%) PSA 10-20, 41 (35%) PSA > 20. CSPC detection rate was significantly higher (p=0.019) in TP-fusion-biopsy patients(38.8%), compared to TRUS-biopsy(14.9%) and TP-biopsy (25%) for PSA< 10 patients. For PSA10-20 patients, CSPC detection rate was 77.8% for TP-fusion-biopsy. Post biopsy sepsis rate low: 1.7% vs. 0.9% vs. 4.4% for TP-fusion-biopsy vs. TP-biopsy vs. TRUS-Biopsy. Conclusions: CSPC detection rate was significantly higher for patients with PSA < 10 and satisfactory for PSA 10-20 patients, using mpMRI TP-fusion- biopsy. Post biopsy sepsis rate acceptable. mpMRI thus advisable as initial test for prostate cancer management algorithm. The Use of Prostate Health Index to Predict Clinically Significant Cancer in Prostate Imaging-Reporting and Data System 3 Lesions Ziting Wang (1) (1) National University Hospital Introduction andObjectives: With the incorporation of Magnetic Resonance Imaging (MRI) scans into our preliminary evaluation of menwith raised PSA, the diagnostic dilemma of Prostate Imaging-Reporting and Data System (PIRADS) 3 lesion is an increasing phenomenon. Studies have shown a 10- 15% risk of clinically significant cancer detected on the biopsies of PIRADS 3 lesions. This equates to the excessive subjecting of 85-90% of patients to the risks of prostatic biopsies. We hypothesize that the use of phi can help to risk stratify patients with PIRADS 3 lesons and better identify candidates for prostate biopsy. Methods: We performed a retrospective review of patients who had PIRADS 3 lesions and underwent MRI targeted prostatic biopsies at the National University Hospital of Singapore. All patients who underwent MRI targeted biopsy also had a saturation biopsy performed at the same setting. The histological findings on biopsy were evaluated together with phi levels. Results: 63 patients were collected and analysed in the study. Mean prostate- specific antigen (PSA) level was 9.49 (SD 3.44). Mean lesion size was 0.44 cm (SD 0.46). 8 (12.7%) patients had clinically insignificant cancer and 5 (7.9%) had clinically significant cancer. A cut-off of PHI value 30 has a sensitivity of 100% and specificity of 15.5%. Conclusions: PHI score of < 30 demonstrates high sensitivity and may be useful in ruling out clinically significant prostate cancer in PIRADS 3 lesions. The incorporation of phi for the further evaluation of patients with PIRADS 3 lesions would enable a certain group of patients to avoid unnecessary biopsies. C-10034 C-10023 Optimal Prostate Biopsy Regime for the 21st Century: Is it Necessary to do a Combined Target and Saturation Biopsies? Yufei Qiao (1) , Woon Tsang (1) , Karthik Thandapani (1) , QingHui Wu (1) , Lincoln Tan (2) , Edmund Chiong (1) (1) National University Hospital, (2) Tan Urology Introduction and Objectives: There’s dispute over optimal prostate biopsy strategy, whether target only or with systemic biopsy. Recent meta-analysis suggested that target only biopsy couldmiss up to 13%CSPC. Our aims were to determine the missed CSPC rate for target-saturation combined biopsies. Methods: Sept 2015–Sept 2019, 241 patients recruited into a prospective study for TPMRI-fusion biopsies. Lesions identified via 3TMRI and classified with PIRADv2. Any PIRADv3 lesions were targeted. Results: Of 241 TP-Fusion-BX patients, 235 (95.4%) had target and saturation biopsies, total 306 lesions targeted. 116 (48%) biopsy-naive, 73 (30%) prior negative biopsy, 52(22%) on AS. Mean target cores 5.452.60; mean positive target cores 1.752.52. Mean target lesion volume 0.951.54cc. Mean saturation cores 13.774.30 (right) and 13.414.66 (left). Mean positive saturation core 1.382.10 (right) and 1.311.90 (left). Proportion of positive cores 565/1792 (31.5%) for target biopsy, 647/6531(9.9%) for saturation biopsy. 235 patients had TP MRI-Fusion biopsies with target and saturation biopsies: 46.4% (n=109) both target and saturation positive (T+/S+); 6.4% (n=15) had target only (T+/S-) positive; 35.3% (n=83) both target and saturation negative (T-/S-); 11.5% (n=27) saturation positive only (T-/S+). For T-/S+ group, 27 patients had total 39 target lesions negative. 74.1% (n=20) had insignificant cancer and 25.9% (n=7) CSPC. Fromour cohort, we would have missed 2.97% (7/235) CSPC. Post biopsy sepsis was 0.9% and urinary retention was 10%. Conclusions: This comprehensive target-saturation-combined biopsies had a miss rate 2.97%CSPC, 2-3 times lower than target only and target-systematic biopsy. 57.1% of the missed CSPC was in contralateral side of PIRAD lesion. Characteristics of Microbial Colonisation of Ureteric Stents and Urinary Tract Cultures Brielle Wood (2) , David Habashy (1) , Timothy Skyring (1) (1) NSW Health, (2) Queensland Health Introduction and Objectives: Urosepsis post-instrumentation of the upper urinary tract is a commonly observed event. The aim of this study is to describe the microbiology of stent colonisation, the use of pre- and intra- operative urinary tract cultures and the potential clinical implications. Methods: Aprospective study of all pre-stented patients whose upper urinary tract was instrumented from June 2017. The urine and ureteric stents were sent for culture for all patients who underwent a ureteroscopy. Patients were followed for the development of urosepsis. Results: The study involved 46 patients, median age of 61 years, and 28% were female. Pre-operative urine cultures were positive in 26% of patients, whereas 11% of intra-operative bladder cultures and 9% of the kidney urine cultures were positive. The bladder end of the stent was colonised in 26% of patients and the kidney end was colonised in 15%. The most commonly cultured organisms from stents were Escherichia coli (24%) and Enterococcus (24%), and from bladder urine was Escherichia coli (60%). Apatient deemed clinically infected had an increased risk of a positive pre-operative urine culture (3-fold), intra-operative urine culture (4-fold) and stent colonisation (5-fold). 4% of patients developed post-operative urosepsis, whose cultures were most concordant with the intraoperative stent cultures. Conclusions: The most commonly isolated organism was Escherichia coli which is covered by the recommended empirical antibiotics for urosepsis. Ongoing research into the usefulness of a preoperative urine culture compared with intraoperative cultures is needed to decrease the rate of urosepsis in this population. C-10033 C-10022 4