UROFAIR Virtual 2020

UROFAIR Virtual 2020 Abstracts Improving the Identification of Clinically Significant Prostate Cancer using Multiparametric Magnetic Resonance Imaging - a Predictive Model based on PIRADSv2, PSA Density and Lesional Volume Derived from a Radiopathologic Correlation Study Yu Xi Terence Law (1) (1) National University Hospital Introduction and Objectives: The aim of this study is to establish a clinic- radiological model that improves upon mpMRI in the detection of clinically significant prostate cancer. Methods: Retrospective review of our institutional database of men who have radical prostatectomies operated between 1/1/2015 to 31/12/2017 with available whole-mount histology, as well as biopsy-naive mpMRI. mpMRIs were over-read by an expert radiologist with special interest in prostate MRI. PIRADSv2 was used to assess the imaging. Each lesion was outlined on wholemount histology, with the low grade (LG) (Gleason 3) and high-grade (HG) components (Gleason 4 and 5) colour coded differently. Lesions on imaging were matched to wholemount histology. For the model derivation, data from PIRADSv2 and other clinical parameters were used. Receiving operator characteristic curves was generated and the area under curves (AUC) were compared. Results: 70 patients met criteria. Most missed lesions by mpMRI were LG. Missed HG lesions has a median diameter of 4.90 mm versus 8.20 mm (p=0.002) compared to HG lesions detected by mpMRI. Our model using a combination of PIRADSv2, PSA density and MRI Volume of lesion showed improved predictive performance of AUC=0.799, superior to that of mpMRI using PIRADSv2 alone (AUC=0.769, p=0.001). A cut-off point of predicted probability of HG, P (HG) <20% corresponded to a negative predictive value of 87.5% and a positive predictive value of 59.7%. Which means that for P (HG) <20%, the lesion is most likely to be LG. Conclusions: Our study derived a risk model using PIRADSv2, PSAdensity and mpMRI volume of lesion could help clinicians better select for gland sparing strategies and/or, avoid unnecessary biopsies. C-10049 C-10041 Patient-Reported Outcomes of Neoadjuvant Apalutamide (ARN-509) and Radical Prostatectomy in Treatment of Intermediate to High Risk Prostate Cancer (NEAR) Trial - A Phase II Trial XinYan Yang (2) , Edwin Jonathan Aslim (2) , Tsung Wen Chong (2) , John Shyi Peng Yuen (2) , Henry Sun Sien Ho (2) , Lui Shiong Lee (1) (1) Sengkang General Hospital, (2) Singapore General Hospital Introduction and Objectives: We report on the patient-reported outcomes following 12 weeks of neoadjuvant ARN-509 therapy. Methods: Participants receivedARN-509 240 mg daily for 12 weeks followed by RP within 6 weeks of the last dose of medication. Patient-reported outcomes assessed included Sexual Health Inventory forMen (SHIM), EORTC QLQ-PR25 and QLQ-C30 questionnaires. The total daily step counts taken by the subjects were taken as a surrogate measure of physical activity level. Metabolic outcomes were measured using body mass index (BMI). Results: Of the 30 subjects to enrolled, 25 have completed the study. The SHIMmedian scores showed a statistically significant reductionwithARN509 therapy (p<0.001). Therewere no statistically significant changes toQLQ-PR25 total scores (p=0.1) and in the in QLQC30-overall health and quality of life mean scores (p=0.8 and p=0.1). QLQC30-single items mean scores showed a small deterioration that was statistically significant (p=0.01), but not clinically significant. There were no significant changes in weight or BMI during ARN 509 therapy (p=0.3). Activity levels of subjects remained stable throughout the trial period (p=0.99). The most common adverse events (AE) attributable to ARN-509 therapy included skin disorders (88%) and general disorders (72%). There were no falls, fractures or seizures described. Conclusions: These results show that 12 weeks of neoadjuvant ARN-509 treatment is fairly well tolerated. There was also no impact on the daily physical activity of the patients. Robotic Heminephrectomy for Renal Cell Carcinoma in a Horseshoe Kidney Kelven Chen (1) (1) National University Hospital Introduction and Objectives: Horseshoe kidney is the most common renal fusion anomaly. When performing extirpative renal surgery in a horseshoe kidney, one must consider the variations in anatomy like the lower positioned renal unit and the aberrant blood supply. Here we present a case of robot- assisted laparoscopic heminephrectomy in a horseshoe kidney for a left sided renal tumour. Methods: A 36 year old gentleman presented with an incidental 4 cm left renal tumour in a horseshoe kidney during health screening. We performed a robotic left hemiphrectomy rather than a partial nephrectomy, as the tumour was postero-medially located with overlying hilar vessels, and there was limited mobility of the horseshoe kidney. We used the Da Vinci SI system. Patient was in right lateral position with the camera port, 2 robotic working ports and two assistant ports. A transperitoneal approach was used and renal hilar vessels supplying left renal moiety controlled with Hem-o-lok clips after adequate mobilization of bowel. This resulted in a demarcation zone of the ischemic left renal unit along the isthmus. A Satinsky clamp was placed across before transection and over-sewingwith Vicryl and interlocking Hem-o-lok clips. Results: Patients recover was uneventful and he stayed in hospital for six days. Estimated blood loss was 200 mls. Renal function before and after surgery was normal. The final histology was that of Fuhrman Grade 2 clear cell renal cell carcinoma with negative margins. Conclusions: Careful pre-operative planning is crucial prior to extirpative surgery for renal cell carcinomas that arise in horseshoe kidneys as the anatomy is widely variable. Neoadjuvant Apalutamide (ARN-509) and Radical Prostatectomy in Treatment of Intermediate to High Risk Prostate Cancer (NEAR) Phase II Trial XinYan Yang (2) , Edwin Jonathan Aslim (2) , Nye Thane Ngo (2) , Li Yan Khor (2) , TsungWen Chong (2) , John Shyi Peng Yuen (2) , Kae Jack Tay (2) , Henry Sun Sien Ho (2) , Lui Shiong Lee (1) (1) Sengkang General Hospital, (2) Singapore General Hospital Introduction and Objectives: The NEAR trial is a phase II single arm study of neoadjuvant apalutamide (ARN-509) and radical prostatectomy (RP) in the treatment of DAmico intermediate and high-risk prostate cancer (Clinicaltrials.gov identifier: NCT03124433). Methods: Participants receivedARN509 240mg daily for 12 weeks followed by RP within 6 weeks of the last dose of medication. Primary outcomes included tumour response defined by residual cancer burden (RCB), post- therapy morphologic characterization, and post-operative serumPSAlevels. Secondary outcomes included prevalence of significant adverse events (AE) with ARN509 and operative complications following RP. Statistical significance was defined as p < 0.05. Results: 25 participants completed the study. The median age was 68 years, and serum PSA at recruitment was 11.6 ng/mL. They comprised D-Amico intermediate-risk n = 12 (48%) and high-risk n = 13 (52%). 84% of subjects achieved post-prostatectomy nadir PSA levels, and the rest achieved nadir PSA levels of 0.03-0.05. The post-therapy morphology classifications were group A (50%), group B (10%) and group C (40%). The median reduction in RCB was 19% (range 7% to 40%, p = 0.0002). The median reduction of serum PSA after neoadjuvant apalutamide alone was 97.3% (range 61.2 to 100.0, p < 0.0001). No subjects with Clavien-Dindo grade III and above surgical complications. Conclusions: Results of the phase II NEAR trial show safe and reasonable oncological outcomes in patients with organ confined prostate cancer. C-10035 C-10040 5