BACKGROUND: Most Prostate Imaging-Reporting and Data System (PI-RADS) 3 lesions do not contain clinically significant prostate cancer (CSPCa; grade group ≥2). This study was aimed at identifying clinical and magnetic resonance imaging (MRI)-derived risk factors that predict CSPCa in men with PI-RADS 3 lesions. METHODS: This study analyzed the detection of CSPCa in men who underwent MRI-targeted biopsy for PI-RADS 3 lesions. Multivariable logistic regression models with goodness-of-fit testing were used to identify variables associated with CSPCa. Receiver operating curves and decision curve analyses were used to estimate the clinical utility of a predictive model. RESULTS: Of the 1784 men reviewed, 1537 were included in the training cohort, and 247 were included in the validation cohort. The 309 men with CSPCa (17.3%) were older, had a higher prostate-specific antigen (PSA) density, and had a greater likelihood of an anteriorly located lesion than men without CSPCa (p < .01). Multivariable analysis revealed that PSA density (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.05-1.85; p < .01), age (OR, 1.05; 95% CI, 1.02-1.07; p < .01), and a biopsy-naive status (OR, 1.83; 95% CI, 1.38-2.44) were independently associated with CSPCa. A prior negative biopsy was negatively associated (OR, 0.35; 95% CI, 0.24-0.50; p < .01). The application of the model to the validation cohort resulted in an area under the curve of 0.78. A predicted risk threshold of 12% could have prevented 25% of biopsies while detecting almost 95% of CSPCas with a sensitivity of 94% and a specificity of 34%. CONCLUSIONS: For PI-RADS 3 lesions, an elevated PSA density, older age, and a biopsy-naive status were associated with CSPCa, whereas a prior negative biopsy was negatively associated. A predictive model could prevent PI-RADS 3 biopsies while missing few CSPCas.
Clostridium difficile screening prior to cystectomy is associated with a significant decrease in rates of clinically symptomatic infections postoperatively. These results should be confirmed in a randomized controlled trial.
Introduction There is a paucity of outcome data for prolonged (>48 hours) closed-suction drains following inflatable penile prosthesis (IPP) placement. Tissue dissection and corporal dilation make scrotal hematomas a potential complication within the first 72 hours following surgery. Maintaining a closed-suction drain represents a method to reduce scrotal hematoma formation and prevent sequela such as infection. However, maintaining a percutaneous tract also represents a feasible pathway for bacterial seeding of a new prosthesis. Given the severe consequences of prosthetic infection, establishing comparable outcomes for delayed drain removal is necessary. Objective To evaluate rates of infection, hematoma and device explantation in a multi-institutional cohort of patients undergoing IPP placement with delayed closed-suction drain removal (48-hour duration or greater) and compare observed outcomes to published outcomes in modern IPP cohorts. Methods Data was collected retrospectively for 209 patients undergoing virgin IPP placement with delayed closed-suction drain removal. Cases were performed by three surgeons at three high-volume centers between 01/01/2020 and 3/31/2022. R for Statistical Computing was used to generate descriptive statistics (Figure 1) and categorical data visualization (Figure 2). No quantitative statistical analysis was performed regarding infection outcomes as the low observed rate would not accommodate robust quantitative analysis. Results Mean drain duration was 66 hours (48 – 312, SD 23). There were 3 device infections (1.4%). Mean patient age was 64.5 years. 84 (40.2%) patients were diabetic, with a mean hemoglobin A1c of 7.2 in these patients. Both penoscrotal and infrapubic approaches were performed (95 versus 114). Reservoir location was either space of Retzius (SOR) or high submuscular (HSM) with the former being more common (164 versus 45). There were 7 (3.3%) post-operative hematomas and 6 patients (2.9%) required device revision for non-infectious causes. Mean follow up interval postoperatively was 170 days (10 – 421 days, SD 78). Conclusions Delayed removal of closed-suction drains after virgin IPP is safe. The outcomes for this study cohort are similar to outcomes reported in other modern virgin IPP series where closed-suction drains were not routinely employed. Prospective studies to further characterize how closed-suction drain placement influences hematoma formation, infection rates, and postoperative pain are necessary to definitively establish the role of delayed drain removal following IPP implantation. Disclosure No
Ductal carcinoma of the prostate (DAC) is a rare histological subtype of prostate cancer (PC). Although it is reported to be an aggressive tumor, often with locally advanced and/or metastatic disease at presentation, the available literature still lacks of reports on treatment recommendations since there are still controversies about the optimal therapeutic approach. We present our 20-year outcome of multidisciplinary management of non-metastatic DAC (nmDAC).METHODS: A retrospective analysis of our Institutional Urology-Radiation Oncology database was performed. Patients (pts) with nmDAC undergoing radical treatment were included. All these pts were discussed at our multidisciplinary Oncology board in order to highly personalize the treatment. The cohort was divided into three groups according to received treatment: group A surgery (either radical prostatectomy or cystectomy), group B surgery and post-operative radiation therapy (RT, either adjuvant or salvage) and group C RT alone. Kaplan-Meier method was used to estimate survival outcome, after adjusting for predictive variable (age, comorbidities, pathological stage, histology). Statistical analysis was performed using SPSSv20, considering statistically significant p value <0,05.RESULTS: The features of the population in study are summarized in Table 1. From 1997 to 2016, about 8470 PC pts underwent radical treatment at our Institution, 71 were diagnosed with nmDAC (0.84%): group A with 21 patients (29.6%), group B 27 (38%) and group C 23 (32.4%). Histological examination showed 17 pure DAC (23.9%) and 56 mixed DAC and acinar adenocarcinoma (78.9%). At a median follow-up time of 60 and 120 months, overall survival (OS) was 86% and 70% respectively for group A, 100% and 92% for group B, 65% and 49% for group C (p¼0.054). Pure DAC undergoing surgery showed an OS at a median follow up of 60 months of 34%, while adding post-operative RT leads to a OS of 100% (p¼0.029).CONCLUSIONS: DAC is a rare, often aggressive subtype of PC, especially in pure form. Our large series seems to support the role of a radical, aggressive, combined therapeutic approach, when feasible, in order to achieve better local disease control and long-term survival outcome.
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