Perioperative alpha blockers in voiding dysfunction secondary to prostate biopsy: A meta-analysis.

Introduction and Objectives: Voiding dysfunction remains a common side effect postprostate biopsy leading to significant morbidity. Alpha blockers have emerged as a potential therapeutic option to mitigate this risk, with various centres already incorporating its use in practice. Despite this, the literature regarding its efficacy remains inconclusive. Hence, a systematic review was performed to quantify the effect of perioperative alpha blockers on prostate biopsy-related voiding function. Methods: A systematic search in MEDLINE, Embase and PubMed between January 1989 and July 2023 was performed to identify relevant articles. Two independent reviewers independently screened abstracts, full texts and performed data extraction. Data including International Prostate Symptom Scores (IPSS), voiding flow rates (Qmax), postvoid residuals (PVR), rates of acute urinary retention (AUR) and quality of life (QoL) scores were extracted. Results were combined in an inverse variance random effects meta-analysis. Results: A total 808 patients from six randomised controlled trials (RCTs) comparing alpha blockers to controls were included. All articles excluded patients with pre-existing voiding dysfunction. Pooled outcomes demonstrated statistically significant differences favouring alpha blocker usage in all objective and subjective measures including IPSS (mean difference 4.21, 95% confidence interval [CI] 2.58-5.84, p < 0.00001), PVR (mean difference 20.41 mL, 95% CI 3.44-37.39, p = 0.02), Qmax (mean difference 3.07 mL/s, 95% CI 2.55-3.59, p < 0.00001), QoL (weighted-mean difference 0.82, CI 0.17-1.48, p = 0.01) as well as overall risk of AUR (odds ratio 0.22, CI 0.09-0.55, p = 0.001). There was variable heterogeneity (I 2 = 0-86%) between outcomes. Conclusions: This review highlights the potential role of alpha blockers in improving urinary function and reducing adverse voiding outcomes postprostate biopsy. The standard practice of incorporating the usage of perioperative alpha blockers may be considered to reduce the morbidity of voiding complications secondary to prostate biopsy.

Patterns of chemotherapy use in muscle-invasive bladder cancer in a tertiary centre.

Objectives: Although neoadjuvant chemotherapy (NAC) has been demonstrated to have significant benefits to survival in patients with muscle-invasive bladder cancer (MIBC), the current utilization of NAC in Australia is unknown. The aim of this study was to evaluate the patterns of neoadjuvant and adjuvant chemotherapy (AC) use in patients undergoing cystectomy for MIBC at a large tertiary institution in Australia. Methods: A retrospective study was conducted using data of patients who underwent a radical cystectomy (RC) at a high-volume centre for MIBC between 2011 and 2021. Results: Of 69 patients who had a cystectomy for ≥ pT2 bladder cancer, 73.9% were eligible for NAC. However, of those eligible, only five patients received NAC (9.8%). Of the total patients who were eligible for AC, only 44.4% received postoperative chemotherapy. Common reasons for the lack of uptake were due to patients being unfit or declining treatment. There was no difference in progression-free survival or overall survival in those who received NAC and AC. Conclusions: The majority of patients undergoing RC for MIBC received AC compared to NAC, reflecting the real-world challenge of NAC uptake. This highlights the need for ongoing improvements in selection and usage of NAC and less reliance of AC utilization post RC.

68 Ga-prostate-specific membrane antigen (PSMA) PET/CT as a clinical decision-making tool in biochemically recurrent prostate cancer.

OBJECTIVE: PSMA PET/CT has demonstrated superior sensitivity over conventional imaging in the detection of local and distant recurrence in biochemically relapsed (BCR) prostate cancer. We prospectively investigated the management impact of 68 Ga-PSMA PET/CT imaging in men with BCR, with the aim of identifying baseline clinicopathological predictors for management change. PATIENTS AND METHODS: Men with BCR who met eligibility criteria underwent 68 Ga-PSMA-11 PET/CT at Monash Health (Melbourne, Australia). Intended management plans were prospectively documented before and after 68 Ga-PSMA PET/CT imaging. Binary logistic regression analysis was performed to identify potential clinicopathological predictors of management change. Descriptive statistics were used to characterize the nature of these changes. RESULTS: Seventy men underwent 68 Ga-PSMA-11 PET/CT imaging. Median age was 67 years (IQR 63-72) and median PSA was 0.48 ng/ml (IQR 0.21-1.9). PSMA-avid disease was observed in 56% (39/70) of patients. Pre-scan management plan was altered following scanning in 43% (30/70) of patients. Management changes were significantly more common in patients with higher baseline PSA levels (PSA≥2 ng/ml, p = 0.01). 18/36 (50%) of the patients initially planned for watchful waiting had their management changed, including the use of salvage pelvic radiotherapy (n = 7) and stereotactic ablative body radiotherapy to oligometastatic disease (n = 6). CONCLUSION: Management change after 68 Ga-PSMA PET/CT for BCR is common and typically resulted in treatment intensification strategies in those planned for a watchful waiting approach. This study adds to the growing pool of evidence supporting the clinical utility of PSMA PET/CT imaging in the care of patients with BCR after definitive therapy.

Synchronous urothelial carcinoma of the bladder and urachal adenoma with subsequent malignant transformation.

Malignant transformation of urachal adenoma is exceedingly rare, with intestinal metaplasia as the most common contributing mechanism. It is recommended that a urachal adenoma be regarded as a pre-malignant condition and be subject to endoscopic surveillance. A local en block excision of the tumor mass with urachalectomy and umbilectomy results in possible long-term survival. The median survival after platinum-based chemotherapy is limited for patients with extravesical disease. Here we report a case of synchronous urothelial carcinoma of the bladder and urachal adenoma that transformed into adenocarcinoma.

Complete resolution of urinary bladder condyloma acuminatum following definitive chemoradiotherapy for anal cancer.

UNLABELLED: What's known on the subject? and What does the study add? Condyloma acuminatum of the bladder is a rare affliction and as such its ideal management is unknown. This manuscript describes curative treatment of severe disease with external beam radiotherapy concurrent with low dose chemotherapy, an approach which has not previously been utilised. OBJECTIVES: • To report the first occurrence of complete and sustained resolution of symptomatic condyloma acuminatum of the bladder with chemoradiotherapy. • To describe the relevant patient details, imaging findings and chemoradiation treatment. PATIENT AND METHOD: • A 54-year-old female with extensive condyloma acuminatum of the bladder and a long history of human papilloma virus related anogenital disease was diagnosed with anal squamous cell carcinoma. • Cystectomy for the bladder disease was delayed whilst chemoradiotherapy was administered for the anal cancer. RESULTS: • There was complete resolution of bladder disease at follow-up which has negated the need for cystectomy with its associated morbidity. • Condyloma acuminatum has not recurred in 4 years of follow-up. CONCLUSION: • This is the first published report to our knowledge of the successful treatment of condyloma acuminatum of the bladder with chemoradiotherapy. • The individual contributions of radiotherapy vs chemotherapy cannot be discerned.