Diagnostic Pathway Outcomes for Biparametric Magnetic Resonance Imaging-Targeted Lesions Using Cognitive Registration and Freehand Transperineal Prostate Biopsy in Biopsy-Naïve Men (CRAFT Single-Center Study).

PURPOSE: Enhanced histological detection of clinically significant prostate cancer is the goal of the prebiopsy imaging pathway. Risk stratification at a prebiopsy meeting can facilitate optimization of lesion targeting. We aimed to evaluate the feasibility of cognitive registration, freehand transperineal prostate biopsy in a biopsy-naïve population following biparametric MRI for the detection of clinically significant disease (International Society of Urological Pathology Grade Group ≥2). MATERIALS AND METHODS: A consecutive series of biopsy-naïve men, prospectively recorded between July 2018 and March 2023, were risk-stratified at our prebiopsy meeting following biparametric MRI to undergo either target-only biopsy or target with systematic biopsy. Biopsies were routinely performed under local anesthesia and without antibiotic prophylaxis in the outpatient setting. Overall prostate cancer and clinically significant prostate cancer detection were primary outcomes. RESULTS: Of 1251 biopsies, prostate cancer was detected in 84% and clinically significant disease in 70.6%. Prostate cancer and clinically significant disease were detected in 86.2% and 76.5% of target-only biopsies, respectively, and in 78.7% and 56.3% of target with systematic biopsies. Postbiopsy complication rate was 0.7%. CONCLUSIONS: Prebiopsy biparametric MRI with risk stratification at a prebiopsy meeting in the setting of cognitive targeting and freehand transperineal prostate biopsy yielded a high detection of prostate cancer that is comparable to other studies. These data support the use of cognitive registration, freehand transperineal prostate biopsy as safe, feasible, and cost-effective.

Prostate cancer metastasis to the testis: an unexpected presentation of a solitary recurrence.

A 74-year-old man with a history of prostate cancer was referred to the urology team with a new left sided testicular lump. He had a background of prostate cancer 4 years previous which had been treated with external beam radiotherapy and androgen deprivation therapy, both of which had been completed. Concurrently, he also had evidence of biochemical recurrence of prostate cancer with a rising prostate-specific antigen (PSA). He underwent a left radical orchidectomy. Following histopathological analysis, this was found to be metastatic spread from his prostate cancer. Subsequent staging showed no evidence of metastatic spread elsewhere. The patient made a good recovery following surgery and his PSA levels returned to undetectable levels. He received no further treatment for metastatic prostate cancer.

A Systematic Review of the Prognostic Role of Hematologic Scoring Systems in Patients With Renal Cell Carcinoma Undergoing Nephrectomy With Curative Intent.

The objective is to evaluate the prognostic benefit of the Glasgow Prognostic Score (GPS), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and Prognostic Nutrition Index (PNI) in patients with localized renal cell carcinoma undergoing nephrectomy with curative intent. Embase and MEDLINE databases were searched for all publications before April 2015. Duplicates were excluded, and inclusion/exclusion criteria were applied to all abstracts; of those remaining, full articles were obtained and inclusion/exclusion criteria were again applied, and the remaining articles were included and critically appraised. Eight articles were included in this review. Three articles were included for GPS. Outcomes included recurrence-free survival, cancer-specific survival (CSS), and overall survival (OS). All articles demonstrated better prognosis associated with a lower GPS on multivariate analysis: 1-year recurrence-free survival hazard ratio (HR), 7.0 (P = .001); CSS HR, 6.7 to 8.6 (P < .001); and OS HR 4.2 (P < .001). Four articles were included for NLR. All articles demonstrated elevated NLR to be associated with a poorer prognosis. Two articles demonstrated elevated NLR to be associated with a lower progression-free survival. One article demonstrated elevated NLR to be associated with a lower CSS (HR, 1.02, P = .009), and 2 articles demonstrated elevated NLR to be associated with a lower OS (HR, 1.02-1.6). No articles were included for PLR, and only 1 article was identified for PNI. There may be a role for modified GPS and NLR in patients with renal cell carcinoma undergoing nephrectomy with curative intent. Evidence for PLR and PNI is minimal.

The PSA tracker: a computerised health care system initiative in Northern Ireland.

INTRODUCTION: [corrected] The follow-up of men with prostate cancer forms a large part of many urologists workload. However, a rising PSA usually announces disease progression long before any clinically apparent symptom. Thus, many men can be safely monitored with PSA measurement alone. To facilitate this process, PSA tracking software was introduced to remotely monitor PSA results, minimising the work required for follow-up. METHODS: Stable prostate cancer patients were into the PSA tracker. When each PSA test was performed, the result was reviewed. The program automatically generated patient reminder letters, summary reports for clinic use and all correspondence to patients and primary care physicians. RESULTS: Since 2006, 65 patients have been entered into the PSA tracker. Median age was 81 (57-94) years. 274 outpatient appointments have been saved, indicating a potential saving of £32,000. More importantly it increased the capacity of the department to assess new patients. For the individual patient, the system has saved them, a median of 3 appointments each. CONCLUSION: Remote follow-up of prostate cancer is associated with significant savings for both healthcare organisations and individual patients. This example, further demonstrates the benefits of implanting healthcare software for patients and hospitals.

Urologists versus radiologists made PCNL tracts: the U.K. experience.

We aim to explore the practice of who makes the PCNL tract in the U.K. and Northern Ireland as well as presenting our data for two different approaches to PCNL tracts in Northern Ireland. A national questionnaire survey was carried out across the National Health Services hospitals in U.K. In addition, a retrospective analysis of 134 PCNL cases was carried out. Group I included 103 (77%) cases with urologist-made tracts, while group II included 31 (23%) cases with radiologists-made tracts. The survey suggested that 45% (42) of the hospitals adopted a radiologist-made tract, 44% (41) use urologist-made tract, while the remaining 11% (11) use both. Most of the radiologists' performed tracts in our series were for complex cases. Failed access occurred in 6 (5.8%) in group I and none in Group II. The overall stone-free rate was 92 and 50% for group I and II, respectively. There is a better stone clearance rate in Group I (p = 0.0016). This however is likely to be attributed to the complexity of the cases in group II. However, urologist made percutaneous tract is safe and efficacious but a team approach with radiology is needed for more complex cases.

Vesico-vaginal fistula post cold cup bladder biopsy: mini review.

INTRODUCTION: We report a case of a vesico-vaginal fistula (VVF) post cold cup biopsy; to our knowledge this is the only reported case. We present the clinical history/presentation, investigation and the outcome of the treatment. VVFs are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing a VVF is more than 1% after radical surgery and radiotherapy for malignancies. Management of these fistulas has been better defined and standardized over the last decade. METHODS AND RESULTS: A case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder. In addition there was a long history of smoking with its effects on tissue integrity and healing. VVFs are very rare and are an unpleasant outcome post a cold cup biopsy, adding to the psychological and social effects of the surgical treatment. CONCLUSION: Although cold cup biopsy is a normal day procedure performed by both residents and consultants, consensus should exist on how to treat a patient who has a bladder with defective integrity and small capacity. The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.

Squamous cell carcinoma and transitional cell carcinoma arising in bladder augmentations.

Tumours arising in bowel-augmented bladders are rare. Usually these tumours are adenocarcinomas that occur along the anastomotic line. We present two unusual tumours, squamous cell carcinoma and transitional cell carcinoma, that occurred in bladder augmentations. We also emphasize the need for regular cystoscopic surveillance.