Page 17 - CUA 2020_Endourology

Unmoderated Posters 1: Prostate Cancer, Endourology, BPH

incurred higher cancer-related out-of-pocket costs (odds ratio [OR] 1.001; UP-1.25
95% confidence interval [CI] 1.001–1.002) and a private drug insur- Functional and oncological outcomes after prostate cancer
ance (vs. public, OR 5.23; 95% CI 1.13–24.17) were associated with a focal cryoablation using magnetic resonance imaging-ultrasound
greater perceived financial burden. Having better physical health-related fusion technique
quality of life (OR 0.95; 95% CI 0.913–0.997), a university education Jeffrey R. Talarek , Sean Maynor , Juliana Tobler , Sadhna Verma , Abhinav
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(vs. elementary/high school level, OR 0.03; 95% CI 0.00–0.79), and an Sidana 1
income between $40 000 and $79 999 (vs. ≤$39,999, OR 0.15; 95% CI 1 Department of Urology, University of Cincinnati, Cincinnati, OH, United
0.03–0.69) were associated with a lower perceived burden. States; Department of Radiology, University of Cincinnati, Cincinnati,
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Conclusion: Patients perceived financial prostate cancer burden as signifi- OH, United States
cant. Greater attention should be paid to the development of services to Introduction: Focal cryoablation (FC) of prostate cancer (PCa) has tradi-
help patients manage this burden. Conversations between health profes- tionally used a predefined template or a cognitive interpretation of imag-
sional and patients about the financial consequences of prostate cancer ing. These imprecise methods excessively destroy benign tissue because
treatment are fundamental and may help address patients’ perceived the cancerous area is not localized intraoperatively. magnetic resonance
financial burden. Optimizing coverage by the public health system and imaging-ultrasound (MRI-US) fusion directs cryoablation, improving accu-
private insurance companies is also essential. racy while preserving genitourinary structures and function. Here, we
References evaluate the short-term functional and oncological outcomes of prostate
1. Régie de l’assurance maladie du Québec. Services couverts et frais FC using MRI-US fusion to treat clinically significant (CS) PCa.
accessoires 2019. Available at: www.ramq.gouv.qc.ca. Accessed Methods: We conducted a retrospective review of consecutive patients
April 21, 2020. undergoing FC using MRI-US fusion with the Artemis transperineal needle
2. Gouvernement du Canada. Système de soins de santé du Canada attachment, which enables guidance of interventional needles through
2016. Available at: www.canada.ca. Accessed April 21, 2020. the perineum. Men with localized intermediate-risk PCa (grade 2 and 3)
stage T1-T2cN0M0 disease and prostate-specific (PSA) ≤20 were offered
UP-1.24 FC. Patients were followed every three months to assess PSA, functional
Magnetic resonance imaging-guided transurethral ultrasound outcomes, and complications. At six months, patients received repeat
ablation (TULSA) in men with localized prostate cancer: Five- prostate MRI and MRI-US fusion biopsy of the ablated area, any new
year followup of a prospective phase 1 study lesion, and systematic biopsy.
L.K. Joseph Chin , Shiva Nair , Gencay Hatiboglu , James Relle , Jason Results: A total of 20 patients with median followup of 7.9 months (1.5–
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Hafron , Matthias Roethke , Maya Mueller-Wolf , David Bonekamp , Zahra 20.7) were included in the analysis. Median age and pre-procedure PSA
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Kassam , Robert Staruch , Mathieu Burtnyk , Heinz-Peter Schlemmer , were 62.5 (60–70) and 6.0 (4.8–10.1), respectively. Median post-ablation
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Sascha Pahernik 2 PSA decline at three, six, and 12 months were 69.6%, 65.0%, and 37.2%,
1 Division of Urology, Department of Surgery, London Health Sciences respectively. Median change in Sexual Health Inventory for Men (SHIM)
Centre, London, ON, Canada; German Cancer Research Center, University and International Prostate Symptom Score (IPSS) at three, six, and 12
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Hospital, Heidelberg, Germany; Beaumont Health System, Royal Oak, MI, mon were -2.0, -1.5, and -8.0, and -2.0, 0.0, and -4.0, respectively. No
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United States; Profound Medical Inc., Toronto, ON, Canada patient developed urinary incontinence or grade 3 or 4 complications;
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Introduction: Magnetic resonance imaging (MRI)-guided transurethral 61.5% of patients had absence of any PCa and 76.9% had absence of
ultrasound ablation (TULSA) is a minimally invasive procedure for cus- CS PCa (any pattern 4) at six-month biopsy. Thirty-three percent of the
tomized ablation of prostate tissue. We report five-year outcomes of a failures were ‘in field,’ while 67% were ‘selection failures.’
single-arm, prospective, phase 1 study in men with localized prostate Conclusions: MRI-US fusion FC therapy results in excellent preserva-
cancer (PCa). tion of genitourinary function with encouraging oncological outcomes.
Methods: The study enrolled 30 men at three sites, with median (inter- Additional long-term research is needed to further establish and optimize
quartile rage [IQR]) age 69 (67–71) years, stage T1c–T2a, prostate-specific MRI-US fusion for FC of PCa.
antigen (PSA) 5.8 (3.8–8.0) ng/ml, Gleason grade group 1 (GG1) disease
in 80%, and GG2 in 20%. TULSA was delivered with 3 mm margins spar- UP-1.26
ing 10% viable prostate at the gland periphery. Primary endpoints were Prostatic dystrophic calcification following salvage cryotherapy:
safety (adverse events [AE]) and feasibility (spatial precision of ablation). An under-reported entity
Exploratory outcomes included one-year MRI, one-year and three-year Arnon Lavi , Shiva M Nair , L.K. Joseph Chin 1
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12-core biopsy, plus five-year PSA, quality of life, and survival. 1 Urology Division, Department of Surgery, Schulich School of Medicine
Results: AE to one year included urinary tract infection (10 men G2), and Dentistry, Western University, London, ON, Canada
acute retention (three G1, five G2), and epididymitis (one G3), with no Introduction: Adverse effects (AE) following salvage cryoablation (SC) for
rectal injuries. From one year to five years, there were no new serious/ radio-recurrent prostate cancer include urethral sloughing and urethro-
severe AE. MRI thermometry confirmed ablation precision of ±1.4 mm, rectal fistula. Prostate dystrophic calcifications (DC) following SC have
1,2
with 90% coverage of the prostate. By one year, PSA decreased 90% to a rarely been reported. Our mature SC database (median followup 12
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nadir of 0.6 (0.3–0.8) ng/ml, prostate volume decreased 88% (83–95%). years) revealed this phenomenon in 9.4%, which is herein reported.
Biopsy at one year identified significant PCa in 9/29 men (31%), and GG Methods: A database was prospectively maintained on 187 patients who
≥1 in 16/29 (55%). At three years, 3/22 refused biopsy, 7/22 were positive underwent whole-gland SC from March 1995 to September 2004. All
(two significant). By five years, 16 men completed protocol followup, patients had biopsy-proven, clinically localized, radio-recurrent cancer.
three withdrew with PSA <0.4 ng/ml, 10 had salvage therapy without Urinary functional followup data were available in 85 patients.
complications (six prostatectomy, three radiation, one laser), and one Results: Among those with severe urinary obstructive symptoms requir-
died of unrelated cause. Of 16 men with complete data, PSA remained at ing surgical intervention, heavy prostatic DC was encountered in eight
0.55 (0.4–1.2) ng/ml at five years. International Prostate Symptom Score patients (9.4%) either at cystoscopy or attempted transurethral resection.
(IPSS) of 6 (5–13) returned to 5 (4–10) by three months and 6.5 (6–9) at The bladder outlet became impassable, necessitating urinary drainage
five years. Erections sufficient for penetration were reported by 9/16 at with permanent suprapubic catheter (seven patients) and nephrostomy
baseline, 11/16 at one year, and 7/16 at five years. Leak-free, pad-free (one patient). Mean time from SC to emergence of severe obstructive
continence was reported by 16/16 at one and five years. Predictors of symptoms was 8.6 years (standard deviation [SD] 6 years). With the small
salvage therapy included lower ablation coverage and higher PSA nadir. sample size as a limitation, all DC patients developed biochemical fail-
Conclusions: MRI-guided TULSA in men with localized PCa demonstrates ure, whereas failure rate for the remaining cohort was 57.1% (p=0.01).
low toxicity and stable quality of life, while maintaining salvage treat- Surprisingly, mean time from SC to death was 17.7 years for DC vs. 12.4
ment options. years for the remaining cohort (p=0.02). No correlations were found with
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S55