SIU 2018: Irreversible Electroporation for Prostate Cancer
Seoul, South-Korea (UroToday.com) Dr. Sun gave an interesting talk on a new focal therapy modality for prostate cancer. He began discussing the evolution of the surgical scalpel through the years from the prehistoric flint dagger to the robotic surgical system. Despite the development of the scalpel through the years, its functions are still limited to cutting, ablating and anatomy destruction. In surgery, the surgeons must continue to try to maintain the balance between removing the lesion thoroughly, and maximally preserving the function of the organ and surrounding organs.
SIU 2018: Interpretation and Clinical Implication of Cancer Genetics in Uro-Oncology -Bladder Cancer
Seoul, South-Korea (UroToday.com) Dr. Agarwal provides a nice summary of the current status of the rapidly advancing landscape of bladder cancer genomics. He starts by describing our initial concept of a dual pathway in bladder cancer – depicted below. In this model, normal urothelium has 2 pathways – either development of FGFR3 mutations and progression to low-grade low risk bladder cancer OR development of P53, Rb, etc. mutations leading to high-grade disease, CIS and invasive bladder cancer.
SIU 2018: European Association of Urology Lecture, what is the Role of Radical Prostatectomy in Locally Advanced and Oligo-Metastatic Prostate Cancer?
Seoul, South-Korea (UroToday.com) The role of radical prostatectomy in locally advanced and oligo-metastatic disease was discussed in this interesting talk given by Dr. Manfred Wirth from Germany, as part of the European Association of Urology (EAU) lecture in the SIU 2018 meeting.
High risk tumors in prostate cancer have at least seven different definitions, beginning from the first definition created by D’Amico in 1998 and published in JAMA, to the most recent definition described in the EAU guidelines in 2018. In recent years there has been an increasing use of radical treatment in the setting of locally advanced and very high-risk prostate cancer, as can be seen in figure 1.
SIU 2018: Finetuning Estimates of Short-term Morbidity After Radical Cystectomy: A rigorous Approach for Assessing 30-day Adverse Events
Seoul, South-Korea (UroToday.com) In this work, Dr. Malte and colleagues presented a study attempting to improve the short-term morbidity after racial cystectomy. According to the authors, there are no clinical guidelines defining what surgeons need to report on perioperative complications for urologic procedures. In this study the authors aimed to perform a rigorous standardized assessment of the 30-day morbidity following radical cystectomy, with the goal to create a catalogue of procedure-specific complications. The aim of the catalogue is to characterize most common adverse effects, and eventually compare it to known validated complication recording system. These include the Clavien-Dindo scoring system, which considers the highest-grade complication, and the comprehensive complication index (CCI), recording all complications into a single formula, reflecting the overall perioperative burden.
SIU 2018: Interpretation and Clinical Implication of Cancer Genetics in Uro-Oncology -Renal Cell Carcinoma
Seoul, South-Korea (UroToday.com) Bradley Leibovich, MD presented on the genomic landscape of renal cell carcinoma (RCC). He started off by pointing out that RCC, more so than most GU malignancies, is a grab-bag term for multiple different histologies – and that list continues to grow. The most recent 2016 WHO classification system actually introduced a few new histologies. All these tumors are histology, and more importantly, genetically distinct subtypes – and so broad statements for RCC are not possible.
SIU 2018: Atypical Anterior Localization of Prostate Cancer Foci in Patients Undergoing Initial and Repeat Biopsy: Results from 1,161 Patients Undergoing MRI Fusion Biopsies
Seoul, South-Korea (UroToday.com) In this work, Dr. Sami-Ramzi and colleagues described their experience with anterior prostate tumors in patients undergoing MRI-fusion biopsies. It is known that a substantial proportion of prostate cancers are located in the anterior segment of the prostate, leading to a phenomenon called “evasive prostate cancer syndrome”. Diagnosing these anterior tumors during a transrectal ultrasound (TRUS) biopsy is quite challenging, with multiple repeat biopsies and extended number of cores needed. As a result, these lead to a delay in diagnosis. The authors hypothesized that using MRI fusion biopsies will help identify these tumors more easily. In this study the authors examined the distribution of PIRADS >=3 lesions in the anterior and posterior segment of the prostate and reported the histopathological characteristics of these lesions.
SIU 2018: Reading Multiparametric Prostate MRI and Reporting Using PI-RADS v2
Seoul, South-Korea (UroToday.com) Dr. Park started off this Master Class on reading mpMRI (multiparametric MRI) and reporting using the PI-RADS v2 system. His talk, understandably, included lots of images as examples, but I will try to highlight some of his take-home points in the summary below.
The PIRADS (Prostate Imaging and Reporting and Data System) system is an important tool for prostate MRI evaluations. While mpMRI was introduced around 2005 (including 3 phases – T2 weighted images [T2W], diffusion weighted images [DWI] and dynamic contrast enhancement [DCE]), the first PIRADS reporting system was first introduced 2012. It was limited significantly by poor inter-observer and intra-observer variability – and therefore uptake was very poor. As a result, the ACR, ESUR and AdMeTech organizations generated a 2nd version (PIRADS v2) in 2014.