Introduction: Nerve-sparing prostatectomy is recommended in cases of organconfined prostate cancer but is generally contraindicated in patients with suspected extra-prostatic extension (EPE). PSMA ligand imaging has been shown to be valuable in predicting EPE when performed on a hybrid PET/MRI scanner; however, the majority of PSMA-PET imaging is performed using PET/CT. To our knowledge, there are no established PET/CT criteria for assessing EPE. In this study, we aim to provide a reproducible method for evaluating EPE on PSMA-PET/CT imaging and assess its utility compared with MRI. Methods: Imaging findings and histopathology were reviewed for 100 consecutive patients who underwent a radical prostatectomy after imaging with MRI and 18F-DCFPyL PSMA-PET/CT. Results: A broad tumour-capsule interface measured using a standardised technique on fused PSMA-PET/CT imaging is associated with a higher risk for established EPE (P < 0.001). In our cohort, applying the criteria of tumourcapsule contact ≥ 10 mm measured on PET/CT was as sensitive as applying PI-RADS version 2 criteria to mpMRI imaging for predicting EPE (74% and 79%, respectively, P = 0.11) and had superior specificity (86% and 61%, respectively, P = 0.035). 93% of MRI-occult lesions were visualised on PSMA-PET/CT. Applying the proposed PET/CT criteria for EPE to this subgroup of 14 patients yielded a sensitivity of 67% and specificity of 92%. Conclusion: Our results suggest that tumour-capsule interface measured on fused F18-DCFPyL PSMA-PET/CT imaging is comparable to MRI criteria for predicting the presence of EPE. Applying PET/CT criteria may be of particular benefit in predicting EPE in patients with MRI-occult prostate cancer.

Introduction: This study expands results from recent prostatic urethral lift (PUL) clinical trials by examining outcomes within a large unconstrained multicenter data set. Methods: Retrospective chart review and analysis of 1413 consecutive patients who received PUL in North America and Australia was performed. International Prostate Symptom Score (IPSS), quality of life (QoL), and maximum urinary flow rate (Qmax) were evaluated at 1, 3, 6, 12, and 24 months post-procedure for all nonurinary retention subjects (Group A) and retention subjects (Group B). Within Group A outcomes were further analyzed using paired t -tests and 95% mean confidence intervals under the following parameters: IPSS baseline ≥13, age, prostate size, site of service, prostate cancer treatment, and diabetic status. Adverse events, surgical interventions, and catheterization rates were summarized in detail. Results: Compared with the randomized controlled prosatic urethral lift (L.I.F.T.) study, subjects in this retrospective study were older and less symptomatic. After PUL, mean IPSS for Group A improved significantly from baseline by at least 8.1 points throughout follow-up. No significant differences were observed between Group A and B follow-up symptom scores. Within Group A, subjects with an IPSS baseline ≥13 behaved similarly to L.I.F.T. subjects. Age, prostate volume, site of service, prior cancer treatment, and diabetic status did not significantly affect PUL outcomes. When completed in a clinic office, PUL resulted in less side effects and catheter placement compared to other sites of service. Previous prostate cancer treatment did not elevate adverse events of high concern such as incontinence and infection. Conclusion: PUL performs well in a real-world setting in terms of symptom relief, morbidity, and patient experience for all studied patient cohorts.

What ' s known on the subject? and What does the study add?The ' learning curve ' of surgeons transitioning from open radical prostatectomy (RP) to robot-assisted laparoscopic RP (RALP) has been well examined. To achieve the same results as open RP, this learning curve is known to be considerable. However, the transition to RALP for surgeons experienced in laparoscopic RP (LRP) has been less well documented. Given that RALP replicates the LRP technique but with a robot that allows such surgery to performed more easily, one can hypothesise that any ' learning curve ' would be minimised.This study supports the hypothesis that previous fellowship training and experience in LRP eliminates any signifi cant learning curve effect when transitioning to the robotic interface. Abstract Objective• To ascertain whether prior experience in laparoscopic radical prostatectomy (LRP) shortens the ' learning curve ' and therefore improves early patient outcomes when transitioning to robot-assisted laparoscopic RP (RALP). Patients and methods• Retrospective analysis of prospectively collected data of the most recent 87 cases of LRP compared with the initial 73 cases of RALP.• LRP was performed via a fi ve-port extraperitoneal approach, while transperitoneal RALP was performed using a four-arm da Vinci S unit. Results• The median operative duration for RALP (skin-to-skin, including docking time) rapidly reduced, although never exceeded 3.5 h, for each consecutive set of 10 cases.• Oncological outcomes were preserved with no cases of pT2 positive surgical margins (PSMs) in any group. pT3 PSM rates were not signifi cantly different at 50% and 38% for LRP and RALP, respectively.• Penetrative intercourse rates at 3 months for bilateral nerve-sparing procedures in preoperatively potent patients were similar, at 50% for LRP (median Sexual Health Inventory for Men [ SHIM ] 17) and 48.1% for RALP (median SHIM 18). The pad-free rate at 3 months was signifi cantly better for RALP at 59.7%, compared with 39.8% for LRP ( P = 0.043).• Complications were minimal and comparable for the two groups except for a higher LRP radiological anastomotic leak rate of 16 vs 1% ( P = 0.004). Conclusion• In this comparative series fellowship training and prior experience in LRP resulted in no signifi cant RALP learning curve with regards to oncological and functional outcomes, while maintaining a low complication rate.• A short learning curve existed for operative duration but this improved rapidly and there were no prolonged cases.• Differences in early continence and radiological leaks may refl ect changing from an interrupted anastomosis (LRP) to a continuous anastomosis with posterior rhabdosphincter reconstruction (RALP).

Objectives To assess the degree of upgrading and increase in clinical risk category of transperineal template biopsy (TTB) compared with transrectal ultrasonography‐guided prostate biopsy (TRUSB). Upgrading of TRUSB Gleason grade and sum after radical prostatectomy (RP) is well recognised. TTB may offer a more thorough mapping of the prostate than TRUSB, as well as a more accurate assessment of the tumour. In this retrospective cohort study of prospectively collected data, we compare the initial TRUSB and TTB Gleason grade and sum with the final assessment at RP. Patients and Methods Following Ethics Committee approval, 431 laparoscopic and robotic RP specimens of two urologists, fellowship‐trained in minimally invasive RP, were examined in the private sector between April 2009 and October 2013. Final RP Gleason grade and sum were compared with the initial prostate biopsy. All pathological assessments were performed by a dedicated uropathology unit, experienced in prostate pathology. Upgrading was defined either as an increase in the primary Gleason grade, or as identification of a higher grade tertiary pattern at final RP analysis. Increase in clinical risk category was defined as an increase from low‐ (Gleason ≤6), to either intermediate‐ (Gleason 7) or high‐risk disease (Gleason 8–10); or as an increase from intermediate‐ to high‐risk disease. The chi‐squared test was used to compare categorical variables, while the Wilcoxon rank sum was used for continuous quantitative variables. Results The 431 RP specimens comprised 283 in which the prostate cancer was diagnosed at TRUSB and 148 diagnosed at TTB. There was no difference between TRUSB and TTB in mean prostate weight (46.4 vs 44.2 g), final RP pathological stage (pT2: 187 vs 102; pT3 97 vs 48; P = 0.65) or mean tumour volume (2.15 vs 2.14 mL). Overall, 33.22% of TRUSB and 30.41% of TTB were upgraded, which was not significantly different (P = 0.55). Similarly there was no difference in whether there was an increase to a higher Gleason sum (TRUSB 23.3% vs TTB 20.9%; P = 0.57). TTB was more reflective of the actual clinical risk category, with TRUSB more likely to show an increase in clinical risk (TRUSB 22.3% vs TTB 14.2%; P = 0.04). Conclusions In this series, TTB more accurately predicted clinical risk category than TRUSB. TTB should be considered before active surveillance, to ensure that occult higher risk disease has not been under diagnosed. Upgrading and increase in clinical risk category was relatively common in each group highlighting the need for improved pretreatment staging accuracy.