consultation with physicians and nurses, whilst the IMP provided consistent and animated information on these topics, and included multiple-choice questions probing understanding of key points. Progression through the IMP only occurred with correct responses; incorrect responses prompted a review of the information before repeating the question. Telephone interviews assessed usability, overall understanding, educational level and primary language. RESULTSThe patient groups had similar demographics. The IMP group (78%) had significantly higher knowledge test scores ( P < 0.001) than the SC group (57%), suggesting a better understanding of the implications of surgery. This was maintained on crossover, with the SC group scores improving by 11% compared to testing before IMP ( P < 0.001). The initial IMP group scores were unchanged on crossover and repeat testing ( P < 0.05). CONCLUSIONIMP provides better patient understanding than SC for RP, by ensuring that the procedure and risks have been explained consistently, and by actively testing the patient. Such tools assist in obtaining ethical and legally informed consent, thus increasing patient knowledge whilst reducing patient anxiety and potential dissatisfaction or medico-legal consequences when less than ideal outcomes occur. KEYWORDSprostate neoplasm, prostatectomy, informed consent, multimedia, patient education handout, computer-assisted decision making Study Type -Therapy (RCT) Level of Evidence 1b OBJECTIVETo compare the comprehension gained by standard consent (SC) vs a unique interactive multimedia presentation (IMP), for radical prostatectomy (RP), as informed consent for RP requires that the patient understands the procedure and potential complications. PATIENTS AND METHODSForty patients undergoing RP were prospectively randomized to SC or IMP, followed by a 26-question test on critical aspects of the surgery and its implications. The groups were crossed over and re-tested, with a subsequent statistical analysis. SC involved typical verbal interaction and

IntroductionLife expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks. ObjectiveTo outline the complications and survival in surgical patients 80 years and over undergoing radical cystectomy for bladder cancer. Patients and MethodsA review of a radical cystectomy in elderly recorded in four different institutional prospective databases during the period between 1991 and 2014. Clinical and pathologic features, complications and survival were evaluated. ResultsA total of 111 patients were available. Median (range) age 82.2 (80-89) years. Seventeen women and 94 men. Regarding the ASA score, 6 patients were ASA I, 47 patients were ASA II, 49 patients ASA III and 9 ASA IV. Prior to surgery, 48 patients had hydronephrosis. The median (range) creatinine series was 1.1 (0.71-11.1) ng/dL. In 88 cases an ileal conduit was performed, 17 a cutaneous ureterostomy diversion, 5 neobladders and 1 ureterosigmoidostomy case. The median (range) operative time was 230 (120-420) min and a total of 97 patients required blood transfusion. The median (range) hospital stay was 14 (7-126) days. The early and late complication rates were 50.4% and 32%, respectively. A total of 14 patients (12.6%) required surgical reintervention. Eight patients (7.2%) died in the immediate postoperative period. The readmission rate of the series was 27.2%. The mean follow-up of the series was 18 (0.27-134.73) months. During this period 66 patients died, 52 of them due to the tumor. Twelve month tumour progression free survival was 83.9% for ≤pT1, 70.2% for pT2 and 36% for ≥pT3, respectively. Twelve month cancer specific survival was 85.6% for ≤pT1, 75.1% for pT2 and 42.5% for ≥pT3, respectively. ConclusionRadical cystectomy in elderly population is an aggressive surgical treatment with a significant complication rate, hospital readmission and perioperative mortality rate. Careful selection of patients is essential in order to minimize the complications of this surgery and balance benefits against risks in the elderly population. Tumour progression and cancer specific survival are poor for patients with ≥pT3 disease. Alternatives such as tri-modality therapy need to be considered within a multidisciplinary approach. More data is required to determine which sub-groups of elderly patients would benefit from a complication, survival and quality of life perspective.

Purpose Prostate speci c membrane antigen (PSMA) PET/CT is increasingly used in men with biochemical recurrence post-prostatectomy to detect local recurrence and metastatic disease at low PSA levels. The aim of this study was to assess patterns of disease detection, predictive factors and safety using 18 F-DCFPyL PET/CT versus diagnostic CT in men being considered for salvage radiotherapy with biochemical recurrence post-prostatectomy.Methods We conducted a prospective trial recruiting 100 patients with biochemical failure postprostatectomy (PSA 0.2-2.0ng/mL) in men referred for salvage radiotherapy from August 2018 to July 2020. All patients underwent a PSMA PET/CT using the 18 F-DCFPyL tracer and a diagnostic CT. The detection rates of 18 F-DCFPyL PET/CT vs diagnostic CT were compared and patterns of disease are reported. Clinical patient and tumour characteristics were analysed for predictive utility. Thirty-day postscan safety is reported.Results Of 100 patients recruited, 98 were suitable for analysis with a median PSA of 0.32ng/mL. 18 F-DCFPyL PET/CT was positive or equivocal in 52% compared to 19.6% for diagnostic CT. Local recurrence was detected on 18 F-DCFPyL PET/CT in 29.2%, nodal disease was seen in 29.6% and bony metastases in 7.1%. Both ISUP grade group (p = 0.003) and pre-scan PSA (p = 0.061) were signi cant predictors of 18 F-DCFPyL PET/CT positivity, and logistic regression generated probabilities combining the two showed improved prediction rates. No signi cant safety events were reported post 18 F-DCFPyL administration.Conclusions 18 F-DCFPyL PET/CT increases detection of disease in men with biochemical recurrence post-prostatectomy compared to diagnostic CT. Men being considered for salvage radiotherapy with a PSA > 0.2ng/mL should be considered for 18 F-DCFPyL PET/CT scan.

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