Transperineal prostate mapping may provide an effective method to risk stratify men with localized prostate cancer. The definitions that we present require prospective validation.

To our knowledge our biopsy simulation study is the first to evaluate the performance of different sampling strategies to detect clinically important prostate cancer in a population that better reflects the demographics of a screened cohort. Compared to other strategies standard transrectal ultrasound biopsy performs poorly for detecting clinically important cancer. Marginal improvement can be achieved using additional cores placed anterior but the performance attained by template prostate mapping is optimal.

Study Type – Diagnostic (validating cohort) Level of Evidence 1b What's known on the subject? and What does the study add? Transrectal ultrasonography (TRUS)‐guided biopsies can miss prostate cancer and misclassify risk in a diagnostic setting; the exact extent to which it does so in a repeat biopsy strategy in men with low–intermediate risk prostate cancer is unknown. A simulation study of different biopsy strategies showed that repeat 12‐core TRUS biopsy performs poorly. Adding anterior sampling improves on this but the highest accuracy is achieved using transperineal template prostate mapping using a 5 mm sampling frame. OBJECTIVE To determine the effectiveness of two sampling strategies; repeat transrectal ultrasonography (TRUS)‐biopsy and transperineal template prostate mapping (TPM) to detect and exclude lesions of ≥0.2 mL or ≥0.5 mL using computer simulation on reconstructed three‐dimensional (3‐D) computer models of radical whole‐mount specimens. PATIENTS AND METHODS Computer simulation on reconstructed 3‐D computer models of radical whole‐mount specimens was used to evaluate the performance characteristics of repeat TRUS‐biopsy and TPM to detect and exclude lesions of ≥0.2 mL or ≥0.5 mL. In all, 107 consecutive cases were analysed (1999–2001) with simulations repeated 500 times for each biopsy strategy. TPM and five different TRUS‐biopsy strategies were simulated; the latter involved a standard 12‐core sampling and incorporated variable amounts of error, as well as the addition of anterior cores. Sensitivity, specificity, negative and positive predictive values for detection of lesions with a volume of ≥0.2 mL or ≥0.5 mL were calculated. RESULTS The mean (sd) age and PSA concentration were 61 (6.4) years and 8.5 (5.9) ng/mL, respectively.In all, 53% (57/107) had low–intermediate risk disease. In all, 665 foci were reconstructed; there were 149 foci ≥0.2 mL and 97 ≥ 0.5 mL in the full cohort and 68 ≥ 0.2 mL and 43 ≥ 0.5 mL in the low–intermediate risk group. Overall, TPM accuracy (area under the receiver operating curve, AUC) was ≈0.90 compared with AUC 0.70–0.80 for TRUS‐biopsy. In addition, at best, TRUS‐biopsy missed 30–40% of lesions of ≥0.2 mL and ≥0.5 mL whilst TPM missed 5% of such lesions. CONCLUSION TPM under simulation conditions appears the most effective re‐classification strategy, although augmented TRUS‐biopsy techniques are better than standard TRUS‐biopsy.

Introduction: We evaluate the technical feasibility of robotic prostatectomy in renal transplant recipients. Methods: We retrospectively analyzed preoperative and perioperative settings, as well as functional and oncologic results of 12 patients operated on between 2009 and 2013. Prostatectomy was performed via a transperitoneal approach without any changing in the ports position. The average age was 61.92 ± 2.98 years. The period between transplant and the diagnosis of adenocarcinoma was 79.7 months. The mean PSA was 7.34 ng/mL (range: 4.9-11). Results: The operative time was 241.3 ± 35.6 minutes with only one conversion and one transfusion. The intervention was difficult due to adhesions on the side of the graft in 50% of cases. There was a case of obstructive acute renal failure resulting from a hematoma of the Retzius treated by percutaneous nephrostomy at D20. There was a majority of pT2c (72.7%), including 3 positive margins (27.3%) and 2 biochemical relapses treated with radiotherapy and hormonotherapy, respectively. The end point prostate-specific antigen was undetectable. There was no significant difference between preoperative and J7 creatinine (p = 0. 22). Conclusions: Robotic prostatectomy in renal transplant recipients is a safe technique with no serious effects on the allograft. IntroductionFor patients with end-stage renal disease, renal transplantation is the best treatment in terms of patient survival and quality of life.1 However, the need for immunosuppressive therapy following transplantation increases the incidence of certain cancers, 2 including urological cancers. 3 Prostate cancer is the most common urological cancer in male renal transplant recipients, with an incidence of 3.1%. 3The functional and oncological results of radical prostatectomy in these patients remain poorly evaluated. The results of retropubic 4,5 and laparoscopic prostatectomy have been previously reported, 6-8 but few studies have evaluated robot-assisted laparoscopic prostatectomy. 9 We therefore evaluated the technical feasibility and oncological results of robot-assisted laparoscopic radical prostatectomy (RALP) in renal transplant recipients. MethodsThis single-centre retrospective study included 12 renal transplant recipients who underwent RALP between January 2009 and January 2013.Clinicom 2001 version 6.50.0102 (Cliniom, Inc.) was used for data collection and Fusion Pégase 4D version 4.0.0 (Fusion Pégase Inc.) was used for anesthetic data. RALP was performed according to the conventional technique with 6 transperitoneal trocars. Lymph node dissection was not performed on the side of the transplant.Clinical data (age at the time of prostatectomy, etiology of end-stage renal disease, interval between renal transplantation and prostatectomy, side of transplantation, immunosuppressive therapy, American Society of Anesthesiologists [ASA] score, body mass index [BMI], and Charlson comorbidity index) were recorded for each patient.The diagnosis of prostate cancer was established on the basis of digital rectal e...