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Increased experience with robot-assisted prostatectomy resulted in improvements in oncologic and functional outcomes. Modifications to robot-assisted prostatectomy techniques may aid in this improvement but are also associated with transient worsening of outcomes during the learning curve of the new technique.

to the 982 patients without imaging. Of the 110 patients with histopathologically organ-confined disease, 81 (74%) were correctly diagnosed as such on erMRI, whereas 29 (26%) were felt to have cT3 disease and constituted false-positives. Among the 69 patients with pT3 disease, erMRI correctly predicted 30 (43%), whereas 39 (57%) were incorrectly considered organ-confined.• The overall sensitivity and specificity for diagnosing pT3 disease was 43% and 73%.• When stratified by pT3a and pT3b, the sensitivity and specificity of erMRI to accurately diagnose ECE is 33% and 81%, respectively. In evaluating SVI, erMRI has a sensitivity and specificity of 33% and 89%, respectively. The positive predictive value of erMRI to assess for ECE and SVI is 50% in both, with a negative predictive value of 61% and 63%, respectively.• erMRIs performed at academic centres compared to non-academic locations demonstrated similar rates of sensitivity at 67% vs 77% and specificity at 39% vs 54%, respectively ( P = 0.33). CONCLUSIONS• In the setting of the present study, which was designed to be more reflective of current practice patterns in the USA, erMRI has limited clinical value in preoperatively detecting ECE and SVI.• The accuracy of detecting T3 disease did not improve in academic centres or in highrisk patients. KEYWORDSprostate cancer, neoplasm staging, endorectal magnetic resonance imaging (erMRI), radical prostatectomy Study Type -Diagnostic (nonconsecutive case series) Level of Evidence 3bWhat's known on the subject? and What does the study add? A wide range of performance characteristics has been reported for the preoperative prediction of extraprostatic extension by erMRI, with sensitivities as high as 90%. Our study differs in design from previous investigations in three ways: we examined the performance characteristics of the erMRI on patients with clinical parameters of prostate cancer worrisome for advanced disease; we dichotomized erMRI reports as "positive" or "negative"; and erMRIs were conducted at both academic and community radiology centers, which we believe is more reflective of current practice patterns in the USA. We found the overall accuracy of erMRI to be 62%, with a positive predictive value of 50%, suggesting that pretreatment erMRI offers minimal clinical information. OBJECTIVE• To assess the clinical value of preoperative knowledge of the presence of extracapsular extension (ECE) or seminal vesicle invasion (SVI) in the planning for prostatectomy. MATERIALS AND METHODS• An institutional database of 1161 roboticassisted laparoscopic prostatectomies (RALP) performed by a single surgeon (D.B.S.) was queried for those who underwent endorectal coil magnetic resonance imaging (erMRI) before robotic-assisted laparoscopic prostatectomy.• erMRI reports were dichotomized into positive or negative and compared with the final histopathology. The erMRIs performed at academic centres were compared with those performed in non-academic settings.• A sub-group of high-risk patients was also analyzed for erMRI accuracy.

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Interim result of this study had shown promising efficacy, with response rate of 14.7% and median PFS of 7.4 months, and good tolerability in previously‐treated Japanese metastatic RCC patients. The final result of the study adds: The median overall survival in Japanese metastatic RCC patients was 25.3 months, which is longer than that in the Treatment Approaches in Renal Cancer Global Evaluation Trial (TARGET). The response rate elevated from 14.7% to 19.4% because of 6 late responders achieved after 9.2 months or longer of SD period. Neither unknown adverse events nor cumulative toxicity was observed in the long‐term use of sorafenib. OBJECTIVE • To evaluate a novel technique to lower positive surgical margin rates while preserving as much of the neurovascular bundles as possible during nerve‐sparing robotic prostatectomy. MATERIALS AND METHODS • In situ intraoperative frozen section (IFS) was performed during robotic‐assisted laparoscopic prostatectomy (RALP) when there was macroscopic concern for a positive margin or residual prostate tissue. • When IFS was positive, additional sections were taken from the same area until the IFS was negative, similar to the procedure of Mohs micrographic surgery. • Positive surgical margin and biochemical recurrence rates were compared between the patients who underwent IFS and those who did not. RESULTS • Of 970 patients consecutively undergoing RALP at a single institution, IFS was performed on 177 (18%). • Eleven patients (6%) had IFS positive for carcinoma, whereas another 25 (14%) had benign prostatic tissue in the IFS specimen. • IFS and non‐IFS patients had similar pathological and nerve‐sparing characteristics. • The IFS group had significantly lower rates of positive surgical margins, 7% vs 18% (P= 0.001) but similar rates of biochemical recurrence (5%) at a median follow‐up of 11 months. CONCLUSIONS • In situ IFS is an effective way of reducing positive margins during RALP. • Twenty percent of patients who underwent IFS, representing 4% of the overall RALP population, had either malignant or benign prostate tissue removed from their prostatic fossa. • Although a reduction of biochemical recurrence was not demonstrated, the follow‐up is short and a difference may become apparent as the data mature.