No abstract

In our single-center institutional experience, Angio-Seal is the device with the best technical success rate. Major complications of VCDs were rare, with no statistically significant difference between devices.

e16572 Background: Presently, prostate biopsy (PBx) results typically report the highest Gleason Grade Group in the PBx as the single metric used to gauge the clinical aggressiveness of tumor and dictate treatment. However, using that single parameter alone limits the clinician by lack of consideration of the entire PBx. Intuitively we presumed that a PBx showing multiple cores of cancer would represent more aggressive disease. Herein, we propose the Weighted Gleason Grade Group (WGGG), a novel scoring system that synthesizes histopathologic data and cancer volume into a single numeric value representing the entire PBx, allowing the urologist to more accurately predict adverse pathologic outcomes of radical prostatectomy (RP). Methods: We studied 246 men who underwent RP after standard multi-core PBx. The highest Gleason score of each PBx was converted to its final GGG. The WGGG was calculated by summing the Gleason score of each positive core and normalized for a 12 core total. RP pathology was studied to determine adverse pathological outcomes, specifically, extraprostatic extension (EPE), positive surgical margins (PSM), seminal vesical invasion (SVI), pathological up-grading and any adverse feature. We then studied the ability of conventional GGG versus WGGG to have ‘predicted’ the risk of these adverse features comparing their respective receiver operating characteristic (ROC) areas under the curve (AUC) for each, as well as any adverse feature. Results: The AUC for the WGGG vs. GGG was significantly higher for predicting EPE (AUC 0.782 vs. 0.697, respectively; z = -3.29; p = .0009), PSM (AUC 0.644 vs. 0.563, respectively; z = -3.00; p = .0027), SVI (AUC 0.829 vs. 0.713, respectively; z = -3.05; p = .0023) and pathologic up-grading (AUC 0.584 vs. 0.349, respectively; z = -3.13; p = .002). Finally, the AUC for any adverse feature was 0.637 for WGGG versus 0.556 for GGG; z = -3.29; p = .001. Conclusions: The WGGG, by providing a metric reflecting the entirety of the PBx, is more informative than conventional single GGG alone in ‘predicting’ adverse pathologic outcomes on radical prostatectomy specimens. We are now studying if % cancer/ PBx core will improve WGGG performance.

INTRODUCTION AND OBJECTIVES: Concern exists regarding overuse of computed tomography (CT) children with nephrolithiasis. While guidelines for pediatric nephrolithiasis call for imaging such as plain film of the kidney-ureter-bladder (KUB) or renal ultrasound (US) to minimize ionizing radiation in both initial and follow-up management, little is known regarding follow-up imaging practices. We explored nationwide imaging patterns in children following emergency department (ED) evaluations for nephrolithiasis, hypothesizing that initial imaging choice and need for admission or readmission increase the risk of follow-up CT scans. METHODS: Claims from MarketScan (2007-2013), an employer-based dataset of privately insured patients, were used to assess children 1-18 presenting to the ED an acute nephrolithiasis event, defined as no prior ED visits or surgical interventions for nephrolithiasis within 6 months. Independent variables were age, gender, region of care and insurance status, initial imaging modality, need for hospital admission, and return ED visits. Primary outcome was imaging modality 90 days following an encounter. Appropriate imaging was defined as either KUB or US. Using logistic regression, odds for receiving CT or appropriate imaging in follow-up were calculated. RESULTS: A total of 871 children with an ED visit for nephrolithiasis met inclusion criteria. Median age was 16 (range 1-18) and the majority of patients were female (550, 63.0%). KUB was the most common initial modality (520, 59.7%) followed by CT (196, 22.5%) and US (150, 17.2%). A total of 282 (30.9%) children received no follow-up imaging. Of children receiving any follow-up imaging, appropriate imaging was obtained in 306 (51.9%) and CT obtained in 283 (48.0%) children. Of children initially receiving a CT, 79 (40.3%) had a CT in follow-up. Predictors for imaging patterns are shown in the Table. CONCLUSIONS: Overuse of CT in children with nephrolithiasis is not limited to initial presentation as one third of all children presenting to the ED received a CT in follow-up. Identifiable risk factors for followup CT include younger age, complexity of stone event, and region of care. Clinical pathways directing imaging strategies for pediatric nephrolithiasis should focus on follow-up imaging as well as initial evaluation.

18F-rhPSMA7 PET/CT offers good detection of BCR in men who have undergone radical prostatectomy; detection rates appear favorable compared with those previously reported for 68Ga-PSMA11.