Decipher correlation patterns post prostatectomy: initial experience from 2 342 prospective patients.

BACKGROUND: Currently, there are multiple commercially available RNA-based biomarkers that are Medicare approved and suggested for use by the National Comprehensive Cancer Network guidelines. There is uncertainty as to which patients benefit from genomic testing and for whom these tests should be ordered. Here, we examined the correlation patterns of Decipher assay to understand the relationship between the Decipher and patient tumor characteristics. METHODS: De-identified Decipher test results (including Decipher risk scores and clinicopathologic data) from 2 342 consecutive radical prostatectomy (RP) patients tested between January and September 2015 were analyzed. For clinical testing, tumor specimen from the highest Gleason grade was sampled using a 1.5 mm tissue punch. Decipher scores were calculated based on a previously locked model. Correlations between Decipher score and clinicopathologic variables were computed using Spearman's rank correlation. Mixed-effect linear models were used to study the association of practice type and Decipher score. The significance level was 0.05 for all tests. RESULTS: Decipher score had a positive correlation with pathologic Gleason score (PGS; r=0.37, 95% confidence interval (CI) 0.34-0.41), pathologic T-stage (r=0.31, 95% CI 0.28-0.35), CAPRA-S (r=0.32, 95% CI 0.28-0.37) and patient age (r=0.09, 95% CI 0.05-0.13). Decipher reclassified 52%, 76% and 40% of patients in CAPRA-S low-, intermediate- and high-risk groups, respectively. We detected a 28% incidence of high-risk disease through the Decipher score in pT2 patients and 7% low risk in pT3b/pT4, PGS 8-10 patients. There was no significant difference in the Decipher score between patients from community centers and those from academic centers (P=0.82). CONCLUSIONS: Although Decipher correlated with baseline tumor characteristics for over 2 000 patients, there was significant reclassification of tumor aggressiveness as compared to clinical parameters alone. Utilization of the Decipher genomic classifier can have major implications in assessment of postoperative risk that may impact physician-patient decision making and ultimately patient management.

Comparison of studer ileal neobladder and ileal conduit urinary diversion with respect to perioperative outcome and late complications.

PURPOSE: We compare the perioperative and long-term morbidity of a cohort of patients who had undergone Studer ileal neobladder urinary diversion with that of a similar cohort who had undergone ileal conduit urinary diversion during the same interval and by the same surgeons. MATERIALS AND METHODS: Between 1990 and 1996 we performed Studer ileal neobladder urinary diversion in 62 men and 4 women, and ileal conduit urinary diversion in 66 men. Mean age of the neobladder and conduit patients was 62 and 69 years, and mean followup was 17 and 20 months, respectively. RESULTS: Of 66 neobladder cases (18%) 12 had a total of 16 perioperative complications and a 5% reoperation rate, whereas 12 of 66 conduit cases (18%) had a total of 17 perioperative complications and a 6% reoperation rate. Mean hospital stay was 13 days for each group. Of the neobladder cases 14 (21%) had 14 late complications and an 11% reoperation rate, whereas 8 conduit cases (12%) had 9 late complications and an 8% reoperation rate. CONCLUSIONS: The Studer ileal neobladder urinary diversion is a safe procedure with perioperative and long-term morbidity comparable to ileal conduit diversion at our institution.

Continent orthotopic urinary diversion in female patients: early Mayo Clinic experience.

OBJECTIVE: To review our initial experience with orthotopic neobladder urinary diversion in female patients. MATERIAL AND METHODS: We reviewed the clinical characteristics, operative reports, and pathologic results of five female patients who underwent radical or simple cystectomy and continent orthotopic urinary diversion. Peri-operative morbidity, postoperative daytime and nighttime continence, renal function, need for protective pads, and self-catheterization were documented. All urodynamic and upper urinary tract imaging studies were reviewed. RESULTS: Follow-up has ranged from 9 to 18 months in these initial patients. Thus far, all five women have achieved acceptable daytime continence, and four of five women have achieved nighttime continence. Only one patient augments volitional voiding with intermittent self catheterization. Complications consisted of urinary retention in one patient and development of a urinary tract and bladder calculus, which necessitated cystolitholapaxy, in another patients. Neobladder capacities have ranged from 400 to 600 mL with voided volumes up to 300 mL. Only one patient has had a substantial residual urine volume (300 mL). All upper urinary tract imaging studies have shown stable function, and urodynamic studies have revealed high-compliance, large-volume neobladder capacities in all patients. CONCLUSION: Bladder replacement pouches designed from detubularized bowel are gaining widespread acceptance among urologists and their patients. Although these operations have previously been limited to men because of concerns about cancer-involved margins and continence after cystectomy in female patients, recent advances in the knowledge of female pelvic anatomy and neurovascular innervation of the bladder neck and proximal urethra have facilitated nerve-preserving radical cystectomy in women that allows continence and volitional voiding through the urethra.

Chromosomal anomalies in stage D1 prostate adenocarcinoma primary tumors and lymph node metastases detected by fluorescence in situ hybridization.

PURPOSE: We determined if characteristic chromosomal anomalies exist within the primary tumors and lymph node metastases in patients with stage D1 prostate cancer, and compared the patterns of chromosomal alterations between primary tumors and nodal metastases. MATERIALS AND METHODS: Fluorescence in situ hybridization analysis using peri-centromeric probes for chromosomes 6, 7, 8, 17, X and Y was performed on 5 mu. sections from paraffin embedded tissue blocks obtained from 23 consecutive patients who underwent radical prostatectomy and bilateral pelvic lymphadenectomy in 1990 for stage D1 prostate cancer. RESULTS: The dominant focus of primary tumor was compared to matched nodal metastases in 12 cases. Five of 12 primary tumor foci (41.7%) had similar chromosomal gains and the same fluorescence in situ hybridization ploidy result as the corresponding nodal metastases. Chromosomes 7 and X (73.2% of cases) were most frequently gained in the primary tumors, and chromosomes X and Y (81.2% of cases) were most frequently gained in the metastases. No primary tumor or metastasis demonstrated chromosomal loss. Three of 19 primary tumors (15.7%) were diploid, while 16 of 19 (84.3%) were nondiploid. Chromosomal aneusomy was inversely correlated with increasing Gleason summary score. CONCLUSIONS: These data indicate that the dominant primary tumor foci may not give rise to nodal metastases, gains of chromosomes 7, X and Y may be associated with metastatic behavior, and patients with stage D1 disease have a greater rate of aneuploidy than those with lower stage cancer.

Acquired cystic disease and renal adenocarcinoma following renal transplantation.

Acquired renal cystic disease has been associated with the development of renal cell carcinoma in patients on chronic dialysis. The disease has been documented to regress in the native kidney after successful renal transplantation. We report 4 cases of renal cell carcinoma occurring in the native kidney 3 to 8 years after successful renal transplantation. Of these patients 3 also had acquired cystic disease of the native kidney. These 3 cases suggest that the malignant potential associated with acquired renal cystic disease may not be reduced significantly by renal transplantation and that periodic imaging of the native kidney is advisable after transplantation, particularly when the disease is present before transplantation.