Preoperative PSMA-PET/CT as a predictor of biochemical persistence and early recurrence following radical prostatectomy with lymph node dissection.

BACKGROUND: This study aims to evaluate the predictive value of lymph nodes (LN) suspicious for metastases on preoperative prostate-specific membrane antigen (PSMA) PET/CT for biochemical persistence (BCP) and early biochemical recurrence (BCR) following robotic-assisted radical prostatectomy (RARP) with extended pelvic LN dissection (ePLND). METHODS: We evaluated 213 patients with intermediate and high-risk prostate cancer (PCa) who underwent clinical staging with preoperative 68Ga- or 18F-PSMA-PET/CT scan and subsequent RARP with ePLND. Patients were grouped as PSMA- or PSMA+ depending on their LN status on PSMA-PET/CT and subdivided according to histological LN status in pN0 or pN1. Diagnostic accuracy of PSMA-PET/CT for the detection of pN1 was evaluated. BCP was defined as a first postoperative serum PSA level ≥0.1 ng/mL 6-12 weeks following RP. Early BCR was defined as detectable PSA > 0.2 ng/mL within 12 months of follow-up. Univariable logistic regression analyses were used to evaluate the effect of PSMA+ on BCP and BCR. RESULTS: Forty patients (19%) were PSMA+. The overall incidence of pN1 was 23%. Sensitivity, specificity, PPV and NPV on a per patient level for the detection of pN1 was 29%, 84%, 35%, and 80% respectively. BCP was observed in 26 of 211 patients (12%) and early BCR in 23 of 110 patients (21%). The presence of PSMA+ was a significant predictor for BCP (OR 7.1, 2.9-17.1 95% CI) and BCR (OR 8.1, 2.9-22.6 95% CI). CONCLUSION: Preoperative PSMA-PET/CT may be a valuable tool for patient counseling for RARP and ePLND as it is a significant predictor for the risk of postoperative BCP and early BCR. We conclude that an ePLND should not be avoided in men with intermediate or high-risk PCa and preoperative negative PSMA-PET/CT, as 20% have microscopic LN metastasis.

Reassessment of Prostate Biopsy Specimens for Patients Referred for Robot-assisted Radical Prostatectomy Rarely Influences Surgical Planning.

BACKGROUND: The minimum volume standard is 100 robot-assisted radical prostatectomy (RARP) procedures per hospital in the Netherlands, so patients have to be referred to high-volume surgical centers for RARP. During preoperative work-up, prostate biopsies taken elsewhere are reassessed, with upgrading or downgrading of the initial Gleason grade group a possible consequence. OBJECTIVE: To determine if prostate biopsy reassessment leads to adjustment of the surgical plan regarding a nerve-sparing approach and extended pelvic lymph node dissection (ePLND) during RARP. DESIGN SETTING AND PARTICIPANTS: For 125 men who were referred to the Prosper prostate center at Canisius Wilhelmina Hospital (CWH) in the Netherlands between 2013 and 2016, results for the initial assessment of prostate biopsy by a local uropathologist were compared to results for biopsy reassessment by dedicated uropathologists at CWH. RESULTS AND LIMITATIONS: The pathologists reached agreement in 80% of the cases. In cases for which there was disagreement (n = 25), biopsy revision involved upgrading of the initial grade group in 68% and downgrading in 32%. Biopsy reassessment led to a change in surgical plan in ten cases (8%). As a result of upgrading, ePLND was performed in three patients (2%). ePLND was omitted in one patient (1%) because of downgrading. For three patients (2%) a non-nerve-sparing procedure was planned after upgrading of the initial grade group. For four patients (3%), a unilateral nerve-sparing procedure was performed after downgrading. CONCLUSIONS: This study shows that there is large interobserver agreement between uropathologists in the assessment of Gleason grade group in prostate biopsy specimens. Reassessment rarely leads to a change in surgical plan regarding the indication for a nerve-sparing approach and ePLND. Therefore, reassessment of prostate biopsy before radical prostatectomy can be omitted when the initial pathological assessment was performed by a dedicated uropathologist. PATIENT SUMMARY: Reassessment of the initial prostate biopsy specimen for patients referred to a specialist center for robot-assisted removal of the prostate rarely influences surgical planning and can be omitted.

Eye irritation: updated reference chemicals data bank.

A list of 55 chemicals for which comprehensive rabbit eye irritation data were available was published by ECETOC in 1992. Similar data for a further 77 chemicals are now available. The total of chemicals included in the enlarged data bank is 132, assessed in 149 in vivo studies in rabbits. 28 of the chemicals were tested as solids, 24 as aqueous solutions. No new in vivo testing was carried out in order to qualify a chemical for inclusion in the data bank. The chemicals are available at known, high, consistent purity and are expected to be stable in storage. The in vivo data have been generated since 1981 in studies carried out according to OECD Test Guideline 405 and following the principles of Good Laboratory Practice. The data were obtained from tests normally using at least three animals evaluated at the same time, involving instillation of 0.1ml (or equivalent weight) into the conjunctival sac, and in which observations were made at least 1, 2 and 3 days after instillation. The chemicals are ranked for eye irritation potential on the basis of a 'modified maximum average score'. The reference chemicals data bank should be of use in validation tests of promising alternatives to the in vivo rabbit eye irritation test.

Persistence or reappearance of nonmotile sperm after vasectomy: does it have clinical consequences?

OBJECTIVE: To determine the percentage of patients with nonmotile sperm 12 weeks after vasectomy, to estimate the time needed for eventual azoospermia in these patients, and to record the percentage of patients with recurrence of nonmotile sperm after initial azoospermia after vasectomy. DESIGN: A review of the semen analysis of vasectomies performed in a 2-year period. Semen analysis in a group of volunteers from 4 months until 24 months after vasectomy. SETTING: Vasectomies performed in an outpatient department of the University Hospital of Maastricht. PATIENT(S): Men referred by the general practitioner for a vasectomy. INTERVENTION(S): Vasectomy. MAIN OUTCOME MEASURE(S): Amount and motility of sperm in postvasectomy semen samples. RESULT(S): Nonmotile sperm was found in 33% of the patients 12 weeks after vasectomy. The mean time to azoospermia was 6.36 months. Nonmotile sperm after initial azoospermia was found in 5 of 65 patients. CONCLUSION(S): Azoospermia as a criterion for sterility leads to unnecessary prolonged semen analysis in a large percentage of the vasectomized patients. Reappearance of nonmotile sperm was found in an unexpectedly high percentage.

PIP: A study was conducted to determine the percentage of patients with nonmotile sperm 12 weeks after vasectomy, to estimate the time needed for eventual azoospermia in the men, and to record the percentage of patients with recurrence of nonmotile sperm after initial azoospermia following vasectomy. A review of semen analyses was conducted in 413 patients who underwent vasectomy between April 1, 1993, and July 31, 1995, in an outpatient department of the University Hospital of Maastricht. 395 patients delivered a sperm sample 12 weeks after vasectomy. Nonmotile sperm was found in 33% of patients 12 weeks after vasectomy, the mean time to azoospermia was 6.36 months, and nonmotile sperm after initial azoospermia was found in 5 of 65 patients. The authors conclude that azoospermia as a criterion for sterility leads to unnecessary prolonged semen analysis in a large percentage of vasectomized patients. The reappearance of nonmotile sperm was found in an unexpectedly high percentage.

Vacuum constriction devices in erectile dysfunction: acceptance and effectiveness in patients with impotence of organic or mixed aetiology.

OBJECTIVE: To investigate the value of vacuum constriction devices in the treatment of erectile dysfunction. PATIENTS AND METHODS: A total of 67 patients were treated with vacuum constriction devices. The impotence was of organic origin in 36 men (54%) while in the remaining 31 (46%) it was of mixed aetiology (organic and psychological factors). Forty-seven patients continued to use the device at home for the duration of the practice period. RESULTS: All 67 patients underwent a vacuum test which resulted in nearly half of them achieving an erection sufficient for intercourse. Adequate erections were achieved in 34 of 47 (72%) patients who used the device at home during the practice period. In the group of patients with organic impotence (venous leakage), rigidity was better and the frequency of intercourse higher than in patients with diabetes and in those with neurogenic disorders. CONCLUSION: These findings support further the role for vacuum devices for the treatment of erectile dysfunction in carefully selected patients.

Vasovasostomy results in 66 patients related to obstructive intervals and serum agglutinin titres.

In this series we present the results of a retrospective analysis of 66 vasovasostomy procedures performed between 1983 and 1991. Obstructive intervals and serum antisperm antibodies were correlated with pregnancy and patency rates. With obstructive intervals of less than 5 years a patency rate of 100% (31/31) was obtained. Even more than 10 years after reversal, pregnancy occurred in 25% (2/8) of the patients. Preoperative serum antisperm antibodies were correlated with pregnancy rates. Patients with a high agglutinin titre of 1/64 obtained a pregnancy rate of 23% (3/13). Those men who had no circulating antisperm antibodies in their blood had a significantly better chance in obtaining pregnancy (pregnancy rate 80%). In this study we accounted for an overall pregnancy rate of 51.5% (34/66) versus an overall patency rate of 84.8% (56/66). Neither long obstructive intervals nor high antisperm antibody titres should dissuade a surgeon from performing a vasovasostomy procedure.

Organotin compounds and international treaties on the pollution of water by dangerous substances: black or grey list substances?

A brief review is given of international agreements governing water pollution by hazardous organotin compounds. Emphasis is placed on the Rhine Chemical Convention (1976) and the Dangerous Substances Directive 76/464/EEC. Organotin pesticides first appeared in 1974 on the grey list. In 1976, however, the whole group of organotin compounds was placed on the black list. Although priorities have recently been set for the Rhine and the European Community (EC), no scientific arguments have apparently been put forward to date either in support of these priorities or to explain the need to move this group of substances to the black list.