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3+3 (5%), 3+4 (63%), 4+3 (18%), 4+4/3+5 (3%) and t4+5
(10%). PSMA-PET/CT (80%) detected more lesions than
mpMRI (66%). Considering "per patient" analysis, PSMA
PET/CT (70%) correctly identified all tumour foci more reliably than mpMRI (49%) due to superior characterisation of
multifocal disease in 31 patients (52% vs 19%), equating to a
sensitivity/specificity of 52%/85% and 18%/81% respectively.
Conclusions: 68Ga-PSMA PET/CT better reflects RP
histopathology compared to mpMRI and may improve
pre-operative characterisation of multifocal prostate cancer. These findings have implications for targeted biopsy
strategies, focal therapies and surgical planning.
P6-8 Outcomes of local anaesthetic
transperineal biopsies in the outpatient
setting: How does this compare to
conventional biopsy methods?
Kum F1, Maliyil J2, Kulkarni M1, Faure-Walker N1,
Elhage O1,2, Challacombe B1,2, Cathcart P1, Popert R1
1Guy's and St. Thomas' Hospitals, London, United Kingdom, 2King's
College London School of Medicine, London, United Kingdom

Introduction: Traditionally, prostate biopsies in the outpatient department use the transrectal (TRUS) approach.
The PrecisionPoint™ transperineal (TP) system facilitates
freehand transperineal biopsy under local anesthetic (LA).
Methods: 176 patients underwent freehand TP biopsies
between April 2016 and September 2017. 16 (9%) were
performed under LA + Sedation and 160 (91%) under LA
alone. Pain scores using the validated 'Visual Analogue
Score' and histological outcomes were compared with
contemporary TRUS and standard transperineal template
biopsies from our prospective database.
Results: Mean age was 65 years (36-83), median PSA
7.9ng/ml (0.7-1374) and mean prostate volume 45.5cc (15157). The indication for biopsy was for primary diagnosis
(88.6%). Cognitively targeted biopsies were performed in
45 (26%) patients; 40 (23%) had target + systematic biopsies; and 91 (52%) patients underwent systematic biopsies
only. Of the 75 cases who had primary systematic biopsies
alone, 46 (61%) were positive. This was similar to standard
transperineal template (68%, 32/47, P=0.51) and TRUS
biopsy (62%, 61/98, P=0.90) methods. When comparing TP
freehand vs. TRUS biopsy methods, VAS scores were not
significantly different for any procedural stage: Probe insertion (P=0.61), LA administration (P=0.32), Biopsies
(P=0.51) and Overall (P=0.28). Pain scores were significantly less for Probe insertion in the TP freehand group
(P<0.0001) vs. LA standard template biopsies, and P=NS
for other stages. No patients developed urinary sepsis.
Conclusions: Prostate biopsies can be performed safely
under LA using the PrecisionPoint™ system and are well
tolerated. Cancer pickup rates are equivalent to conventional biopsy methods. This method has a potential to
replace the TRUS approach in the outpatient setting.

Journal of Clinical Urology 11(1S)
P6-9 PREDICT: prostate - a novel
individualised prognostic model that
estimates survival in newly diagnosed primary
non-metastatic prostate cancer
Thurtle D1,2, Greenberg D4, Huang H5, Lee L5, Pharoah
P3, Gnanapragasam V1,2
1Cambridge University Hospitals NHSFT, United Kingdom,
2Academic Urology Group, University of Cambridge, United Kingdom,
3Centre for Cancer Genetic Epidemiology, University of Cambridge,
United Kingdom, 4National Cancer Registry and Analysis Service,
Public Health England, Fulbourn, United Kingdom, 5Department of
Urology, Singapore General Hospital

Introduction: Prognostic stratification is the cornerstone of management in non-metastatic prostate cancer
(PCa). However, prognostic models bespoke to an individual are unavailable. To address this, we developed a
novel prognostic model which contextualises PCaspecific mortality (PCSM) against other cause mortality
for an individual and estimates the survival benefit of
treatment.
Methods: Using records from the National Cancer
Registration and Analysis Service, data were collated
for 10,089 men diagnosed with non-metastatic PCa
between 2000-2010 in Eastern England. Models were
developed against 10-year survival outcomes using
patient, clinical and pathological parameters at diagnosis. Data were randomly split 70:30 into model development and validation cohorts. Discrimination and
calibration were assessed by area under the curve
(AUC) and Chi-Square goodness-of-fit respectively. A
Singaporean cohort of 2546 men represented an external validation dataset.
Results: Median follow-up was 9.8-years with 3276
deaths (1030 PCa-specific). Age, PSA, histological grade
group, biopsy involvement, stage and primary treatment
were each independent prognostic factors for PCSM. Age
and comorbidity were prognostic for non-PCa mortality.
Examples are shown in Figure 1. The model demonstrated
good discrimination and calibration in the validation
cohort with no significant difference in observed and predicted PCSM (p=0.16) or overall mortality (p=0.46) and
AUC 0.81(95%CI: 0.78-0.83) and 0.83 (95%CI: 0.81-0.84)
respectively. In the Singapore cohort (417 deaths, median
f/u 5.1-years) the model again performed well with <1%
differences in observed and predicted mortality and AUC
of 0.91 and 0.89 respectively.
Conclusion: PREDICT: Prostate is the first individualised
prognostic model for non-metastatic PCa; it has significant
potential to aid treatment decision-making.
P6-10 Predicting risk for pathological stage
and prognostic grade in patients undergoing
robotic prostatectomy: a contemporary UK
based calculator



Table of Contents for the Digital Edition of JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018

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