Advances in Prostate Treatment: Clinical Understanding & Therapeutic Innovations

2. Plenary session • 5 Moderated poster sessions (98 abstracts) • 2 Podium sessions (24 abstracts) • 1 Video session (12 abstracts)

3. MP02-02 PURE BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE: 5-YEAR FOLLOW-UP FROM A PROSPECTIVE 3D ULTRASOUND VOLUMETRY STUDY Benedikt Kranzbühler*, Oliver Gross, et al. • At 5 years follow-up improvements in IPSS, Qmax, PVR remained stable • Relative prostate volume reduction increased up to 12 months • Complications included 9 (12%) urethral strictures and 6 (8%) BN contractures • Overall procedure appears safe and effective but BN contractures are not uncommon

4. MP02-15 PSA-CHANGES AND MICTURITION IMPROVEMENT 5-YEARS AFTER THULIUM VAPOENUCLEATION OF THE PROSTATE FOR SYMPTOMATIC BENIGN PROSTATIC OBSTRUCTION Christopher Netsch, Benedikt Becker, et al. • 131 patients treated with ThuVEP (2007- 2010) with 5-year follow-up data • At 5 years median PSA reduction was 77.1% • 3.1% patients developed BN contractures and urethral strictures • 2.3% patients required re-treatment for recurrent tissue • Durable improvements were seen in Qmax, QoL, PVR, IPSS • ThuVEP is a durable procedure

5. MP09-04 COMPARISON BETWEEN TADALAFIL 5 MG VS. SERENOA REPENS/SELENIUM/LYCOPENE FOR THE TREATMENT OF BENIGN PROSTATIC LUTS SECONDARY TO BPH. A PHASE IV, RANDOMIZED, MULTICENTER, NON-INFERIORITY CLINICAL STUDY. SPRITE STUDY. Giuseppe Morgia, Giulio Reale, et al. • Aim was to compare efficacy and tolerability of s. repens, selenium, and lycopene to tadalafil 5mg for 6 months for treatment of LUTS • At 6 months no differences were seen between groups in change in IPSS, Qmax, and PVR • Treament with s.repens/selenium/lycopene was not inferior to tadalafil 5mg at 6 months and fewer adverse events were seen

6. MP09-05 DOES CONCOMITANT TESTOSTERONE REPLACEMENT IMPROVE THE RESPONSE OF TADALAFIL 5 MG ONCE DAILY IN MEN WITH LOWER URINARY TRACT SYMPTOMS? Hyun Jun Park*, Tae Nam Kim, et al. • 12-week randomized parallel study of clinical outcomes in men with symptomatic BPH and testosterone < 100 ng/dL • Patients randomized to tadalafil 5mg + transdermal testosterone or tadalafil alone • Improvements in IPSS, Qmax, and PVR similar • Greater improvements in testosterone group in QoL and IPSS storage subscore • Testosterone + tadalafil was superior in improving LUTS

7. MP 09-12 DECISION-MAKING IN MEN CONSIDERING USE OF NON-PRESCRIPTION TAMSULOSIN FOR LUTS Joshua Cohn, Roger Dmochowski, et al. • 92.8% and 97.9% of men met appropriate self-selection criteria on unmitigtated and mitigated analyses. • Decision to use tamsulosin based on indications and warning was appropriate for most men, even those with low health literacy.

8. MP09-14 COMPARISON OF THE EFFICACY OF COMBINATION THERAPY WITH AN ANTICHOLINERGIC AGENT AND AN a1-BLOCKER VERSUS A b3-ADRENOCEPTOR AGONIST AND AN a1-BLOCKER FOR PATIENTS WITH BENIGN PROSTATIC ENLARGEMENT COMPLICATED BY OVERACTIVE BLADDER: A RANDOMIZED, PROSPECTIVE TRIAL BASED ON A URODYNAMIC STUDY Yoshihisa Matsukawa, Takashi Fujita, et al. • 80 men with LUTS, BPH and OAB were randomized to silodosin 8mg + fesoterodine 4mg or silodosin + mirabegron 50 mg • Patients filled out questionnaires and underwent UDS • At 12 weeks mean IPSS and OABSS in both groups improved significantly but greater improvements seen in fesoterodine group in incidence of detrusor overactivity

9. MP13-1 COMPARISON OF A MEXICAN VISUAL ANALOG SCALE (GEA SCALE) VS IPSS IN THE EVALUATION OF LOWER URINARY TRACT SYMPTOMS IN A LOW SOCIO-CULTURAL LEVEL POPULATION Diego Preciado Estrella, Steven Kaplan, et al. • IPSS compared to GEA scale in men with mean 7 years of schooling • 42% needed to help to fill out IPSS versus 10% for GEA score • GEA score may be useful in assessing LUTS in patients with cultural or academic constraints

10. MP17-18 PERIPROSTATIC FAT (PPF) SECRETOME IN BPH PROGRESSION Omar Franco, Rodrigo Javier et al. • Periperostatic fat (PPF) is an adipose tissue containing adipose tissue macrophages (ATM) • Production of pro-inflammatory adipokines leads to development of metabolic syndrome and activation of NF-ΚB signalling pathway • PPF collected from prostatectomy patients and MRI used to determine thickness

11. MP17-18 PERIPROSTATIC FAT (PPF) SECRETOME IN BPH PROGRESSION Omar Franco, Rodrigo Javier et al. • Obese patients showed increased PPF thickness compared to lean patients • PPF samples showed expression of pro-inflammatory factors • These findings suggest potential role for PPF pro-inflammatory secretome in BPH pathogenisis

12. PD23-10 CONVECTIVE RADIOFREQUENCY THERMAL THERAPY: DURABLE TWO-YEAR OUTCOMES OF A RANDOMIZED CONTROLLED AND PROSPECTIVE CROSSOVER STUDY TO RELIEVE LUTS DUE TO BPH Claus Roehrborn, Steven Gange, et al. • Crossover subjects had IPSS, Qmax, and QoL markedly improved after RF vs. prior control procedure (p<0.024 - <0.0001) • Median lobe treatments performed in 31% subjects • No de novo erectile dysfunction was reported. • Convective RF thermal therapy is a minimally-invasive office or outpatient procedure that demonstrates LUTS relief and improved Qmax durable to 2 years including in patients with median lobe.

13. PD23-10 CONVECTIVE RADIOFREQUENCY THERMAL THERAPY: DURABLE TWO-YEAR OUTCOMES OF A RANDOMIZED CONTROLLED AND PROSPECTIVE CROSSOVER STUDY TO RELIEVE LUTS DUE TO BPH Claus Roehrborn, Steven Gange, et al. • 2-year outcomes of a RCT plus 1-year results of a crossover trial after treament with convective radiofrequency (FR) water vapor thermal therapy (Rezum System) • RF energy generates water vapor that convectively disperses throughout tissue to ablate tissue • Mean IPSS reduced by 50% (11.2) vs. 20% (-4.3) for control at 3 months (p<0.0001). Qmax increased by 6.2 ml/s vs. 0 in controls (p<0.0001).

14. PD27-01 5 YEAR PROSPECTIVE, RANDOMIZED, CONTROLLED STUDY RESULTS ON THE MINIMALLY INVASIVE PROSTATIC URETHRAL LIFT (PUL) Claus Roehrborn, Steven Gange, et al. • 5-year data from large multicenter RCT on PUL in patients with prostate volume 30 -80 cc. • Patients experienced improvement in symptoms by 1 months and improvements remained improved at 5 years (p<0.001) • Sexual fuction was preserved in the PUL cohort, including ejaculatory function • No de novo erectile dysfunction was reported

15. PD27-01 5 YEAR PROSPECTIVE, RANDOMIZED, CONTROLLED STUDY RESULTS ON THE MINIMALLY INVASIVE PROSTATIC URETHRAL LIFT (PUL) Claus Roehrborn, Steven Gange, et al.

16. PD27-05 COMPLICATIONS OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A SINGLE CENTRE CASE SERIES WITH 13 YEARS OF FOLLOW-UP Danielle Whiting, Thomas Smith, et al. • Complications described or a large single center case series with 13 years of follow-up • 969 cases • Improvements in IPSS and Qmax • HoLEP is effective and safe with few early and late complications

17. Aquablation vs. Transurethral Resection of the Prostate (TURP) for Moderate-to-Severe Benign Prostatic Hyperplasia (BPH) Dr. Claus Roehrborn Department of Urology, UT Southwestern Medical CenterDallas, TX USA Dr. Peter Gilling Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand

18. Aquablation vs. Transurethral Resection of the Prostate (TURP) for Moderate-to-Severe Benign Prostatic Hyperplasia (BPH) 275 men with moderate to severe LUTS due to BPH Inclusion: 45-80 years of age, 30-80 gram prostates by TRUS, intravesical lobe permitted, IPSS ≥ 12, Qmax ≤ 15 (72) screen fail / withdraw (19) roll-in (3) randomized, but not treated Exclusion: prostate cancer, prior BPH surgery, neurogenic bladder Yes (N=181) R Patient Blinded and Randomized 2:1, Stratified by IPSS and center TURP (N=65) Aquablation (N=116) Blinded Investigator Follow-up: 1 week, 3 months, 6 months, 1 year, annually through 3 years

19. AquaBeam System Overview AQUABLATION: Tissue removal with a heat-free waterjet Details on the company and technology http://www.procept-biorobotics.com Real-time image guidance Intra-procedural bi-plane TRUS imaging plus endoscopic visualization Surgical planning Surgeon defined treatment plan developed prior to Aquablation Robotic execution Robotically controlled tissue removal in ~4 minutes independent of prostate size

20. Voiding, Storage, and Quality of Life Quality of Life 0 – 6 points Storage 0 – 15 points Voiding 0 – 20 points p<0.05 p=NS p=NS Change Scores From Baseline Data reported as mean (95% CI) P-value uses repeated measures

21. Conclusion • The TURP comparator arm in the WATER achieved excellent symptom (Δ15.2) and Q max improvements (9.1 18.1 mls/sec) • Aquablation met both primary safety and efficacy endpoints compared to TURP • No differences in terms of blood loss and PSA changes at 6 mo • Aquablation provided TURP-like results despite newness of procedure • Aquablation produced superior safety and efficacy results in larger glands • Avoiding thermal energy induces an early and pronounced benefit, particularly with storage symptoms • Aquablationpreserves ejaculatory function and continence to a greater degree than TURP • Combination of robotics and image guidance significantly reduces tissue removal time independent of prostate size

22. Baseline

23. PD27-10 ROBOTIC SIMPLE PROSTATECTOMY: THE USC EXPERIENCE Carlos Fay, Daniel Melecchi Freitas • 129 men underwent transvesical robotic simple prostatectomy (RSC) with median follow-up 7 months. • Median prostate volume was 137.5 mL (54 – 300) and median operative time was 225 min (135 – 400). • There were no intraoperative complications and 1 (0.8%) patient required blood transfusion.