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1002 DO PROSTATE CANCER NOMOGRAMS GIVE ACCURATE INFORMATION WHEN APPLIED TO EUROPEAN PATIENTS?
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
THE JOURNAL OF UROLOGY姞
e411
Source of Funding: None
Source of Funding: None
1002 1001 PREOPERATIVE PREDICTIVE FACTORS AND FURTHER RISK STRATIFICATION OF BIOCHEMICAL RECURRENCE IN CLINICALLY LOCALIZED HIGH RISK PROSTATE CANCER Riu Hamada*, Jun Nakashima, Takeshi Hashimoto, Naoya Satake, Yoshihiro Nakagami, Choichiro Ozu, Yoshio Ohno, Yutaka Horiguchi, Kazunori Namiki, Kunihiko Yoshioka, Makoto Ohori, Masaaki Tachibana, Tokyo, Japan INTRODUCTION AND OBJECTIVES: High risk prostate cancer may includes various patient groups. The present study was undertaken to identify preoperative predictive parameters of biochemical recurrence (BR) and to further stratify its risk in patients with high risk localized prostate cancer treated with radical prostatectomy (RP). METHODS: The study population included 139 men with high risk prostate cancer (D’Amico risk classification) treated with RP alone. Estimates of BR were generated with a Kaplan-Meier method. Cox proportional hazards regression was used to examine preoperative predictors for BR. RESULTS: Univariate analyses showed that prostate volume, transition zone volume and biopsy Gleason score were not significantly associated with BR. On the other hand, patients with preoperative PSA value ⱖ23ng/ml, PSA density (PSAD) ⱖ0.3, PSA density of trasition zone (PSATZD) ⱖ0.85, the total percentage of cores positive ⱖ37 % and the percentage of cores positive from the dominant side ⱖ70% showed significantly higher BR rates than their respective counterpart. Multivariate analysis demonstrated that the percentage of cores positive from the dominant side and PSATZD are significant independent prognostic factors for BR. Using these significant variables, the relative risk (RR) of BR could be expressed with the formula, exp (1.03 ⫻ the percentage of cores positive from the dominant side ⫹ 0.54 ⫻ PSATZD). The patients were stratified into three risk groups ; Group 1 (the percentage of cores positive from the dominant side ⬍70% and PSATZD ⬍0.85), Group 2 (the percentage of cores positive from the dominant side ⱖ70% and PSATZD ⬍0.85, or the percentage of cores positive from the dominant side ⬍70% and PSATZD ⱖ0.85), Group 3 (the percentage of cores positive from the dominant side ⱖ70% and PSATZD ⱖ0.85). There were significant differences in the BR rate among these groups (Figure). CONCLUSIONS: Patients with localized high risk prostate cancer by the currently available definition do not have a uniformly poor prognosis after RP. The percentage of cores positive from the dominant side and PSATZD are significant predictors for BR and can provide the further stratification model to enable urologists to identify high risk patients with really poor prognosis.
DO PROSTATE CANCER NOMOGRAMS GIVE ACCURATE INFORMATION WHEN APPLIED TO EUROPEAN PATIENTS? Rafal Turo*, James Forster, Robert West, Stephen Prescott, Alan Paul, William Cross, Leeds, United Kingdom INTRODUCTION AND OBJECTIVES: Nomograms are increasingly used in pre-treatment counselling of prostate cancer patients. Clinicians regularly use predictive nomograms e.g. the Memorial-Sloan Kettering (MSKCC) website to give predictions of outcomes following surgery. However, these nomograms are largely created using data from United States databases. Their lack of validation to UK patients may mean that patients receive inaccurate prognostic information. METHODS: Patients were identified from databases of radical prostatectomy between 1996 and 2011. Information on demographics, PSAs, staging, biopsy and specimen histopathology and follow-up were obtained. Data was inputted into MSKCC, Partin 1997, Makarov/ Partin 2007 and University of California San Francisco Cancer of the Prostate Risk Assessment (UCSF-CAPRA) nomograms. The risks of extra-capsular extension (ECE), seminal vesicle invasion (SVI) and lymph node involvement (LNI) were calculated and compared with known outcomes. Nomogram performance was measured using Hosmer-Lemeshow (HL) goodness-of-fit tests, calculating concordance indices (CI), and calibration curves. RESULTS: Data was obtained for 542 patients. Prediction of ECE was relatively poor using all nomograms, with the Makarov/Partin 2007 the most sensitive over the range of risk stratification (HL 9.9, CI 0.62). Predictions of SVI and LNI were better, with the MSKCC nomogram performing best for SVI (HL 10.9, CI 0.73), and all nomograms performing well for LNI prediction (CIs 0.8 to 0.815). CONCLUSIONS: Caution should be used when counselling patients using nomograms. Although they may be used as a guide, patients should be warned they are not validated on UK patients, and may give misleading information regarding that patient’s specific risks. Source of Funding: None
1003 LONG TERM HEALTH RELATED QUALITY OF LIFE OUTCOMES AFTER PRIMARY TREATMENT FOR LOCALIZED PROSTATE CANCER: RESULTS FROM THE CAPSURE REGISTRY Sanoj Punnen*, Janet Cowan, Peter Carroll, Matthew Cooperberg, San Francisco, CA INTRODUCTION AND OBJECTIVES: There is a lack of data regarding late declines in health related quality of life after primary treatment of localized prostate cancer and few studies have reported
THE JOURNAL OF UROLOGY姞
e411
Source of Funding: None
Source of Funding: None
1002 1001 PREOPERATIVE PREDICTIVE FACTORS AND FURTHER RISK STRATIFICATION OF BIOCHEMICAL RECURRENCE IN CLINICALLY LOCALIZED HIGH RISK PROSTATE CANCER Riu Hamada*, Jun Nakashima, Takeshi Hashimoto, Naoya Satake, Yoshihiro Nakagami, Choichiro Ozu, Yoshio Ohno, Yutaka Horiguchi, Kazunori Namiki, Kunihiko Yoshioka, Makoto Ohori, Masaaki Tachibana, Tokyo, Japan INTRODUCTION AND OBJECTIVES: High risk prostate cancer may includes various patient groups. The present study was undertaken to identify preoperative predictive parameters of biochemical recurrence (BR) and to further stratify its risk in patients with high risk localized prostate cancer treated with radical prostatectomy (RP). METHODS: The study population included 139 men with high risk prostate cancer (D’Amico risk classification) treated with RP alone. Estimates of BR were generated with a Kaplan-Meier method. Cox proportional hazards regression was used to examine preoperative predictors for BR. RESULTS: Univariate analyses showed that prostate volume, transition zone volume and biopsy Gleason score were not significantly associated with BR. On the other hand, patients with preoperative PSA value ⱖ23ng/ml, PSA density (PSAD) ⱖ0.3, PSA density of trasition zone (PSATZD) ⱖ0.85, the total percentage of cores positive ⱖ37 % and the percentage of cores positive from the dominant side ⱖ70% showed significantly higher BR rates than their respective counterpart. Multivariate analysis demonstrated that the percentage of cores positive from the dominant side and PSATZD are significant independent prognostic factors for BR. Using these significant variables, the relative risk (RR) of BR could be expressed with the formula, exp (1.03 ⫻ the percentage of cores positive from the dominant side ⫹ 0.54 ⫻ PSATZD). The patients were stratified into three risk groups ; Group 1 (the percentage of cores positive from the dominant side ⬍70% and PSATZD ⬍0.85), Group 2 (the percentage of cores positive from the dominant side ⱖ70% and PSATZD ⬍0.85, or the percentage of cores positive from the dominant side ⬍70% and PSATZD ⱖ0.85), Group 3 (the percentage of cores positive from the dominant side ⱖ70% and PSATZD ⱖ0.85). There were significant differences in the BR rate among these groups (Figure). CONCLUSIONS: Patients with localized high risk prostate cancer by the currently available definition do not have a uniformly poor prognosis after RP. The percentage of cores positive from the dominant side and PSATZD are significant predictors for BR and can provide the further stratification model to enable urologists to identify high risk patients with really poor prognosis.
DO PROSTATE CANCER NOMOGRAMS GIVE ACCURATE INFORMATION WHEN APPLIED TO EUROPEAN PATIENTS? Rafal Turo*, James Forster, Robert West, Stephen Prescott, Alan Paul, William Cross, Leeds, United Kingdom INTRODUCTION AND OBJECTIVES: Nomograms are increasingly used in pre-treatment counselling of prostate cancer patients. Clinicians regularly use predictive nomograms e.g. the Memorial-Sloan Kettering (MSKCC) website to give predictions of outcomes following surgery. However, these nomograms are largely created using data from United States databases. Their lack of validation to UK patients may mean that patients receive inaccurate prognostic information. METHODS: Patients were identified from databases of radical prostatectomy between 1996 and 2011. Information on demographics, PSAs, staging, biopsy and specimen histopathology and follow-up were obtained. Data was inputted into MSKCC, Partin 1997, Makarov/ Partin 2007 and University of California San Francisco Cancer of the Prostate Risk Assessment (UCSF-CAPRA) nomograms. The risks of extra-capsular extension (ECE), seminal vesicle invasion (SVI) and lymph node involvement (LNI) were calculated and compared with known outcomes. Nomogram performance was measured using Hosmer-Lemeshow (HL) goodness-of-fit tests, calculating concordance indices (CI), and calibration curves. RESULTS: Data was obtained for 542 patients. Prediction of ECE was relatively poor using all nomograms, with the Makarov/Partin 2007 the most sensitive over the range of risk stratification (HL 9.9, CI 0.62). Predictions of SVI and LNI were better, with the MSKCC nomogram performing best for SVI (HL 10.9, CI 0.73), and all nomograms performing well for LNI prediction (CIs 0.8 to 0.815). CONCLUSIONS: Caution should be used when counselling patients using nomograms. Although they may be used as a guide, patients should be warned they are not validated on UK patients, and may give misleading information regarding that patient’s specific risks. Source of Funding: None
1003 LONG TERM HEALTH RELATED QUALITY OF LIFE OUTCOMES AFTER PRIMARY TREATMENT FOR LOCALIZED PROSTATE CANCER: RESULTS FROM THE CAPSURE REGISTRY Sanoj Punnen*, Janet Cowan, Peter Carroll, Matthew Cooperberg, San Francisco, CA INTRODUCTION AND OBJECTIVES: There is a lack of data regarding late declines in health related quality of life after primary treatment of localized prostate cancer and few studies have reported