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MP51-16 PATHOLOGIC FINDINGS AT RADICAL PROSTATECTOMY OF PATIENT'S ELIGIBLE FOR ACTIVE SURVEILLANCE: STRATIFICATION BY SELECTION CRITERIA AND RACE
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
was performed on the day of imaging and the excised prostate was imaged with SPECT/CT and planar scintigraphy before being sent to surgical pathology. 2) Cohort 2: Eleven patients were injected intravenously with 5mCi 89Zr-J591 followed 6 days later by whole body PET imaging. Patients underwent surgery the day of PET imaging and the specimens were imaged by ex vivo PET and custom 3 Tesla magnetic resonance scanner coil. SPECT/ PET imaging studies and histopathology were correlated. RESULTS: 111In-J591 whole body images showed the expected bio-distribution seen in other ongoing imaging/therapy trials for metastatic Prostate Cancer (PCa). Imuno-scintigraphic images were consistent with the pathologic diagnoses for all of the patients. In case of 89Zr-J591/PSMA PET imaging in localized PCa it is observed 89ZrJ591-PET binds to tumor foci in situ and binds primarily to Gleason 7 and larger sized tumors, likely corresponding to clinically significant disease that warrants definitive therapy. CONCLUSIONS: 111In-J591 demonstrated targeting in localized disease in prostatectomy specimen, but pathologic validation was only inferred by quadrant due to low soft tissue contrast and the inherent resolution limits of the clinical scanner on a relatively small specimen. 89Zr-J591-PET can identify discrete intra-prostatic tumor foci, and in our cohort, visualized most of the index lesions. Additionally, high-grade tumors are generally better visualized with this novel imaging agent. There is a relationship between SUV on the 89Zr-J591-PET of tumor foci and their aggressiveness as defined by Gleason score. The preliminary data from this pilot study warrants further investigation with MicroSPECT and autoradiograph or ImmunoPET and MRI. Source of Funding: None
MP51-15 TIME FROM SURGERY TO URINARY CONTINENCE SIGNIFICANTLY INFLUENCES THE SUBSEQUENT RECOVERY OF ERECTILE FUNCTION IN PATIENTS TREATED WITH BILATERAL NERVE-SPARING RADICAL PROSTATECTOMY Giorgio Gandaglia*, Firas Abdollah, Andrea Gallina, Paolo Dell’Oglio, Maria Passoni, Andrea Salonia, Vincenzo Scattoni, Niccolo Nicola Fossati, Damiano Vizziello, Milan, Italy; Pierre I. Karakiewicz, Maxine Sun, Montreal, Canada; Shahrokh F. Shariat, Vienna, Austria; Francesco Montorsi, Alberto Briganti, Milan, Italy INTRODUCTION AND OBJECTIVES: Time from surgery to patient evaluation represents an important predictor of subsequent erectile function (EF) recovery in prostate cancer (PCa) patients after nerve-sparing radical prostatectomy (NSRP). However, evidence is scarce regarding the role of time between urinary continence (UC) recovery on subsequent EF recovery after surgery. We hypothesized that the early UC recovery might be a reliable predictor of EF recovery after bilateral NSRP (BNSRP). METHODS: The study included 870 patients with PCa treated with BNSRP between January 2008 and July 2013 at a single institution. UC recovery was defined as being completely pad-free over a 24hour period. The International Index of Erectile Function-Erectile Function Index (IIEF-EF) was used to evaluate EF after BNSRP. Postoperative EF recovery was defined as an IIEF-EF domain score 22. We focused our analyses on preoperatively fully potent patients (namely, IIEF-EF26; n¼223). Cumulative survival estimates were used to generate conditional recovery rates assessed at 6-month intervals. Our analyses were repeated after stratifying patients according to age at surgery (65 vs. 66-70 vs. 71), CCI (0 vs. 1 vs. 2), and D’Amico risk group (low- vs. intermediate/high-risk). Multivariate Cox regression analyses (MVA) tested the relationship between early UC recovery (within 1 month after surgery) and EF recovery after adjusting for age at surgery, Charlson Comorbidity Index (CCI), and risk group. RESULTS: At a mean follow up of 43 months (median 40), the 1- and 2-year EF recovery rates were 54.9% and 64.5%, respectively. The 1- and 2-year UC recovery rates were 79.4 and 85.9%, respectively. In patients who were still incontinent at 1-, 6-, 12-, and 18-months
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after surgery, EF recovery rates in the following 6-month period substantially decreased as the time following surgery increased: 34.2, 31.6, 26, and 6.7%, respectively. Similar trends were observed after stratifying patients according to age at surgery, CCI, and risk group. In MVA, earlier UC was associated with 2-fold higher probability of EF recovery, after adjusting for confounders (P<0.001). CONCLUSIONS: The time elapsed between BNSRP and UC recovery has a substantial impact on the subsequent probability of EF recovery. Since UC recovery precedes EF recovery in the vast majority of the cases, these observations might help provide clinicians better postoperative counseling and planning of therapeutic approaches aimed at the optimal recovery of EF. Source of Funding: None
MP51-16 PATHOLOGIC FINDINGS AT RADICAL PROSTATECTOMY OF PATIENT’S ELIGIBLE FOR ACTIVE SURVEILLANCE: STRATIFICATION BY SELECTION CRITERIA AND RACE Kenneth DeLay*, Michael Williams, Norfolk, VA; Hind Beydoun, Norfolk, WA; Robert Given, Raymond Lance, Norfolk, VA INTRODUCTION AND OBJECTIVES: To compare prostate cancer specific outcomes between selection criteria for patients considering active surveillance(AS). METHODS: Materials & Methods: We queried our institutional radical prostatectomy (RP) database for pathologic data on prostatectomy specimens from 1991 to 2012. From this three groups were formed. Ultra low risk patients were defined as those with a Gleason 3+3 disease, no more than 30% tumor of involvement of one core, PSA <10, and cT2a or less on initial biopsy. Low risk was defined as Gleason 3+3 disease, 1-3 cores involved, no core with more than 50% tumor involvement, PSA <10, and cT2a or less. Intermediate risk was defined as those with Gleason 3+4 disease, one core involved, and no core with more than 30% involvement RESULTS: We identified 545 men from 3097 specimens who met eligibility the above criteria. The average age in years and PSA were 59.1 and 5.1 respectively. There were 414 Caucasians and 156 African-Americans. 23 patients did not have their race identified in the database. On multivariate analysis including age, race, and gland size no differences were found among groups with respect to pathologic stage, Seminal Vesicle Invasion, or biochemical recurrence. The intermediate risk groups did carry an increased risk of harboring primary Gleason 4 or 5 on final pathology compared to the low risk and ultra-low groups with Odds Ratios of 5.32 (2.24-12.65) and 10.92 (3.54-33.69). The low risk group did not have an increased risk of primary Gleason 4 or 5 compared to the ultra-low risk group. CONCLUSIONS: Patients with even low volume 3+4 disease adenocarcinoma of the prostate on initial biopsy are more likely to harbor Gleason 4 or 5 disease at final pathology compared to those with only low volume Gleason 3+3. However, in our cohort we did not see any other significant differences in other pathological findings nor and most importantly in biochemical disease free survival. Table Pathology Total Patients Extraprostatic Disease(T3) Semival Vesicle Invasion Positive Margins Biochemical Recurrence Primary Gleason 4/5 on Final Pathology
Ultra Low Risk 194 8.2%(16) 0.4%(1)
Low Risk 302 10.2%(31) 1.6(5)
Intermediate Risk 49 12.2%(6)
P value 0.75
4.2%(2)
0.41
18.6(40) 14.2%(31)
15.8%(50) 14.4%(47)
18.2%(11) 18.3%(9)
0.66 0.47
2.2%(5)
4.6%(15)
20.4%(10)
0.0001
Source of Funding: None
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
was performed on the day of imaging and the excised prostate was imaged with SPECT/CT and planar scintigraphy before being sent to surgical pathology. 2) Cohort 2: Eleven patients were injected intravenously with 5mCi 89Zr-J591 followed 6 days later by whole body PET imaging. Patients underwent surgery the day of PET imaging and the specimens were imaged by ex vivo PET and custom 3 Tesla magnetic resonance scanner coil. SPECT/ PET imaging studies and histopathology were correlated. RESULTS: 111In-J591 whole body images showed the expected bio-distribution seen in other ongoing imaging/therapy trials for metastatic Prostate Cancer (PCa). Imuno-scintigraphic images were consistent with the pathologic diagnoses for all of the patients. In case of 89Zr-J591/PSMA PET imaging in localized PCa it is observed 89ZrJ591-PET binds to tumor foci in situ and binds primarily to Gleason 7 and larger sized tumors, likely corresponding to clinically significant disease that warrants definitive therapy. CONCLUSIONS: 111In-J591 demonstrated targeting in localized disease in prostatectomy specimen, but pathologic validation was only inferred by quadrant due to low soft tissue contrast and the inherent resolution limits of the clinical scanner on a relatively small specimen. 89Zr-J591-PET can identify discrete intra-prostatic tumor foci, and in our cohort, visualized most of the index lesions. Additionally, high-grade tumors are generally better visualized with this novel imaging agent. There is a relationship between SUV on the 89Zr-J591-PET of tumor foci and their aggressiveness as defined by Gleason score. The preliminary data from this pilot study warrants further investigation with MicroSPECT and autoradiograph or ImmunoPET and MRI. Source of Funding: None
MP51-15 TIME FROM SURGERY TO URINARY CONTINENCE SIGNIFICANTLY INFLUENCES THE SUBSEQUENT RECOVERY OF ERECTILE FUNCTION IN PATIENTS TREATED WITH BILATERAL NERVE-SPARING RADICAL PROSTATECTOMY Giorgio Gandaglia*, Firas Abdollah, Andrea Gallina, Paolo Dell’Oglio, Maria Passoni, Andrea Salonia, Vincenzo Scattoni, Niccolo Nicola Fossati, Damiano Vizziello, Milan, Italy; Pierre I. Karakiewicz, Maxine Sun, Montreal, Canada; Shahrokh F. Shariat, Vienna, Austria; Francesco Montorsi, Alberto Briganti, Milan, Italy INTRODUCTION AND OBJECTIVES: Time from surgery to patient evaluation represents an important predictor of subsequent erectile function (EF) recovery in prostate cancer (PCa) patients after nerve-sparing radical prostatectomy (NSRP). However, evidence is scarce regarding the role of time between urinary continence (UC) recovery on subsequent EF recovery after surgery. We hypothesized that the early UC recovery might be a reliable predictor of EF recovery after bilateral NSRP (BNSRP). METHODS: The study included 870 patients with PCa treated with BNSRP between January 2008 and July 2013 at a single institution. UC recovery was defined as being completely pad-free over a 24hour period. The International Index of Erectile Function-Erectile Function Index (IIEF-EF) was used to evaluate EF after BNSRP. Postoperative EF recovery was defined as an IIEF-EF domain score 22. We focused our analyses on preoperatively fully potent patients (namely, IIEF-EF26; n¼223). Cumulative survival estimates were used to generate conditional recovery rates assessed at 6-month intervals. Our analyses were repeated after stratifying patients according to age at surgery (65 vs. 66-70 vs. 71), CCI (0 vs. 1 vs. 2), and D’Amico risk group (low- vs. intermediate/high-risk). Multivariate Cox regression analyses (MVA) tested the relationship between early UC recovery (within 1 month after surgery) and EF recovery after adjusting for age at surgery, Charlson Comorbidity Index (CCI), and risk group. RESULTS: At a mean follow up of 43 months (median 40), the 1- and 2-year EF recovery rates were 54.9% and 64.5%, respectively. The 1- and 2-year UC recovery rates were 79.4 and 85.9%, respectively. In patients who were still incontinent at 1-, 6-, 12-, and 18-months
e603
after surgery, EF recovery rates in the following 6-month period substantially decreased as the time following surgery increased: 34.2, 31.6, 26, and 6.7%, respectively. Similar trends were observed after stratifying patients according to age at surgery, CCI, and risk group. In MVA, earlier UC was associated with 2-fold higher probability of EF recovery, after adjusting for confounders (P<0.001). CONCLUSIONS: The time elapsed between BNSRP and UC recovery has a substantial impact on the subsequent probability of EF recovery. Since UC recovery precedes EF recovery in the vast majority of the cases, these observations might help provide clinicians better postoperative counseling and planning of therapeutic approaches aimed at the optimal recovery of EF. Source of Funding: None
MP51-16 PATHOLOGIC FINDINGS AT RADICAL PROSTATECTOMY OF PATIENT’S ELIGIBLE FOR ACTIVE SURVEILLANCE: STRATIFICATION BY SELECTION CRITERIA AND RACE Kenneth DeLay*, Michael Williams, Norfolk, VA; Hind Beydoun, Norfolk, WA; Robert Given, Raymond Lance, Norfolk, VA INTRODUCTION AND OBJECTIVES: To compare prostate cancer specific outcomes between selection criteria for patients considering active surveillance(AS). METHODS: Materials & Methods: We queried our institutional radical prostatectomy (RP) database for pathologic data on prostatectomy specimens from 1991 to 2012. From this three groups were formed. Ultra low risk patients were defined as those with a Gleason 3+3 disease, no more than 30% tumor of involvement of one core, PSA <10, and cT2a or less on initial biopsy. Low risk was defined as Gleason 3+3 disease, 1-3 cores involved, no core with more than 50% tumor involvement, PSA <10, and cT2a or less. Intermediate risk was defined as those with Gleason 3+4 disease, one core involved, and no core with more than 30% involvement RESULTS: We identified 545 men from 3097 specimens who met eligibility the above criteria. The average age in years and PSA were 59.1 and 5.1 respectively. There were 414 Caucasians and 156 African-Americans. 23 patients did not have their race identified in the database. On multivariate analysis including age, race, and gland size no differences were found among groups with respect to pathologic stage, Seminal Vesicle Invasion, or biochemical recurrence. The intermediate risk groups did carry an increased risk of harboring primary Gleason 4 or 5 on final pathology compared to the low risk and ultra-low groups with Odds Ratios of 5.32 (2.24-12.65) and 10.92 (3.54-33.69). The low risk group did not have an increased risk of primary Gleason 4 or 5 compared to the ultra-low risk group. CONCLUSIONS: Patients with even low volume 3+4 disease adenocarcinoma of the prostate on initial biopsy are more likely to harbor Gleason 4 or 5 disease at final pathology compared to those with only low volume Gleason 3+3. However, in our cohort we did not see any other significant differences in other pathological findings nor and most importantly in biochemical disease free survival. Table Pathology Total Patients Extraprostatic Disease(T3) Semival Vesicle Invasion Positive Margins Biochemical Recurrence Primary Gleason 4/5 on Final Pathology
Ultra Low Risk 194 8.2%(16) 0.4%(1)
Low Risk 302 10.2%(31) 1.6(5)
Intermediate Risk 49 12.2%(6)
P value 0.75
4.2%(2)
0.41
18.6(40) 14.2%(31)
15.8%(50) 14.4%(47)
18.2%(11) 18.3%(9)
0.66 0.47
2.2%(5)
4.6%(15)
20.4%(10)
0.0001
Source of Funding: None