1341 CHARACTERISTICS OF ANTERIOR PREDOMINANT PROSTATE CANCER AND THE USEFULNESS OF MULTIPARAMETRIC MRI IN DIAGNOSIS

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THE JOURNAL OF UROLOGY姞

1341 CHARACTERISTICS OF ANTERIOR PREDOMINANT PROSTATE CANCER AND THE USEFULNESS OF MULTIPARAMETRIC MRI IN DIAGNOSIS Sahyun Pak*, Sejun Park, Sang Hoon Song, Dalsan You, Cheryn Song, Hanjong Ahn, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: In prostate-specific antigen(PSA) era, late detection of prostate cancer still exists when the tumor arised from anterior portion of prostate. We analyzed the characteristics of anterior predominant prostate cancer, and assess the usefulness of MRI to detect the tumor preoperatively. METHODS: We evaluated clinicopathological data and radiologic findings of 660 patients treated with radical prostatectomy between July, 2007 and June, 2012. All patients underwent MRI with diffusion-weighted imaging, and ADC mapping. When the lesion was larger than 8mm in diameter, showed low signal intensity on T2weighted image, restricted diffusion on diffusion-weighted images and ADC maps, it was considered presence of tumor. RESULTS: Anterior predominant prostate cancer constituted 26.8% of total patients. Index tumor in anterior peripheral zone, anterior fibromuscular stroma, and transition zone were 27.7%, 3.4%, and 69.0% respectively. Age, BMI, PSA, prostate volume, and PSA density in anterior predominant prostate cancer were not different from posterior prostate cancer. Diagnosis with repeated biopsy was more frequent in anterior predominant cancer, and clinical T stage (p⬍0.001), pathologic T stage (p⬍0.001), pathologic GS (p⫽0.040) were lower. In D’Amico low-risk patients, anterior predominant cancer presented in 40.1%, and upgrading was more frequently observed than posterior predominant cancer (65.1% vs 49.5%, p⫽0.027). In anterior predominant cancer, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI were 64.2%, 83.0%, 63.8%, 83.2%, and 77.0%, respectively. CONCLUSIONS: Anterior predominant cancer had favorable pathologic features compared with posterior dominant cancer. However, more frequent upgrading was noted. MRI was useful to detect the hidden anterior predominant cancer. Source of Funding: None

1342 PSYCHOLOGICAL STRESS ASSOCIATED WITH ACTIVE SURVEILLANCE FOR LOCALISED LOW RISK PROSTATE CANCER Mark Frydenberg*, Jake Anderson, Lina Ricciardelli, Susan Burney, Joanne Brooker, Jane Fletcher, Melbourne, Australia INTRODUCTION AND OBJECTIVES: Prostate cancer is a major cause of mortality in Australian men. One treatment for low risk prostate cancer, is active surveillance (AS). Anectdotal evidence suggests that some men on AS are vulnerable to anxiety which may have an impact on health related quality of life (HRQOL) and may also impact on the mens ability to remain on AS. The objectives of this study were to describe a range of anxieties in men on AS, and which of these anxieties predicted HRQOL in these men. Our final aim was to examine the satisfaction that these men reported in the information provided to them about AS by their treating urologist. METHODS: 265 men with prostate cancer on an AS database from a single urologist were invited to participate in the study. Inclusion criteria for the AS database were in accord with the PRIAS protocol. Sociodemographic information was collected, and patients completed the Hospital and Anxiety depression scale (HADS), State-trait anxiety inventory-trait scale (STAT), memorial anxiety scale for prostate cancer (MAX-PC), Functional assessment of cancer therapy - prostate version 4 (FACT-P), illness perception questionnaire-revised (IPQ-R) and Likert scale analysis questionnaire regarding information provision. All data was analysed using SPSS version 19. RESULTS: 104 men agreed to participate in the study. 91% of men did not demonstrate anxiety on HADS, 98% demonstrated low

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levels of PSA anxiety and 87% low levels of prostate cancer anxiety on MAX-PC. However 81% of men demonstrated higher levels regarding fear of recurrence on MAX-PC. General (state/trait) anxieties and younger age were significantly associated with illness specific prostate cancer and fear of recurrence anxieties. 92% of men were satisfied with the information received from their urologist regarding prostate cancer and AS specifically. CONCLUSIONS: Men experience low levels of anxiety and high HRQOL on AS for localised prostate cancer but still experience some concerns regarding fear of recurrence. Younger age and underlying trait anxiety emerged as significant predictors of overall HRQOL suggesting that these men may indeed be vulnerable psychologically on AS, and consideration could be given to urologists administering a short trait anxiety screening tool to help identify these men and consider them for active therapy. High levels of patient education as seen in this study may explain the low levels of anxiety seen in men on AS, underlying the importance of the provision of detailed verbal and written information about AS and its risks and benefits in real terms. Source of Funding: None

1343 ONCOLOGIC OUTCOME AFTER ACTIVE TREATMENT IN MEN INITIALLY ON ACTIVE SURVEILLANCE: IMPACT OF POPULATION-BASED SCREENING ON PROSTATE CANCER PROGRESSION [THE EXPERIENCE OF THE SWISS ARM OF THE ERSPC] Marco Randazzo*, Daniel Seiler, Josef Beatrice, Aarau, Switzerland; Felix H. K. Chun, Hendrik Isbarn, Sascha A. Ahyai, Hamburg, Germany; Andreas Huber, Rainer Grobholz, Martin Baumgartner, Franz Recker, Maciej Kwiatkowski, Aarau, Switzerland INTRODUCTION AND OBJECTIVES: Low-risk prostate cancer (PCa) is frequently diagnosed in the context of PSA screening or during routine evaluation. For such patients, active surveillance (AS) is an attractive treatment option. However, it is unknown whether the route of detection (systematic PSA screening vs. early detection) impacts outcome in men initially under AS who clinically progressed and finally underwent radical prostatectomy. Our study objective was to assess the impact of the population-based screening (ERSPC) on the outcome of this patient group. METHODS: From December 1998 to October 2010, n⫽191 men with low-risk PCa fulfilling clinical Epstein-criteria at diagnosis experienced active surveillance as initial treatment. These patients originated either from swiss arm of the ERSPC or were diagnosed during routine GP check-up. Invariably, the AS protocol consisted of PSA measurements every 6 months and an annual 10 core biopsy. Of these, 48 men demonstrated clinical progression, and thus definitive treatment was performed. Kaplan-Meier analysis was used to test risk of disease progression. Additionally, Cox regression analyses addressed the association between pre-operative clinical risk factors and biochemical recurrence (BCR). RESULTS: 40 men finally underwent RP due to clinical progression in course of AS. Of these, 19 were systematic screening and 21 were early detected PCa. Time to RP did not differ in a significantly manner between both groups (1.7 and 2.0 years, respectively, p ⬎ 0.05). No significant differences regarding histopathological results in case of radical prostatectomy (RP) were recorded. Four men were found to have BCR after a median time from surgery of 6.5 months, one of which developed metastasis after 44 months from surgery. None of them originated from the screening cohort (p⫽0.05). Interestingly, screen-detected RP men were significantly older (p ⬍ 0.001), had lower PSA-values (p ⬍ 0.001), lower PSA-density (p ⫽ 0.001) and longer follow-up (p ⬍ 0.001). Kaplan Meier analysis demonstrated no difference in terms of disease progression between both groups (p ⫽ 0.3). CONCLUSIONS: The origin of PCa diagnosis in men undergoing AS has no influence on disease progression but was associated