1869 ANALYSIS OF PATHOLOGICAL FINDINGS IN RADICAL PROSTATECTOMY SPECIMENS OF PATIENTS WHO ARE CANDIDATES FOR ACTIVE SURVEILLANCE PROTOCOLS

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THE JOURNAL OF UROLOGY姞

Vol. 183, No. 4, Supplement, Wednesday, June 2, 2010

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1870

ANALYSIS OF PATHOLOGICAL FINDINGS IN RADICAL PROSTATECTOMY SPECIMENS OF PATIENTS WHO ARE CANDIDATES FOR ACTIVE SURVEILLANCE PROTOCOLS

QUALITY OF LIFE, SURVIVAL OUTCOMES AND RECTAL/GENITOURINARY TOXICITY IN PATIENTS TREATED WITH 70GY SALVAGE RADIOTHERAPY AFTER RISE IN PSA POST RADICAL PROSTATECTOMY

Dong Il Kang*, Jeongyun Jeong, Eun Young Choi, Kelly Johnson, Isaac Yi Kim, New Brunswick, NJ INTRODUCTION AND OBJECTIVES: Optimal treatment of low risk, clinically organ-confined prostate cancer is still debated. Recent articles and guidelines on active surveillance (AS) show it as one of the treatment options in selected patients with localized prostate cancer. Our objective was to examine the accuracy of AS using the inclusion criteria of 3 different multi-institutional studies. METHODS: The data of 400 patients who underwent robotassisted radical prostatectomy (RARP) by a single surgeon between 2006 and 2009 were reviewed. Pathological characteristics were studied in patients who fulfilled the inclusion criteria for AS according in 3 different studies and guidelines: National Cancer Institute (NCI), University of California San Francisco (UCSF), and European Association of Urology (EAU). RESULTS: Of the 400 patients, 134 patients, 128 patients and 31 patients fulfilled the AS criteria of NCI, UCSF, EAU, respectively. Table 1 summarizes patient characteristics. High grade prostate cancer (prostatectomy specimen; 4⫹3, 8-10) was found in 6.5%-7.8% of patients. Rates of upgrading (Gleason scores from 7 to 10) were 34.8%, 34.9%, and 41.9% and rates of upstaging (pT3) were 6.7%, 8.6%, and 16.1% for the 3 guidelines, respectively. After a median follow-up of 18.0 months, there was 1 patient with PSA biochemical recurrence on NCI and UCSF protocol. CONCLUSIONS: In our experience, patients who meet the criteria for AS showed upstaging (pT3) or upgrading (Gleason scores from 7 to 10) in 37.3%-48.4% on pathological analysis. The risks of AS are still unclear to the urologist and prostate cancer patients. If patients choose AS, informed consent should include explanation of its potential risks.

Jeff R. Cortes-Gonzalez*, Enrique Castellanos, Seymour Levitt, Anders R. Holmberg, Marcela Marquez, Agneta Richard-Holm, Karl M Ka¨lkner, Yvonne Brandberg, Sten Nilsson, Stockholm, Sweden INTRODUCTION AND OBJECTIVES: Thirty to forty percent of patients will develop Biochemical failure (BcF) after Radical Prostatectomy (RP). For some of these patients, Salvage Radiotherapy (SRT) is the only potentially curative therapy. SRT has been described in doses of irradiation ranging between 60-78 Gy. We report the largest series with homogeneous SRT dose of 70 Gy with 2Gy fractions, in patients with prostate cancer (PCa) BcF after RP and the first to evaluate, at this dose, the Health related quality of life (HRQoL) EORTC QLQ-C30 and PR-25 (prostate specific) and to correlate comorbidities with the Charlson comorbidity index adjusted for age (CCIAA) and Gastrointestinal (GI)/Genitourinary (GU) toxicity with the Radiation Therapy Oncology Group (RTOG) toxicity scale. METHODS: We reviewed 220 medical records of SRT patients treated between Oct/2001-Feb/2007, 184 were included. Median age was 64 with median follow up of 48 months. Ninety percent received a median 3 months neoadjuvant hormonal therapy. Pre RP PSA, pre SRT PSA, PSA doubling time, Gleason score and pT status, were recorded. BcF was defined as a PSA ⬎0.1ng/ml or 3 rising values if nadir was ⬎0.1ng/ml. RTOG GI/GU toxicity was recorded. The CCIAA was analyzed to correlate comorbidities and RTOG toxicity. The HRQoL EORTC QLQ-C30 and PR-25 were also evaluated. Statistical analysis was done with the Kaplan-Meyer, the Log Rank, the Cox proportional hazards regression model, the Mann-Whitney U and the Fisher’s exact tests. RESULTS: Sixty five (35%) patients had BcF, statistical significance was found in the post RP Gleason score (p⫽0.006), pre SRT PSA (p⫽⬍0.001), and seminal vesicles (SV) invasion (p⫽0.001) in univariate survival analysis. These variables showed significant prognostic value in the BcF model, however, only SV invasion in the metastasis risk model. PCa-specific/overall survival was 99 and 95% respectively. Seven patients (4%) had bone metastasis. No association was found between CCIAA and RTOG toxicity. RTOG GU/GI acute grade 3-4 toxicity was observed in 5(3%) and 0% respectively. Late GI/GU toxicity at the 2nd and 5th year of follow-up was 1(1%)/5(5%) and 5(3%)/11(9%) respectively. The patients had similar to slightly better HRQoL (EORTC QLQ-C30) vs reference values. CONCLUSIONS: SRT at 70Gy can produce local control with acceptable GU/GI toxicity without sacrificing HRQoL and could be an alternative when RP fails to produce local control of the disease. The clinical value of 70Gy SRT after RP’s BcF has to be challenged in a randomized clinical trial. Source of Funding: None

1871 THE ROLE OF PREVIOUS TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) ON THE ACCURACY OF NOMOGRAMS TO PREDICT FINAL PATHOLOGICAL STAGE IN MEN UNDERGOING RADICAL PROSTATECTOMY FOR PROSTATE CANCER (PCA) Source of Funding: None

David Thu¨er*, David Pfister, Peter Firek, Robin Epplen, Ketevan Toronjadze, Bernhard Brehmer, Axel Heidenreich, Aachen, Germany INTRODUCTION AND OBJECTIVES: Partin nomograms are widely used to predict pathological stage of PCA in men scheduled for radical prostatectomy (RP). About 5-10% of RP candidates have already undergone TUR-P for benign prostatic disease. Partin nomograms never have been validated in this cohort of men.