1947 AFRICAN-AMERICAN RACE IS AN INDEPENDENT PREDICTOR OF PROSTATE CANCER SPECIFIC DEATH AFTER PSA RECURRENCE

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THE JOURNAL OF UROLOGY姞

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

1947 AFRICAN-AMERICAN RACE IS AN INDEPENDENT PREDICTOR OF PROSTATE CANCER SPECIFIC DEATH AFTER PSA RECURRENCE Jorge Caso*, Ping Tang, Matvey Tsivian, Vladimir Mouraviev, Thomas Polascik, Judd Moul, Durham, NC

Source of Funding: None

1946 INVERSE CORRELATION BETWEEN PROSTATE SIZE AND POSITIVE SURGICAL MARGINS IN ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY AND RADICAL RETROPUBIC PROSTATECTOMY Adeep Thumar*, Thenappan Chandrasekar, Franklin Lee, Stefanie Lappe, Peter McCue, Costas Lallas, Leonard Gomella, Edouard Trabulsi, Philadelphia, PA INTRODUCTION AND OBJECTIVES: RALP has been compared to RRP in terms of oncological outcomes. We hypothesized that prostate size may be an inverse predictor of positive surgical margins (PSM) METHODS: We retrospectively examined our departmental, IRB approved, database of radical prostatectomy procedures performed by several surgeons from 2001-2009. A total of 600 RALP and 397 RRP patients were reviewed. Pathological reports yielding prostatic weight in grams was identified in 565 RALP patients and 355 RRP patients. A standard whole mount, step sectioned pathologic evaluation was used for all patients. Statistical analysis was conducted using the Student’s t-test and chi-square statistical models. RESULTS: The mean and median prostate weight for RALP was 41.0g and 37g, and for RRP was 44.2g and 39g, respectively (p⫽0.15). For the RALP cohort, PSM was lower for prostate weights ⬎40g than ⬍40g, 17.6% (43/245) vs 29.0% (93/320), respectively (p⫽0.002). When examining higher prostate weights, this inverse association was maintained with PSM rate for glands ⬎50g vs. ⬍50g: 11.5% (15/130) vs. 27.9% (121/435), respectively (p⫽0.0001); and for prostate sizes ⬎60g vs ⬍60g: 13.1% (8/61) vs. 25% (128/504), respectively (p⫽0.03). When examining organ confined disease (pT2), the PSM for larger prostates (⬎40g) were lower than prostates ⬍40g: 9.3% (18/193) vs. 24.0% (63/263), respectively (p⬍0.0001); for even larger prostates (⬎50g), the PSM rate was similarly improved: 6.6% (7/106) vs. 21% (74/350), respectively (p⫽0.0001). Conversely, for pT3/T4 disease prostate weight had no association with PSM in RALP patients. For the RRP cohort, larger prostate size (⬎40g) was similarly associated with a significantly lower PSM: 10.7% (18/167) vs. 22.4% (42/ 145), respectively (p⫽0.003),. Examining pathologic stage for RRP, prostate size ⬎40g in pT2 patients had lower PSM than prostates ⬍40g: 6.4% (9/140) vs. 14.5% (20/138), respectively (p⫽0.03).Similarly for RRP, pT3/4 had no association between prostate size and and margin status. CONCLUSIONS: Prostate size is inversely associated with PSM for both RALP and RRP. Prostate size greater than 40g are at a lower risk of PSM with either technique. The benefit for PSM for each technique appears to be present only for organ confined disease (pT2), with no significant association between prostate size and PSM for pT3/4 patients with either technique. Source of Funding: None

INTRODUCTION AND OBJECTIVES: The effect of AfricanAmerican (AA) race on cancer specific death following radical prostatectomy is unclear. We sought to evaluate race as a predictor of prostate cancer specific mortality (PCSM) in men who experienced a prostate specific antigen (PSA) recurrence following surgery. METHODS: We queried our prostate cancer database for men who had undergone radical prostatectomy and had experienced a PSA recurrence. Men were divided by race into AA and non-AA. For PSA recurrence, a PSA level of ⱖ 0.2 ng/mL had to be recorded following radical prostatectomy. A multivariate Cox proportional hazard model was used to determine which variables were associated with death from prostate cancer. Kaplan-Meier and log rank tests were used to assess significant differences in PCSM between groups. RESULTS: 406 men were identified with a PSA recurrence. After a median follow up of 7.8 years, and with a median time to PSA recurrence of 1.0 years, there were 22 (5.4%) deaths from prostate cancer. On multivariate analysis, using the variables of age, preoperative PSA, race, pathologic tumor stage, pathologic Gleason score, seminal vesicle invasion, extracapsular extension, and surgical margins, it was found that AA race was significantly associated with an increased rate of PCSM. CONCLUSIONS: AA race appears to be an independent predictor of PCSM following PSA recurrence. This may prove useful in stratifying risk and offering more aggressive therapy if there is a PSA recurrence following radical prostatectomy. Our finding that AA race was independently associated with cancer-specific death raises further questions as to whether this finding is due to a biologic basis or whether environmental and behavioral factors, such as suboptimal follow up, treatment during recurrence, or factors such as diet and obesity impact the progression of the disease. Source of Funding: Supported by research funds from the Committee for Urologic Research, Education, and Development (CURED) of Duke University.

1948 THREE YEAR POSTOPERATIVE PSA FOLLOWING OPEN RADICAL RETROPUBIC PROSTATECTOMY (ORRP) IS A PREDICTOR FOR DELAYED BIOCHEMICAL RECURRENCES (BCR) Rena Malik*, Judith Goldberg, Samir Taneja, Herbert Lepor, New York, NY INTRODUCTION AND OBJECTIVES: Several preoperative and postoperative parameters independently predict BCR following radical prostatectomy (RP). The objective of the present is to determine if the three year postoperative PSA measurement predicts subsequent BCR after ORRP. METHODS: Between the years 2000 to 2006, 1197 men underwent ORRP by a single surgeon. Men with a PSA level ⬎0.2 ng/ml or those who underwent salvage radiation therapy following at least 3 consecutively rising PSAs were categorized as BCRs. Serum PSA levels were routinely measured 3,6,12,18,24,30 and 36 months following ORRP and then annually. Additional PSA levels were obtained if clinically indicated. 956 evaluable men did not experience BCR 3 years postoperatively. Men were stratified into three groups based on their PSA at three years: Group 1 PSA ⬍0.01 (n⫽496); Group 2 PSA 0.01-0.04 (n⫽297), and Group 3 PSA⬎0.04 (n⫽163). Delayed BCR represented those men who developed a BCR after 3 years of follow up. RESULTS: BCR free survival rates for Groups 1, 2 and 3 were 99.8%, 99.0%, and 90.1%, respectively (p ⬍0.001). Using a univariate Cox proportional hazards model, preoperative and postoperative Glea-