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196 poster Simplified data analysis with a relational database dedicated to prostate brachytherapy
Posters
the discretion of the attending physician. PAP was obtained using a microparticle enzyme immunoassay (MEIA). A multivariate logistic regression model was constructed using pretreatment variables to determine whether pretreatment PAP represented an independent predictor of positive bone and/or CT scans. A linear regression evaluated the predictive value of age, PSA, prostate volume, PAP, and the percent positive biopsies with the subsequent radiographic work-up. Results: Patients with either positive bone scintography and/or CT presented with markedly elevated PSA and/or PAP, higher Gleason scores, and a greater percent positive biopsies. In linear regression analysis, PAP was the most accurate predictor of positive bone scintography, while PSA and PAP were virtually identical in their ability to predict CT findings. Using cut points of 15 ng/mL for PAP and 50 ng/mL for PSA, the negative predictive value for a positive bone scan or a positive CT scan was 99.8% and 100%, respectively. Conclusions: Enzymatic PAP is useful in the clinical staging of newly diagnosed, untreated prostate cancer and further refines the subset of patients requiring radiographic staging. With a combination of cut points of 15 ng/mL for PAP and 50 ng/mL for PSA, the negative predictive value for radiographically-detected metastases was 99.8%. 195 poster The impact of prostate volume and neoadjuvant androgen deprivation therapy on urinary function following prostate brachytherapy
D. Reed ~, G. Merrick z3, W. Butler "3, K. Wallner ~, Z Allen E, J. ~ Hinerman-Mulroy 2, R. GalbreathE ~University of Washington School of Medicine, Department of Radiation Oncology, Seattle, U.S.A. 2Wheeling Hospital, Schiffler Cancer Center, Wheeling, U.S.A. ~Wheeling JesLtit University, Department of Physics, Wheeling, U.S.A. Purpose: To evaluate the impact of prostate size and the magnitude of cytoreduction following neoadjuvant androgen deprivation therapy (ADT) on catheter dependency, urinary symptomatology and the need for post-brachytherapy surgical intervention. Materials and Methods: From February 1998 through August 2002, 186 consecutive patients underwent monotherapeutic brachytherapy (no supplemental XRT or ADT) and 101 consecutive patients received _< 6 months of ADT (an LHRH agonist and an anti-androgen) in conjunction with brachytherapy without supplemental XRT for clinical Tlc-T2b (2002 AJCC) prostate cancer. ADT was initiated approximately 3 months prior to brachytherapy. The median follow-up was 38.6 months. An alpha blocker was initiated prior to implantation and continued at least until the International Prostate Symptom Score (I-PSS) returned to baseline levels. Evaluated parameters included patient age, pretreatment PSA, Gleason score, clinical T-stage, preimplant I-PSS, ultrasound volume, hormonal status, isotope, Dg0, V100/150/200,and urethral dose (average and maximum). Results: Patients receiving neoadjuvant ADT were statistically older, presented with higher preimplant I-PS scores and larger prostate volumes. ADT patients were more likely to require a urinary catheter for the first 3 days following implantation; however, by day 4 no statistical difference in catheter dependency could be discerned between the 2 cohorts. Hormonal status did not predict for post-brachytherapy surgical intervention (p = 0.35). I-PSS returned to baseline at a mean of 1.8 and 1.7 months in hormone nafve and ADT patients, respectively (p = 0.81). In multivariate Cox regression analysis, the maximum post-implant I-PSS increase, the ultrasound volume and dose 'inhomogeneities (V~50 or V200) predicted for I-
$89
PSS normalization in both cohorts. In hormone nafve patients, any need for a urinary catheter following brachytherapy also predicted for I-PSS normalization. Ultrasound prostate volume did not predict for catheter dependency or the need for postimplant surgical intervention. Conclusion: Although ADT patients were more likely to require a urinary catheter for the first 3 days following implantation, hormonal manipulation did not impact I-PSS normalization, prolonged catheter dependency or the need for postbrachytherapy surgical intervention in these brachytherapy patients treated without supplemental XRT. In addition, ultrasound prostate volume predicted for I-PSS normalization in both cohorts, but did not predict for catheter dependency or the need for post-implant surgical intervention. 196 poster Simplified data analysis with a dedicated to prostate brachytherapy
relational
database
L. Astrom The Norwegian Radium Hospital, Oncology, Oslo, Norway Purpose: To simplify retrospective and prospective analysis of data from patients treated with prostate brachytherapy (BT) Material & method: There is no standard software handling all aspects of patient data analysis. Retrieving information from patient or case records could be a tedious task with many pitfalls. A relational database was therefore developed in Microsoft Access. With a relational database different data categories (e g treatment details, follow up data) are handled separately and can easily be modified according to desired requirements. The database was customised for handling prostate BT data. Separate forms for data input were adapted for patient data, treatment details, follow up data and complication registration. Algorithms for e g risk group classification, equivalent dose in 2 Gy fractions (EQD2), and biochemical relapse-free survival were included. Data from one institution were analysed with aid of the database. Results: Patient and treatment data were entered or imported from other data sources into the database. Data for survival analyses and actuarial estimates for late complications could thereafter easily be retrieved from the database. Conclusion: The Prosta~te-BT database was a convenient and simple tool for data analysis. It will be used in institutions in Sweden and Norway. 197 poster Intermediate results of ferromagnetic thermal ablation for radiation failure local recurrence of prostate cancer
K. Shinohard, V. Master ~, P. Carroll 1, D. McLeod 2, D. Beyet~ 1University of California, San Francisco, Urology, San Francisco, U.S.A. 2Walter Reed Army Hospital, Urology, Washington D.C., U.S.A. 3Arizona Oncology Services, Radiation Oncology, Scottsdale, U.S.A. Introduction and Objectives: Ferromagnetic rods capable of temperature self-regulation were created for prostatic tumor thermal tissue ablation. These rods produce heat using a magnetic field and are capable of temperature self-regulation via a phenomenon called Curie transition. This thermal ablation treatment was applied to patients with locally recurrent prostate cancer in order to evaluate treatment efficacy and side effect profiles. We report an IRB approved multi-center experience of intermediate follow-up data of patients treated by this novel treatment method.
the discretion of the attending physician. PAP was obtained using a microparticle enzyme immunoassay (MEIA). A multivariate logistic regression model was constructed using pretreatment variables to determine whether pretreatment PAP represented an independent predictor of positive bone and/or CT scans. A linear regression evaluated the predictive value of age, PSA, prostate volume, PAP, and the percent positive biopsies with the subsequent radiographic work-up. Results: Patients with either positive bone scintography and/or CT presented with markedly elevated PSA and/or PAP, higher Gleason scores, and a greater percent positive biopsies. In linear regression analysis, PAP was the most accurate predictor of positive bone scintography, while PSA and PAP were virtually identical in their ability to predict CT findings. Using cut points of 15 ng/mL for PAP and 50 ng/mL for PSA, the negative predictive value for a positive bone scan or a positive CT scan was 99.8% and 100%, respectively. Conclusions: Enzymatic PAP is useful in the clinical staging of newly diagnosed, untreated prostate cancer and further refines the subset of patients requiring radiographic staging. With a combination of cut points of 15 ng/mL for PAP and 50 ng/mL for PSA, the negative predictive value for radiographically-detected metastases was 99.8%. 195 poster The impact of prostate volume and neoadjuvant androgen deprivation therapy on urinary function following prostate brachytherapy
D. Reed ~, G. Merrick z3, W. Butler "3, K. Wallner ~, Z Allen E, J. ~ Hinerman-Mulroy 2, R. GalbreathE ~University of Washington School of Medicine, Department of Radiation Oncology, Seattle, U.S.A. 2Wheeling Hospital, Schiffler Cancer Center, Wheeling, U.S.A. ~Wheeling JesLtit University, Department of Physics, Wheeling, U.S.A. Purpose: To evaluate the impact of prostate size and the magnitude of cytoreduction following neoadjuvant androgen deprivation therapy (ADT) on catheter dependency, urinary symptomatology and the need for post-brachytherapy surgical intervention. Materials and Methods: From February 1998 through August 2002, 186 consecutive patients underwent monotherapeutic brachytherapy (no supplemental XRT or ADT) and 101 consecutive patients received _< 6 months of ADT (an LHRH agonist and an anti-androgen) in conjunction with brachytherapy without supplemental XRT for clinical Tlc-T2b (2002 AJCC) prostate cancer. ADT was initiated approximately 3 months prior to brachytherapy. The median follow-up was 38.6 months. An alpha blocker was initiated prior to implantation and continued at least until the International Prostate Symptom Score (I-PSS) returned to baseline levels. Evaluated parameters included patient age, pretreatment PSA, Gleason score, clinical T-stage, preimplant I-PSS, ultrasound volume, hormonal status, isotope, Dg0, V100/150/200,and urethral dose (average and maximum). Results: Patients receiving neoadjuvant ADT were statistically older, presented with higher preimplant I-PS scores and larger prostate volumes. ADT patients were more likely to require a urinary catheter for the first 3 days following implantation; however, by day 4 no statistical difference in catheter dependency could be discerned between the 2 cohorts. Hormonal status did not predict for post-brachytherapy surgical intervention (p = 0.35). I-PSS returned to baseline at a mean of 1.8 and 1.7 months in hormone nafve and ADT patients, respectively (p = 0.81). In multivariate Cox regression analysis, the maximum post-implant I-PSS increase, the ultrasound volume and dose 'inhomogeneities (V~50 or V200) predicted for I-
$89
PSS normalization in both cohorts. In hormone nafve patients, any need for a urinary catheter following brachytherapy also predicted for I-PSS normalization. Ultrasound prostate volume did not predict for catheter dependency or the need for postimplant surgical intervention. Conclusion: Although ADT patients were more likely to require a urinary catheter for the first 3 days following implantation, hormonal manipulation did not impact I-PSS normalization, prolonged catheter dependency or the need for postbrachytherapy surgical intervention in these brachytherapy patients treated without supplemental XRT. In addition, ultrasound prostate volume predicted for I-PSS normalization in both cohorts, but did not predict for catheter dependency or the need for post-implant surgical intervention. 196 poster Simplified data analysis with a dedicated to prostate brachytherapy
relational
database
L. Astrom The Norwegian Radium Hospital, Oncology, Oslo, Norway Purpose: To simplify retrospective and prospective analysis of data from patients treated with prostate brachytherapy (BT) Material & method: There is no standard software handling all aspects of patient data analysis. Retrieving information from patient or case records could be a tedious task with many pitfalls. A relational database was therefore developed in Microsoft Access. With a relational database different data categories (e g treatment details, follow up data) are handled separately and can easily be modified according to desired requirements. The database was customised for handling prostate BT data. Separate forms for data input were adapted for patient data, treatment details, follow up data and complication registration. Algorithms for e g risk group classification, equivalent dose in 2 Gy fractions (EQD2), and biochemical relapse-free survival were included. Data from one institution were analysed with aid of the database. Results: Patient and treatment data were entered or imported from other data sources into the database. Data for survival analyses and actuarial estimates for late complications could thereafter easily be retrieved from the database. Conclusion: The Prosta~te-BT database was a convenient and simple tool for data analysis. It will be used in institutions in Sweden and Norway. 197 poster Intermediate results of ferromagnetic thermal ablation for radiation failure local recurrence of prostate cancer
K. Shinohard, V. Master ~, P. Carroll 1, D. McLeod 2, D. Beyet~ 1University of California, San Francisco, Urology, San Francisco, U.S.A. 2Walter Reed Army Hospital, Urology, Washington D.C., U.S.A. 3Arizona Oncology Services, Radiation Oncology, Scottsdale, U.S.A. Introduction and Objectives: Ferromagnetic rods capable of temperature self-regulation were created for prostatic tumor thermal tissue ablation. These rods produce heat using a magnetic field and are capable of temperature self-regulation via a phenomenon called Curie transition. This thermal ablation treatment was applied to patients with locally recurrent prostate cancer in order to evaluate treatment efficacy and side effect profiles. We report an IRB approved multi-center experience of intermediate follow-up data of patients treated by this novel treatment method.