2040 OBESITY AND PROSTATE ENLARGEMENT IN MEN WITH LOCALIZED PROSTATE CANCER

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PC Dx after bx One or more bx Elevated Ever had Outcome for elevated PSA after elevated PSA PSA PSA

Age 40 – 49 y (n⫽93,656)

Table 1. AA and white veterans Age 50 –59 y Age 60 –70 y (n⫽139,896) (n⫽77,182)

Vol. 185, No. 4S, Supplement, Wednesday, May 18, 2011

2039 Total (n⫽310,734)

n%

n%

n%

P value

59,017/93, 656 (63%)

114,385/139, 896 (82%)

61,774/77, 182 (80%)

⬍.0001

1,930/93, 656 (2%)

8,779/139, 896 (6%)

8,513/77, 182 (11%)

⬍.0001

689/1,930 (36%)

3,942/8,779 (45%)

3,518/8,513 (41%)

⬍.0001

390/1,901 (21%)

2,224/7,616 (29%)

2,203/7,220 (31%)

⬍.0001

Table 2. Odds (OR) and Hazard (HR) Ratios with Confidence Interval (CI) for Undergoing a PSA Test by Race and Age Predictors Age 40 – 49 y Age 50 –59 y Age 60 –70 y AA race (white is OR: 1.16 OR: 0.95 OR: 1.02 reference) (1.13–1.20) (0.92–0.99) (0.97–1.08) Time to Elevated PSA Age

HR: 1.19 (1.17–1.21)

HR: 1.10 (1.10–1.11)

HR: 1.02 (1.02–1.03)

AA race (white is reference)

HR: 1.72 (1.57–1.88)

HR: 1.65 (1.57–1.73)

HR: 1.65 (1.56–1.74)

Age

HR: 1.03 (1.01–1.07)

HR: 1.02 (1.01–1.03)

HR: 0.95 (0.94–0.96)

AA race (white is reference)

HR: 1.22 (1.05–1.43)

HR: 1.16 (1.08–1.25)

HR: 1.23 (1.14–1.34)

Age

HR: 1.07 (1.02–1.11)

HR: 1.03 (1.02–1.05)

HR: 0.99 (0.98–1.01)

AA race (white is reference)

HR: 2.12 (1.73–2.59)

HR: 1.76 (1.61–1.92)

HR: 1.63 (1.47–1.87)

Time to Bx after elevated PSA

ONCOLOGIC OUTCOMES AFTER PROSTATECTOMY FOR MEN WITH INITIAL HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA AND SUBSEQUENT PROSTATE CANCER ON REPEAT BIOPSY Michael Lee*, Changhong Yu, Cristina Magi-Galluzzi, J. Stephen Jones, Cleveland, OH INTRODUCTION AND OBJECTIVES: The natural history of high-grade intraepithelial neoplasia (HGPIN) is poorly understood and the management of HGPIN remains controversial. Our aim was to characterize prostate cancer (CaP) post-prostatectomy after an initial diagnosis of HGPIN alone. METHODS: From December 1997 to February 2008, 328 men underwent repeat prostate biopsy after initially being diagnosed with isolated HGPIN. Men with concurrent CaP or atypia were excluded. Clinical and pathologic characteristics were analyzed. Two groups were created for comparison, men detected with CaP on repeat biopsy after initial diagnosis of HGPIN (group 1) and men without CaP on repeat biopsy (group 2). Those diagnosed with CaP, intervention was reported in 72 patients of whom 36 men underwent radical prostatectomy. Final pathology was summarized and oncologic outcomes were obtained through retrospective review. RESULTS: Of 328 men with HGPIN alone at initial biopsy, 79 men (24.1%) were diagnosed with CaP on repeat biopsy. For the entire cohort, mean age was 63.3⫾7.8 years, mean pre-biopsy PSA (ng/mL) was 6.4⫾4.0, mean number of cores 11.9⫾4.0, median time to repeat biopsy was 277 days (range: 14 –2372). On multivariate analysis, the number of cores on repeat biopsy and the presence of multifocal HGPIN were independent predictors of CaP on repeat biopsy. Of the men treated with radical prostatectomy, at median follow-up of 44.4 months, overall, disease-specific and biochemical recurrence-free survival were all 100%. 3 patients received adjuvant treatment with either chemotherapy as part of a clinical trial, or adjuvant radiation for highgrade tumor, positive margins or positive lymph nodes. 15 specimens (41.7%) of cancers were classified as insignificant (⬍Gleason 6, organconfined, tumor volume ⬍0.5mL). 19 specimens (52.8%) were Gleason 7 or higher with 3 being Gleason 8 or 9. 5 specimens (13.9%) were not organ-confined. Of men with high-risk of recurrence post-prostatectomy (Gleason 8⫹, extracapsular extension or positive margins), 6 of 9 (66.6%) men had multifocal HGPIN on initial biopsy. Positive margins were reported in 4 patients (11.1%). CONCLUSIONS: Men initially diagnosed with HPGIN only that are found to have CaP on repeat biopsy are at risk of having clinically significant tumors. Aggressive treatment with prostatectomy appears to cure a majority of these men. Source of Funding: None

Time to PC Dx after elevated PSA

2040 OBESITY AND PROSTATE ENLARGEMENT IN MEN WITH LOCALIZED PROSTATE CANCER Ryan Kopp*, J. Kellogg Parsons, San Diego, CA; Alan Partin, Elizabeth Humphreys, Baltimore, MD; Stephen Freedland, Durham, NC; Misop Han, Baltimore, MD

Time to Treatment after PC Dx Age

HR: 1.03 (0.98–1.08)

HR: 0.99 (0.98–1.02)

HR: 0.96 (0.94–0.98)

AA race (white is reference)

HR: 1.72 (1.35–2.21)

HR: 1.32 (1.18–1.47)

HR: 1.66 (1.47–1.87)

Source of Funding: None

INTRODUCTION AND OBJECTIVES: Obesity is associated with prostate cancer aggressiveness; obesity is also associated with increased prostate size and risk of clinical BPH in men without prostate cancer. We sought to determine if obesity is associated with prostate size in men with prostate cancer. METHODS: We examined pre-operative body mass index (BMI) and whole prostate weight in a cohort of 16,325 patients undergoing radical prostatectomy for localized prostate cancer from 1975 to 2008 at a single institution. We utilized multivariable regression modeling adjusting for age, year of surgery, pre-operative serum prostatespecific antigen (PSA), pathologic stage, and Gleason grade. Prostate enlargement was defined as prostate surgical weight of at least 40 g.

Vol. 185, No. 4S, Supplement, Wednesday, May 18, 2011

RESULTS: Of the entire cohort, 13,343 (82%) patients had prostate enlargement. These men were older (p⬍0.001), had a higher pre-operative BMI (p⫽0.002), higher pre-operative PSA (p⬍0.001), and were more likely to have pT2 disease (p⬍0.001). Gleason grade on prostatectomy was significantly different between those with enlarged (Gleason sum ⱕ 6 in 60.6%, 7 in 32.6%, ⱖ 8 in 6.8%) and those with non-enlarged (Gleason sum ⱕ 6 in 59.6%, 7 in 35%, ⱖ 8 in 5.4%) prostates (p⫽0.003). Gleason upgrading was similar between groups. In multivariable regression, pre-operative BMI was associated with increased prostate weight: for each 1 kg/m2 increase in BMI, prostate weight increased by 0.45 g (95% CI 0.35 to 0.55, P-trend⬍0.001). Compared to men with BMI⬍25 kg/m2, men with a BMI ⱖ 35 kg/m2 had a 40% (OR 1.40, 95% CI, 1.01–1.95) increased risk of prostate weight of at least 40 g and a 70% (OR 1.70, 95% CI 1.32 to 2.20) increased risk of prostate weight of at least 50 g. CONCLUSIONS: In men with localized prostate cancer, obesity is associated with an increased risk of prostate enlargement. These data validate prior observations linking obesity with prostate enlargement and may have important ramifications for prostate cancer diagnosis in obese men. Source of Funding: None

2041 DEMONSTRATION OF THE VARIABILITY OF THE DIFFERENT TOTAL PSA ASSAYS CURRENTLY IN USE THROUGHOUT IRISH HOSPITALS James Forde*, Ophelia Blake, Laure Marignol, TED McDermott, Ronald Grainger, Vivion Crowley, Thomas Lynch, Dublin, Ireland INTRODUCTION AND OBJECTIVES: Between 2000 and 2020, it is estimated that prostate cancer incidence in Ireland will rise by 275% representing one of the largest increases in cancer incidence. This increase is likely related to enhanced public awareness, improved diagnostics and widespread determination of prostate-specific antigen (PSA). There are at least 9 different total PSA assay methods used throughout Ireland. The National Cancer Control Programme is developing standards for diagnostics of prostate cancer including standardisation of PSA testing. We aimed to demonstrate the variability of total PSA assays throughout Ireland. METHODS: Blood samples were taken from 110 patients attending a single urology department for determination of total PSA. Each sample was separated into 9 different aliquots and transported to 9 different hospitals throughout Ireland where total PSA of each sample was measured independently under the same conditions. 6 different methods of total PSA detection are used between the 9 hospitals including Beckman Hybritech WHO Calibrated (reference method), Tosoh AIA1800, Roche E170 (three hospitals), Abbott-AxSYM, Immulite 2500 2nd Generation (two hospitals) and Siemens Centaur. RESULTS: Patients whose total PSA value was ⱖ0.5␮g/L and ⱕ 30␮g/L (using reference method) were included in the analysis, leaving the sample size at 84 patients. Deviation from the reference method varied by a factor of up to 1.356 (Hospital 8). Variability for a sub group of patients who had a total PSA value of 3 to 7␮g/L (using reference method) varied by a factor of up to 1.765 (Hospital 9). Total serum PSA values were significantly different (paired sample t-tests, p⬍0.0001) in all hospitals tested, when compared to that measured with the reference method in Hospital 4. 52% of samples with values between 3 and 7 ␮g/L using the reference method had total PSA value range ⬎2 ␮g/L when measured with the other methods. We then compared results from 4 hospitals currently use the same method of detection. The difference in mean total PSA values measured by each hospital in this cohort was not statistically significant between the 4 hospitals using the same assay (ANOVA, p⫽0.9899). In these 4 hospitals using the same method of detection variability was reduced with maximum slope of 1.093. CONCLUSIONS: We have demonstrated the inter-hospital variability on the same patient samples with statistically significant

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differences. Variability was reduced among 4 hospitals currently using the same method of detection. Standardisation of PSA testing on a nationwide scale is warranted. Source of Funding: None

2042 PROSTATE CANCER AND MEN’S HEALTH SCREENING: COMPARISON OF THE SCREENING POPULATIONS FROM 2003 AND 2009 Nelson Stone*, New York, NY; Nicole Weiffenbach, Wendy Poage, Centennial, CO; E. David Crawford, Aurora, CO INTRODUCTION AND OBJECTIVES: To describe the differences in men who present for prostate cancer and men’s health screening for 2003 and 2009. METHODS: 21,339 men attended prostate cancer awareness week in 2003 (13,672) and in 2009 (7,667) at 131 longitudinal screening sites (mean 246 attendees/site). Demographic and health related information was collected by questionnaire. In addition, PSA, testosterone (T) and cholesterol (C) was determined in a central lab. Patients were divided into 6 age groups by decade. Associations (means) were compared by ANOVA and Chi-square (Pearson) analyses. RESULTS: Compared to 2009, men in 2003 were younger (60.3 vs 61, p⬍0.001), had lower body mass index (BMI, 27.2 vs. 28.1, p⬍0.001), had higher PSA (1.61 vs 1.57 ng/ml, p⬍0.001), higher T (414.3 vs 333.7 ng/dl, p⬍0.001) and higher C (201.6 vs. 185.9, p⬍0.001). Over the 6 years there was a decrease in Caucasian vs. African American and Hispanic attendees (76.5 vs 73.3%, 15.3 vs. 16.8% and 4.9 vs 5.2%, respectively, p⬍0.001). A high fat diet was more common in 2003 as was taking vitamin E and selenium (p⬍0.001). Men attending 2009 screening had more urinary complaints (AUA score 5.98 vs 9.42, p⬍0.001) and lower SHIM scores (19.8 vs 20.4, p⬍0.001). The 2009 group also reported more frequent PSA testing in the prior 3 years (p⬍0.001). A comparison of PSA, T, C and BMI by age group and year revealed in 2009 lower PSA, T, C and higher BMI (table). CONCLUSIONS: It appears that men attending prostate conditions screening in 2009 may be more motivated because they had increase urinary stymptoms. The increase use of PSA screening has decreased the mean PSA in the older patients. More recent attendees may also be less healthy because of higher BMI and lower T values. Comparison of Screening Values by Age Group for Participants in 2003 vs. 2009 Age PSA Testosterone Cholesterol BMI 40 0.69/0.88 417/363 200/192 28.2/28.9* 40–49

0.92/0.95

434/326*

206/196*

27.7/28.1*

50–59

1.28/1.26

410/338*

200/182*

27.5/28.3*

60–69

1.79/1.71

404/358*

195/177*

27.3/28.1*

70–79

2.34/2.08*

399/319*

192/171*

26.4/27.4*

Mean values for 2003/2009. * differences are p

Source of Funding: PCEC