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853 NATURAL HISTORY OF BIOCHEMICAL PERSISTENT PROSTATE CANCER DIAGNOSED IN THE ERA OF PSA SCREENING
Vol. 183, No. 4, Supplement, Monday, May 31, 2010
Prostate Cancer: Advanced III Moderated Poster 28 Monday, May 31, 2010
10:30 AM-12:30 PM
853 NATURAL HISTORY OF BIOCHEMICAL PERSISTENT PROSTATE CANCER DIAGNOSED IN THE ERA OF PSA SCREENING Sanjeev Kaul*, Troy, MI; Mireya Diaz, Nilesh Patil, Emil Kheterpal, Akshay Bhandari, James Peabody, Mani Menon, Craig Rogers, Detroit, MI INTRODUCTION AND OBJECTIVES: Biochemcial persistence (BCP) after RRP traditionally portends poor outcomes. However PSA screening has resulted in stage and grade migration. There is no data available on the frequency of BCP and its natural history in the PSA era. We elaborate the natural history of patients with BCP following RRP in the new millenium over a 8 year follow up. METHODS: 4116 consecutive pts underwent RRP with a curative intent from 2001-08 at a single institution. 390 were lost to follow up. BCP was defined as detectable PSA at first postoperative PSA draw within 3 months of surgery. The patients were administered salvage treatment at discretion of treating urologist. Development of metastatic disease and overall and cancer specific survival were assessed over a 8 year follow up. RESULTS: 306 of 3726 (8.2%) patients had a detectable PSA at a mean follow up of 24 mths. Of these 122 (39.4%) developed BCP. Mean age of this cohort was 61 yrs & mean PSA was 11.3 (2 - 21 ng/ml). Mean tumor vol was 33.9%. Table 1 details the biopsy and pathologic features of our cohort. Although all patients had clinically organ confined disease, only 16% had so on pathology analysis. 15% patients underwent upgrading of biopsy Gleason from 3⫹3/3⫹4 to 8-10. 50% had either SVI/N1 disease. 21 patients developed metastatic disease at a mean follow up of 2 years. All cause mortality was 11% and cancer specific survival was 97%. The stepwise regression model identified only pathology stage as predictor of both BCP and development of metastatic disease. CONCLUSIONS: BCP is seen in a distinct minority of patients undergoing surgery for localised prostate cancer in the PSA era as is development of metastasis. Pathology upgrading is uncommon, although upstaging was significant. Pathology stage is a strong predictor of both BCP and development of metastatic disease
THE JOURNAL OF UROLOGY姞
e333
854 SCREENING HISTORY OF MEN WITH FATAL PROSTATE CANCER Joshua J. Meeks*, Chicago, IL; Stacy Loeb, Baltimore, MD; Ronald Kim, Donghui Kan, Jessica A. Banks, Phillip R. Cooper, Brian T. Helfand, William J. Catalona, Chicago, IL INTRODUCTION AND OBJECTIVES: The European Randomized Study of Screening for Prostate Cancer (ERSPC) demonstrated that PSA screening was associated with a significant mortality benefit; whereas, the Prostate, Lung, Colorectal and Ovarian (PLCO) screening trial did not find a difference in mortality. Possible reasons for this discrepancy include high rates of contamination and pre-screening as well as considerable delays in the follow-up of abnormal screening test results in the PLCO trial. The objective of our study was to compare the screening history between men with prostate cancer from a large follow-up study who died from the disease to those with no evidence of disease progression after at least 7 years of follow-up. METHODS: Men diagnosed with prostate cancer in a large screening program were enrolled into a prospective follow-up study. From this population, we identified 134 men who died from prostate cancer, as confirmed using the National Death Index. As a comparison group, we identified 1033 prostate cancer cases with at least 7 years of follow-up and no disease recurrence. RESULTS: As shown in Table 1, men who died from prostate cancer were significantly older and had significantly higher PSA levels at diagnosis. A greater proportion of men who died from prostate cancer had a suspicious DRE and a Gleason score of 7 to 10. Although less frequent, there were some prostate cancer deaths among men diagnosed with Gleason ⱕ6 prostate cancer in the screening study. Overall, men who died from prostate cancer had significantly fewer PSA tests and DREs prior to the diagnosis of prostate cancer, and had a significantly greater delay between abnormal screening results and follow-up biopsy. CONCLUSIONS: In this case-case analysis of men who died from prostate cancer compared to those who did not, disease-specific death was associated with a lower frequency of PSA and DRE testing. Men who died from prostate cancer also had a significantly greater delay in undergoing biopsy following abnormal test results, suggesting that this may be an important factor behind the negative findings of the PLCO trial.
Median Age at Diagnosis (yrs)
Death from Prostate Cancer (Nⴝ134) 70 (51-85)
No Recurrence with At Least 7-year Follow-up (Nⴝ1033) 65 (45-79)
p-value ⬍0.0001 ⬍0.0001
Median PSA (ng/mL)
6.5 (0.3-3373)
5.4 (0-82)
No. of PSA Screenings
Mean 4.0, Median 1.0 (1-23)
Mean 5.4, Median 3.0 (1-22)
0.003
# DRE
Mean 2.2, Median 1.0 (0-13)
Mean 3.0, Median 2.0 (0-18)
0.0005
Last DRE Suspicious (%)
73/126 (58%)
283/953 (30%)
⬍0.0001
Biopsy Gleason <6
51/104 (50%)
731/818 (89%)
⬍0.0001
Days from abnormal screening test to 1st biopsy
Mean 140, Median 40 (8-1532) (N⫽119)
Mean 181, Median 42 (1-2885) (N⫽890)
0.26
Source of Funding: Supported in part by the Urological Research Foundation, Prostate SPORE grant (P50 CA9038605S2) and the Robert H. Lurie Comprehensive Cancer Center grant (P30 CA60553)
Source of Funding: None
Prostate Cancer: Advanced III Moderated Poster 28 Monday, May 31, 2010
10:30 AM-12:30 PM
853 NATURAL HISTORY OF BIOCHEMICAL PERSISTENT PROSTATE CANCER DIAGNOSED IN THE ERA OF PSA SCREENING Sanjeev Kaul*, Troy, MI; Mireya Diaz, Nilesh Patil, Emil Kheterpal, Akshay Bhandari, James Peabody, Mani Menon, Craig Rogers, Detroit, MI INTRODUCTION AND OBJECTIVES: Biochemcial persistence (BCP) after RRP traditionally portends poor outcomes. However PSA screening has resulted in stage and grade migration. There is no data available on the frequency of BCP and its natural history in the PSA era. We elaborate the natural history of patients with BCP following RRP in the new millenium over a 8 year follow up. METHODS: 4116 consecutive pts underwent RRP with a curative intent from 2001-08 at a single institution. 390 were lost to follow up. BCP was defined as detectable PSA at first postoperative PSA draw within 3 months of surgery. The patients were administered salvage treatment at discretion of treating urologist. Development of metastatic disease and overall and cancer specific survival were assessed over a 8 year follow up. RESULTS: 306 of 3726 (8.2%) patients had a detectable PSA at a mean follow up of 24 mths. Of these 122 (39.4%) developed BCP. Mean age of this cohort was 61 yrs & mean PSA was 11.3 (2 - 21 ng/ml). Mean tumor vol was 33.9%. Table 1 details the biopsy and pathologic features of our cohort. Although all patients had clinically organ confined disease, only 16% had so on pathology analysis. 15% patients underwent upgrading of biopsy Gleason from 3⫹3/3⫹4 to 8-10. 50% had either SVI/N1 disease. 21 patients developed metastatic disease at a mean follow up of 2 years. All cause mortality was 11% and cancer specific survival was 97%. The stepwise regression model identified only pathology stage as predictor of both BCP and development of metastatic disease. CONCLUSIONS: BCP is seen in a distinct minority of patients undergoing surgery for localised prostate cancer in the PSA era as is development of metastasis. Pathology upgrading is uncommon, although upstaging was significant. Pathology stage is a strong predictor of both BCP and development of metastatic disease
THE JOURNAL OF UROLOGY姞
e333
854 SCREENING HISTORY OF MEN WITH FATAL PROSTATE CANCER Joshua J. Meeks*, Chicago, IL; Stacy Loeb, Baltimore, MD; Ronald Kim, Donghui Kan, Jessica A. Banks, Phillip R. Cooper, Brian T. Helfand, William J. Catalona, Chicago, IL INTRODUCTION AND OBJECTIVES: The European Randomized Study of Screening for Prostate Cancer (ERSPC) demonstrated that PSA screening was associated with a significant mortality benefit; whereas, the Prostate, Lung, Colorectal and Ovarian (PLCO) screening trial did not find a difference in mortality. Possible reasons for this discrepancy include high rates of contamination and pre-screening as well as considerable delays in the follow-up of abnormal screening test results in the PLCO trial. The objective of our study was to compare the screening history between men with prostate cancer from a large follow-up study who died from the disease to those with no evidence of disease progression after at least 7 years of follow-up. METHODS: Men diagnosed with prostate cancer in a large screening program were enrolled into a prospective follow-up study. From this population, we identified 134 men who died from prostate cancer, as confirmed using the National Death Index. As a comparison group, we identified 1033 prostate cancer cases with at least 7 years of follow-up and no disease recurrence. RESULTS: As shown in Table 1, men who died from prostate cancer were significantly older and had significantly higher PSA levels at diagnosis. A greater proportion of men who died from prostate cancer had a suspicious DRE and a Gleason score of 7 to 10. Although less frequent, there were some prostate cancer deaths among men diagnosed with Gleason ⱕ6 prostate cancer in the screening study. Overall, men who died from prostate cancer had significantly fewer PSA tests and DREs prior to the diagnosis of prostate cancer, and had a significantly greater delay between abnormal screening results and follow-up biopsy. CONCLUSIONS: In this case-case analysis of men who died from prostate cancer compared to those who did not, disease-specific death was associated with a lower frequency of PSA and DRE testing. Men who died from prostate cancer also had a significantly greater delay in undergoing biopsy following abnormal test results, suggesting that this may be an important factor behind the negative findings of the PLCO trial.
Median Age at Diagnosis (yrs)
Death from Prostate Cancer (Nⴝ134) 70 (51-85)
No Recurrence with At Least 7-year Follow-up (Nⴝ1033) 65 (45-79)
p-value ⬍0.0001 ⬍0.0001
Median PSA (ng/mL)
6.5 (0.3-3373)
5.4 (0-82)
No. of PSA Screenings
Mean 4.0, Median 1.0 (1-23)
Mean 5.4, Median 3.0 (1-22)
0.003
# DRE
Mean 2.2, Median 1.0 (0-13)
Mean 3.0, Median 2.0 (0-18)
0.0005
Last DRE Suspicious (%)
73/126 (58%)
283/953 (30%)
⬍0.0001
Biopsy Gleason <6
51/104 (50%)
731/818 (89%)
⬍0.0001
Days from abnormal screening test to 1st biopsy
Mean 140, Median 40 (8-1532) (N⫽119)
Mean 181, Median 42 (1-2885) (N⫽890)
0.26
Source of Funding: Supported in part by the Urological Research Foundation, Prostate SPORE grant (P50 CA9038605S2) and the Robert H. Lurie Comprehensive Cancer Center grant (P30 CA60553)
Source of Funding: None