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891 CURRENT TREATMENT PATTERNS AND CHARACTERISTICS OF CASTRATION RESISTANT PROSTATE CANCER (CRPC) PATIENTS; A EUROPEAN SURVEY
Vol. 185, No. 4S, Supplement, Monday, May 16, 2011
THE JOURNAL OF UROLOGY姞
e357
Source of Funding: None
891 CURRENT TREATMENT PATTERNS AND CHARACTERISTICS OF CASTRATION RESISTANT PROSTATE CANCER (CRPC) PATIENTS; A EUROPEAN SURVEY Edwina Baskin-Bey, Mark Watson, Staines, United Kingdom; Andrew Worsfold, Alex Rider, Macclesfield, United Kingdom; Bertrand Tombal, Brussels, Belgium; Cora N. Sternberg*, Rome, Italy INTRODUCTION AND OBJECTIVES: Management of patients (pts) with CRPC remains a challenge in clinical practice. METHODS: A survey was performed from Dec 2009 to May 2010 among urologists and oncologists in France (FR), Germany (DE), Italy (IT), Spain (ES), and the UK concerning the management of prostate cancer (PC) pts. We report on characteristics of the CRPC population and their current treatment regime. Pt characteristics were derived from a pt record form completed by physicians. RESULTS: A total of 191 urologists (52% academic institutions) and 157 medical/clinical oncologists completed the survey. 40% (n⫽1405) of pts had CRPC and of these 35% (n⫽487) had metastatic CRPC. CRPC pts had a mean age of 71 years, 35% were current or ex-smokers and 10% had a family history of PC. The majority of CRPC pts had 2 co-morbidities, primarily hypertension (64%) and diabetes (33%). Bone metastases were most common (77%), followed by liver (35%) and lung (26%). The majority of physicians believed that pts would stop responding to initial hormone therapy between 19 –24 months. 58% and 49% of CRPC pts terminated the 1st and 2nd treatment regimen due to disease progression. 85% of physicians considered PSA the most important method to assess disease progression. After failure of initial luteinizing hormone releasing hormone agonist (LHRHa) defined by elevated PSA, 49% of all European physicians opted to change to LHRHa ⫹ antiandrogen (AA) or to another LHRHa (20%) (Figure). A switch from one LHRHa to another LHRHa is common in DE (29%), FR (26%) and IT (24%). In all countries, CRPC pts who required chemotherapy, would initially receive this without LHRHa (Figure). CONCLUSIONS: From this EU survey, 40% of all PC pts seen in daily practice have CRPC, which develops approximately after 19 –24 months on LHRHa. When CRPC pts fail initial LHRHa, most European physicians add AA or switch to another LHRHa, and if CRPC pts undergo chemotherapy, this is usually given without LHRHa. Based upon the literature, LHRHa treatment should be maintained during chemotherapy [Manni et al. J Clin Oncol 1988; 6(9):1456 – 66; Taylor CD et al. J Clin Oncol 1993;11:2167–72; Heidenreich et al. Guidelines on prostate cancer. EAU; April 2010]
Source of Funding: Astellas Pharma Europe
892 OUTCOMES OF PATIENTS WITH PATHOLOGIC LYMPH NODE METASTASES TREATED WITH RADICAL PROSTATECTOMY; THE PROGNOSTIC VALUE OF PREOPERATIVE RADIOGRAPHIC LYMPHADENOPATHY Ty Higuchi*, Rodney Breau, Stephen Boorjian, Rachel Carlson, Laureano Rangel, Eric Bergstralh, R. Jeffrey Karnes, Rochester, MN INTRODUCTION AND OBJECTIVES: Some patients with pathologic lymph node metastases experience prolonged survival following radical prostatectomy (RP) and lymphadenectomy (PLND). However, the benefit of surgery for patients with clinically suspicious lymphadenopathy (cN⫹) is not well defined. Therefore, we evaluated the outcomes of patients with cN⫹ after RP with PLND. METHODS: Patients with lymph node metastases diagnosed during radical prostatectomy from 1988 –2003 were reviewed. Patients with preoperative CT or MRI images were included in the study. Radiology reports were reviewed to determine if patients had cN⫹. For all analyses, patients with cN⫹ were compared to those with clinically negative nodes (cN⫺). RESULTS: Preoperative imaging was available in 199 men with lymph node metastasis at the time of RP and PLND. Of 199 patients, 31 (16%) were cN⫹. No patient had a pre-operative lymph node biopsy and none had abandoned RP. Adjuvant androgen deprivation therapy was given to 84% (26/31) cN⫹ patients and 91% (153/168) cN⫺ patients, while 7% (2/31) and 10% (17/168) underwent adjuvant radiotherapy, respectively. At a median follow-up of 10.9 years (IQR 6.3–15.0), 52% (16/31) of cN⫹ and 49% (82/168) of cN⫺ patients experienced PSA recurrence, 16% (5/31) of cN⫹ and 13% (22/168) demonstrated local recurrence, and 32% (10/31) and 24% (40/168) had systemic progression, respectively. On univariate analysis cN⫹ was not associated with a significant (p⬎0.05) increase in the risk of biochemical recurrence (HR 1.22, 95%CI 0.71– 2.08), local recurrence (HR 1.53, 95%CI 0.58 – 4.1), systemic progression (HR 1.63, 95%CI 0.81–3.26) or death from prostate cancer (HR 1.34, 95% CI 0.56 –3.23). CONCLUSIONS: RP, PLND, and adjuvant androgen deprivation may be associated with durable cancer control even for patients with preoperative cN⫹. In fact, among patients with lymph node metastases, radiographic adenopathy did not significantly increase the
THE JOURNAL OF UROLOGY姞
e357
Source of Funding: None
891 CURRENT TREATMENT PATTERNS AND CHARACTERISTICS OF CASTRATION RESISTANT PROSTATE CANCER (CRPC) PATIENTS; A EUROPEAN SURVEY Edwina Baskin-Bey, Mark Watson, Staines, United Kingdom; Andrew Worsfold, Alex Rider, Macclesfield, United Kingdom; Bertrand Tombal, Brussels, Belgium; Cora N. Sternberg*, Rome, Italy INTRODUCTION AND OBJECTIVES: Management of patients (pts) with CRPC remains a challenge in clinical practice. METHODS: A survey was performed from Dec 2009 to May 2010 among urologists and oncologists in France (FR), Germany (DE), Italy (IT), Spain (ES), and the UK concerning the management of prostate cancer (PC) pts. We report on characteristics of the CRPC population and their current treatment regime. Pt characteristics were derived from a pt record form completed by physicians. RESULTS: A total of 191 urologists (52% academic institutions) and 157 medical/clinical oncologists completed the survey. 40% (n⫽1405) of pts had CRPC and of these 35% (n⫽487) had metastatic CRPC. CRPC pts had a mean age of 71 years, 35% were current or ex-smokers and 10% had a family history of PC. The majority of CRPC pts had 2 co-morbidities, primarily hypertension (64%) and diabetes (33%). Bone metastases were most common (77%), followed by liver (35%) and lung (26%). The majority of physicians believed that pts would stop responding to initial hormone therapy between 19 –24 months. 58% and 49% of CRPC pts terminated the 1st and 2nd treatment regimen due to disease progression. 85% of physicians considered PSA the most important method to assess disease progression. After failure of initial luteinizing hormone releasing hormone agonist (LHRHa) defined by elevated PSA, 49% of all European physicians opted to change to LHRHa ⫹ antiandrogen (AA) or to another LHRHa (20%) (Figure). A switch from one LHRHa to another LHRHa is common in DE (29%), FR (26%) and IT (24%). In all countries, CRPC pts who required chemotherapy, would initially receive this without LHRHa (Figure). CONCLUSIONS: From this EU survey, 40% of all PC pts seen in daily practice have CRPC, which develops approximately after 19 –24 months on LHRHa. When CRPC pts fail initial LHRHa, most European physicians add AA or switch to another LHRHa, and if CRPC pts undergo chemotherapy, this is usually given without LHRHa. Based upon the literature, LHRHa treatment should be maintained during chemotherapy [Manni et al. J Clin Oncol 1988; 6(9):1456 – 66; Taylor CD et al. J Clin Oncol 1993;11:2167–72; Heidenreich et al. Guidelines on prostate cancer. EAU; April 2010]
Source of Funding: Astellas Pharma Europe
892 OUTCOMES OF PATIENTS WITH PATHOLOGIC LYMPH NODE METASTASES TREATED WITH RADICAL PROSTATECTOMY; THE PROGNOSTIC VALUE OF PREOPERATIVE RADIOGRAPHIC LYMPHADENOPATHY Ty Higuchi*, Rodney Breau, Stephen Boorjian, Rachel Carlson, Laureano Rangel, Eric Bergstralh, R. Jeffrey Karnes, Rochester, MN INTRODUCTION AND OBJECTIVES: Some patients with pathologic lymph node metastases experience prolonged survival following radical prostatectomy (RP) and lymphadenectomy (PLND). However, the benefit of surgery for patients with clinically suspicious lymphadenopathy (cN⫹) is not well defined. Therefore, we evaluated the outcomes of patients with cN⫹ after RP with PLND. METHODS: Patients with lymph node metastases diagnosed during radical prostatectomy from 1988 –2003 were reviewed. Patients with preoperative CT or MRI images were included in the study. Radiology reports were reviewed to determine if patients had cN⫹. For all analyses, patients with cN⫹ were compared to those with clinically negative nodes (cN⫺). RESULTS: Preoperative imaging was available in 199 men with lymph node metastasis at the time of RP and PLND. Of 199 patients, 31 (16%) were cN⫹. No patient had a pre-operative lymph node biopsy and none had abandoned RP. Adjuvant androgen deprivation therapy was given to 84% (26/31) cN⫹ patients and 91% (153/168) cN⫺ patients, while 7% (2/31) and 10% (17/168) underwent adjuvant radiotherapy, respectively. At a median follow-up of 10.9 years (IQR 6.3–15.0), 52% (16/31) of cN⫹ and 49% (82/168) of cN⫺ patients experienced PSA recurrence, 16% (5/31) of cN⫹ and 13% (22/168) demonstrated local recurrence, and 32% (10/31) and 24% (40/168) had systemic progression, respectively. On univariate analysis cN⫹ was not associated with a significant (p⬎0.05) increase in the risk of biochemical recurrence (HR 1.22, 95%CI 0.71– 2.08), local recurrence (HR 1.53, 95%CI 0.58 – 4.1), systemic progression (HR 1.63, 95%CI 0.81–3.26) or death from prostate cancer (HR 1.34, 95% CI 0.56 –3.23). CONCLUSIONS: RP, PLND, and adjuvant androgen deprivation may be associated with durable cancer control even for patients with preoperative cN⫹. In fact, among patients with lymph node metastases, radiographic adenopathy did not significantly increase the