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Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
966 ONCOLOGIC OUTCOMES FOLLOWING ROBOTIC-ASSISTED LAPAROSCOPIC VS. OPEN RADICAL PROSTATECTOMY FOR INTERMEDIATE AND HIGH-RISK PROSTATE CANCER Chad Ritch*, Daniel Barocas, Chaochen You, Alexandra May, S. Duke Herrell, Peter Clark, David Penson, Sam Chang, Michael Cookson, Joseph Smith, Nashville, TN
Source of Funding: None
965 WHEN STARTING ANDROGEN BLOKADE FOR ADVANCED PROSTATE CANCER, IS THERE A CORRELATION BETWEEN INFORMATION PROVIDED BY UROLOGISTS AND MESSAGES UNDERSTOOD BY PATIENTS? Thierry LEBRET*, SURESNES, France; Bénédicte DUCLOS-MORLAES, LEVALLOIS-PERRET, France; Denis COMET, NANTERRE, France; Stéphane DROUPY, NIMES, France INTRODUCTION AND OBJECTIVES: Communication and information have increasingly been considered important in helping people to cope with cancer. The primary objective of this study was to compare information given by the physician when starting androgen deprivation therapy [adT] for prostate cancer (PCa) with that perceived by the pt overall, and according to the main circumstances of care (metastatic [M] stage, recurrence [R], adjuvant therapy [AT]). METHODS: An observational, non-interventional, multicenter study was conducted among French urologists between September 2011 and June 2012. Physicians completed questionnaires about the information they gave to the patients (pts) concerning their PCa, prognosis and treatment the day they intiate adT. Patients filled in self-questionnaires one day after the consultation about messages they understood. Concordance between physician and pt answers was assessed using pourcentage of condordance, overestimed, underestimated by pts and kappa indexes (k). RESULTS: A total of 165 physicians included 915 pts. 770 pts had evaluable questionnaires (M: 40%, AT: 27%, R: 33%). Mean age of pts was 75 years. At inclusion, the majority of pts had an advanced PCa T3N0M0, Gleasonⱖ 7. A total of 55% of pts went accompanied to the consultation, mainly by their wife. When physicians informed patients of the nature of the prostate disease, respectively 77% of pts understood the information related to disease extension, 82% the palliative nature of treatment and duration of treatement and 92% information on adverse event (AE). The best concordance between responses from physicians and pts was found for treatment (nature, duration, AE; k 0.54-0.68). Concordance was not significantly changed according to the presence/absence of an accompagnist unlike the pts’s status: More M pts overestimated the response regarding the nature (severity) of the disease than pts with AT (respectively 17% vs 7%, k⫽ 0.37 vs 0.17). In contrast, pts with AT underestimated the duration of treatment compared with M pts (respectively 8% vs 14%, k ⫽ 0.56 vs 0.55). CONCLUSIONS: Key information delivered to pts at consultation is not always well grasped and may be improved. Especially in the domain of the disease (stage, severity) while for domains linked to treatments, patients? understanding is better. Source of Funding: ASTELLAS PHARMA
INTRODUCTION AND OBJECTIVES: Recent studies suggest that surgical intervention may confer a benefit over observation for intermediate-risk (IR) and high-risk (HR) prostate cancer patients. It is unclear if this benefit differs based on surgical approach. We compared biochemical recurrence (BCR) free survival as well as predictors of BCR in IR and HR patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) vs. open radical prostatectomy (ORP). METHODS: A retrospective review was performed on 1286 men with IR or HR prostate cancer (cT2b or higher, or clinical Gleason Sum (GS) ⱖ7, or pre-op PSA ⬎10) who underwent either RALP or ORP between 2003 -2009. We excluded any patient who had neoadjuvant therapy, ⬍6 months of follow-up or insufficient clinicopathological data. We compared demographic, clinical and pathologic variables between the groups. Kaplan-Meier analysis was performed to compare the 5-year BCR-free survival between groups. Multivariate models were developed to determine predictors of BCR. RESULTS: A total of 631 IR and HR patients (422 RALP, 209 ORP) met inclusion criteria. Median age was 62.2 years and was similar between groups, while median follow-up was shorter for RALP compared to ORP (3.7 vs. 4.5 yrs, p⬍0.001). Median PSA and clinical GS were 7.5 ng/ml and 7, respectively. ORP patients had a higher median PSA (8.6 vs. 6.9 ng/ml) than RALP patients (p⬍0.01). ORP patients had significantly more pathological GS 8-10 tumors (38% vs. 21%, p⬍0.001). There was a higher proportion of seminal vesicle involvement (SVI) in the ORP group (25% vs. 15%, p⬍0.01). The positive margin rate was similar between groups. Overall, 176 patients (28%) experienced BCR during follow-up (108 RALP, 68 ORP). There was no significant difference in 5-year BCR-free survival between groups. Extracapsular extension, pGS, and PSM were significant independent predictors of BCR in multivariate analysis. CONCLUSIONS: Among IR and HR prostate cancer patients, the oncologic outcomes are similar between RALP and ORP. Not surprisingly, adverse pathologic features are a harbinger of BCR and identify those patients in need of multimodal therapy. Future research should focus on ways to reduce clinical recurrence among these patients. Source of Funding: None
967 METASTASIS TO THE PROSTATIC ANTERIOR FAT PAD LYMPH NODES: A MULTI-INSTITUTION STUDY Isaac Kim, Parth Modi*, Evita Sadimin, Yun-Sok Ha, Jeong Hyun Kim, New Brunswick, NJ; Douglas Skarecky, Orange, CA; Doh Yoon Cha, Chris O. Wambi, New York, NY; Yen-Chuan Ou, Taichung, Taiwan; Bertrum Yuh, Duarte, CA; Sejun Park, Seoul, Korea, Republic of; Elton Llukani, Philadelphia, PA; David Albala, Syracuse, NY; Timothy Wilson, Duarte, CA; Thomas Ahlering, Orange, CA; Ketan Badani, New York, NY; Hanjong Ahn, Seoul, Korea, Republic of; David Lee, Philadelphia, PA; Michael May, New Brunswick, NJ; Wun-Jae Kim, Cheongju, Korea, Republic of; Dong Hyeon Lee, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: The presence of lymph nodes within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. Rarely, these PAFP lymph nodes harbor metastatic disease. The characteristics of patients with PAFP lymph node metastasis are not well described in the literature. The purpose of the present study was to identify perioperative characteristics and assess clinical outcomes of patients with PAFP lymph node metastases.
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THE JOURNAL OF UROLOGY姞
METHODS: From eight tertiary care centers, 4261 patients underwent complete removal and pathologic analysis of the PAFP during radical prostatectomy. In patients with metastatic disease to the PAFP, preoperative and pathologic characteristics as well as clinical management and outcomes are described. RESULTS: Metastatic disease to the PAFP lymph nodes was detected in forty patients (0.94%). Thirty-seven of these patients (92.5%) had intermediate or high-risk features pre-operatively. Most patients with PAFP metastases underwent concomitant pelvic lymph node dissection (PLND) and had adjuvant therapy with radiation, androgen ablation, and/or chemotherapy. Twenty-seven patients (67.5%) with PAFP metastatic disease were upstaged as a result of PAFP pathologic analysis of whom 15 (55.6%) remained free of biochemical recurrence (BCR) with observation and/or definitive adjuvant/salvage therapy. CONCLUSIONS: Most patients with PAFP metastatic disease had intermediate to high-risk features pre-operatively. In some patients with metastasis to the PAFP lymph nodes, removal of these lymph nodes resulted in prolonged BCR free survival. Therefore, we recommend that the PAFP be removed in all patients undergoing radical prostatectomy. However, pathologic analysis of the PAFP may be limited to patients with pre-operative intermediate to high-risk oncologic features.
Age (y) 62
PSA (ng/ml) 8.4
Range
45-77
2.5-102
Mean
62.6
16.9
63
8.65
Patient # 40
Median
Gleason score 4⫹3
Clinical stage T2b
Postoperative characteristics of patients with metastasis to the PAFP Patient Gleason Pathologic Pelvic LN status # score stage (# pos/total) PAFP LN Status (#pos/total) 1 4⫹5 T4 Neg (0/16) 1/1 2
4⫹5
T2c
Neg (0/4)
1/1
3
4⫹3
T2c
Neg (0/5)
1/1
4
4⫹3
T3a
Neg (0/6)
1/1
5
5⫹3
T3b
Neg (0/9)
1/1
6
5⫹5
T4
Pos (2/10)
1/1
7
4⫹5
T3b
Pos (1/14)
1/1
8
4⫹5
T3a
Neg (0/2)
1/1
9
3⫹4
T2b
Neg (0/1)
1/1
10
4⫹5
T3a
Neg (0/7)
1/1
11
4⫹5
T3a
Not performed
2/2
12
4⫹5
T3a
Pos (1/2)
1/1
13
4⫹3
T3a
Pos (1/2)
3/3
14
5⫹3
T3a
Pos (1/22)
1/1
Preoperative characteristics of patients with metastasis to the PAFP PSA Gleason Clinical Patient # Age (y) (ng/ml) score stage 1 47 7.9 4⫹5 T2a
15
4⫹5
T3b
Pos (5/38)
1/1
16
5⫹5
T3b
Pos (6/8)
1/1
17
3⫹4
T3b
Pos (1/16)
1/1
2
73
6.1
4⫹3
T1c
18
3⫹5
T3a
Neg (0/12)
1/1
3
69
5.5
3⫹3
T1c
19
5⫹4
T3b
Pos (1/9)
1/1
4
64
31.0
4⫹4
T2b
20
3⫹5
T3b
Pos (1/11)
1/1
5⫹4
T3a
Neg (0/8)
1/1
5
45
26.0
5⫹3
T3
21
6
66
6.8
5⫹5
T3
22
4⫹3
T3a
Not performed
1/1
7
62
102.0
5⫹4
T3
23
4⫹3
T3a
Neg (0/9)
1/1
8
56
6.3
5⫹4
T2
24
3⫹4
T3a
Neg (0/5)
1/1
4⫹5
T2c
Neg (0/4)
1/1
9
62
5.4
3⫹3
T2a
25
10
59
20.9
4⫹5
T3
26
4⫹5
T3a
Neg (0/22)
1/1
11
63
26.4
4⫹5
T2c
27
4⫹4
T4
Pos (5/15)
1/1
12
66
8.0
4⫹5
T2a
28
4⫹3
T3b
Neg (NA)*
1*
4⫹5
T3b
Neg (NA)*
1*
13
60
11.0
3⫹4
T2a
29
14
77
7.9
4⫹5
T2b
30
4⫹5
T3b
Neg (NA)*
1*
15
51
37.7
4⫹5
T2b
31
4⫹3
T3a
Neg (NA)*
1*
16
66
6.9
5⫹5
T2c
32
4⫹3
T3b
Pos (NA)*
1*
3⫹3
T3a
Not performed
1/1
17
68
22.3
4⫹3
T2b
33
18
61
5.0
4⫹4
T2a
34
4⫹5
T3b
Neg (NA)*
1/1
19
63
31.3
4⫹5
T2c
35
4⫹5
T3b
Neg (NA)*
1/1
20
58
6.1
4⫹4
T2c
36
4⫹5
T3a
Neg (NA)*
2/2
5⫹4
T3b
Neg (NA)*
1/1
21
59
10.3
4⫹4
T1c
37
22
64
5.0
3⫹4
T2a
38
4⫹3
T3b
Pos (1/11)
1/1
23
60
8.9
3⫹4
T1c
39
3⫹4
T3a
Neg (0/7)
1/1
24
70
7.4
3⫹4
T1c
40
4⫹3
T3a
Neg (0/6)
1/1
25
70
14
4⫹5
T2
26
65
24.6
4⫹5
T2
27
45
52
5⫹4
T2
28
68
18.3
4⫹4
T1c
29
65
4.8
4⫹4
T1c
30
71
2.5
4⫹4
T2a
31
54
14.8
4⫹5
T1c
32
61
52.3
3⫹5
T1c
33
65
8
3⫹3
T1c
34
70
15
4⫹5
T1c
35
61
24.4
4⫹4
T1c
36
58
9.7
5⫹5
T1c
37
70
6.1
5⫹5
T2b
38
62
18.77
3⫹3
T2c
39
68
3.6
3⫹4
T2c
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LN: Lymph node; PAFP: Prostate anterior fat pad; NA: not available; *per institutional protocol, number of nodes not reported.
Source of Funding: None