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ANTHROPOMORPHIC DIFFERENCES IN OBESE MEN WITH BIOCHEMICAL FAILURE AFTER RADICAL RETROPUBIC PROSTATECTOMY
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
THE JOURNAL OF UROLOGY®
67
CONCLUSIONS: These results suggest that high intake of dairy products including butter also increase the risk of prostate cancer in Japan. +D]DUGUDWLRV +5V IRU3URVWDWH&DQFHU,QFLGHQFH Item Age Family History of Prostate Cancer Butter
Category
Incidence HR
95%Cl
205
1.12
1.10-1.24 <0.001
P
no
199
1
yes Scarcely any 1-2/m to 1-2/w 3-4/w+
2 62 61 17
4.34 1 1.40 1.53
trend P
1.07-17.53 0.040 0.045 0.98-2.00 0.067 0.89-2.63 0.127
Source of Funding:6XEVLG\IRUVFLHQWL¿FUHVHDUFKIURP the Ministry of Education, Culture, Sports, Science and Technology.
189 ANTHROPOMORPHIC DIFFERENCES IN OBESE MEN WITH BIOCHEMICAL FAILURE AFTER RADICAL RETROPUBIC PROSTATECTOMY Phillip Mucksavage*, Christopher R Mitchell, Alexander Kutikov, Alan J Wein, Drew A Torigian, S Bruce Malkowicz. Philadelphia, PA. INTRODUCTION AND OBJECTIVE: The effect of obesity on biochemical failure after radical retropubic prostatectomy (RRP) is controversial. The differences in study outcomes may be a result of using body mass index (BMI) rather then direct anthropomorphic measurements of fat distribution. To investigate these differences, we used endorectal coil MRI (eMRI) data to directly measure fat thicknesses in obese men who underwent RRP. METHODS: We performed a retrospective analysis on an RRP database containing 1987 men with available BMI, clinicopathologic characteristics and biochemical outcomes. Obese men (BMI>30) were compared to lean men (BMI<25) and overweight men (BMI 25-30) for clinical and pathological differences and biochemical failure. The eMRI data for 143 obese men were reviewed and the fat thicknesses in the anterior, posterior and total anteroposterior diameters were measured and averaged in three separate images at and around the midline in the ZLGHVWVHJPHQWRIWKHVDJLWWDO7ZHLJKWHGORFDOL]LQJVFDQV )LJXUH Percent visceral fat thickness was calculated by subtracting the average anterior and posterior thicknesses from the total anteroposterior diameter and dividing by the total anteroposterior diameter. RESULTS: Kaplan Meyer curves with log rank analysis UHYHDOHG D VLJQL¿FDQW GLIIHUHQFH LQ ELRFKHPLFDO IUHH VXUYLYDO LQ OHDQ men and overweight men compared to obese men. (p=0.016, p=0.021). A BMI>30 also predicted time to biochemical failure (HR 1.43, 95% CI 1.09-1.86, p=0.009). The anterior fat thickness on eMRI in obese men ZLWK ELRFKHPLFDO IDLOXUH Q ZDV VLJQL¿FDQWO\ VPDOOHU WKDQ REHVH men without biochemical failure (n=122) (35mm vs. 44mm, p=0.003). &DOFXODWHGSHUFHQWYLVFHUDOIDWWKLFNQHVVZDVDOVRVLJQL¿FDQWO\ODUJHU in obese men with biochemical failure (74% vs.71%, p=0.02). Subset analysis on patients with extracapsular extension and higher pathological Gleason scores revealed similar trends in anterior and percent visceral fat thicknesses (p=0.003, p=0.02). CONCLUSIONS: All obese men are not created equal DQG VLJQL¿FDQW IDW GLVWULEXWLRQ GLIIHUHQFHV FDQ H[LVW EHWZHHQ WKHP These differences may explain why body mass index alone may not DGHTXDWHO\ SUHGLFW WKH LQÀXHQFH RI REHVLW\ RQ RXWFRPHV RI SURVWDWH cancer treatment.
Source of Funding: None
190 PSA TRIGGERS FOR INTERVENTION DURING ACTIVE SURVEILLANCE: VELOCITY VS DOUBLING TIME VS GENERAL LINEAR MIXED MODELLING Laurence H Klotz*, Andrew Loblaw, Liyang Zhang. Toronto, ON, Canada. INTRODUCTION AND OBJECTIVE: Active surveillance (AS) LVEHFRPLQJDQDFFHSWHGPDQDJHPHQWRSWLRQIRUPHQZLWKORFDOL]HG prostate cancer. PSA kinetics are a commonly used trigger for starting treatment. The objective of this study is to compare commonly used PSA triggers in stable patients. METHODS: A prospective phase II study of patients with favorable clinical parameters (stage T1b-T2b N0M0, Gleason score 36$ QJPO RQ DFWLYH VXUYHLOODQFH ZLWK VHOHFWLYH GHOD\HG intervention (AS) was initiated in 1995. Those who had a PSAdt < 3 y, JUDGHSURJUHVVLRQRQUHELRSV\RUGRXEOLQJLQVL]HRIDFOLQLFDOQRGXOH were offered radical intervention. The remaining patients were closely monitored and formed the cohort for this study. The proportion and frequency of patients who would have been offered treatment based on the following PSAdt triggers were calculated: i) PSA threshold (PSAt) of QJPOIRUSDWLHQWVZLWKDQLQLWLDO36$ LL 36$WRI LLL DOLQHDU UHJUHVVLRQRIOQ 36$ YVWLPH \IRUDOO36$YDOXHV /536$GW LY OQ 36$ YVWLPH \XVLQJWKH¿UVWDQGODVW36$RQUHFRUG )/36$GW Y DFWXDO36$YHORFLW\ D36$Y !\RYHUODVW\HDU YL FDOFXODWHG36$ YHORFLW\!\ F36$Y DQGYLL DJHQHUDOOLQHDUPL[HGPRGHO */00 of ln(PSA). 5(68/76 SDWLHQWV KDG PRUH WKDQ PR IROORZXS 134(58%) remain on AS and form the cohort for this study. As of March 2006, the median follow-up was 4.9 y (1.0-9.6 y). No patient has died RISURVWDWHFDQFHURUKDGPHWDVWDWLFGLVHDVH KDYHGLHGRI other causes. The following proportion patients would have received
THE JOURNAL OF UROLOGY®
67
CONCLUSIONS: These results suggest that high intake of dairy products including butter also increase the risk of prostate cancer in Japan. +D]DUGUDWLRV +5V IRU3URVWDWH&DQFHU,QFLGHQFH Item Age Family History of Prostate Cancer Butter
Category
Incidence HR
95%Cl
205
1.12
1.10-1.24 <0.001
P
no
199
1
yes Scarcely any 1-2/m to 1-2/w 3-4/w+
2 62 61 17
4.34 1 1.40 1.53
trend P
1.07-17.53 0.040 0.045 0.98-2.00 0.067 0.89-2.63 0.127
Source of Funding:6XEVLG\IRUVFLHQWL¿FUHVHDUFKIURP the Ministry of Education, Culture, Sports, Science and Technology.
189 ANTHROPOMORPHIC DIFFERENCES IN OBESE MEN WITH BIOCHEMICAL FAILURE AFTER RADICAL RETROPUBIC PROSTATECTOMY Phillip Mucksavage*, Christopher R Mitchell, Alexander Kutikov, Alan J Wein, Drew A Torigian, S Bruce Malkowicz. Philadelphia, PA. INTRODUCTION AND OBJECTIVE: The effect of obesity on biochemical failure after radical retropubic prostatectomy (RRP) is controversial. The differences in study outcomes may be a result of using body mass index (BMI) rather then direct anthropomorphic measurements of fat distribution. To investigate these differences, we used endorectal coil MRI (eMRI) data to directly measure fat thicknesses in obese men who underwent RRP. METHODS: We performed a retrospective analysis on an RRP database containing 1987 men with available BMI, clinicopathologic characteristics and biochemical outcomes. Obese men (BMI>30) were compared to lean men (BMI<25) and overweight men (BMI 25-30) for clinical and pathological differences and biochemical failure. The eMRI data for 143 obese men were reviewed and the fat thicknesses in the anterior, posterior and total anteroposterior diameters were measured and averaged in three separate images at and around the midline in the ZLGHVWVHJPHQWRIWKHVDJLWWDO7ZHLJKWHGORFDOL]LQJVFDQV )LJXUH Percent visceral fat thickness was calculated by subtracting the average anterior and posterior thicknesses from the total anteroposterior diameter and dividing by the total anteroposterior diameter. RESULTS: Kaplan Meyer curves with log rank analysis UHYHDOHG D VLJQL¿FDQW GLIIHUHQFH LQ ELRFKHPLFDO IUHH VXUYLYDO LQ OHDQ men and overweight men compared to obese men. (p=0.016, p=0.021). A BMI>30 also predicted time to biochemical failure (HR 1.43, 95% CI 1.09-1.86, p=0.009). The anterior fat thickness on eMRI in obese men ZLWK ELRFKHPLFDO IDLOXUH Q ZDV VLJQL¿FDQWO\ VPDOOHU WKDQ REHVH men without biochemical failure (n=122) (35mm vs. 44mm, p=0.003). &DOFXODWHGSHUFHQWYLVFHUDOIDWWKLFNQHVVZDVDOVRVLJQL¿FDQWO\ODUJHU in obese men with biochemical failure (74% vs.71%, p=0.02). Subset analysis on patients with extracapsular extension and higher pathological Gleason scores revealed similar trends in anterior and percent visceral fat thicknesses (p=0.003, p=0.02). CONCLUSIONS: All obese men are not created equal DQG VLJQL¿FDQW IDW GLVWULEXWLRQ GLIIHUHQFHV FDQ H[LVW EHWZHHQ WKHP These differences may explain why body mass index alone may not DGHTXDWHO\ SUHGLFW WKH LQÀXHQFH RI REHVLW\ RQ RXWFRPHV RI SURVWDWH cancer treatment.
Source of Funding: None
190 PSA TRIGGERS FOR INTERVENTION DURING ACTIVE SURVEILLANCE: VELOCITY VS DOUBLING TIME VS GENERAL LINEAR MIXED MODELLING Laurence H Klotz*, Andrew Loblaw, Liyang Zhang. Toronto, ON, Canada. INTRODUCTION AND OBJECTIVE: Active surveillance (AS) LVEHFRPLQJDQDFFHSWHGPDQDJHPHQWRSWLRQIRUPHQZLWKORFDOL]HG prostate cancer. PSA kinetics are a commonly used trigger for starting treatment. The objective of this study is to compare commonly used PSA triggers in stable patients. METHODS: A prospective phase II study of patients with favorable clinical parameters (stage T1b-T2b N0M0, Gleason score 36$ QJPO RQ DFWLYH VXUYHLOODQFH ZLWK VHOHFWLYH GHOD\HG intervention (AS) was initiated in 1995. Those who had a PSAdt < 3 y, JUDGHSURJUHVVLRQRQUHELRSV\RUGRXEOLQJLQVL]HRIDFOLQLFDOQRGXOH were offered radical intervention. The remaining patients were closely monitored and formed the cohort for this study. The proportion and frequency of patients who would have been offered treatment based on the following PSAdt triggers were calculated: i) PSA threshold (PSAt) of QJPOIRUSDWLHQWVZLWKDQLQLWLDO36$ LL 36$WRI LLL DOLQHDU UHJUHVVLRQRIOQ 36$ YVWLPH \IRUDOO36$YDOXHV /536$GW LY OQ 36$ YVWLPH \XVLQJWKH¿UVWDQGODVW36$RQUHFRUG )/36$GW Y DFWXDO36$YHORFLW\ D36$Y !\RYHUODVW\HDU YL FDOFXODWHG36$ YHORFLW\!\ F36$Y DQGYLL DJHQHUDOOLQHDUPL[HGPRGHO */00 of ln(PSA). 5(68/76 SDWLHQWV KDG PRUH WKDQ PR IROORZXS 134(58%) remain on AS and form the cohort for this study. As of March 2006, the median follow-up was 4.9 y (1.0-9.6 y). No patient has died RISURVWDWHFDQFHURUKDGPHWDVWDWLFGLVHDVH KDYHGLHGRI other causes. The following proportion patients would have received