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INFLUENCE OF THE EXTENT OF POSITIVE MARGINS ON BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY
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422
INFLUENCE OF THE EXTENT OF POSITIVE MARGINS ON BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY
PROGNOSTIC FACTORS OF RECURRENCE FOLLOWING RADICAL PROSTATECTOMY FOR CLINICALLY LOCALISED PROSTATE CANCER. EVALUATION OF THE PROSTATE GLANDULAR NONMALIGNANT MARGINS
Llorente C.1, De La Morena J.M.1, Martin D.2, Capitan C.1, Dominguez P.3, Alvarez M.1, Sanchez M.1 1
Fundación Hospital Alcorcón, Urology, Alcorcon (Madrid), Spain, 2Fha, Epidemiology, Madrid, Spain, 3Fha, Pathology, Madrid, Spain
INTRODUCTION & OBJECTIVES: The finding of positive surgical margins (PSM) after radical prostatectomy for prostate cancer is well as identified risk factor for biochemical recurrence (BR). Accordingly, it seems logical that a larger tumour burden on the margin site could expose patients to a higher risk of biochemical relapse. We have evaluated the role of the extent of the positive surgical on PSA recurrence on our patients. MATERIAL & METHODS: 213 have been prospectively studied after open (145) or laparoscopic (68) radical prostatectomy was performed in our institution. All specimen were sectioned at 3 mm intervals with saggital sections at the apex and bladder neck. All sections were entirely embedded and studied microscopically by a single pathologists. Tumour volume was assessed based on the size and number of sections affected and surgical margins measured in millimetres. PSA recurrence was considered with a value exceeding 0.4 ng/ml and only patients without adjuvant treatment of any type were included. Age, preoperative T stage and PSA value, Gleason score of the biopsy, pT stage, tumour volume, incidence, site and extent of positive surgical margins and primary and secondary Gleason of the specimen were studied in all patients. RESULTS: Mean age of the population studied was 63.5 years. Median PSA value was 7,3 (+- 5,3) and 39% had PSM with a median tumour volume of 5 (0.09-56) cc. Median follow-up was 27 months (2.3-76.2). 20 (24%) had PSM < 3mm, 13 (15%) between 3 and 5 and 51 (60%) had PSM >5 mm. Biochemical progression- free survival was detected on 86.4% of patients with PSM and 96% of those without PSM (p=0.002). Median extension of PSM of those who progressed was 7.5 mm compared with 6 mm of those who did not progress (p= 0.34). A multivariate risk analysis showed that 78.6% of patients with a specimen Gleason score >6 and PSM>3 mm experienced no progression whilst 98.2% of those with PSM< 3mm did not. Hazard ratio of the first group was 3.05 (95% CI: 1.08-8.8) and for the second group it was 0.95 (95% CI: 0.1-8.8). The other variables did not show any significance as risk factor for BR. CONCLUSIONS: Based n this study the extent of PSM poses those patients with a Gleason score>6 at higher risk for BR when larger than 3 mm. Accordingly, the measurement of the extent of PSM is a useful variables that provides important clinical information. Further studies should confirm this preliminary finding.
Allepuz C.1, Borque A.1, Allúe M.1, Alfaro J.2, Gil M.J.1, Gil P.1, Servera A.1, Rioja C.3, Rioja L.1 1 Miguel Servet University Hospital, Urology, Zaragoza, Spain, 2Miguel Servet University Hospital, Pathology, Zaragoza, Spain, 3Royo Villanova Hospital, Urology, Zaragoza, Spain
INTRODUCTION & OBJECTIVES: The radical prostatectomyor clinically localised prostate cancer is not synonymous of cure. It is our objective to know the prognostic factors of biochemical recurrence following radical prostatectomy. MATERIAL & METHODS: From June, 1986 to September, 2002, 746 consecutive men underwent radical retropubic prostatectomy (PR) and pelvic lymphadenectomy for clinically localised adenocarcinoma of the prostate without neoadjuvant hormonal therapy and a minimal follow-up of 2 year. We have study as predictive variables of biochemical recurrence (PSA > 0.4 ng. /ml.) (BR), the Gleason score from surgical specimen, preoperative PSA, pathological TNM stage, tumour volume, positive tumour margins and glandular non-malignant margins. RESULTS: With a median follow-up of 3.4 years 142 men (19%) had biochemical recurrence. In the univariate analysis using the Kaplan-Meier method all variables were statistically significant predictive factor for BR with the exception of the glandular margins in absence of tumour positive margins. In the multivariate analysis, using the log rank statistic or the Cox proportional hazards regression model, preoperative PSA, Gleason score, pathological stage and positive tumour margins were statistically significant predictive factor for BR whereas the tumour volume (p=0.08) and glandular margins (p=0.055) not. CONCLUSIONS: The preoperative PSA, Gleason score, pathological stage and positive tumour margins are independent prognostic factors of recurrence following radical prostatectomy. The tumour volume and glandular margins might be in use to improve the model of prediction.
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THE EFFECT OF SURGICAL VOLUME ON FAILURE-FREE SURVIVAL AFTER RADICAL PROSTATECTOMY IN THE PROVINCE OF QUEBEC
RATIO OF URINE LOSS (UL) TO MICTURATION VOLUME (MV) ON
Antebi E., Benayoun S., Ramirez A., Perrotte P., Mccormack M., Benard F., Valiquette L., Saad F., Karakiewicz P.I. University of Montreal, Cancer Prognostics and Outcomes Research Unit, Montreal, Canada INTRODUCTION & OBJECTIVES: Several studies demonstrated that the number of radical prostatectomies (RPs) performed within a specific time (surgical volume: SV) is a determinant of positive surgical margins, morbidity, length of stay, cost and mortality after radical prostatectomy. The effect of surgical volume on various outcome determinants has not yet been studied in the province of Quebec. We studied the effect of surgical volume on the rate of failure (use of hormonal therapy, orchiectomy or radiotherapy) after RP. Univariate and multivariate Cox regression models were used, where surgical volume predicted failure-free survival after RP. Covariates included age, Charlson comorbidity index and region of residence as proxy of socio-economic status. To allow non-linear effects surgical volume was modelled as a cubic spline. MATERIAL & METHODS: We used the RAMQ database to identify 7937 men treated with RP as monotherapy, between 1989 and 2000, by 130 urologic surgeons. All patients treated with neoadjuvant hormonal therapy or those who received hormonal therapy between 0 and 6 months after surgery were excluded. Average annual surgical volume ranged from 1 to 56 RPs (mean 17, median 11). The follow-up ranged from 0.1 to 185.7 months. RESULTS: Of 7937 men, 1982 failed (25%). Time to failure ranged from 6.1 months to 170.3 months (mean 141.8, median not reached). In the univariate analysis surgical volume represented a statistically significant predictor of failure-free survival (p=0.03). Its significance increased (p=0.018) in the multivariate model. CONCLUSIONS: Surgical volume appears to represent an important univariate and multivariate determinant of failure-free survival after RP.
THE FIRST DAY AFTER CATHETER REMOVAL PREDICTS RECOVER OF Ates M., Teber D., Goezen A., Hruza M., Rassweiler J. Klinikum Heilbronn, Urology, Heilbronn, Germany INTRODUCTION & OBJECTIVES: One of the most frequently asked questions by the patients after removal of catheter is always the time for continence, but we still don’t have enough parameter that can show us the time. So, to be able to give a probability for the time for continence, we measured leakages and micturation volumes at the first day that urethral catheter is taken out. MATERIAL & METHODS: From 1400 LRP, we measured the weight of urine loss (UL) and micturation volumes (MV) in the pad separately for every micturation of 611 patients, at the first day that catheter is taken out. The ratio of UL/MV was calculated. The time for continence was classified in 3 categories: within 3 months as early continence, 4-12 months as mid-term continence, 13-24 months as late continence. Spearman correlation test, Mantel Haenszel linear by linear test, One way ANOVA test and Mann Whitney U tests were used for statistical analysis. RESULTS: There is a significant correlation between UL/MV ratio and the time to continence (r=0.482, p<0.001). Probability of early, mid-term and late continence are 71.8%, 21.4% and 6,7% at a UL/MV ratio of 0-0.15, 44.4%, 33.3% and 22.2% at a UL/MV ratio of 0.15-0.25 and 26.6%, 29.8% and 43,5% at a UL/MV ratio of 0.25-1. A UL/MV ratio of 0.23 represents a cut-off point indicating a 8.12 fold high risk of late continence. CONCLUSIONS: UL/MV predicts the time to continence and may be used for selection of patients for special rehabilitation programs and pelvic exercise earlier after a cut-off value of 23% leakage percentage.
Eur Urol Suppl 2006;5(2):128
422
INFLUENCE OF THE EXTENT OF POSITIVE MARGINS ON BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY
PROGNOSTIC FACTORS OF RECURRENCE FOLLOWING RADICAL PROSTATECTOMY FOR CLINICALLY LOCALISED PROSTATE CANCER. EVALUATION OF THE PROSTATE GLANDULAR NONMALIGNANT MARGINS
Llorente C.1, De La Morena J.M.1, Martin D.2, Capitan C.1, Dominguez P.3, Alvarez M.1, Sanchez M.1 1
Fundación Hospital Alcorcón, Urology, Alcorcon (Madrid), Spain, 2Fha, Epidemiology, Madrid, Spain, 3Fha, Pathology, Madrid, Spain
INTRODUCTION & OBJECTIVES: The finding of positive surgical margins (PSM) after radical prostatectomy for prostate cancer is well as identified risk factor for biochemical recurrence (BR). Accordingly, it seems logical that a larger tumour burden on the margin site could expose patients to a higher risk of biochemical relapse. We have evaluated the role of the extent of the positive surgical on PSA recurrence on our patients. MATERIAL & METHODS: 213 have been prospectively studied after open (145) or laparoscopic (68) radical prostatectomy was performed in our institution. All specimen were sectioned at 3 mm intervals with saggital sections at the apex and bladder neck. All sections were entirely embedded and studied microscopically by a single pathologists. Tumour volume was assessed based on the size and number of sections affected and surgical margins measured in millimetres. PSA recurrence was considered with a value exceeding 0.4 ng/ml and only patients without adjuvant treatment of any type were included. Age, preoperative T stage and PSA value, Gleason score of the biopsy, pT stage, tumour volume, incidence, site and extent of positive surgical margins and primary and secondary Gleason of the specimen were studied in all patients. RESULTS: Mean age of the population studied was 63.5 years. Median PSA value was 7,3 (+- 5,3) and 39% had PSM with a median tumour volume of 5 (0.09-56) cc. Median follow-up was 27 months (2.3-76.2). 20 (24%) had PSM < 3mm, 13 (15%) between 3 and 5 and 51 (60%) had PSM >5 mm. Biochemical progression- free survival was detected on 86.4% of patients with PSM and 96% of those without PSM (p=0.002). Median extension of PSM of those who progressed was 7.5 mm compared with 6 mm of those who did not progress (p= 0.34). A multivariate risk analysis showed that 78.6% of patients with a specimen Gleason score >6 and PSM>3 mm experienced no progression whilst 98.2% of those with PSM< 3mm did not. Hazard ratio of the first group was 3.05 (95% CI: 1.08-8.8) and for the second group it was 0.95 (95% CI: 0.1-8.8). The other variables did not show any significance as risk factor for BR. CONCLUSIONS: Based n this study the extent of PSM poses those patients with a Gleason score>6 at higher risk for BR when larger than 3 mm. Accordingly, the measurement of the extent of PSM is a useful variables that provides important clinical information. Further studies should confirm this preliminary finding.
Allepuz C.1, Borque A.1, Allúe M.1, Alfaro J.2, Gil M.J.1, Gil P.1, Servera A.1, Rioja C.3, Rioja L.1 1 Miguel Servet University Hospital, Urology, Zaragoza, Spain, 2Miguel Servet University Hospital, Pathology, Zaragoza, Spain, 3Royo Villanova Hospital, Urology, Zaragoza, Spain
INTRODUCTION & OBJECTIVES: The radical prostatectomyor clinically localised prostate cancer is not synonymous of cure. It is our objective to know the prognostic factors of biochemical recurrence following radical prostatectomy. MATERIAL & METHODS: From June, 1986 to September, 2002, 746 consecutive men underwent radical retropubic prostatectomy (PR) and pelvic lymphadenectomy for clinically localised adenocarcinoma of the prostate without neoadjuvant hormonal therapy and a minimal follow-up of 2 year. We have study as predictive variables of biochemical recurrence (PSA > 0.4 ng. /ml.) (BR), the Gleason score from surgical specimen, preoperative PSA, pathological TNM stage, tumour volume, positive tumour margins and glandular non-malignant margins. RESULTS: With a median follow-up of 3.4 years 142 men (19%) had biochemical recurrence. In the univariate analysis using the Kaplan-Meier method all variables were statistically significant predictive factor for BR with the exception of the glandular margins in absence of tumour positive margins. In the multivariate analysis, using the log rank statistic or the Cox proportional hazards regression model, preoperative PSA, Gleason score, pathological stage and positive tumour margins were statistically significant predictive factor for BR whereas the tumour volume (p=0.08) and glandular margins (p=0.055) not. CONCLUSIONS: The preoperative PSA, Gleason score, pathological stage and positive tumour margins are independent prognostic factors of recurrence following radical prostatectomy. The tumour volume and glandular margins might be in use to improve the model of prediction.
423
424
THE EFFECT OF SURGICAL VOLUME ON FAILURE-FREE SURVIVAL AFTER RADICAL PROSTATECTOMY IN THE PROVINCE OF QUEBEC
RATIO OF URINE LOSS (UL) TO MICTURATION VOLUME (MV) ON
Antebi E., Benayoun S., Ramirez A., Perrotte P., Mccormack M., Benard F., Valiquette L., Saad F., Karakiewicz P.I. University of Montreal, Cancer Prognostics and Outcomes Research Unit, Montreal, Canada INTRODUCTION & OBJECTIVES: Several studies demonstrated that the number of radical prostatectomies (RPs) performed within a specific time (surgical volume: SV) is a determinant of positive surgical margins, morbidity, length of stay, cost and mortality after radical prostatectomy. The effect of surgical volume on various outcome determinants has not yet been studied in the province of Quebec. We studied the effect of surgical volume on the rate of failure (use of hormonal therapy, orchiectomy or radiotherapy) after RP. Univariate and multivariate Cox regression models were used, where surgical volume predicted failure-free survival after RP. Covariates included age, Charlson comorbidity index and region of residence as proxy of socio-economic status. To allow non-linear effects surgical volume was modelled as a cubic spline. MATERIAL & METHODS: We used the RAMQ database to identify 7937 men treated with RP as monotherapy, between 1989 and 2000, by 130 urologic surgeons. All patients treated with neoadjuvant hormonal therapy or those who received hormonal therapy between 0 and 6 months after surgery were excluded. Average annual surgical volume ranged from 1 to 56 RPs (mean 17, median 11). The follow-up ranged from 0.1 to 185.7 months. RESULTS: Of 7937 men, 1982 failed (25%). Time to failure ranged from 6.1 months to 170.3 months (mean 141.8, median not reached). In the univariate analysis surgical volume represented a statistically significant predictor of failure-free survival (p=0.03). Its significance increased (p=0.018) in the multivariate model. CONCLUSIONS: Surgical volume appears to represent an important univariate and multivariate determinant of failure-free survival after RP.
THE FIRST DAY AFTER CATHETER REMOVAL PREDICTS RECOVER OF Ates M., Teber D., Goezen A., Hruza M., Rassweiler J. Klinikum Heilbronn, Urology, Heilbronn, Germany INTRODUCTION & OBJECTIVES: One of the most frequently asked questions by the patients after removal of catheter is always the time for continence, but we still don’t have enough parameter that can show us the time. So, to be able to give a probability for the time for continence, we measured leakages and micturation volumes at the first day that urethral catheter is taken out. MATERIAL & METHODS: From 1400 LRP, we measured the weight of urine loss (UL) and micturation volumes (MV) in the pad separately for every micturation of 611 patients, at the first day that catheter is taken out. The ratio of UL/MV was calculated. The time for continence was classified in 3 categories: within 3 months as early continence, 4-12 months as mid-term continence, 13-24 months as late continence. Spearman correlation test, Mantel Haenszel linear by linear test, One way ANOVA test and Mann Whitney U tests were used for statistical analysis. RESULTS: There is a significant correlation between UL/MV ratio and the time to continence (r=0.482, p<0.001). Probability of early, mid-term and late continence are 71.8%, 21.4% and 6,7% at a UL/MV ratio of 0-0.15, 44.4%, 33.3% and 22.2% at a UL/MV ratio of 0.15-0.25 and 26.6%, 29.8% and 43,5% at a UL/MV ratio of 0.25-1. A UL/MV ratio of 0.23 represents a cut-off point indicating a 8.12 fold high risk of late continence. CONCLUSIONS: UL/MV predicts the time to continence and may be used for selection of patients for special rehabilitation programs and pelvic exercise earlier after a cut-off value of 23% leakage percentage.
Eur Urol Suppl 2006;5(2):128