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LONGTERM OUTCOME FOLLOWING NO DEFINITE THERAPY, RADIATION AND SURGERY FOR LOCO-REGIONAL PROSTATE CANCER IN PATIENTS LESS THAN 50 YEARS OF AGE- ANALYSIS OF 6906 PATIENTS
THE JOURNAL OF UROLOGY®
60
Vol. 181, No. 4, Supplement, Sunday, April 26, 2009
164
165
LONGTERM OUTCOME FOLLOWING NO DEFINITE THERAPY, RADIATION AND SURGERY FOR LOCO-REGIONAL PROSTATE CANCER IN PATIENTS LESS THAN 50 YEARS OF AGEANALYSIS OF 6906 PATIENTS
PATHOLOGIC OUTCOMES IN MEN MEETING CRITERIA FOR ACTIVE SURVEILLANCE OF PROSTATE CANCER
Naveen Pokala*, Mani Menon, Detroit, MI
INTRODUCTION AND OBJECTIVE: Active surveillance (AS) of prostate cancer has emerged as a viable management option for men with features of low risk disease. Five prospective studies have enrolled patients for AS with varying inclusion criteria. Here we evaluate the pathologic outcomes of men meeting published criteria for AS who elected immediate radical prostatectomy (RP) to assess the risk of undergrading and understaging in those who are candidates for AS. METHODS: Data were extracted from our institutional urologic oncology database for all men undergoing RP between 1996 and 2007. The primary outcome was pathologic upstaging, defined as occurrence of extracapsular extension (ECE) or seminal vesicle involvement (SVI). Pathologic upgrade was identified as a secondary outcome.We determined the proportion of men who would have qualified for each published AS study and the respective rates of upgrading and upstaging in each group. RESULTS: We identified 1,097 men who underwent RP with a mean age of 59. Overall, 28% of men experienced a Gleason upgrade, 21% had ECE and 11% had SVI. In men qualifying for published AS inclusion criteria, rates of upgrading varied between 23% and 35%, the incidence of ECE ranged from 7% to 19% and SVI ranged from 2% to 9%. CONCLUSIONS: Varying entry criteria for AS show different rates of adverse pathologic features at RP. Predictably, fewer men meet the more stringent criteria, but these men had lower incidence of SVI and ECE. Such data can be used to advise men of the risks of AS.
INTRODUCTION AND OBJECTIVE: To compare the long-term overall and cancer specific survival following no definite therapy(NDT), radiotherapy(EBRT) and Radical retropubic prostatectomy (RRP) in patients less than 50 years of age with prostatic adenocarcinoma. METHODS: All patients less than 50 years of age with prostate cancer were identified from the SEER 17 database between 1973-2005. Inclusion criteria; localized disease; adenocarcinoma; single modality of Rx-NDT, EBRT or RRP. Exclusions: histology other than adenoca.; combined modality of Rx, other surgical treatment; more than one primary cancers, unknown data in any of the fields; distant metastasis. Appropriate statistical tests wer used. RESULTS: Of 12234, 6906 patients met inclusion criteria. Mean age was 46.4± 2.7 years, 72% were white, 22.1% black and 5.9% other races. 2.6% patients had well, 75% moderately and 22.4% had poorly differentiated cancers. 1032 patients had NDT, 5282 had RRP and 592 had EBRT. (Table 1) There were 207 all cause deaths, 62 in EBRT, 59 in RRP and 86 in NDT. Prostate cancer specific death: 117 patients, 43 in EBRT, 15 in RRP and 59 in the NDT. The 5-year, 10-year and 15 year overall survival (OS) and cancer specific survival (CSS) was significantly (p=<0.00001) increased after RRP. On multivariate analysis, year of diagnosis, race and grade significantly altered the outcome (p=0.0001). RRP resulted in significantly improved OS in all grades (p=0.0001) and improved CSS in mod. and poorly diff. cancer. (Table 2) CONCLUSIONS: RRP significantly improves the 5, 10 and 15-year survival in patients of less than 50 years with moderately differentiated and and especially in poorly differentiated prostate cancers and should be the recommended treatment of choice for patients who are less than 50 years of age.
Simon Conti*, Marc Dall’Era, Vincent Fradet, Janet E Cowan, Jeffery Simko, Peter R Carroll, San Francisco, CA
Prospective Active Surveillance Studies Institution
Study
Year of Pub
University of Toronto
Loblaw
Royal Marsden
Hardie
2005
Johns Hopkins
Carter
2007
University of California San Francisco
Dall’Era
2008
Memorial Sloan Kettering
Patel
2004
Table 1: Age, Race and histology in different treatment arms
Mean Age (years) Race
Histology
NDT (n=1032)
RRP (n=5282)
EBRT (n=592)
46.3±2.4
46.4±2.6
46.8±3.1
White (n=4977)
n=596
n=4021
n=360
Black (n=1528)
n=283
n=1049
n=196
Other (n=401) n=153 n=212 Well differntiated n=56 (5.42%) n=110 (2.8%) (n=182) Moderately differentiated n=778(75.38%) n=4012(75.95%) (n=5183) Poorly differentiated n=198 (19%) n=1160(21.97%) (n=1541)
n=36 n=16 (2.7%)
Inclusion Criteria
Gleason <= 3+4, PSA <= 15, stage T12006 T2, , <= 3 Biopsy cores +, <= 50% single core involvement Gleason <= 7, stage T1-T2, PSA <= 20 Gleason <= 6, no pattern 4 or 5 PSAD <= 0.15, stage T1, <= 2 Biopsy cores +, <= 50% single core involvement Gleason <= 6, PSA <= 10, stage T1-T2, <= 1/3 Biopsy cores +, <= 50% single core involvement Gleason <= 7, Stage T1-T2
n=393 (66.4%) n=183 (30.9%)
Table 2: Overall and cancer specific survival in different grades Survival (overall/ Cancer specific survival) Well differentiated
Moderately differntiated
Poorly Differentiated
5-year (OS/CSS) NDT (168 months*) RRP (144 months*) EBRT (144 months*) NDT (168 months*) RRP (204 months*) EBRT (180 months*) NDT (168 months*) RRP (192 months*) EBRT(192 months*)
10-year (OS/CSS)
15-year(OS/ CSS)
End of Follo-up (OS/CSS)
98.2%/100%
93%/100%
NA
93%/100%
99%/100%
94.3%/100%
NA
94.3%/100%
100%/100%
88.9%/100%
NA
88.9%/100%
93.3%/96.9% 85.9%/94.3%
NA
85.9%/94.3%
98.6%/99.8% 94.4%/99.6% 77.2%/99.6%
77.2%/99.6%
89.4%/94.1% 74.5%/83.7% 74.5%/83.1%
74.5%/83.1%
58.5%/64.4% 93.7%/97%
45.4%/50%
NA
45.4%/50%
86.2%/94.3% 86.2%/94.3%
86.2%/94.3%
67.2%/70.5% 60.2%/63.2% 60.2%/63.3%
60.2%/63.3%
*- median follow-up
Source of Funding: None
Source of Funding: National Institutes of Health Prostate Cancer Specialized Programs of Research Excellence (SPORE); Grant Number: 1P50CA089520-01, Vincent Fradet is supported by the McLaughlin Dean’s grant from Laval University
60
Vol. 181, No. 4, Supplement, Sunday, April 26, 2009
164
165
LONGTERM OUTCOME FOLLOWING NO DEFINITE THERAPY, RADIATION AND SURGERY FOR LOCO-REGIONAL PROSTATE CANCER IN PATIENTS LESS THAN 50 YEARS OF AGEANALYSIS OF 6906 PATIENTS
PATHOLOGIC OUTCOMES IN MEN MEETING CRITERIA FOR ACTIVE SURVEILLANCE OF PROSTATE CANCER
Naveen Pokala*, Mani Menon, Detroit, MI
INTRODUCTION AND OBJECTIVE: Active surveillance (AS) of prostate cancer has emerged as a viable management option for men with features of low risk disease. Five prospective studies have enrolled patients for AS with varying inclusion criteria. Here we evaluate the pathologic outcomes of men meeting published criteria for AS who elected immediate radical prostatectomy (RP) to assess the risk of undergrading and understaging in those who are candidates for AS. METHODS: Data were extracted from our institutional urologic oncology database for all men undergoing RP between 1996 and 2007. The primary outcome was pathologic upstaging, defined as occurrence of extracapsular extension (ECE) or seminal vesicle involvement (SVI). Pathologic upgrade was identified as a secondary outcome.We determined the proportion of men who would have qualified for each published AS study and the respective rates of upgrading and upstaging in each group. RESULTS: We identified 1,097 men who underwent RP with a mean age of 59. Overall, 28% of men experienced a Gleason upgrade, 21% had ECE and 11% had SVI. In men qualifying for published AS inclusion criteria, rates of upgrading varied between 23% and 35%, the incidence of ECE ranged from 7% to 19% and SVI ranged from 2% to 9%. CONCLUSIONS: Varying entry criteria for AS show different rates of adverse pathologic features at RP. Predictably, fewer men meet the more stringent criteria, but these men had lower incidence of SVI and ECE. Such data can be used to advise men of the risks of AS.
INTRODUCTION AND OBJECTIVE: To compare the long-term overall and cancer specific survival following no definite therapy(NDT), radiotherapy(EBRT) and Radical retropubic prostatectomy (RRP) in patients less than 50 years of age with prostatic adenocarcinoma. METHODS: All patients less than 50 years of age with prostate cancer were identified from the SEER 17 database between 1973-2005. Inclusion criteria; localized disease; adenocarcinoma; single modality of Rx-NDT, EBRT or RRP. Exclusions: histology other than adenoca.; combined modality of Rx, other surgical treatment; more than one primary cancers, unknown data in any of the fields; distant metastasis. Appropriate statistical tests wer used. RESULTS: Of 12234, 6906 patients met inclusion criteria. Mean age was 46.4± 2.7 years, 72% were white, 22.1% black and 5.9% other races. 2.6% patients had well, 75% moderately and 22.4% had poorly differentiated cancers. 1032 patients had NDT, 5282 had RRP and 592 had EBRT. (Table 1) There were 207 all cause deaths, 62 in EBRT, 59 in RRP and 86 in NDT. Prostate cancer specific death: 117 patients, 43 in EBRT, 15 in RRP and 59 in the NDT. The 5-year, 10-year and 15 year overall survival (OS) and cancer specific survival (CSS) was significantly (p=<0.00001) increased after RRP. On multivariate analysis, year of diagnosis, race and grade significantly altered the outcome (p=0.0001). RRP resulted in significantly improved OS in all grades (p=0.0001) and improved CSS in mod. and poorly diff. cancer. (Table 2) CONCLUSIONS: RRP significantly improves the 5, 10 and 15-year survival in patients of less than 50 years with moderately differentiated and and especially in poorly differentiated prostate cancers and should be the recommended treatment of choice for patients who are less than 50 years of age.
Simon Conti*, Marc Dall’Era, Vincent Fradet, Janet E Cowan, Jeffery Simko, Peter R Carroll, San Francisco, CA
Prospective Active Surveillance Studies Institution
Study
Year of Pub
University of Toronto
Loblaw
Royal Marsden
Hardie
2005
Johns Hopkins
Carter
2007
University of California San Francisco
Dall’Era
2008
Memorial Sloan Kettering
Patel
2004
Table 1: Age, Race and histology in different treatment arms
Mean Age (years) Race
Histology
NDT (n=1032)
RRP (n=5282)
EBRT (n=592)
46.3±2.4
46.4±2.6
46.8±3.1
White (n=4977)
n=596
n=4021
n=360
Black (n=1528)
n=283
n=1049
n=196
Other (n=401) n=153 n=212 Well differntiated n=56 (5.42%) n=110 (2.8%) (n=182) Moderately differentiated n=778(75.38%) n=4012(75.95%) (n=5183) Poorly differentiated n=198 (19%) n=1160(21.97%) (n=1541)
n=36 n=16 (2.7%)
Inclusion Criteria
Gleason <= 3+4, PSA <= 15, stage T12006 T2, , <= 3 Biopsy cores +, <= 50% single core involvement Gleason <= 7, stage T1-T2, PSA <= 20 Gleason <= 6, no pattern 4 or 5 PSAD <= 0.15, stage T1, <= 2 Biopsy cores +, <= 50% single core involvement Gleason <= 6, PSA <= 10, stage T1-T2, <= 1/3 Biopsy cores +, <= 50% single core involvement Gleason <= 7, Stage T1-T2
n=393 (66.4%) n=183 (30.9%)
Table 2: Overall and cancer specific survival in different grades Survival (overall/ Cancer specific survival) Well differentiated
Moderately differntiated
Poorly Differentiated
5-year (OS/CSS) NDT (168 months*) RRP (144 months*) EBRT (144 months*) NDT (168 months*) RRP (204 months*) EBRT (180 months*) NDT (168 months*) RRP (192 months*) EBRT(192 months*)
10-year (OS/CSS)
15-year(OS/ CSS)
End of Follo-up (OS/CSS)
98.2%/100%
93%/100%
NA
93%/100%
99%/100%
94.3%/100%
NA
94.3%/100%
100%/100%
88.9%/100%
NA
88.9%/100%
93.3%/96.9% 85.9%/94.3%
NA
85.9%/94.3%
98.6%/99.8% 94.4%/99.6% 77.2%/99.6%
77.2%/99.6%
89.4%/94.1% 74.5%/83.7% 74.5%/83.1%
74.5%/83.1%
58.5%/64.4% 93.7%/97%
45.4%/50%
NA
45.4%/50%
86.2%/94.3% 86.2%/94.3%
86.2%/94.3%
67.2%/70.5% 60.2%/63.2% 60.2%/63.3%
60.2%/63.3%
*- median follow-up
Source of Funding: None
Source of Funding: National Institutes of Health Prostate Cancer Specialized Programs of Research Excellence (SPORE); Grant Number: 1P50CA089520-01, Vincent Fradet is supported by the McLaughlin Dean’s grant from Laval University