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MP-18.04: Impact of Seminal Vesicle Invasion on Oncological Outcome after Radical Prostatectomy
MODERATED POSTER SESSIONS
provement in hot flash and gynecomastia (P⬍0.05). But patients treated with CAD experience remaining in these symptoms after 5 months of androgen deprivation therapy (P0.05). Conclusions: IAD therapy is safe and feasible. It can minimize the negative effects of androgen deprivation therapy while maximize the clinical benefits and patients’ quality of life. The efficacy of IAD therapy prolonging the time to androgen independence is equal to CAD therapy at least. Accordingly, maybe IAD therapy is a better choice of androgen deprivation treatment for advanced prostate cancer. MP-18.04 Impact of Seminal Vesicle Invasion on Oncological Outcome after Radical Prostatectomy Hinev A1, Krasnaliev I2, Marinova L3, Kalev D4 1 Department of Surgery, Division of Urology, Varna Medical University, Varna, Bulgaria; 2Department of Pathology, Varna Medical University Varna, Bulgaria; 3Department of Radiology, Varna Medical University, Varna, Bulgaria; 4Department of Chemotherapy, Varna Medical University, Varna, Bulgaria Introduction and Objective: Seminal vesicle invasion (SVI) is generally considered as an adverse pathological feature in prostate cancer (PC). Our objectives were to estimate the impact of radical prostatectomy (RP) on disease-specific survival of patients with PC and SVI and to identify a subset of patients who might have a favorable oncological outcome. Materials and Methods: A total of 135 men with localized and locally advanced PC, who underwent RP by a single expert surgeon, were examined. Patients were stratified based on the presence or absence of SVI at the time of RP. The two groups were compared with regard to the functional and oncological outcome after surgery. Clinicopathological variables and outcome data were compared across the groups using chi-square and log-rank tests. Multivariate Cox proportional hazards analysis was used to determine the significant predictors of outcome among men with SVI. Results: The median follow-up in the entire series was 37 months (range 1 to 154). Of the 135 patients, 38 (28%) had histological evidence of SVI. Men with SVI had significantly higher initial PSA values, clinical stage and Gleason grade, and were more likely to have concomitant extracapsular extension, lymph node involvement and positive surgical margins. The Kaplan-
S132
Meier estimates of the disease-free, the overall and the cancer-specific survival at the 10th year after surgery were 71.3%, 70.6% and 87.8% for SV negative disease, and 35.9%, 54.7% and 59.7% for SV positive disease, respectively. Using multivariate analysis, the adjuvant radiotherapy applied (p ⫽ 0.004), the surgical margin status (p ⫽ 0.021) and the pathological Gleason score (p ⫽ 0.025), were found to be independent predictors of PSA failure among men with SVI. Patients with favorable combination of these prognostic variables had significantly longer disease-free (p ⬍ 0.001) and cancer-specific (p ⫽ 0.012) survival, close to those of men without SVI. Conclusions: SVI does not uniformly indicate poor prognosis after radical prostatectomy. Patients, who might benefit the most from complete surgical excision, are those with negative surgical margins and pathological Gleason score ⱕ 7, additionally treated by adjuvant radiotherapy. MP-18.05 Factors Affecting Femoral Bone Mineral Density in Japanese Prostate Cancer Under Maximum Androgen Deprivation Therapy Oh-Oka H Kobe Medical Center, Kobe, Japan Introduction and Objective: Androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) has many well recognized adverse events including flushing, fatigue, osteoporosis, etc. I retrospectively analyzed factors affecting bone mineral density (BMD). Materials and Methods: Fifty ADT treated PCa patients (age; 59.2-92.1 [median; 80.9] years, ADT duration; 2.0-100.0 [median; 41.0] months), whose PSA level was favorably controlled (⬍0.01-5.5ng/ ml), were enrolled in this study. BMD of femoral neck, as measured by dual-energy X-ray absorptometry [DXA], is considered the preferred site of assessment. The diagnosis of osteoporosis [OP] was made under condition of T-score less than 70% and apparent osteoporotic changes on plain X-rays. Factors affecting BMD were divided as follows and analyzed; Bone related factors (presence of compression fracture [comp. fx.], serum adjusted Ca, P, ALP, bone-specific alkaline phosphatase [BAP], C-telopeptide [CTX], urine N-telopeptide [NTx]), PCa related factors (Gleason’s total scoreduration of ADT, baseline PSA level), blood making factors (Hb, Fe), build/nourishment factors (serum albumin, age [alb], body mass index [BMI], height [Ht], weight [Wt]), renal
factors (serum uric acid [UA], blood urea nitrogen [BUN], creatinine [Cr]), liver/ lipid factors (asparate aminotransferase [AST], alanine aminotransferase [ALT], total cholesterol [T-chol], triglyceride [TG], high density lipoprotein [HDL], low density lipoprotein [LDL]). Results: Significant factors affecting BMD using the linear regression analysis of two variables was ALP (p⫽0.010, R2⫽0.111), BAP (p⫽0.013, R2⫽0.103), Fe(p⫽0.005, R2⫽0.135), Ht (p⫽0.016, R2⫽0.096, UA (p⫽0.050, R2⫽0.059), BUN (p⫽0.043, R2⫽0.063, and Cr (p⫽0.010, R2⫽0.111). PCa related factors and Liver/lipid factors had no significant relationship between BMD. A multiple regression analysis using above mentioned factors revealed significance between BMD (p⫽0.050, R2⫽0.343), significant coefficients were Fe (p⫽0.014) and TG (p⫽0.014). Conclusions: In this Japanese PCa population, ADT duration did not decrease BMD significantly. These results indicated better understanding of multifactorial pathological conditions prescribing BMD, including internal environment of a body and various extrinsic factors. MP-18.06 Factors Affecting Femoral Bone Mineral Density in Japanese Populations and Comparison with Prostate Cancer Patients Under Maximum Androgen Deprivation Therapy Oh-Oka H Kobe Medical Center, Kobe, Japan Introduction and Objective: We analyzed factors affecting femoral bone mineral density (BMD) in Japanese populations and compared BMD with patients with prostate cancer (PCa) under androgen deprivation therapy (ADT) retrospectively. Materials and Methods: Fifty no ADT treated (no PCa) male patients (age; 61.896.6 [median; 78.7] years, ADT duration; 2.0-100.0 [median; 41.0] months), were enrolled in this study. Their BMD was compared with 50 PCa patients under ADT. BMD of femoral neck, as measured by dual-energy X-ray absorptometry [DXA], is considered the preferred site of assessment. Factors affecting BMD were divided as follows and analyzed; Bone related factors (presence of compression fracture [comp. fx.], serum adjusted Ca, P, ALP, bone-specific alkaline phosphatase [BAP], C-telopeptide [CTX], urine N-telopeptide [NTx]), PCa related factors (Gleason’s total scoreduration of ADT, baseline PSA level), blood making factors
UROLOGY 74 (Supplment 4A), October 2009
provement in hot flash and gynecomastia (P⬍0.05). But patients treated with CAD experience remaining in these symptoms after 5 months of androgen deprivation therapy (P0.05). Conclusions: IAD therapy is safe and feasible. It can minimize the negative effects of androgen deprivation therapy while maximize the clinical benefits and patients’ quality of life. The efficacy of IAD therapy prolonging the time to androgen independence is equal to CAD therapy at least. Accordingly, maybe IAD therapy is a better choice of androgen deprivation treatment for advanced prostate cancer. MP-18.04 Impact of Seminal Vesicle Invasion on Oncological Outcome after Radical Prostatectomy Hinev A1, Krasnaliev I2, Marinova L3, Kalev D4 1 Department of Surgery, Division of Urology, Varna Medical University, Varna, Bulgaria; 2Department of Pathology, Varna Medical University Varna, Bulgaria; 3Department of Radiology, Varna Medical University, Varna, Bulgaria; 4Department of Chemotherapy, Varna Medical University, Varna, Bulgaria Introduction and Objective: Seminal vesicle invasion (SVI) is generally considered as an adverse pathological feature in prostate cancer (PC). Our objectives were to estimate the impact of radical prostatectomy (RP) on disease-specific survival of patients with PC and SVI and to identify a subset of patients who might have a favorable oncological outcome. Materials and Methods: A total of 135 men with localized and locally advanced PC, who underwent RP by a single expert surgeon, were examined. Patients were stratified based on the presence or absence of SVI at the time of RP. The two groups were compared with regard to the functional and oncological outcome after surgery. Clinicopathological variables and outcome data were compared across the groups using chi-square and log-rank tests. Multivariate Cox proportional hazards analysis was used to determine the significant predictors of outcome among men with SVI. Results: The median follow-up in the entire series was 37 months (range 1 to 154). Of the 135 patients, 38 (28%) had histological evidence of SVI. Men with SVI had significantly higher initial PSA values, clinical stage and Gleason grade, and were more likely to have concomitant extracapsular extension, lymph node involvement and positive surgical margins. The Kaplan-
S132
Meier estimates of the disease-free, the overall and the cancer-specific survival at the 10th year after surgery were 71.3%, 70.6% and 87.8% for SV negative disease, and 35.9%, 54.7% and 59.7% for SV positive disease, respectively. Using multivariate analysis, the adjuvant radiotherapy applied (p ⫽ 0.004), the surgical margin status (p ⫽ 0.021) and the pathological Gleason score (p ⫽ 0.025), were found to be independent predictors of PSA failure among men with SVI. Patients with favorable combination of these prognostic variables had significantly longer disease-free (p ⬍ 0.001) and cancer-specific (p ⫽ 0.012) survival, close to those of men without SVI. Conclusions: SVI does not uniformly indicate poor prognosis after radical prostatectomy. Patients, who might benefit the most from complete surgical excision, are those with negative surgical margins and pathological Gleason score ⱕ 7, additionally treated by adjuvant radiotherapy. MP-18.05 Factors Affecting Femoral Bone Mineral Density in Japanese Prostate Cancer Under Maximum Androgen Deprivation Therapy Oh-Oka H Kobe Medical Center, Kobe, Japan Introduction and Objective: Androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) has many well recognized adverse events including flushing, fatigue, osteoporosis, etc. I retrospectively analyzed factors affecting bone mineral density (BMD). Materials and Methods: Fifty ADT treated PCa patients (age; 59.2-92.1 [median; 80.9] years, ADT duration; 2.0-100.0 [median; 41.0] months), whose PSA level was favorably controlled (⬍0.01-5.5ng/ ml), were enrolled in this study. BMD of femoral neck, as measured by dual-energy X-ray absorptometry [DXA], is considered the preferred site of assessment. The diagnosis of osteoporosis [OP] was made under condition of T-score less than 70% and apparent osteoporotic changes on plain X-rays. Factors affecting BMD were divided as follows and analyzed; Bone related factors (presence of compression fracture [comp. fx.], serum adjusted Ca, P, ALP, bone-specific alkaline phosphatase [BAP], C-telopeptide [CTX], urine N-telopeptide [NTx]), PCa related factors (Gleason’s total scoreduration of ADT, baseline PSA level), blood making factors (Hb, Fe), build/nourishment factors (serum albumin, age [alb], body mass index [BMI], height [Ht], weight [Wt]), renal
factors (serum uric acid [UA], blood urea nitrogen [BUN], creatinine [Cr]), liver/ lipid factors (asparate aminotransferase [AST], alanine aminotransferase [ALT], total cholesterol [T-chol], triglyceride [TG], high density lipoprotein [HDL], low density lipoprotein [LDL]). Results: Significant factors affecting BMD using the linear regression analysis of two variables was ALP (p⫽0.010, R2⫽0.111), BAP (p⫽0.013, R2⫽0.103), Fe(p⫽0.005, R2⫽0.135), Ht (p⫽0.016, R2⫽0.096, UA (p⫽0.050, R2⫽0.059), BUN (p⫽0.043, R2⫽0.063, and Cr (p⫽0.010, R2⫽0.111). PCa related factors and Liver/lipid factors had no significant relationship between BMD. A multiple regression analysis using above mentioned factors revealed significance between BMD (p⫽0.050, R2⫽0.343), significant coefficients were Fe (p⫽0.014) and TG (p⫽0.014). Conclusions: In this Japanese PCa population, ADT duration did not decrease BMD significantly. These results indicated better understanding of multifactorial pathological conditions prescribing BMD, including internal environment of a body and various extrinsic factors. MP-18.06 Factors Affecting Femoral Bone Mineral Density in Japanese Populations and Comparison with Prostate Cancer Patients Under Maximum Androgen Deprivation Therapy Oh-Oka H Kobe Medical Center, Kobe, Japan Introduction and Objective: We analyzed factors affecting femoral bone mineral density (BMD) in Japanese populations and compared BMD with patients with prostate cancer (PCa) under androgen deprivation therapy (ADT) retrospectively. Materials and Methods: Fifty no ADT treated (no PCa) male patients (age; 61.896.6 [median; 78.7] years, ADT duration; 2.0-100.0 [median; 41.0] months), were enrolled in this study. Their BMD was compared with 50 PCa patients under ADT. BMD of femoral neck, as measured by dual-energy X-ray absorptometry [DXA], is considered the preferred site of assessment. Factors affecting BMD were divided as follows and analyzed; Bone related factors (presence of compression fracture [comp. fx.], serum adjusted Ca, P, ALP, bone-specific alkaline phosphatase [BAP], C-telopeptide [CTX], urine N-telopeptide [NTx]), PCa related factors (Gleason’s total scoreduration of ADT, baseline PSA level), blood making factors
UROLOGY 74 (Supplment 4A), October 2009