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MP42-13 RISK STRATIFICATION AMONG MEN UNDERGOING RADICAL PROSTATECTOMY FOR HIGH-RISK PROSTATE CANCER IN U.S. COHORT: AN EMPACT STUDY
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Sunday, May 18, 2014
RESULTS: Between 1998 and 2011, there was two-fold increase in the proportion of low-risk prostate cancer from 14% to 28%. The figure shows changes in tumor features within the low-risk group over time. The proportion of men with T1c tumors increased two-fold from 36% to 71%; whereas, T2 tumors decreased from 39% to 20%. PSA levels between 4-6 ng/ml increased from 24 to 38%; and PSA levels of 8-10 decreased from 24% to 15%. The use of Gleason scores 2-5 declined steadily over the study period such that virtually all low-risk cancers were classified as Gleason 6 by 2011. Finally, the proportion of men with <25% of positive cores increased from 41% to 52% between 2003-2006 and 2007-2011. CONCLUSIONS: Men with low-risk prostate cancer in the contemporary era are more likely to have T1c disease, have lower PSA levels and substantially lower tumor volume compared to “low-risk” men diagnosed 15 years ago. Our data indicate that outcomes in studies that recruited cases in previous decades represent “worst case scenarios.”
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p¼0.0008) compared to good as baseline. The C-statistic for the EMPaCT subgrouping was 0.57. Significant differences in presence of nodal disease, positive surgical margins, and seminal vesicles invasion between groups were noted (p<0.0001). CONCLUSIONS: The EMPaCT prognostic high-risk prostate cancer subgroups were applied to a U.S cohort and compared with others and performed stratification although not ideally. A diagnosis of high risk prostate cancer treated by radical prostatectomy is not uniformly associated with poor prognosis and there is an opportunity to better risk-stratify these men with novel methods such as biomarkers or other preoperative risk factors.
Source of Funding: Funding was provided from The Swedish Research Council 825-2012-5047 and The €sterbotten County Swedish Cancer Foundation 11 0471, Va Council and Lion’s Cancer Research Foundation at Umeå University. SL is supported by the Louis Feil Charitable Lead Trust and the National Institutes of Health under Award Number K07CA178258. The content is solely the responsibility of the authors and does not represent the official views of the NIH.
MP42-13 RISK STRATIFICATION AMONG MEN UNDERGOING RADICAL PROSTATECTOMY FOR HIGH-RISK PROSTATE CANCER IN U.S. COHORT: AN EMPACT STUDY Dharam Kaushik*, Christopher Murphy, Rochester, MN; Alberto Briganti, Milan, Italy; Paolo Gontero, Turin, Italy; Martin Spahn, Wurzburg, Germany; Steven Joniau, Leuven, Belgium; R. Jeffrey Karnes, Rochester, MN INTRODUCTION AND OBJECTIVES: We utilized the EMPaCT scoring system for high-risk prostate cancer and then applied it to a series of men treated with radical prostatectomy at a single center in the United States for its validation. METHODS: We reviewed 1,247 patients who underwent radical prostatectomy for high-risk prostate cancer at a single center (Mayo Clinic). Patients were stratified into EMPaCT prognostic subgroups: good (single risk factor), intermediate (PSA>20ng/ml and cT3), or poor (Gleason score 8-10 with at least one other risk factor). Pearson’s chi square test was used to estimate differences between the subgroups. Survival was estimated using the Kaplan-Meier method and compared with log rank test. Multivariate analysis was performed for systemic progression and prostate cancer-specific mortality. RESULTS: Median follow-up was 11.7 years. After substratification, 79.1% (987/1,247) were in the good, 7.5% (94/1,247) in the intermediate, and 13.3% (166/1,247) in the poor subgroup. There was no difference in overall survival (p¼0.08); however, biochemical failure, systemic progression, and prostate cancer-specific mortality were all significantly different (p<0.001) between each subgroups (Figures). The 10-year cancer-specific survival for the good, intermediate, and poor subgroups was 94%, 88%, and 86% respectively (p<0.001). The prostate cancer death (n¼129) HR (95% CI) for intermediate group was 1.90 (1.12-3.20; p¼0.015) and for poor was 2.09 (1.35-3.23;
Source of Funding: None
MP42-14 SMOKING ASSOCIATED WITH HIGHER RISK OF PATHOLOGIC UPGRADING IN HISPANIC MEN WITH LOWeRISK PROSTATE CANCER WHO UNDERGO SURGERY: IMPLICATIONS FOR BRACHYTHERAPY AND ACTIVE SURVEILLANCE Silva*, He ctor Lo pez-Huertas, Ronald Cadillo-Cha vez, Jose nchez-Ortiz, San Juan, PR Ricardo Sa INTRODUCTION AND OBJECTIVES: In contrast to Mexican American Hispanics, the Puerto Rican community has a greater West African genetic admixture, a group with a higher risk of adverse prostate cancer. Using a prostatectomy series, we evaluated the risk of pathologic upgrading or upstaging in Puerto Rican men with lowrisk disease who could have otherwise been candidates for brachytherapy or active surveillance. METHODS: Of 453 consecutive patients who underwent robotic prostatectomy (RP) by a single surgeon, 188 patients were identified with the following criteria: PSA 10 ng/ml, Gleason score 6 (3+3) on biopsy, < 50% positive cores, and cT2a or less. All outside slides were centrally
Vol. 191, No. 4S, Supplement, Sunday, May 18, 2014
RESULTS: Between 1998 and 2011, there was two-fold increase in the proportion of low-risk prostate cancer from 14% to 28%. The figure shows changes in tumor features within the low-risk group over time. The proportion of men with T1c tumors increased two-fold from 36% to 71%; whereas, T2 tumors decreased from 39% to 20%. PSA levels between 4-6 ng/ml increased from 24 to 38%; and PSA levels of 8-10 decreased from 24% to 15%. The use of Gleason scores 2-5 declined steadily over the study period such that virtually all low-risk cancers were classified as Gleason 6 by 2011. Finally, the proportion of men with <25% of positive cores increased from 41% to 52% between 2003-2006 and 2007-2011. CONCLUSIONS: Men with low-risk prostate cancer in the contemporary era are more likely to have T1c disease, have lower PSA levels and substantially lower tumor volume compared to “low-risk” men diagnosed 15 years ago. Our data indicate that outcomes in studies that recruited cases in previous decades represent “worst case scenarios.”
e473
p¼0.0008) compared to good as baseline. The C-statistic for the EMPaCT subgrouping was 0.57. Significant differences in presence of nodal disease, positive surgical margins, and seminal vesicles invasion between groups were noted (p<0.0001). CONCLUSIONS: The EMPaCT prognostic high-risk prostate cancer subgroups were applied to a U.S cohort and compared with others and performed stratification although not ideally. A diagnosis of high risk prostate cancer treated by radical prostatectomy is not uniformly associated with poor prognosis and there is an opportunity to better risk-stratify these men with novel methods such as biomarkers or other preoperative risk factors.
Source of Funding: Funding was provided from The Swedish Research Council 825-2012-5047 and The €sterbotten County Swedish Cancer Foundation 11 0471, Va Council and Lion’s Cancer Research Foundation at Umeå University. SL is supported by the Louis Feil Charitable Lead Trust and the National Institutes of Health under Award Number K07CA178258. The content is solely the responsibility of the authors and does not represent the official views of the NIH.
MP42-13 RISK STRATIFICATION AMONG MEN UNDERGOING RADICAL PROSTATECTOMY FOR HIGH-RISK PROSTATE CANCER IN U.S. COHORT: AN EMPACT STUDY Dharam Kaushik*, Christopher Murphy, Rochester, MN; Alberto Briganti, Milan, Italy; Paolo Gontero, Turin, Italy; Martin Spahn, Wurzburg, Germany; Steven Joniau, Leuven, Belgium; R. Jeffrey Karnes, Rochester, MN INTRODUCTION AND OBJECTIVES: We utilized the EMPaCT scoring system for high-risk prostate cancer and then applied it to a series of men treated with radical prostatectomy at a single center in the United States for its validation. METHODS: We reviewed 1,247 patients who underwent radical prostatectomy for high-risk prostate cancer at a single center (Mayo Clinic). Patients were stratified into EMPaCT prognostic subgroups: good (single risk factor), intermediate (PSA>20ng/ml and cT3), or poor (Gleason score 8-10 with at least one other risk factor). Pearson’s chi square test was used to estimate differences between the subgroups. Survival was estimated using the Kaplan-Meier method and compared with log rank test. Multivariate analysis was performed for systemic progression and prostate cancer-specific mortality. RESULTS: Median follow-up was 11.7 years. After substratification, 79.1% (987/1,247) were in the good, 7.5% (94/1,247) in the intermediate, and 13.3% (166/1,247) in the poor subgroup. There was no difference in overall survival (p¼0.08); however, biochemical failure, systemic progression, and prostate cancer-specific mortality were all significantly different (p<0.001) between each subgroups (Figures). The 10-year cancer-specific survival for the good, intermediate, and poor subgroups was 94%, 88%, and 86% respectively (p<0.001). The prostate cancer death (n¼129) HR (95% CI) for intermediate group was 1.90 (1.12-3.20; p¼0.015) and for poor was 2.09 (1.35-3.23;
Source of Funding: None
MP42-14 SMOKING ASSOCIATED WITH HIGHER RISK OF PATHOLOGIC UPGRADING IN HISPANIC MEN WITH LOWeRISK PROSTATE CANCER WHO UNDERGO SURGERY: IMPLICATIONS FOR BRACHYTHERAPY AND ACTIVE SURVEILLANCE Silva*, He ctor Lo pez-Huertas, Ronald Cadillo-Cha vez, Jose nchez-Ortiz, San Juan, PR Ricardo Sa INTRODUCTION AND OBJECTIVES: In contrast to Mexican American Hispanics, the Puerto Rican community has a greater West African genetic admixture, a group with a higher risk of adverse prostate cancer. Using a prostatectomy series, we evaluated the risk of pathologic upgrading or upstaging in Puerto Rican men with lowrisk disease who could have otherwise been candidates for brachytherapy or active surveillance. METHODS: Of 453 consecutive patients who underwent robotic prostatectomy (RP) by a single surgeon, 188 patients were identified with the following criteria: PSA 10 ng/ml, Gleason score 6 (3+3) on biopsy, < 50% positive cores, and cT2a or less. All outside slides were centrally