MP53-03 MULTIPARAMETRIC MRI IMPROVES PREDICTIVE ACCURACY OF CLINICAL NOMOGRAMS FOR EXTRACAPSULAR EXTENSION OF PROSTATE CANCER

THE JOURNAL OF UROLOGYâ

Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015

CONCLUSIONS: Vitamin D restriction during peri and postnatal periods impairs metabolic parameters in adulthood. Moreover, it contributed to penile morphological changes in offspring, mainly with lower area of tunica albuginea and density of smooth muscle. These data may suggest that vitamin D is an important micronutrient for maintaining the cytoarchitecture that is necessary for penile erection. Source of Funding: Capes, CNPq and Faperj

Prostate Cancer: Staging I Moderated Poster 53 Sunday, May 17, 2015

1:00 PM-3:00 PM

MP53-01 THE RELATIONSHIP OF OBESITY, PATHOLOGIC GLEASON GRADE AND PROSTATE CANCER TUMOR VOLUME AT THE TIME OF RADICAL PROSTATECTOMYdRESULTS FROM THE SEARCH DATABASE Zachary Klaassen*, Augusta, GA; Lauren E. Howard, Durham, NC; Martha K. Terris, Augusta, GA; William J. Aronson, Los Angeles, CA; Matthew R. Cooperberg, San Francisco, CA; Christopher L. Amling, Portland, OR; Christopher J. Kane, San Diego, CA; Stephen J. Freedland, Durham, NC INTRODUCTION AND OBJECTIVES: Obesity has been associated with increased risk of prostate specific antigen (PSA) recurrence after radical prostatectomy (RP) and increased risk of prostate cancer (PCa) death. Whether poorer outcomes are entirely secondary to surgical technical challenges associated with obesity resulting in increased risk of positive margins, or due to an underlying aggressive PCa biology has not been completed elucidated. Thus, the objective of this study was to assess the relationship of obesity and objective measures of disease aggressiveness such as pathologic Gleason score and tumor volume (TV) in a multi
center, equal access cohort of patients. METHODS: We retrospectively analyzed 3721 men from the SEARCH database who underwent RP from 1990 to 2013. Body mass index (BMI) groups were defined as: normal weight (<25kg/m2), overweight (25 to <30kg/m2), mildly obese (30 to <35kg/m2) and moderately þ severely obese (35kg/m2). The association between BMI and pathologic Gleason sum (7 vs 6) was examined using logistic regression, adjusted for age, race, surgery year, PSA, and pathologic features. Logistic regression was also used to assess the association between BMI and other pathologic features (positive margins, extracapsular extension and seminal vesicle invasion), adjusted for age, race, surgery year, PSA, and biopsy Gleason. Adjusted mean and 95% confidence intervals of TV stratified by BMI were calculated from linear regression models. RESULTS: There were 845 (23%) normal weight, 1,686 (45%) overweight, 869 (23%) mildly obese, and 321 (9%) moderately þ severely obese patients. Patients with increasing BMI had a lower median serum PSA (p<0.001), and worse biopsy (p¼0.001) and pathologic (p¼0.02) Gleason disease. There was no difference in median TV (p¼0.55) between the BMI groups on adjusted analysis. Moderately þ severely obese patients (OR 1.47, 95%CI 1.06
2.05, p¼0.02) were more likely to have pathologic Gleason 7 disease compared to normal weight patients (p
trend 0.02). BMI was not associated with positive margins (p
trend 0.07), extracapsular extension (p
trend 0.32), or seminal vesicle invasion (p
trend 0.22). After adjusting for baseline differences, we found that as BMI increased, adjusted mean TV increased (p
trend 0.02). CONCLUSIONS: In this study of men undergoing RP at multiple equal access centers, obesity was associated with higher grade Gleason score and larger tumors. These results suggest that all else being equal, obese men may have biologically more aggressive tumors. Source of Funding: None

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MP53-02 IS CLINICAL STAGE T2C PROSTATE CANCER INTERMEDIATE OR HIGH-RISK DISEASE? Zachary Klaassen*, Augusta, GA; Abhay A. Singh, Lauren E. Howard, Durham, NC; Zhaoyong Feng, Bruce Trock, Baltimore, MD; Martha K. Terris, Augusta, GA; William J. Aronson, Los Angeles, CA; Matthew R. Cooperberg, San Francisco, CA; Christopher L. Amling, Portland, OR; Christopher J. Kane, San Diego, CA; Alan Partin, Misop Han, Baltimore, MD; Stephen J. Freedland, Durham, NC INTRODUCTION AND OBJECTIVES: Clinical stage T2c (cT2c) is an indeterminate factor in the algorithm for prostate cancer (PC) risk stratification. According to D’Amico risk grouping and AUA guidelines, cT2c is high-risk, whereas NCCN and EAU classify cT2c as intermediate-risk. The objective of the study was to assess whether cT2c tumors, without other associated high-risk factors (cT2c not otherwise specified (cT2c-nos)), behave as intermediate or high-risk by analyzing biochemical recurrence (BCR) after radical prostatectomy (RP). METHODS: We retrospectively analyzed 2,759 men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database, and 12,900 men from Johns Hopkins Hospital (JHH) from 1988-2011 and 1982-2012, respectively. Comparisons in time to BCR between cT2c-nos and intermediate-risk, and high-risk patients were performed using log-rank test and Cox proportional analyses. RESULTS: A total of 99 men (4%) from SEARCH and 202 (2%) from JHH were cT2c-nos. Patients with cT2c-nos had similar BCR risk as intermediate-risk (SEARCH p¼0.27; JHH p¼0.23), but significantly lower BCR risk vs. high-risk men (SEARCH p<0.001; JHH p<0.001). When specifically compared to intermediate and high-risk patients, and after adjusting for year and center, cT2c-nos patients had outcomes comparable to intermediate-risk (SEARCH p¼0.44; JHH p¼0.53), but significantly better than high-risk patients (SEARCH p¼0.001; JHH p<0.001). CONCLUSIONS: BCR risk for patients with cT2c disease without other high-risk features was comparable to men with intermediate-risk and significantly better than men with high-risk PC. These findings suggest men with cT2c PC should be offered treatment options for intermediate-risk PC. Source of Funding: None

MP53-03 MULTIPARAMETRIC MRI IMPROVES PREDICTIVE ACCURACY OF CLINICAL NOMOGRAMS FOR EXTRACAPSULAR EXTENSION OF PROSTATE CANCER Tom Feng*, Ali Afshar, Los Angeles, CA; Steven Smith, Richmond, VA; Jonathan Wu, Daniel Luthringer, Rola Saouaf, Hyung Kim, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Multiparametric magnetic resonance imaging (MP-MRI) is useful in detecting extracapsular extension (ECE) of prostate cancer. We compare its predictive accuracy with the Partin tables (PT) and the Memorial Sloan-Kettering prostate cancer nomogram (MN) for estimating ECE risk. METHODS: A retrospective review of 112 patients who underwent 3T MP-MRI of the prostate and radical prostatectomy was performed. Images were reported as negative or suspicious for ECE by single expert radiologist. Radical prostatectomy specimens were reviewed to confirm size and location of ECE. PT and MN were used to estimate risk of ECE. Regression analyses were performed to identify predictors of ECE as well as to create models predicting ECE using PT, MN, and MP-MRI. Area under the curve (AUC) was calculated for each model. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MP-MRI were determined in all patients as well as in patient subsets determined using PT or MN. RESULTS: A total of 33 of patients (29%) had ECE on MP-MRI while 27 patients (24%) had ECE on final pathology. Mean age was 62.8 years and mean PSA was 8.2. Most patients (95%) were clinical stage T1c or T2a. On multivariate analysis, MRI was a significant predictor of ECE that was independent of PSA, Gleason score, and clinical

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stage. MRI had the highest odds ratio of 26.8 (p<0.001) for predicting ECE as compared to Gleason score (OR 2.63, p¼0.003) and PSA (OR 2.9, p¼0.014), while clinical stage was not an independent predictor of ECE (p¼0.969). AUC for PT and MN were comparable at 0.85 and 0.86, respectively. AUC increased to 0.92 and 0.94, respectively, when MP-MRI was added to PT and MN. Sensitivity, specificity, PPV, and NPV of MP-MRI for ECE were 72.7, 90.6, 57.1, and 95.1%, respectively (Table). Sensitivity and PPV improved to 84 and 75%, respectively, in the subset of patients with greater than 25% ECE-risk based on PT. Similarly, sensitivity and PPV was 85 and 77%, respectively, in the analogous subset identified using MN. CONCLUSIONS: MP-MRI may be a useful adjunct for clinically staging prostate cancer. MP-MRI was a significant predictor of ECE even when controlling for PSA, Gleason score, and clinical stage. MRI had a greater PPV when used in a subset of men with greater than 25% chance of ECE based on clinical nomograms.

Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015

CONCLUSIONS: Single institution studies that recommend more stringent AS enrollment criteria for AA men do not capture the complete oncologic landscape due to institutional and regional variability in cancer outcomes. Since seven of the eight institutions demonstrated no significant racial disparity, the current active surveillance should not be modified on the basis of race until a prospective study has been completed. Multivariate logistic regression results with surgical pathology outcomes (all NCCN modified low-risk patients) of 2763 (2214 WA, 549 AA) men managed at Eight Tertiary Care Institutions Odds Ratio

Std Error

Race: WA vs AA

1.06

0.13

Age, years

1.03

.01

BMI

1.03

.01

PSA at diagnosis, ng/ml

1.14

Year of Surgery Biopsy Cores: Single vs Multiple

Upgrade

Max % Cancer/Core Upstage

Source of Funding: none

Pvalue

95% CI:Lower

95% CI: Upper

.62

.84

1.34

< .01

1.01

1.04

< .01

1.01

1.06

.03

< .01

1.08

1.19

1.09

.02

< .01

1.05

1.13

1.55

.15

< .01

1.28

1.87

1.01

.01

.11

1

1.02

Odds Ratio

Std Error

Pvalue

95% CI:Lower

95% CI: Upper

Race: WA vs AA

1.09

.21

.65

.75

1.6

Age, years

1.03

.01

.03

1.0

1.06

BMI

1.05

.02

< .01

1.02

1.09

PSA at diagnosis, ng/ml

1.16

.05

< .01

1.08

1.25

Year of Surgery

0.92

.03

< .01

.87

.98

Biopsy Cores: Single vs Multiple

1.43

.24

.03

1.04

1.98

1.01

.01

.03

1.0

1.02

Odds Ratio

Std Error

Pvale

95% CI: Lower

95% CI: Upper

Max % Cancer/Core Positive Surgical Margins Race: WA vs AA

1.27

.21

.15

.92

1.74

MP53-04

Age, years

1.0

.01

.7

.98

1.02

SIGNIFICANT INTER-INSTITUTIONAL VARIATIONS IN RACIAL DISPARITIES AMONG AFRICAN-AMERICAN MEN ELIGIBLE FOR PROSTATE CANCER ACTIVE SURVEILLANCE

BMI

1.04

.02

.02

1.0

1.07

PSA at diagnosis, ng/ml

1.13

.04

< .01

1.05

1.2

Year of Surgery

0.95

.03

.07

.9

1.0

Biopsy Cores: Single vs Multiple

1.14

.16

.35

.86

1.52

Michael Dinizo*, Weichung Shih, Amirali Salmasi, Izak Faiena, Parth Modi, New Brunswick, NJ; Misop Han, Alan W. Partin, Baltimore, MD; Daniel Eun, Adam Reese, Elton Llukani, Laura Giosto, Sean Wessel, Edourad Trabulsi, Costas Lallas, Philadelphia, PA; Bertram Yuh, Timothy Wilson, Duarte, CA; Daniel Marchalik, Jonathan Hwang, Washington, DC; Shilajit Kundu, William Catalona, Drew Flum, Scott Eggener, Edris Negron, Chicago, IL; Isaac Yi Kim, New Brunswick NJ, NJ INTRODUCTION AND OBJECTIVES: Active Surveillance (AS) is a standard management option for men with low risk prostate cancer (PCa). Conflicting data exists as to the generalizability of current AS protocols for both African-American (AA) and White-American (WA) men. This study aims to clarify the feasibility of lowering the AS enrollment criteria for AA men with localized PCa and assess the impact of racial disparity in current AS protocols. METHODS: A retrospective analysis of prospectively collected clinical, pathologic and oncologic outcomes from eight institutions. AA and WA men were compared in order to assess potential racial disparities in PCa AS. RESULTS: In this study, 549 AA and 2214 WA men met AS eligibility criteria. When pathologic data from all institutions was combined, AA men were shown to have a higher rate of biochemical recurrence (4.53% v 2.01%; p<0.01) and positive surgical margin status (14.73% v 11.39%;p¼0.03). There was no significant difference in the rate of Gleason upgrading or cancer upstaging between races on chi2 analysis. However, when each institution was analyzed individually, one institution had statistically significant differences in rates of Gleason upgrading (31.48% v 15.8%;p<0.01), positive surgical margin status (14.81% v 7.22%; p<0.01), and biochemical recurrence (7.02 v 0.69%; p<0.01) between AA and WA men. When the data from this lone institution was removed, racial disparity was no longer observed. On multivariate analysis, AA race was not found to be a significant predictor of upgrading (OR¼1.09, p¼0.13), upstaging (OR¼1.09, p¼0.21), or positive surgical margin status (OR¼1.27, p¼0.21) when controlling for clinical characteristics.

Max % Cancer/Core

1.01

.01

.02

1.0

1.03

Odds Ratio

Std Error

Pvalue

95% CI: Lower

95% CI: Upper

Race: WA vs AA

3.07

1.01

< .01

1.61

5.86

Age, years

1.04

.02

.11

.99

1.08

Biochemical Recurrence

BMI

1.01

.04

.86

.94

1.08

PSA at diagnosis, ng/ml

1.14

.08

.08

.98

1.32

Year of Surgery

1.3

.1

< .01

1.12

1.51

Biopsy Cores: Single vs Multiple

1.25

.39

.47

.68

2.31

1

.01

.81

.97

1.02

Max % Cancer/Core

Source of Funding: Herbert Brendler, MD Summer Medical Student Award