- Email: [email protected]
EDIC
THE JOURNAL OF UROLOGYâ
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RESULTS: Patients median age was 63.4 years (46-75) and median PSA at diagnosis was 7.02 ng/mL (0.9-29.7). Gleason score was 6 in 269 of the cases (50.7%) and 7 in 261 (49.2%). Median percentage of cores involved was 29.7% (3-100) and PNI was observed in 99 of the cases (18.7%). 439 of the tumours were diagnosed only by PSA (82.8%) while the other 91 were palpable or visible with ultrasonography (17.1%). Following d’Amico criteria 240 of the patients were classified as low risk (45.3%) and 290 as intermediate or high risk (54.7%). Prostate specimen analysis showed that 324 of the cases were localized tumours (61.6%) while 206 were locally advanced (38.8%). Gleason score was 6 in 197 of the cases (37.1%) and Gleason 7 in 333 (62.8%). Seminal vesicles invasion was observed in 20 patients (3.8%) and positive margins in 127 cases (24%). With a median follow up of 30 months (1-90) biochemical recurrence was observed in 51 of the patients (9.6%). Univariate analysis showed that PNI in prostate biopsy was the preoperative feature most strongly associated with extraprostatic extension (OR 8.28, p< 0.001), with the presence of positive margins (OR 3.18, p< 0.001) and with the presence of biochemical recurrence (OR 4.23, p< 0.001), and was the second feature most strongly associated with the invasion of the seminal vesicles (OR 7.35, p< 0.001) after PSA>10 ng/mL at diagnosis (OR 8.08, p<0.001). All of these associations maintained statistical significance in multivariate analysis. CONCLUSIONS: The presence of PNI in prostate biopsy is an independent risk factor of extraprostatic extension, seminal vesicles invasion, presence of positive margins after radical prostatectomy and biochemical failure during follow-up. Its determination may be useful in making clinical decisions and planning the treatment of the patients.
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
and Complication (EDIC) study, the observational follow up of participants of the Diabetes Control and Complications Trial (DCCT). Data on serum creatinine , age, sex and race were used to calculate the estimated GFR with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. An impaired GFR was defined as GFR<60 ml per minute per 1.73m2. The Wilcoxon rank-sum test was used to evaluate differences in PSA by impaired GFR status. A linear regression model was used to assess the relationship between PSA levels and GFR status after adjustment for age, DCCT/ EDIC weighted mean HbA1c, randomization arm, cohort and body mass index (BMI). RESULTS: The 639 DCCT/EDIC male subjects had a mean age of 52 years and mean PSA level of 0.92. Mean PSA levels were higher in men with impaired eGFR compared to men with normal GFR (1.12 ng/mL vs. 0.91 ng/mL, p¼0.13). The difference between impaired and normal eGFR groups was greater (0.33 ng/mL, p¼0.02) after adjustment for age, HbA1c levels, DCCT randomization arm, cohort and BMI (Figure). CONCLUSIONS: PSA increases in men with impaired GFR in type 1 DM. This relationship has potential implications for the use of the PSA test in men with renal disease. Further investigation is needed to determine the effect this finding may have on prostate cancer detection in men with impaired GFR.
Source of Funding: none
MP74-20 ASSOCIATION BETWEEN ESTIMATED GLOMERULAR FILTRATION RATE AND PROSTATE-SPECIFIC ANTIGEN IN MEN WITH TYPE 1 DIABETES: FINDINGS FROM THE DCCT/EDIC Aruna Sarma*, Ann Arbor, MI; James Hotaling, Salt Lake City, UT; Barbara Braffett, Patricia Cleary, Rockville, MD; Rodney Dunn, Ann Arbor, MI; Alan Jacobson, Mineola, NY; Hunter Wessells, Seattle, WA; and theDCCT/EDIC Research GroupRockville, MD INTRODUCTION AND OBJECTIVES: Serum prostate-specific antigen (PSA) concentration has been a controversial screening test for prostate cancer because of low specificity of the test and the lack of conclusive impact on prostate cancer mortality. Recently, studies have demonstrated that diminished renal function was significantly associated with increased PSA concentrations. However, data in men with type 1 diabetes [T1DM] is lacking. The objective of this study was to determine the relationship between glomerular filtration rate (GFR) and PSA concentrations in men with T1DM. METHODS: Total PSA concentrations were measured in men during Year 17 of the Epidemiology of Diabetes Interventions
Source of Funding: National Institute of Diabetes and Digestive and Kidney Diseases, DK083927-01
e864
RESULTS: Patients median age was 63.4 years (46-75) and median PSA at diagnosis was 7.02 ng/mL (0.9-29.7). Gleason score was 6 in 269 of the cases (50.7%) and 7 in 261 (49.2%). Median percentage of cores involved was 29.7% (3-100) and PNI was observed in 99 of the cases (18.7%). 439 of the tumours were diagnosed only by PSA (82.8%) while the other 91 were palpable or visible with ultrasonography (17.1%). Following d’Amico criteria 240 of the patients were classified as low risk (45.3%) and 290 as intermediate or high risk (54.7%). Prostate specimen analysis showed that 324 of the cases were localized tumours (61.6%) while 206 were locally advanced (38.8%). Gleason score was 6 in 197 of the cases (37.1%) and Gleason 7 in 333 (62.8%). Seminal vesicles invasion was observed in 20 patients (3.8%) and positive margins in 127 cases (24%). With a median follow up of 30 months (1-90) biochemical recurrence was observed in 51 of the patients (9.6%). Univariate analysis showed that PNI in prostate biopsy was the preoperative feature most strongly associated with extraprostatic extension (OR 8.28, p< 0.001), with the presence of positive margins (OR 3.18, p< 0.001) and with the presence of biochemical recurrence (OR 4.23, p< 0.001), and was the second feature most strongly associated with the invasion of the seminal vesicles (OR 7.35, p< 0.001) after PSA>10 ng/mL at diagnosis (OR 8.08, p<0.001). All of these associations maintained statistical significance in multivariate analysis. CONCLUSIONS: The presence of PNI in prostate biopsy is an independent risk factor of extraprostatic extension, seminal vesicles invasion, presence of positive margins after radical prostatectomy and biochemical failure during follow-up. Its determination may be useful in making clinical decisions and planning the treatment of the patients.
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
and Complication (EDIC) study, the observational follow up of participants of the Diabetes Control and Complications Trial (DCCT). Data on serum creatinine , age, sex and race were used to calculate the estimated GFR with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. An impaired GFR was defined as GFR<60 ml per minute per 1.73m2. The Wilcoxon rank-sum test was used to evaluate differences in PSA by impaired GFR status. A linear regression model was used to assess the relationship between PSA levels and GFR status after adjustment for age, DCCT/ EDIC weighted mean HbA1c, randomization arm, cohort and body mass index (BMI). RESULTS: The 639 DCCT/EDIC male subjects had a mean age of 52 years and mean PSA level of 0.92. Mean PSA levels were higher in men with impaired eGFR compared to men with normal GFR (1.12 ng/mL vs. 0.91 ng/mL, p¼0.13). The difference between impaired and normal eGFR groups was greater (0.33 ng/mL, p¼0.02) after adjustment for age, HbA1c levels, DCCT randomization arm, cohort and BMI (Figure). CONCLUSIONS: PSA increases in men with impaired GFR in type 1 DM. This relationship has potential implications for the use of the PSA test in men with renal disease. Further investigation is needed to determine the effect this finding may have on prostate cancer detection in men with impaired GFR.
Source of Funding: none
MP74-20 ASSOCIATION BETWEEN ESTIMATED GLOMERULAR FILTRATION RATE AND PROSTATE-SPECIFIC ANTIGEN IN MEN WITH TYPE 1 DIABETES: FINDINGS FROM THE DCCT/EDIC Aruna Sarma*, Ann Arbor, MI; James Hotaling, Salt Lake City, UT; Barbara Braffett, Patricia Cleary, Rockville, MD; Rodney Dunn, Ann Arbor, MI; Alan Jacobson, Mineola, NY; Hunter Wessells, Seattle, WA; and theDCCT/EDIC Research GroupRockville, MD INTRODUCTION AND OBJECTIVES: Serum prostate-specific antigen (PSA) concentration has been a controversial screening test for prostate cancer because of low specificity of the test and the lack of conclusive impact on prostate cancer mortality. Recently, studies have demonstrated that diminished renal function was significantly associated with increased PSA concentrations. However, data in men with type 1 diabetes [T1DM] is lacking. The objective of this study was to determine the relationship between glomerular filtration rate (GFR) and PSA concentrations in men with T1DM. METHODS: Total PSA concentrations were measured in men during Year 17 of the Epidemiology of Diabetes Interventions
Source of Funding: National Institute of Diabetes and Digestive and Kidney Diseases, DK083927-01