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MP93-15 FEASIBILITY OF A WEIGHT MANAGEMENT PROGRAM TAILORED FOR OVERWEIGHT MEN WITH LOCALIZED PROSTATE CANCER: A PILOT STUDY
THE JOURNAL OF UROLOGYâ
e1242
Vol. 197, No. 4S, Supplement, Tuesday, May 16, 2017
MP93-15 FEASIBILITY OF A WEIGHT MANAGEMENT PROGRAM TAILORED FOR OVERWEIGHT MEN WITH LOCALIZED PROSTATE CANCER: A PILOT STUDY Meredith Metcalf*, Cole Chana, Lauren Hand, Abigail Stanley, Misty Bechtel, Prabhakar Chalise, Tanner Isaacson, Debra K. Sullivan, Jennifer Klemp, Christie Befort, J. Brantley Thrasher, Jill M. HamiltonReeves, Kansas City, KS
Source of Funding: None
MP93-14 EXTRAPERITONEAL VS. TRANSPERITONEAL ROBOTASSISTED RADICAL PROSTATECTOMY IN THE MORBIDLY OBESE David Horovitz*, Hao Sun, Changyong Feng, Edward Messing, Jean Joseph, Rochester, NY INTRODUCTION AND OBJECTIVES: When operating deep in the abdomen and pelvis, excess fat can interfere with accessing key anatomical structures and create difficulty in dissection and reconstruction. Since intraperitoneal fat is avoided during extraperitoneal robot assisted radical prostatectomy (eRARP), some Urologists have advocated this approach over its transperitoneal counterpart (tRARP) when operating on morbidly obese men (BMI>40). Herein, we aim to compare outcomes of eRARP vs. tRARP in the morbidly obese. METHODS: A chart review of patients who have undergone robot assisted radical prostatectomy (RARP) at a tertiary care academic center from July 1, 2003 through April 30, 2016 was undertaken. Patients with BMI >40 were identified. Those with concomitant inguinal hernia repair were excluded. The resulting eRARP and tRARP groups were compared for demographic, clinical and pathologic characteristics. Regression analysis was performed between the groups with Age, BMI, ASA score and D’Amico classification as selected covariates. RESULTS: 3168 patients underwent RARP during this time period, of which 82 patients met our inclusion and exclusion criteria; each group comprised 41 patients. No differences were noted in age, BMI, ASA score or pre-operative PSA. The tRARP group had a higher clinical stage (p¼0.016), biopsy Gleason score (p¼0.007) and D’Amico risk category (p<0.00001). The tRARP group had a higher rate of pelvic lymph node dissection (PLND, p<0.00001). No differences were noted in rate of nerve sparing. No differences were noted in OR time, estimated blood loss (EBL), length of stay (LOS) or time to catheter removal (TCR). No differences were noted in surgical margin status or overall complications (either calculated as binary or total number). On regression analysis, no differences were noted in complications, OR time, LOS, TCR or EBL. CONCLUSIONS: In this cohort, surgical approach (eRARP vs. tRARP) did not affect intra- or peri-operative outcomes in morbidly obese men undergoing RARP so surgeons should tailor their approach based on comfort level. Source of Funding: none
INTRODUCTION AND OBJECTIVES: Men who are overweight at the time of prostatectomy are more likely to have recurrence and die from prostate cancer than healthy weight men. They also have higher risk for cardiovascular disease, the most common cause of death for prostate cancer survivors. Our study tests the feasibility of weight loss before and maintenance after prostatectomy in overweight men with localized prostate cancer. METHODS: Men scheduled for prostatectomy received a weight management program (intervention; n¼15) or standard of care (non-intervention; n¼5). The intervention included behavior coaching, diet including meal replacements, physical activity, and self-monitoring technology. Body weight, body composition, cardiometabolic markers, and quality of life were measured at baseline, 1 week before surgery, and 12 weeks after surgery. Changes within and differences between groups were analyzed using the two-sample t-test. RESULTS: The intervention led to 6 kg of weight loss (95%CI, 3-8 kg; p<0.001) and 4 kg of fat loss (95%CI, 2-6 kg; p<0.001) from baseline to surgery (mean¼6.6 weeks). Between group differences in weight change and fat loss were significant (P¼0.012; P¼0.032, respectively). In the intervention group, blood glucose decreased by 11 mg/dL (95%CI, 0.5-22 mg/dL; P¼0.04); insulin decreased by 3.4 mIU/ mL (95%CI, 0.1-7 mIU/mL; P¼0.03); C-peptide decreased by 0.7 ng/L (95%CI, 0.17-1.3 ng/L; P¼0.01); systolic blood pressure decreased by 8 mmHg (95%CI, 1-15 mmHg; P¼0.03); and leptin:adiponectin ratio decreased (P¼0.008) from baseline to surgery. Changes in lipid profiles were not significant. Twelve weeks after surgery, weight was maintained and physical quality of life was better in the intervention group than the non-intervention group (P¼0.03). CONCLUSIONS: The intervention led to significant weight loss and improved cardiometabolic markers. A larger, randomized controlled trial is needed to evaluate efficacy and cancer biomarkers. Source of Funding: The Prostate Cancer Guys Resilient by Individualized Training (PCaGRIT) trial was supported the University of Kansas Cancer Center Cancer Prevention Pilot Grant program (JHR), and in part by an NIH Clinical and Translational Science Award grant (UL1 TR000001, formerly UL1RR033179), awarded to the University of Kansas Medical Center. Support for J. Hamilton-Reeves was provided by KL2 training grant KL2TR000119 a CTSA grant from NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research (JHR). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCATS. Research reported in this publication was supported by the National Cancer Institute Cancer Center Support Grant P30 CA168524 and used the Biospecimen Shared Resource and the Biostatistics and Informatics Shared Resource. Medifast donated the meal replacements for the study.
MP93-16 IMPACT OF OBESITY ON PROSTATE CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY Vidit Sharma*, Mary E Westerman, Michele Colicchia, Alessandro Morlacco, Matthew K. Tollefson, Stephen A Boorjian, R. Houston Thompson, Igor Frank, Matthew T Gettman, R. Jeffrey Karnes, Rochester, MN INTRODUCTION AND OBJECTIVES: Conflicting data exist on the association of obesity with the risk of prostate cancer (PCa)
e1242
Vol. 197, No. 4S, Supplement, Tuesday, May 16, 2017
MP93-15 FEASIBILITY OF A WEIGHT MANAGEMENT PROGRAM TAILORED FOR OVERWEIGHT MEN WITH LOCALIZED PROSTATE CANCER: A PILOT STUDY Meredith Metcalf*, Cole Chana, Lauren Hand, Abigail Stanley, Misty Bechtel, Prabhakar Chalise, Tanner Isaacson, Debra K. Sullivan, Jennifer Klemp, Christie Befort, J. Brantley Thrasher, Jill M. HamiltonReeves, Kansas City, KS
Source of Funding: None
MP93-14 EXTRAPERITONEAL VS. TRANSPERITONEAL ROBOTASSISTED RADICAL PROSTATECTOMY IN THE MORBIDLY OBESE David Horovitz*, Hao Sun, Changyong Feng, Edward Messing, Jean Joseph, Rochester, NY INTRODUCTION AND OBJECTIVES: When operating deep in the abdomen and pelvis, excess fat can interfere with accessing key anatomical structures and create difficulty in dissection and reconstruction. Since intraperitoneal fat is avoided during extraperitoneal robot assisted radical prostatectomy (eRARP), some Urologists have advocated this approach over its transperitoneal counterpart (tRARP) when operating on morbidly obese men (BMI>40). Herein, we aim to compare outcomes of eRARP vs. tRARP in the morbidly obese. METHODS: A chart review of patients who have undergone robot assisted radical prostatectomy (RARP) at a tertiary care academic center from July 1, 2003 through April 30, 2016 was undertaken. Patients with BMI >40 were identified. Those with concomitant inguinal hernia repair were excluded. The resulting eRARP and tRARP groups were compared for demographic, clinical and pathologic characteristics. Regression analysis was performed between the groups with Age, BMI, ASA score and D’Amico classification as selected covariates. RESULTS: 3168 patients underwent RARP during this time period, of which 82 patients met our inclusion and exclusion criteria; each group comprised 41 patients. No differences were noted in age, BMI, ASA score or pre-operative PSA. The tRARP group had a higher clinical stage (p¼0.016), biopsy Gleason score (p¼0.007) and D’Amico risk category (p<0.00001). The tRARP group had a higher rate of pelvic lymph node dissection (PLND, p<0.00001). No differences were noted in rate of nerve sparing. No differences were noted in OR time, estimated blood loss (EBL), length of stay (LOS) or time to catheter removal (TCR). No differences were noted in surgical margin status or overall complications (either calculated as binary or total number). On regression analysis, no differences were noted in complications, OR time, LOS, TCR or EBL. CONCLUSIONS: In this cohort, surgical approach (eRARP vs. tRARP) did not affect intra- or peri-operative outcomes in morbidly obese men undergoing RARP so surgeons should tailor their approach based on comfort level. Source of Funding: none
INTRODUCTION AND OBJECTIVES: Men who are overweight at the time of prostatectomy are more likely to have recurrence and die from prostate cancer than healthy weight men. They also have higher risk for cardiovascular disease, the most common cause of death for prostate cancer survivors. Our study tests the feasibility of weight loss before and maintenance after prostatectomy in overweight men with localized prostate cancer. METHODS: Men scheduled for prostatectomy received a weight management program (intervention; n¼15) or standard of care (non-intervention; n¼5). The intervention included behavior coaching, diet including meal replacements, physical activity, and self-monitoring technology. Body weight, body composition, cardiometabolic markers, and quality of life were measured at baseline, 1 week before surgery, and 12 weeks after surgery. Changes within and differences between groups were analyzed using the two-sample t-test. RESULTS: The intervention led to 6 kg of weight loss (95%CI, 3-8 kg; p<0.001) and 4 kg of fat loss (95%CI, 2-6 kg; p<0.001) from baseline to surgery (mean¼6.6 weeks). Between group differences in weight change and fat loss were significant (P¼0.012; P¼0.032, respectively). In the intervention group, blood glucose decreased by 11 mg/dL (95%CI, 0.5-22 mg/dL; P¼0.04); insulin decreased by 3.4 mIU/ mL (95%CI, 0.1-7 mIU/mL; P¼0.03); C-peptide decreased by 0.7 ng/L (95%CI, 0.17-1.3 ng/L; P¼0.01); systolic blood pressure decreased by 8 mmHg (95%CI, 1-15 mmHg; P¼0.03); and leptin:adiponectin ratio decreased (P¼0.008) from baseline to surgery. Changes in lipid profiles were not significant. Twelve weeks after surgery, weight was maintained and physical quality of life was better in the intervention group than the non-intervention group (P¼0.03). CONCLUSIONS: The intervention led to significant weight loss and improved cardiometabolic markers. A larger, randomized controlled trial is needed to evaluate efficacy and cancer biomarkers. Source of Funding: The Prostate Cancer Guys Resilient by Individualized Training (PCaGRIT) trial was supported the University of Kansas Cancer Center Cancer Prevention Pilot Grant program (JHR), and in part by an NIH Clinical and Translational Science Award grant (UL1 TR000001, formerly UL1RR033179), awarded to the University of Kansas Medical Center. Support for J. Hamilton-Reeves was provided by KL2 training grant KL2TR000119 a CTSA grant from NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research (JHR). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCATS. Research reported in this publication was supported by the National Cancer Institute Cancer Center Support Grant P30 CA168524 and used the Biospecimen Shared Resource and the Biostatistics and Informatics Shared Resource. Medifast donated the meal replacements for the study.
MP93-16 IMPACT OF OBESITY ON PROSTATE CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY Vidit Sharma*, Mary E Westerman, Michele Colicchia, Alessandro Morlacco, Matthew K. Tollefson, Stephen A Boorjian, R. Houston Thompson, Igor Frank, Matthew T Gettman, R. Jeffrey Karnes, Rochester, MN INTRODUCTION AND OBJECTIVES: Conflicting data exist on the association of obesity with the risk of prostate cancer (PCa)