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P054 Diagnostics of local recurrence of prostate cancer after radical prostatectomy: Native endorectal MRI and endorectal DCE-MRI
A B S T R A C T S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 103—194
grading in 23.5% and downgrading in 6.5% of cases (kappa 0.57; p<0.0005). Upgrading in risk group after review by the reference uro-pathologist occurred in 14.8%, whereas 2.9% of cases shifted to a lower prognostic risk group. In pathology reports of general pathologists, tumor volume in mm and percentage was not reported in 81.6% and 54.5% of cases, respectively. In 43.3% cases neither mm nor percentage were mentioned. In 3.2% of the original pathology reports the number of cores positive for cancer was not reported correctly. The obsolete WHO-classification of good, intermediate, or poorly differentiated carcinoma was erroneously used in 32.5% of cases in addition to the Gleason score. Overall, in 28.5% of patients diagnostic assessment and/or treatment recommendations (e.g. indication for extended lymph node dissection or bone scintigraphy) was altered after pathological review. Conclusions: In this series of patients, the pathology report of the prostate biopsy of referring pathologists was not always in accordance with the recommendations on grading and terminology of the ISUP 2005. By pathological review of diagnostic prostate biopsies, a substantial change in Gleason score and prognostic risk group was observed, whereas in more than a quarter of cases the diagnostic assessment or treatment advice was altered. P054 Diagnostics of local recurrence of prostate cancer after radical prostatectomy: Native endorectal MRI and endorectal DCE-MRI Y. Alyaev 1 , S. Ternovoy 2 , E. Bezrukov 1 , S. Morozov 2 , G. Martirosyan 1 , E. Lachinov 1 . 1 First Moscow State Medical University of I. M. Sechenov, Research Institute of Uronephrology and Human Reproductive Health, Moscow, Russia; 2 First Moscow State Medical University of I. M. Sechenov, Chair of Radiological Diagnostics and Radiotherapy, Moscow, Russia Introduction & Objectives: The aims of this study were to evaluate the sensitivity and specificity of endorectal MRI with dynamic contrast enhancement in relation to detecting local recurrence of prostate cancer and also to determine the diagnostic capability of local recurrence detection in patients after radical prostatectomy. Material & Methods: We analyzed 48 patients who had undergone radical prostatectomy for prostate cancer during the period of 2008– 2011. Recurrence of prostate cancer in 27 patients was suspected based on progressive increasing of the PSA level higher than 0.2 ng/ml. The endorectal MRI with dynamic contrast enhancement with gadolinium was performed before transrectal biopsy. The results obtained from combined MRI were qualified as the recurrence if biopsy results were positive. Results: We analyzed the data obtained from 48 patients. Among them 27 patients were suspected to have a recurrence of prostate cancer with average PSA level of 1.6 (0.3–0.7) ng/ml, and 21 patients with no evidence of the recurrence of the disease with average PSA level of lower than 0.2 ng/ml. After gadolinium injection in 25 of 27 patients with increased PSA level (92%) rapid and early signal enhancement occurs. In 21 patients with no evidence of the recurrence of the disease gadolinium accumulation was not revealed by dynamic MRI. The overall sensitivity and specificity of dynamic MRI (with rectal coil, the field density of which was 1.5 T, sensitivity was 93.4% (76–98%) and specificity was 100% (84–100%)) were higher than the capacity of the native MRI, in which sensitivity is 48% (28–69%) and specificity is 52% (30–74%). Diagnostic accuracy of dynamic MRI was 94% (78–98%) in comparison with 50% of native MRI. The most typical local recurrence was diagnosed in the vesico-urethral anastomosis (56%), in seminal vesicles (36%) and in iliac lymphatic nodes (8%). Recurrence of the disease in 24 cases was proven morphologically, and in other cases the outcome was measured upon decreasing of the PSA level after performed Hi-Fu therapy (n=3). Conclusions: Endorectal MRI with dynamic contrast enhancement showed a high sensitivity and specificity in detecting local recurrence of prostate cancer after radical prostatectomy.
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P055 Changes in prostate-specific antigen levels are not associated with changes in circulating tumour cells levels during chemotherapy in castration-resistant prostate cancer 1 , M. Janˇ ˇ O. Capoun cíková 2 , V. Mikulová 2 , H. Honová 3 , K. Kološtová 4 , T. Zima 2 , T. Hanuš 1 . 1 General Teaching Hospital, 1st Faculty of Medicine, Charles University, Dept. of Urology, Prague; 2 General Teaching Hospital, 1st Faculty of Medicine, Charles University, Dept. of Medical Biochemistry and Laboratory Diagnostics, Prague; 3 General Teaching Hospital, 1st Faculty of Medicine, Charles University, Dept. of Oncology, Prague; 4 3rd Faculty of Medicine, Charles University, Dept. of Tumour Biology, Prague, Czech Republic
Introduction & Objectives: The aim of the study is to identify an association of the serum prostate-specific antigen (sPSA) and circulating tumour cells (CTC) levels and their changes during chemotherapy in patients with castration-resistant prostate cancer (CRPC). Material & Methods: Peripheral blood from patients with metastatic CRPC is taken before beginning of docetaxel therapy and after the fourth cycle of chemotherapy (CTX). Isolation of CTC from peripheral blood is done by using an immunomagnetic separation. Reverse transcription and multiplex-PCR were performed after lysis of CTC and the expression of tumour-associated antigens (PSA, PSMA and EGFR) was quantified. Samples were reported verbally as either positive, borderline or negative based on the absolute values (ng/μl) of the transcripts. Values of the levels of sPSA and the three CTC transcripts were compared with each other before and in the course of CTX. Changes in the verbally reported group of CTC detection as well as correlation between the change of sPSA and CTC levels during CTX were evaluated. The Spearman coefficient was used to assess the correlation of the parameters. Results: A total of 34 patients were included in the analysis with both samples taken in 28 of them. Median age was 73 years (56–84), mean sPSA level before and after CTX was 206 and 113ng/ml, respectively. Before CTX only 4 out of 34 patients were considered CTC negative, whereas during the CTX the CTC negativity was confirmed in 13 out of 28 cases. Before CTX, positive detection of fragments of antigens for PSA, PSMA and EGFR was confirmed in 28, 20 and 3 patients, respectively, and after CTX in 14, 4 and 3 case, respectively. The sPSA level before CTX was associated with the level of fragments for PSA (p=0.0020) and PSMA (p=0.0147). During CTX the association was seen in all antigens. However neither a change in sPSA level nor a change in positive vs. negative CTC statement have correlated with a change of any of the tested antigens. Conclusions: The best association was seen between the sPSA level and the level of gene fragment for PSA in CTC. Half of the initially CTC positive patients will become CTC negative during chemotherapy, however the change in CTC detection will not correlate with the change of the sPSA level. The work was supported by Internal Grant Agency of the Ministry of Health of the Czech Republic no. NT-12205-5. P056 HDR brachytherapy for prostate cancer T. Lo, I. Iftimia, P. Cronin. Lahey Medical Center, Dept. of Radiation Oncology, Burlington, United States of America Introduction & Objectives: In our Institution, patients with clinically localized intermediate risk or high risk prostate cancer were generally offered our “tri-modality” therapy protocol, consisting of androgen deprivation, high dose rate (HDR) brachytherapy and external beam radiation therapy. We have been practicing HDR brachytherapy for prostate cancer since 1997 and we have treated over 400 patients to-date. This is a retrospect review of the techniques and outcome in this cohort of patients and we also did a preliminary comparison of our two different HDR regimens used over the years. Material & Methods: Between 1997 and March of 2011, we treated
grading in 23.5% and downgrading in 6.5% of cases (kappa 0.57; p<0.0005). Upgrading in risk group after review by the reference uro-pathologist occurred in 14.8%, whereas 2.9% of cases shifted to a lower prognostic risk group. In pathology reports of general pathologists, tumor volume in mm and percentage was not reported in 81.6% and 54.5% of cases, respectively. In 43.3% cases neither mm nor percentage were mentioned. In 3.2% of the original pathology reports the number of cores positive for cancer was not reported correctly. The obsolete WHO-classification of good, intermediate, or poorly differentiated carcinoma was erroneously used in 32.5% of cases in addition to the Gleason score. Overall, in 28.5% of patients diagnostic assessment and/or treatment recommendations (e.g. indication for extended lymph node dissection or bone scintigraphy) was altered after pathological review. Conclusions: In this series of patients, the pathology report of the prostate biopsy of referring pathologists was not always in accordance with the recommendations on grading and terminology of the ISUP 2005. By pathological review of diagnostic prostate biopsies, a substantial change in Gleason score and prognostic risk group was observed, whereas in more than a quarter of cases the diagnostic assessment or treatment advice was altered. P054 Diagnostics of local recurrence of prostate cancer after radical prostatectomy: Native endorectal MRI and endorectal DCE-MRI Y. Alyaev 1 , S. Ternovoy 2 , E. Bezrukov 1 , S. Morozov 2 , G. Martirosyan 1 , E. Lachinov 1 . 1 First Moscow State Medical University of I. M. Sechenov, Research Institute of Uronephrology and Human Reproductive Health, Moscow, Russia; 2 First Moscow State Medical University of I. M. Sechenov, Chair of Radiological Diagnostics and Radiotherapy, Moscow, Russia Introduction & Objectives: The aims of this study were to evaluate the sensitivity and specificity of endorectal MRI with dynamic contrast enhancement in relation to detecting local recurrence of prostate cancer and also to determine the diagnostic capability of local recurrence detection in patients after radical prostatectomy. Material & Methods: We analyzed 48 patients who had undergone radical prostatectomy for prostate cancer during the period of 2008– 2011. Recurrence of prostate cancer in 27 patients was suspected based on progressive increasing of the PSA level higher than 0.2 ng/ml. The endorectal MRI with dynamic contrast enhancement with gadolinium was performed before transrectal biopsy. The results obtained from combined MRI were qualified as the recurrence if biopsy results were positive. Results: We analyzed the data obtained from 48 patients. Among them 27 patients were suspected to have a recurrence of prostate cancer with average PSA level of 1.6 (0.3–0.7) ng/ml, and 21 patients with no evidence of the recurrence of the disease with average PSA level of lower than 0.2 ng/ml. After gadolinium injection in 25 of 27 patients with increased PSA level (92%) rapid and early signal enhancement occurs. In 21 patients with no evidence of the recurrence of the disease gadolinium accumulation was not revealed by dynamic MRI. The overall sensitivity and specificity of dynamic MRI (with rectal coil, the field density of which was 1.5 T, sensitivity was 93.4% (76–98%) and specificity was 100% (84–100%)) were higher than the capacity of the native MRI, in which sensitivity is 48% (28–69%) and specificity is 52% (30–74%). Diagnostic accuracy of dynamic MRI was 94% (78–98%) in comparison with 50% of native MRI. The most typical local recurrence was diagnosed in the vesico-urethral anastomosis (56%), in seminal vesicles (36%) and in iliac lymphatic nodes (8%). Recurrence of the disease in 24 cases was proven morphologically, and in other cases the outcome was measured upon decreasing of the PSA level after performed Hi-Fu therapy (n=3). Conclusions: Endorectal MRI with dynamic contrast enhancement showed a high sensitivity and specificity in detecting local recurrence of prostate cancer after radical prostatectomy.
129
P055 Changes in prostate-specific antigen levels are not associated with changes in circulating tumour cells levels during chemotherapy in castration-resistant prostate cancer 1 , M. Janˇ ˇ O. Capoun cíková 2 , V. Mikulová 2 , H. Honová 3 , K. Kološtová 4 , T. Zima 2 , T. Hanuš 1 . 1 General Teaching Hospital, 1st Faculty of Medicine, Charles University, Dept. of Urology, Prague; 2 General Teaching Hospital, 1st Faculty of Medicine, Charles University, Dept. of Medical Biochemistry and Laboratory Diagnostics, Prague; 3 General Teaching Hospital, 1st Faculty of Medicine, Charles University, Dept. of Oncology, Prague; 4 3rd Faculty of Medicine, Charles University, Dept. of Tumour Biology, Prague, Czech Republic
Introduction & Objectives: The aim of the study is to identify an association of the serum prostate-specific antigen (sPSA) and circulating tumour cells (CTC) levels and their changes during chemotherapy in patients with castration-resistant prostate cancer (CRPC). Material & Methods: Peripheral blood from patients with metastatic CRPC is taken before beginning of docetaxel therapy and after the fourth cycle of chemotherapy (CTX). Isolation of CTC from peripheral blood is done by using an immunomagnetic separation. Reverse transcription and multiplex-PCR were performed after lysis of CTC and the expression of tumour-associated antigens (PSA, PSMA and EGFR) was quantified. Samples were reported verbally as either positive, borderline or negative based on the absolute values (ng/μl) of the transcripts. Values of the levels of sPSA and the three CTC transcripts were compared with each other before and in the course of CTX. Changes in the verbally reported group of CTC detection as well as correlation between the change of sPSA and CTC levels during CTX were evaluated. The Spearman coefficient was used to assess the correlation of the parameters. Results: A total of 34 patients were included in the analysis with both samples taken in 28 of them. Median age was 73 years (56–84), mean sPSA level before and after CTX was 206 and 113ng/ml, respectively. Before CTX only 4 out of 34 patients were considered CTC negative, whereas during the CTX the CTC negativity was confirmed in 13 out of 28 cases. Before CTX, positive detection of fragments of antigens for PSA, PSMA and EGFR was confirmed in 28, 20 and 3 patients, respectively, and after CTX in 14, 4 and 3 case, respectively. The sPSA level before CTX was associated with the level of fragments for PSA (p=0.0020) and PSMA (p=0.0147). During CTX the association was seen in all antigens. However neither a change in sPSA level nor a change in positive vs. negative CTC statement have correlated with a change of any of the tested antigens. Conclusions: The best association was seen between the sPSA level and the level of gene fragment for PSA in CTC. Half of the initially CTC positive patients will become CTC negative during chemotherapy, however the change in CTC detection will not correlate with the change of the sPSA level. The work was supported by Internal Grant Agency of the Ministry of Health of the Czech Republic no. NT-12205-5. P056 HDR brachytherapy for prostate cancer T. Lo, I. Iftimia, P. Cronin. Lahey Medical Center, Dept. of Radiation Oncology, Burlington, United States of America Introduction & Objectives: In our Institution, patients with clinically localized intermediate risk or high risk prostate cancer were generally offered our “tri-modality” therapy protocol, consisting of androgen deprivation, high dose rate (HDR) brachytherapy and external beam radiation therapy. We have been practicing HDR brachytherapy for prostate cancer since 1997 and we have treated over 400 patients to-date. This is a retrospect review of the techniques and outcome in this cohort of patients and we also did a preliminary comparison of our two different HDR regimens used over the years. Material & Methods: Between 1997 and March of 2011, we treated