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P083 Gleason grade at positive surgical margins: A new predictive factor for recurrence after radical prostatectomy
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posters / european urology supplements 11 (2012) 191–235
the somatostatin analogue – octreotide, labeled with the isotope 111 In is used. Material & Methods: We conducted a pilot study for the visualization of PC in 5 patients with CRPC. Using a standard gamma camera with a tomographic mode octreotide 111 In, (CJSC "Pharm-Synthesis", Russia) was taken. 27 patients with CRPC were assigned to combination therapy including the prescription of long-acting somatostatin analogue – octreotidedepo and dexamethasone against the background of antiandrogen blockade or surgical castration. 20 patients were assigned to combination therapy prior to the course of systemic chemotherapy (group 1) and 7 patients – after the development of resistance to taxotere chemotherapy (group 2). PSA was determined in all patients before treatment and once per month thereafter. ECOG status, pain syndrome on a 6-point scale, tlevel of CgA was measured. Results: In 4 out of 5 patients, somatostatin receptors have been identified in the primary tumor as well as in lymph nodes and bones. This result confirms the literature data on the neuroendocrine activity of CRPC. In average the PSA baseline was 76 ng/ml and 14 ng/ml in groups 1 and 2 respectively. Data analysis showed that 70% of patients responded to combination therapy by the decrease or stabilization of PSA, pain release and improved quality of life. In group 1 the regression of the disease was observed in 10 patients (50%), stabilization – in 4 (20%), lack of response – in 6 (30%). In group 2 the response to combination therapy was observed in all 7 patients. Conclusions: The usage of new methods of CRPC diagnostics and treatment, taking into account the status of neuroendocrine tumors, allows the optimization of the choice and alternation of adequate therapeutic approaches. This will provide the achievement of the encouraging clinical results, including improved quality of patients’ lives and increased time of disease progression. P083 Gleason grade at positive surgical margins: A new predictive factor for recurrence after radical prostatectomy A. Benchikh El Fegoun1 , L. Choudat2 , S. Doizi1 , J.F. Hermieu1 , S. Dominique1 , V. Hupertan1 , V. Ravery1 . 1 Hopital Bichat Claude Bernard, University Paris VII, APHP, HUPNVS, Dept. of Urology, Paris, France; 2 Hopital Bichat Claude Bernard, University Paris VII, APHP, HUPNVS, Dept. of Pathology, Paris, France Introduction & Objectives: To establish predictors of biochemical recurrence by analysing the pathological characteristics of positive surgical margins (PSM), including Gleason grade of the carcinoma at the involved margin in order to select patients for adjuvant radiation therapy. Material & Methods: Retrospective evaluation of patients managed between 1995 and 2010 in a single academic center. 186 patients with PSM were included in this study. Patients with pT3b and pT4 cancers where excluded. Kaplan–Meier analyses were performed to examine the relationships between clinicopathological variables and biochemical recurrence-free survival (BRFS). A decision curve analysis was performed to assess the value of Gleason grade at margins added to other clinical and pathological variables. Results: Median follow-up was 36 months (15–66), 81 patients recurred after a median of 24 months (9–46). 5 years BRFS was 65% and 45% (OR = 1.9; p = 0.004) for patients with Gleason grade 3 and ≥4 at margins. For patients with PSM <3 and ≥3 mm, 5 years BRFS was 68% and 38% (OR = 2.5; p = 0.0005). On multivariate analysis PSA (p = 0.01), clinical stage (p = 0.03), Gleason score on the specimen (p = 0.02), the number (p = 0.02), the length (p = 0.002), and the Gleason score at the PSM (p = 0.05) where independent predictors of recurrence. The best
model to predict 5 years BRFS included PSA, length and Gleason grade at margins (graph 1).
Graph 1. Decision curve analysis comparing 3 models: model 1 (PSA, clinical stage, Gleason score on the specimen), model 2 (PSA, length of PSM, Gleason grade at PSM) and model 3 (PSA, length of PSM).
Conclusions: Gleason grade at PSM is an independent prognostic factor of recurrence after radical prostatectomy. The use of a predictive model including PSA, the length of PSM and Gleason grade at PSM will help to better select patients at higher risk of recurrence who will benefit of adjuvant radiation therapy. P084 Histoscanning in monitoring of patients after prostate HIFU-ablation P.V. Glybochko, Y.G. Alyaev, A.V. Amosov, G.E. Krupinov, T.M. Ganzha, A.A. Obuhov. First Moscow State Medical University, Dept. of Urology, Moscow, Russia Introduction & Objectives: Prostate cancer is now regarded as one of the most serious health problems among the male population. Improved diagnosis has allowed to identify prostate cancer at an early stage, which led to the introduction into clinical practice a wide range of focal surgical treatment methods that aim to achieve disease control without a significant loss in quality of life. However, it still remains the problem of monitoring in the postoperative period, related to the imperfection of the existing methods of assessment and adequate visualization of the tumor process. In our opinion a promising solution to these issues is histoscanning. Material & Methods: Since September 2011 histoscanning was performed in 90 patients who have been previously (in terms from 1 year to 7 years) HIFU-therapy for localized prostate cancer. Histoscanning was performed using a diagnostic system, which consists of an ultrasonic apparatus Pro Focus 3D Professional 2202 (BK Medical), 8818 probe, magnetic sensor and the rotator signal processing computer system "Histoscanning". The list included the DRE, PSA, PSA doubling time, PSA velocity increment, TRUS with color and power Doppler mapping, dynamic magnetic resonance imaging of the pelvis with contrast enhancement and the use of rectal coils. Patients were divided into three groups depending on the amount of the identified areas suspicious for malignancy: 1 (51 people) – less than 0.2 cm3 , 2 (24 people) – from 0.2 cm3 to 0.5 cm3 , and 3 (15 people) – more than 0.5 cm3 . On the
posters / european urology supplements 11 (2012) 191–235
the somatostatin analogue – octreotide, labeled with the isotope 111 In is used. Material & Methods: We conducted a pilot study for the visualization of PC in 5 patients with CRPC. Using a standard gamma camera with a tomographic mode octreotide 111 In, (CJSC "Pharm-Synthesis", Russia) was taken. 27 patients with CRPC were assigned to combination therapy including the prescription of long-acting somatostatin analogue – octreotidedepo and dexamethasone against the background of antiandrogen blockade or surgical castration. 20 patients were assigned to combination therapy prior to the course of systemic chemotherapy (group 1) and 7 patients – after the development of resistance to taxotere chemotherapy (group 2). PSA was determined in all patients before treatment and once per month thereafter. ECOG status, pain syndrome on a 6-point scale, tlevel of CgA was measured. Results: In 4 out of 5 patients, somatostatin receptors have been identified in the primary tumor as well as in lymph nodes and bones. This result confirms the literature data on the neuroendocrine activity of CRPC. In average the PSA baseline was 76 ng/ml and 14 ng/ml in groups 1 and 2 respectively. Data analysis showed that 70% of patients responded to combination therapy by the decrease or stabilization of PSA, pain release and improved quality of life. In group 1 the regression of the disease was observed in 10 patients (50%), stabilization – in 4 (20%), lack of response – in 6 (30%). In group 2 the response to combination therapy was observed in all 7 patients. Conclusions: The usage of new methods of CRPC diagnostics and treatment, taking into account the status of neuroendocrine tumors, allows the optimization of the choice and alternation of adequate therapeutic approaches. This will provide the achievement of the encouraging clinical results, including improved quality of patients’ lives and increased time of disease progression. P083 Gleason grade at positive surgical margins: A new predictive factor for recurrence after radical prostatectomy A. Benchikh El Fegoun1 , L. Choudat2 , S. Doizi1 , J.F. Hermieu1 , S. Dominique1 , V. Hupertan1 , V. Ravery1 . 1 Hopital Bichat Claude Bernard, University Paris VII, APHP, HUPNVS, Dept. of Urology, Paris, France; 2 Hopital Bichat Claude Bernard, University Paris VII, APHP, HUPNVS, Dept. of Pathology, Paris, France Introduction & Objectives: To establish predictors of biochemical recurrence by analysing the pathological characteristics of positive surgical margins (PSM), including Gleason grade of the carcinoma at the involved margin in order to select patients for adjuvant radiation therapy. Material & Methods: Retrospective evaluation of patients managed between 1995 and 2010 in a single academic center. 186 patients with PSM were included in this study. Patients with pT3b and pT4 cancers where excluded. Kaplan–Meier analyses were performed to examine the relationships between clinicopathological variables and biochemical recurrence-free survival (BRFS). A decision curve analysis was performed to assess the value of Gleason grade at margins added to other clinical and pathological variables. Results: Median follow-up was 36 months (15–66), 81 patients recurred after a median of 24 months (9–46). 5 years BRFS was 65% and 45% (OR = 1.9; p = 0.004) for patients with Gleason grade 3 and ≥4 at margins. For patients with PSM <3 and ≥3 mm, 5 years BRFS was 68% and 38% (OR = 2.5; p = 0.0005). On multivariate analysis PSA (p = 0.01), clinical stage (p = 0.03), Gleason score on the specimen (p = 0.02), the number (p = 0.02), the length (p = 0.002), and the Gleason score at the PSM (p = 0.05) where independent predictors of recurrence. The best
model to predict 5 years BRFS included PSA, length and Gleason grade at margins (graph 1).
Graph 1. Decision curve analysis comparing 3 models: model 1 (PSA, clinical stage, Gleason score on the specimen), model 2 (PSA, length of PSM, Gleason grade at PSM) and model 3 (PSA, length of PSM).
Conclusions: Gleason grade at PSM is an independent prognostic factor of recurrence after radical prostatectomy. The use of a predictive model including PSA, the length of PSM and Gleason grade at PSM will help to better select patients at higher risk of recurrence who will benefit of adjuvant radiation therapy. P084 Histoscanning in monitoring of patients after prostate HIFU-ablation P.V. Glybochko, Y.G. Alyaev, A.V. Amosov, G.E. Krupinov, T.M. Ganzha, A.A. Obuhov. First Moscow State Medical University, Dept. of Urology, Moscow, Russia Introduction & Objectives: Prostate cancer is now regarded as one of the most serious health problems among the male population. Improved diagnosis has allowed to identify prostate cancer at an early stage, which led to the introduction into clinical practice a wide range of focal surgical treatment methods that aim to achieve disease control without a significant loss in quality of life. However, it still remains the problem of monitoring in the postoperative period, related to the imperfection of the existing methods of assessment and adequate visualization of the tumor process. In our opinion a promising solution to these issues is histoscanning. Material & Methods: Since September 2011 histoscanning was performed in 90 patients who have been previously (in terms from 1 year to 7 years) HIFU-therapy for localized prostate cancer. Histoscanning was performed using a diagnostic system, which consists of an ultrasonic apparatus Pro Focus 3D Professional 2202 (BK Medical), 8818 probe, magnetic sensor and the rotator signal processing computer system "Histoscanning". The list included the DRE, PSA, PSA doubling time, PSA velocity increment, TRUS with color and power Doppler mapping, dynamic magnetic resonance imaging of the pelvis with contrast enhancement and the use of rectal coils. Patients were divided into three groups depending on the amount of the identified areas suspicious for malignancy: 1 (51 people) – less than 0.2 cm3 , 2 (24 people) – from 0.2 cm3 to 0.5 cm3 , and 3 (15 people) – more than 0.5 cm3 . On the