PD31-13 PERI-OPERATIVE MORTALITY AND LONG-TERM SURVIVAL AFTER PARTIAL VERSUS RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER

THE JOURNAL OF UROLOGYâ

e704

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

PD31-13 PERI-OPERATIVE MORTALITY AND LONG-TERM SURVIVAL AFTER PARTIAL VERSUS RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER Malek Meskawi*, Montreal, Canada; Alessandro Larcher, Milan, Italy; Roger Valdivieso, Vincent Trudeau, Montreal, Canada; Katharina Boehm, Jonas Schiffmann, Hamburg, Germany; Maxine Sun, Pierre Karakiewicz, Montreal, Canada INTRODUCTION AND OBJECTIVES: The aim of the study was to compare partial cystectomy (PC) and radical cystectomy (RC) with respect to 90-day mortality as well as long-term, all cause (ACM) and cancer specific mortality (CSM). METHODS: Using the SEER-Medicare database 3913 patients with T2-T3 urothelial carcinoma of the urinary bladder (UCUB) who underwent either RC (n¼3419) or PC (n¼494) were identified. After propensity score matching to reduce potential treatment selection bias, 90day mortality, ACM-free and CSM-free rates between patients treated with PC and RC were estimated. Multivariable regression models (MVA) addressed 90-day mortality as well as 5-years ACM and CSM. RESULTS: After matching, 33% (n¼494) and 67% (n¼988) patients treated respectively with PC or RC remained. Median follow-up was 26 months. The 90-day mortality rate was 3.2% (n¼16) after PC and 8.1% (n¼80) after RC (p¼0.001). In MVA, PC vs. RC was associated with a lower 90-day mortality (p<0.001). At 5 years the ACM-free survival rate was 38% after PC and 40% after RC (p¼0.3) and failed to differ in MVA (p¼0.9). At 5 years the CSM-free survival rate was 59% after PC and 62% after RC (p¼0.2) and also failed to differ in MVA (p¼0.57). The same results were observed after restriction to patients with pT2N0 UCUB. CONCLUSIONS: Relative to RC, PC is associated with lower short-term mortality and the same long-term ACM and CSM rates. These observations should encourage greater consideration to PC in those selected cases when this type of surgery may be applied. Source of Funding: none

RESULTS: 604 men (mean age 658 years; BMI 27.14.3; PSA 6.77.2 ng/ml) met inclusion criteria. MRF-TB detected fewer Gleason 6 (GS6) PCa [75(11%) vs 121(20%), p<0.001] and more Gleason 7 (GS7) PCa [158(26%) vs 116(19%), p<0.001], as compared to SB (see Table 1). MRF-TB also detected more Gleason dominant pattern 4 compared to SB [69(11%) vs 54(9%), p¼0.02]. Evaluating the cohort by biopsy indications, in the biopsy naive cohort, MRF-TB detected fewer GS6 PCa compared to SB [32(11%) vs 60(21%), p<0.001], and detected more GS7 PCa [88(30%) vs 72(25%), p¼0.012]. In the prior negative cohort, MRF-TB and SB were similar in detecting GS6 PCa [13(8%) vs 15(9%), p¼0.838], but MRFTB detected more GS7 PCa than SB [28(16%) vs 15(9%), p¼0.004]. In the AS cohort, MRF-TB detected fewer GS6 PCa compared to SB [30(22%) vs 46(33%), p¼0.034], and detected more GS7 PCa [42(30%) vs 29(21%), p¼0.043] (see Table 2). CONCLUSIONS: Overall, MRF-TB detects more GS7 PCa and less GS6 cancer than SB. The performance characteristics of biopsy vary by clinical indication, offering potential to maintain or improve detection of potentially lethal prostate cancers while reducing overdetection of GS6 disease in all men. Table 1 3x3 table of Whole Cohort GS6 and GS7 Cancer Detection Rate (CDR) using SB versus MRF-TB Targeted Biopsy CDR n(%)

Systematic Biopsy CDR n(%)

Gleason ‡7

Gleason 6

No Cancer

Gleason ‡7

93 (15%)

14 (2%)

9 (1%)

116 (19%) y

Gleason 6

23 (4%)

37 (6%)

61 (10%)

121 (20%) z

No Cancer

42 (7%)

24 (4%)

301 (50%)

367 (61%)

Total

158 (26%) y

75 (12%) z

371 (61%)

604 (100%)

y p< 0.05, McNemar’s test, SB vs MRF-TB for GS7 PCa, z p< 0.05, McNemar’s test, SB vs MRF-TB for GS6 PCa

Prostate Cancer: Staging II

Table 2 Cancer Detection Rate (CDR) of GS6 and GS7 PCa detected with SB versus MRF-TB by patient biopsy indication

Podium 32 Sunday, May 17, 2015

Total

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Systematic Biopsy CDR n(%) Biopsy Indications

Targeted Biopsy CDR n(%)

Systematic Biopsy CDR n(%)

n(%)

GS6

GS6

GS7

Overall Cohort

604 (100%)

121 (20%)*

75 (12%)*

116 (19%)y

Biopsy Naive

292 (48%)

60 (21%)*

32 (11%)*

72 (25%)y

Prior Negative

173 (29%)

15 (9%)

13 (8%)

15 (9%)y

Active Surveillance

139 (23%)

46 (33%)*

30 (22%)*

29 (21%)y

PD32-01 COMPARISON OF MRI-US FUSION TARGETED BIOPSY AND SYSTEMATIC PROSTATE BIOPSY: SINGLE INSTITUTION EXPERIENCE IN 604 PATIENTS. Xiaosong Meng*, Andrew B. Rosenkrantz, Neil Mendhiratta, Michael Fenstermaker, Richard Huang, New York, NY; James Wysock, Flushing, NY; Marc Bjurlin, Susan Marshall, Fang-Ming Deng, Jonathan Melamed, Ming Zhou, William C. Huang, Herbert Lepor, Samir S. Taneja, New York, NY INTRODUCTION AND OBJECTIVES: Increasing evidence supports the use of MRI fusion targeted biopsy (MRF-TB) to improve the detection of clinically significant prostate cancer (PCa) while limiting over-detection of indolent disease. This study reports the results of MRF-TB and systematic 12-core biopsy (SB) for all men presenting to our center for prostate biopsy since June 2012. METHODS: Between 6/12 and 8/14, all 824 men presenting to our institution for prostate biopsy underwent pre-biopsy multi-parametric MRI (mpMRI). Outcomes were recorded in an IRB-approved database. For this analysis, biopsy results, clinical outcomes, and mpMRI suspicion scores (mSS) were queried from those who underwent both SB and MRF-TB using the Artemis/Pro-fuseTM (Eigen, Grass Valley) co-registration system. Biopsy findings and indications per patient were compiled.

Targeted Biopsy CDR n(%) Biopsy Indications

Systematic Biopsy CDR n(%)

Targeted Biopsy CDR n(%)

GS7

All PCa

All PCa

158 (26%)y

238 (39%)

234 (39%)

Biopsy Naive

88 (30%)y

132 (45%)

120 (41%)

Prior Negative

28 (16%)y

31 (18%)

42 (24%)

Active Surveillance

42 (30%)y

75 (54%)

72 (52%)

Overall Cohort

* p< 0.05, McNemar’s test, SB vs MRF-TB for GS6 PCa, y p< 0.05, McNemar’s test, SB vs MRF-TB for GS7 PCa.

Source of Funding: Joseph and Diane Steinberg Charitable Trust