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PD42-07 IMPLEMENTATION OF METHODOLOGY TO CAPTURE DATA FROM PROSTATE MRI WITHIN A REGIONAL QUALITY-IMPROVEMENT COLLABORATIVE
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
e989
PD42-06 INTERMEDIATE-TERM OUTCOMES IN MEN WITH VERY HIGH RISK PROSTATE CANCER Jeffrey Tosoian*, Baltimore, MD; Debasish Sundi, Brian Chapin, Houston, TX; R. Jeffrey Karnes, Rochester, MN; Emmanuel Antonarakis, Meera Chappidi, Ridwan Alam, Stephanie Glavaris, Kamyar Ghabili, Mohamad Allaf, Trinity Bivalacqua, Kenneth Pienta, Phuoc Tran, Baltimore, MD; Edward Schaeffer, Chicago, IL; Ashley Ross, Baltimore, MD INTRODUCTION AND OBJECTIVES: Beginning in 2014, the National Comprehensive Cancer Network (NCCN) recognized very high-risk (VHR) prostate cancer (cT3b-T4, or primary Gleason pattern 5, or more than 4 biopsy cores with Gleason score 8-10, or multiple HR features) as a classification distinct from high-risk (HR) disease. Using prospectively-collected institutional data, we compare oncologic outcomes after radical prostatectomy (RP) from HR and VHR cohorts during the contemporary era. METHODS: The Johns Hopkins RP database was queried to identify men with HR or VHR cancer who underwent RP from January 2005 through June 2015, and oncologic outcomes were compared by risk group. Non organ-confined disease (NOCD) was defined as pT3 or lymph node positivity. Biochemical recurrence (BCR, defined by PSA 0.2 ng/mL) and metastatic disease rates were compared among men with at least one year of follow-up. Multivariable Cox proportional hazards models were used to assess the prognostic significance of previously established VHR criteria. RESULTS: During the study period, 828 men underwent RP for VHR (n¼201; 24%) or HR (n¼627; 76%) cancer. Compared to the HR cohort, men with VHR disease had higher rates of extracapsular extension (73% vs. 56%, p<0.001), seminal vesicle invasion (39% vs. 16%, p<0.001), lymph node positivity (25% vs. 8%, p<0.001), and overall NOCD (75% vs. 56%, p<0.001). Among 724 (87%) men with clinical follow-up, BCR rates were significantly higher in men with VHR than HR disease (44% vs. 31%, p¼0.002) and tended to occur at a shorter interval following surgery (median 12.0 vs. 17.4 months, p¼0.126). The cumulative incidence of metastasis at 1, 2, and 5 years was 7%, 14%, and 25% in VHR and 3%, 4%, and 11% in HR men (p<0.001). In a multivariable model with age, primary Gleason pattern 5 (HR 2.18, 95% CI 1.07-4.46), >4 biopsy cores with Gleason score 8-10 cancer (HR 2.03, 95% CI 0.94-4.36), and meeting multiple HR criteria (HR 2.61, 95% CI 1.14-5.96) predicted increased risk of metastasis. Among the VHR cohort, men meeting multiple VHR criteria (24%) had a more than three-fold increased risk of metastasis (HR 3.19, 95% CI 1.32-7.71) compared to those meeting only one VHR criterion. CONCLUSIONS: Among the high-risk prostate cancer population, VHR classification is associated with the highest risk of adverse pathology and clinical progression following local treatment. Previously defined VHR criteria appear to accurately predict post-surgical outcomes. Assessment in additional cohorts will help to more definitively establish those men at highest risk of progression after treatment. Source of Funding: Dr. Ross is supported by a DOD physician researcher training award and the Patrick C. Walsh fund.
PD42-07 IMPLEMENTATION OF METHODOLOGY TO CAPTURE DATA FROM PROSTATE MRI WITHIN A REGIONAL QUALITYIMPROVEMENT COLLABORATIVE
Source of Funding: none
Tae Kim*, James Montie, Ann Arbor, MI; James Peabody, Detroit, MI; Dinesh Telang, Roseville, MI; C. Peter Fischer, Ypsilanti, MI; Jeffrey O’Connor, Farmington Hills, MI; M. Hugh Solomon, Ypsilanti, MI; Steven Lucas, Detroit, MI; Sabry Mansour, Lapeer, MI; Rafid Yousif, East Lansing, MI; Richard Sarle, Dearborn, MI; David Miller, Ann Arbor, MI; Brian Lane, Grand Rapids, MI INTRODUCTION AND OBJECTIVES: Although multi-parametric prostate MRI (mpMRI) is a promising imaging modality, variability
THE JOURNAL OF UROLOGYâ
e990
in the techniques and reporting are a concern. The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide consortium of diverse urology practices working to improve the quality of urologic care in Michigan. MUSIC piloted a program to determine the ability to obtain information from mpMRI currently performed statewide. METHODS: A 38 item data collection tool was designed with urologist and radiologist input to help determine indication for MRI, MRI equipment and techniques used, how findings are reported, and ease of data abstraction. Data collected by physicians and MUSIC data abstractors was entered using an online tool via Qualtrics or paper equivalent. RESULTS: Eleven MUSIC urologists from 9 practices provided 53 mpMRI reports on their patients for data abstraction. Thirty-nine (76%) studies utilized 3 Tesla systems and 45 (85%) were without endorectal coil. Only 9 (17%) cases defined lesion suspicion level using PI-RADS v2 (Table 1). Most cases (81%) were ordered due to an established prostate cancer (PCa) diagnosis, of which 12 were for staging and 21 were for pre-treatment planning. mpMRI altered treatment plans in some fashion for most patients (Table 2). However, substantial difficulties were encountered in abstracting specific variables, including mpMRI components (57%) and suspicion level of target lesion (37%). CONCLUSIONS: The pilot study revealed mpMRI has the potential to influence clinical pathways in patients with prostate disease. However, data abstraction from current reports is complex (even with physician review) and stresses the need for greater standardization by radiologists.
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
race were categorized using SEER definitions. For incidence trend analyses, data were reported as age-adjusted incidence per 100,000 U.S. population. Temporal trends in prostate cancer incidence rates by stage at diagnosis were performed using Poisson regression stratified by race. Predictors of distant stage prostate cancer at diagnosis were determined using logistic regression adjusted for year of diagnosis, age at diagnosis, SEER region, and race. RESULTS: A total of 656,662 cases were identified. The median age was 67 years, and the race distribution was 79.1% white, 13.7% black, 4.6% other, and 2.5% unknown. The majority of the cases were diagnosed with localized prostate cancer (83.7%), however 11.9% were diagnosed with regional disease and 4.4% with distant disease. Black race (OR 1.95 [1.89-2.02], p<0.01), and older age (OR 1.07/year [1.06-1.07], p<0.01) were associated with distant prostate cancer at diagnosis. Age at diagnosis <55 years was associated with a reduced likelihood of distant stage at diagnosis (OR 0.63 [0.60-0.66], p<0.01). The incidence rate of distant prostate cancer tended to decline over the study period for black men (OR 0.97/year [0.93-1.00], p¼0.05), but not for white men (OR 0.99/year [0.95-1.03], p¼0.56). CONCLUSIONS: In the contemporary PSA era prostate cancer stage migration towards a lower stage of disease is still occurring among black men but appears to have stabilized among white men. Discontinuation of PSA-based screening for prostate cancer could disproportionately affect black men, whom, as a group, remain most likely to be diagnosed with metastatic and potentially fatal disease.
Source of Funding: None
Source of Funding: Blue Cross Blue Shield of Michigan
PD42-08 IS PROSTATE CANCER STAGE MIGRATION CONTINUING FOR BLACK MEN IN THE PSA ERA? Ryan Dobbs*, David Greenwald, Harpreet Wadhwa, Vincent Freeman, Michael Abern, Chicago, IL INTRODUCTION AND OBJECTIVES: In the U.S., disease specific mortality from prostate cancer is highest among black men. The introduction of widespread prostate specific antigen (PSA) testing has been associated with a reduction in men presenting with metastatic disease and a significant shift towards a lower stage of disease on radical prostatectomy specimens. The objective of our study was to evaluate current prostate cancer stage migration patterns in the U.S. by race. METHODS: The Surveillance, Epidemiology and End Results (SEER) registry was queried to obtain all cases of prostate cancer in adult males reported between 2000 and 2011. Stage at diagnosis and
PD42-09 TUMOR CONTACT LENGTH ON MULTIPARAMETRIC MRI PREDICTS HIGH RISK PATHOLOGY AT RADICAL PROSTATECTOMY Michael kongnyuy*, Arvin George, Akhil Muthigi, Abhinav Sidana, Amogh Iyer, Thomas Frye, Amichai Kilchevsky, Francesca Mertan, RIchard Ho, Daniel Su, Maria Merino, Baris Turkbey, Peter Choyke, Bradford Wood, Peter Pinto, Bethesda, MD INTRODUCTION AND OBJECTIVES: The high spatial resolution of multiparametric MRI (mpMRI) has improved detection of clinically significant prostate cancer (PCa). MpMRI characteristics [extracapsular extension (ECE), number of lesions etc] may predict final pathological findings such as positive lymph node (pLN) status and pathological ECE (pECE) at radical prostatectomy (RP). Tumor contact length on MRI (TCL), defined as the length of a lesion in contact with the prostatic capsule, is a novel marker with promising early results. Here, we evaluate the ability of mpMRI determined TCL in predicting pECE and pLN in patients undergoing RP. METHODS: A review of a prospectively maintained database of men undergoing mpMRI followed by RP without prior therapy was
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
e989
PD42-06 INTERMEDIATE-TERM OUTCOMES IN MEN WITH VERY HIGH RISK PROSTATE CANCER Jeffrey Tosoian*, Baltimore, MD; Debasish Sundi, Brian Chapin, Houston, TX; R. Jeffrey Karnes, Rochester, MN; Emmanuel Antonarakis, Meera Chappidi, Ridwan Alam, Stephanie Glavaris, Kamyar Ghabili, Mohamad Allaf, Trinity Bivalacqua, Kenneth Pienta, Phuoc Tran, Baltimore, MD; Edward Schaeffer, Chicago, IL; Ashley Ross, Baltimore, MD INTRODUCTION AND OBJECTIVES: Beginning in 2014, the National Comprehensive Cancer Network (NCCN) recognized very high-risk (VHR) prostate cancer (cT3b-T4, or primary Gleason pattern 5, or more than 4 biopsy cores with Gleason score 8-10, or multiple HR features) as a classification distinct from high-risk (HR) disease. Using prospectively-collected institutional data, we compare oncologic outcomes after radical prostatectomy (RP) from HR and VHR cohorts during the contemporary era. METHODS: The Johns Hopkins RP database was queried to identify men with HR or VHR cancer who underwent RP from January 2005 through June 2015, and oncologic outcomes were compared by risk group. Non organ-confined disease (NOCD) was defined as pT3 or lymph node positivity. Biochemical recurrence (BCR, defined by PSA 0.2 ng/mL) and metastatic disease rates were compared among men with at least one year of follow-up. Multivariable Cox proportional hazards models were used to assess the prognostic significance of previously established VHR criteria. RESULTS: During the study period, 828 men underwent RP for VHR (n¼201; 24%) or HR (n¼627; 76%) cancer. Compared to the HR cohort, men with VHR disease had higher rates of extracapsular extension (73% vs. 56%, p<0.001), seminal vesicle invasion (39% vs. 16%, p<0.001), lymph node positivity (25% vs. 8%, p<0.001), and overall NOCD (75% vs. 56%, p<0.001). Among 724 (87%) men with clinical follow-up, BCR rates were significantly higher in men with VHR than HR disease (44% vs. 31%, p¼0.002) and tended to occur at a shorter interval following surgery (median 12.0 vs. 17.4 months, p¼0.126). The cumulative incidence of metastasis at 1, 2, and 5 years was 7%, 14%, and 25% in VHR and 3%, 4%, and 11% in HR men (p<0.001). In a multivariable model with age, primary Gleason pattern 5 (HR 2.18, 95% CI 1.07-4.46), >4 biopsy cores with Gleason score 8-10 cancer (HR 2.03, 95% CI 0.94-4.36), and meeting multiple HR criteria (HR 2.61, 95% CI 1.14-5.96) predicted increased risk of metastasis. Among the VHR cohort, men meeting multiple VHR criteria (24%) had a more than three-fold increased risk of metastasis (HR 3.19, 95% CI 1.32-7.71) compared to those meeting only one VHR criterion. CONCLUSIONS: Among the high-risk prostate cancer population, VHR classification is associated with the highest risk of adverse pathology and clinical progression following local treatment. Previously defined VHR criteria appear to accurately predict post-surgical outcomes. Assessment in additional cohorts will help to more definitively establish those men at highest risk of progression after treatment. Source of Funding: Dr. Ross is supported by a DOD physician researcher training award and the Patrick C. Walsh fund.
PD42-07 IMPLEMENTATION OF METHODOLOGY TO CAPTURE DATA FROM PROSTATE MRI WITHIN A REGIONAL QUALITYIMPROVEMENT COLLABORATIVE
Source of Funding: none
Tae Kim*, James Montie, Ann Arbor, MI; James Peabody, Detroit, MI; Dinesh Telang, Roseville, MI; C. Peter Fischer, Ypsilanti, MI; Jeffrey O’Connor, Farmington Hills, MI; M. Hugh Solomon, Ypsilanti, MI; Steven Lucas, Detroit, MI; Sabry Mansour, Lapeer, MI; Rafid Yousif, East Lansing, MI; Richard Sarle, Dearborn, MI; David Miller, Ann Arbor, MI; Brian Lane, Grand Rapids, MI INTRODUCTION AND OBJECTIVES: Although multi-parametric prostate MRI (mpMRI) is a promising imaging modality, variability
THE JOURNAL OF UROLOGYâ
e990
in the techniques and reporting are a concern. The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide consortium of diverse urology practices working to improve the quality of urologic care in Michigan. MUSIC piloted a program to determine the ability to obtain information from mpMRI currently performed statewide. METHODS: A 38 item data collection tool was designed with urologist and radiologist input to help determine indication for MRI, MRI equipment and techniques used, how findings are reported, and ease of data abstraction. Data collected by physicians and MUSIC data abstractors was entered using an online tool via Qualtrics or paper equivalent. RESULTS: Eleven MUSIC urologists from 9 practices provided 53 mpMRI reports on their patients for data abstraction. Thirty-nine (76%) studies utilized 3 Tesla systems and 45 (85%) were without endorectal coil. Only 9 (17%) cases defined lesion suspicion level using PI-RADS v2 (Table 1). Most cases (81%) were ordered due to an established prostate cancer (PCa) diagnosis, of which 12 were for staging and 21 were for pre-treatment planning. mpMRI altered treatment plans in some fashion for most patients (Table 2). However, substantial difficulties were encountered in abstracting specific variables, including mpMRI components (57%) and suspicion level of target lesion (37%). CONCLUSIONS: The pilot study revealed mpMRI has the potential to influence clinical pathways in patients with prostate disease. However, data abstraction from current reports is complex (even with physician review) and stresses the need for greater standardization by radiologists.
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
race were categorized using SEER definitions. For incidence trend analyses, data were reported as age-adjusted incidence per 100,000 U.S. population. Temporal trends in prostate cancer incidence rates by stage at diagnosis were performed using Poisson regression stratified by race. Predictors of distant stage prostate cancer at diagnosis were determined using logistic regression adjusted for year of diagnosis, age at diagnosis, SEER region, and race. RESULTS: A total of 656,662 cases were identified. The median age was 67 years, and the race distribution was 79.1% white, 13.7% black, 4.6% other, and 2.5% unknown. The majority of the cases were diagnosed with localized prostate cancer (83.7%), however 11.9% were diagnosed with regional disease and 4.4% with distant disease. Black race (OR 1.95 [1.89-2.02], p<0.01), and older age (OR 1.07/year [1.06-1.07], p<0.01) were associated with distant prostate cancer at diagnosis. Age at diagnosis <55 years was associated with a reduced likelihood of distant stage at diagnosis (OR 0.63 [0.60-0.66], p<0.01). The incidence rate of distant prostate cancer tended to decline over the study period for black men (OR 0.97/year [0.93-1.00], p¼0.05), but not for white men (OR 0.99/year [0.95-1.03], p¼0.56). CONCLUSIONS: In the contemporary PSA era prostate cancer stage migration towards a lower stage of disease is still occurring among black men but appears to have stabilized among white men. Discontinuation of PSA-based screening for prostate cancer could disproportionately affect black men, whom, as a group, remain most likely to be diagnosed with metastatic and potentially fatal disease.
Source of Funding: None
Source of Funding: Blue Cross Blue Shield of Michigan
PD42-08 IS PROSTATE CANCER STAGE MIGRATION CONTINUING FOR BLACK MEN IN THE PSA ERA? Ryan Dobbs*, David Greenwald, Harpreet Wadhwa, Vincent Freeman, Michael Abern, Chicago, IL INTRODUCTION AND OBJECTIVES: In the U.S., disease specific mortality from prostate cancer is highest among black men. The introduction of widespread prostate specific antigen (PSA) testing has been associated with a reduction in men presenting with metastatic disease and a significant shift towards a lower stage of disease on radical prostatectomy specimens. The objective of our study was to evaluate current prostate cancer stage migration patterns in the U.S. by race. METHODS: The Surveillance, Epidemiology and End Results (SEER) registry was queried to obtain all cases of prostate cancer in adult males reported between 2000 and 2011. Stage at diagnosis and
PD42-09 TUMOR CONTACT LENGTH ON MULTIPARAMETRIC MRI PREDICTS HIGH RISK PATHOLOGY AT RADICAL PROSTATECTOMY Michael kongnyuy*, Arvin George, Akhil Muthigi, Abhinav Sidana, Amogh Iyer, Thomas Frye, Amichai Kilchevsky, Francesca Mertan, RIchard Ho, Daniel Su, Maria Merino, Baris Turkbey, Peter Choyke, Bradford Wood, Peter Pinto, Bethesda, MD INTRODUCTION AND OBJECTIVES: The high spatial resolution of multiparametric MRI (mpMRI) has improved detection of clinically significant prostate cancer (PCa). MpMRI characteristics [extracapsular extension (ECE), number of lesions etc] may predict final pathological findings such as positive lymph node (pLN) status and pathological ECE (pECE) at radical prostatectomy (RP). Tumor contact length on MRI (TCL), defined as the length of a lesion in contact with the prostatic capsule, is a novel marker with promising early results. Here, we evaluate the ability of mpMRI determined TCL in predicting pECE and pLN in patients undergoing RP. METHODS: A review of a prospectively maintained database of men undergoing mpMRI followed by RP without prior therapy was