PIV-01 NON VISIBLE TUMOR ON MULTIPARAMETRIC MRI WOULD NOT PREDICT THE LOW RISK PROSTATE CANCER

THE JOURNAL OF UROLOGYâ

Vol. 191, No. 4S, Supplement, Wednesday, May 21, 2014

Number

Pathological upgrading

No pathological upgrading

49

128

e955

P value

Age (Mean, years)

63.67.3(49-71)

63.17.8(48-74)

0.45

PSA (ng/ml)

6.51.8(3.5-19.3)

5.11.2(3.2-21.7)

<0.01

PSA density

0.200.06(0.07-0.67)

0.150.04(0.10-0.45)

<0.01

Prostate volume (cc)

30.28.9(16.4-64.5)

33.79.3(14.8-71.3)

0.13

Biopsy findings (MeanSD) Gleason scores

5.90.7

5.8 0.4

0.24

No of involved cores

2.13.3

1.61.9

0.02

Maximal tumor diameter (mm)

19.22.8

11.81.7

<0.01

T2

7 (14.3%)

91 (71.6%)

T3

42 (85.7%)

37 (28.4%)

Positive surgical margin

44 (89.8%)

18 (10.2%)

<0.01

Final stage

Source of Funding: none

Plenary Session IV: Best Abstracts Wednesday, May 21, 2014

7:30 AM-7:58 AM

<0.01 <0.01

Tumor volume (cc) 0.5>

13 (26.5%)

88 (68.8%)

0.5<

36 (73.5%)

40 (31.2%)

Biochemical recurrence (N)

11 (22.4%)

6(4.7%)

<0.01

Source of Funding: none

PIV-02 PIV-01 NON VISIBLE TUMOR ON MULTIPARAMETRIC MRI WOULD NOT PREDICT THE LOW RISK PROSTATE CANCER Seung Hwan Lee, Kwang Suk Lee, Seoul, Korea, Republic of; Tae Nam Kim, Seung Wook Lee, , Please choose an option below; Dong Hoon Lee, Busan, Korea, Republic of; Kyo Chul Koo, Byung Ha Chung*, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: Widespread use of PSA screening has led to increase the detection of low risk prostate cancer(PCA). We aimed to assess the pathological characteristics of non visible tumor on multiparametric MRI that was done preoperatively. METHODS: We retrospectively analyzed 623 prostate cancer patients who underwent multiparametric MRI before radical prostatectomy(RP) at our institution. All patients underwent a transrectal ultrasound-guided 12 core needle biopsy. Image sequences obtained included high resolution T1 and T2-weighted, diffusion-weighted and dynamic pre and post contrast sequences. Of these patients, 177 (28.4%) had non visible tumor on MRI and the clinical stage was T1c. Imaging results were compared with pathological findings in regard to stage and Gleason scores (GS). Low risk PCA was defined as organ confined, postoperative GS 6 with tumor volume less than 0.5cm3. RESULTS: Preoperative mean PSA and PSA density were 5.7 (SD 4.9, range 3.2-21.7) and 0.16 (SD 0.11, range 0.07-0.67), respectively. The clinical stage was T1c in all patients. Of the 177 prostatectomy specimens which were non visible tumor on MRI, pathological finding resulted in upgrading in 49 (27.7%) patients and tumor volume more than 0.5cc in 101 (57.1%). Comparison between pathological upgrading group and no pathological upgrading group was shown in Table 1. Biochemical recurrence rate was significantly higher in pathological upgrading group rather than in non upgrading group at mean 29 months. On multivariate logistic analysis, preoperative PSA and PSA density were significant predictors of low risk PCA (odds ratio ¼ 1.38 and 1.29 95% CI, 1.10 to 2.01 and 1.08 to 1.84, respectively). CONCLUSIONS: Even though cancer foci were not visualized on MRI after biopsy, pathological tumor volume and Gleason scores upgrading was relatively high. Therefore, non visible tumor on multiparametric MRI would not predict the low risk prostate cancer.

SALVAGE LYMPH NODE DISSECTION FOR PROSTATE CANCER NODAL RECURRENCE DETECTED BY 11C-CHOLINE POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY R. Jeffrey Karnes*, Christopher Murphy, Val Lowe, Lance Mynderse, Eugene Kwon, Rochester, MN INTRODUCTION AND OBJECTIVES: Management of prostate cancer nodal recurrence remains challenging. However, recently, more aggressive approaches including salvage lymph node dissection (sLND) have garnered attention with newer imaging such as 11 C-choline positron emission tomography/computed tomography (PET/CT). This study represents a single surgeon approach to sLND for prostate cancer nodal recurrence detected by 11C-choline PET/CT. METHODS: Retrospective analysis was performed for all patients who underwent sLND e pelvic and/or retroperitoneal - for prostate cancer lymph node recurrence by a single surgeon. Only patients who previously had a radical prostatectomy (RP) were included and the main surgical intent was a sLND. Primary endpoints including biochemical recurrence (BCR), systemic progression, and prostate cancer-specific mortality were evaluated using Kaplan Meier analysis. RESULTS: In total, 54 men underwent sLND for prostate cancer nodal recurrence from 2008 to 2013. Of these men, 77.8% (42/54) had undergone some form of post-RP therapy even prior to sLND. At last follow-up, 96.3% (52/54) were alive while two patients had died from prostate cancer. Mean and median follow-up times were 21.9 and 20.5 months, respectively. Age at sLND ranged from 47-78 years with mean age of 62.2 and PSA at sLND ranged from 0.24-47.7 ng/mL with median of 2.1 (IQR 1.4-3). The total number of lymph nodes dissected for each patient ranged from 7 to 61 with median 21.5 (IQR 15.7529.25). The number of positive nodes dissected ranged from 0-31 with median of 3.5 (IQR 1-6.5). Since sLND, 44.4% (24/54) patients have had no further treatment, 35.2% (19/54) are on hormonal therapy, and 20.4% (11/54) have received multiple different treatment modalities. At last follow-up, 14.8% (8/54) had suffered BCR while PSA remained undetectable in 55.6% (30/54). PSA never became undetectable following sLND in 29.6% (16/54). 25.9% (14/54) have suffered systemic progression while 74.1% (40/54) remain free of systemic progression. CONCLUSIONS: This, to our knowledge, represents the largest U.S. study of sLND in the setting of metastatic prostate cancer with PSA failure post RP. Although the follow-up period is short, sLND may represent a valid treatment option as part of a multimodal approach or may even be potentially curative in select men. Source of Funding: None