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POD-01.04: High-intensity focused ultrasound for the treatment in 503 patients with localized prostate cancer
PODIUM SESSIONS
gan-confined disease except one. 4 of the treated patients had post treatment failure in a median post treatment follow-up of 48 months. Conclusion: Negative re-biopsy in patients with prostate cancer on AS is associated with low volume disease. The result of first repeated biopsy has strong impact in predicting disease progression. Patients with positive first re-biopsy should be considered for treatment. Pathological progression usually occurs in the first 2 years of follow up. Intensive biopsy protocol in the first 2-3 years is required to identify and to offer treatment to patients at high risk of progression. Abstract Withdrawn POD-01.04 High-intensity focused ultrasound for the treatment in 503 patients with localized prostate cancer Uchida T1, Nitta M1, Hongo S1, Shoji S1, Nagata Y1, Usui Y2, Terachi T2 1 Tokai University Hachioji Hospital, Tokyo, Japan; 2Tokai University, Tokyo, Japan Introduction: The purpose of the study was to assess the prostate-specific antigen (PSA) level with a long-term follow-up after high-intensity focused ultrasound therapy (HIFU) for prostate cancer, and to identify the predictors for an improved disease-fee survival. Methods: Between 1999 and 2006, 503 patients who underwent treatment with the Sonablate® HIFU device (Focus surgery, Indianapolis, USA) for T1-3 N0M0 prostate cancer, with at least 1 year of follow-up, were studied. During the follow-up evaluation, PSA measurement and prostate biopsy were performed. Biochemical failure was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology (ASTRO), i.e., a rise of 2 ng/ml, or more, above the nadir PSA, consensus panel. None of the patients had received androgen deprivation, with or without other anticancer therapy, prior to documenting a biochemical failure. The median follow-up was of 22 months duration. Both Kaplan-Meier curves and multivariate regression analyses were employed. Results: The median age, PSA and prostate volume were 68 years, 9.510 ng/ml and 22 ml, respectively. The stage was determined to be as follows: T1c in 280 (55.7%), T2a in 132 (26.2%), T2b in 68 (13.5%) and T3 in 23 (4.6%) patients. The Gleason scores were 2 to 4, 5 to 7 and 8
2
to 10 in 42 (8.4%), 398 (79.1%) and 63 (12.5%) respectively. R, withpvingvingving. The biochemical disease-free survival rate (bDFR) at 5 –years for all patients was 63.5%. The actual 5-year bDFR with the low, intermediate and high –risk groups were 86.3%, 64.8% and 31.3%, respectively (p⬍0.0001). Negative prostate biopsy findings were obtained in 80.2% of the patients. A multivariate analysis identified the pretreatment PSA level (p⬍0.0001) and the disease stage (p⫽0.0125) to be associated with the bDFR. Urethral stricture and epididymitis were observed in 16% and 4% of the patients. Transit grade I incontinence was noted in 0.8% of the patients. The majority of men (86%) who had erections prior to therapy managed to preserve their erectile function. Conclusion: HIFU appears to be both an effective and well tolerated procedure for men with localized prostate cancer, especially those with low- and intermediate-risk. POD-01.05 The advanced learning curve in robotic-assisted laparoscopic radical prostatectomy: a multi-institutional survey Lavery HJ1, Ahlering T2, Tewari A3, Smith JA4, Shalhav A5, Albala D6, Wiklund P7, Costello AJ8, Palmer KJ1, Shah K1, Thaly R1, Patel V1 1 Center for Robotic and Computer-Assisted Surgery, Ohio State University, Columbus, OH, USA; 2University of California at Irvine, CA, USA; 3Cornell University, NY, USA; 4Vanderbilt University, Nashville, TN, USA; 5University of Chicago,Chicago, IL, USA; 6Duke University, Durham. NC, USA; 7Karolinska Institutet, Sweden; 8University of Melbourne, Melbourne, Australia Introduction: Several studies have attempted to define the learning curve associated with robotic-assisted laparoscopic prostatectomy (RALP). These studies have focused on the acquisition of skills in novice robotic surgeons but basic proficiency, however, cannot be equated with satisfactory patient outcomes. We collected data from experienced high volume robotic surgeons in an attempt to define an ‘advanced’ learning curve. Methods: High volume, experienced robotic surgeons completed a questionnaire designed at the Ohio State University assessing basic to advanced techniques. Results: Nine institutions participated in the study accounting for a total of 6276. Parameters assessed included: surgeon experience (mean 460 cases, range 325-
1500), total operative and console time (mean 165/105 minutes, respectively), median time to ‘basic proficiency’ (25 cases), challenging cases (50 cases) and surgical outcomes were satisfactory (continence, margins and potency) after 100, 200 and 200 procedures, respectively. Conclusions: Basic proficiency can be achieved at 25 cases and satisfactory outcomes regarding continence, margins and potency at 100-200 cases. POD-01.06 Phase II trial of weekly docetaxel and complete androgen blockade prior to radical prostatectomy in high-risk localized prostate cancer patients Go´mez Veiga FJ1, Sousa A2, Alcaraz A3, Areal J4, Hannaoui N5, Aparicio LA6, ´ n P9, Font Mellado B7, Gallardo E8, Gasco 10 A 1 Hospital Juan Canalejo, Servicio de Urologı´a, A Corun ˜ a, Spain; 2Hospital Comarcal de Monforte, Servicio de Urologı´a, Monforte, Spain; 3Hospital Clinic, Servicio de Urologı´a, Barcelona, Spain; 4Hospital Germans Trias i Pujol, Servicio de Urologı´a, Badalona, Spain; 5Hospital Parc Tauli, Servicio de Urologı´a, Sabadell, Spain; 6Hospital Juan Canalejo, Servicio de Oncologı´a Me´dica, A Corun ˜ a, Spain; 7ICHMO, IDIBAPS Hospital Clinic, Servicio de Oncologı´a Me´dica, Barcelona, Spain; 8Hospital Parc Tauli, Servicio de Oncologı´a Me´dica, Sabadell, Spain; 9Hospital Clinic, Servicio de Oncologı´a Me´dica, Barcelona, Spain; 10Instituto Catala ´n de Oncologı´a, Hospital Germans Trias i Pujol, Servicio de Oncologı´a Me´dica, Badalona, Spain Introduction: Patients with high-risk localized prostate cancer have an increased risk of positive margins and recurrence after radical prostatectomy. Neoadjuvant hormonotherapy has not shown a survival benefit prior to surgery. Docetaxel-based chemotherapy improves survival in hormone refractory prostate cancer. These data support the investigation of multimodality approaches to improve the aggressive behavior of high-risk localized prostate cancer. The main objective of this study was to assess the pathologic complete response (pCR) rate. Secondary objectives were clinical activity, toxicity profile, time to progression and survival. Material and Methods: Patients with clinical stage T1-2 (⫹ Gleason ‡ 7 (4⫹3) and/or PSA ‡ 20 ng/mL) and T3 prostate cancer received 3 cycles of docetaxel (35 mg/m2 i.v. days 1, 8 and 15, every 28 days) concomitant with a depot goserelin (10.8 mg sc) plus flutamide (750 mg po
UROLOGY 70 (Supplment 3A), September 2007
gan-confined disease except one. 4 of the treated patients had post treatment failure in a median post treatment follow-up of 48 months. Conclusion: Negative re-biopsy in patients with prostate cancer on AS is associated with low volume disease. The result of first repeated biopsy has strong impact in predicting disease progression. Patients with positive first re-biopsy should be considered for treatment. Pathological progression usually occurs in the first 2 years of follow up. Intensive biopsy protocol in the first 2-3 years is required to identify and to offer treatment to patients at high risk of progression. Abstract Withdrawn POD-01.04 High-intensity focused ultrasound for the treatment in 503 patients with localized prostate cancer Uchida T1, Nitta M1, Hongo S1, Shoji S1, Nagata Y1, Usui Y2, Terachi T2 1 Tokai University Hachioji Hospital, Tokyo, Japan; 2Tokai University, Tokyo, Japan Introduction: The purpose of the study was to assess the prostate-specific antigen (PSA) level with a long-term follow-up after high-intensity focused ultrasound therapy (HIFU) for prostate cancer, and to identify the predictors for an improved disease-fee survival. Methods: Between 1999 and 2006, 503 patients who underwent treatment with the Sonablate® HIFU device (Focus surgery, Indianapolis, USA) for T1-3 N0M0 prostate cancer, with at least 1 year of follow-up, were studied. During the follow-up evaluation, PSA measurement and prostate biopsy were performed. Biochemical failure was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology (ASTRO), i.e., a rise of 2 ng/ml, or more, above the nadir PSA, consensus panel. None of the patients had received androgen deprivation, with or without other anticancer therapy, prior to documenting a biochemical failure. The median follow-up was of 22 months duration. Both Kaplan-Meier curves and multivariate regression analyses were employed. Results: The median age, PSA and prostate volume were 68 years, 9.510 ng/ml and 22 ml, respectively. The stage was determined to be as follows: T1c in 280 (55.7%), T2a in 132 (26.2%), T2b in 68 (13.5%) and T3 in 23 (4.6%) patients. The Gleason scores were 2 to 4, 5 to 7 and 8
2
to 10 in 42 (8.4%), 398 (79.1%) and 63 (12.5%) respectively. R, withpvingvingving. The biochemical disease-free survival rate (bDFR) at 5 –years for all patients was 63.5%. The actual 5-year bDFR with the low, intermediate and high –risk groups were 86.3%, 64.8% and 31.3%, respectively (p⬍0.0001). Negative prostate biopsy findings were obtained in 80.2% of the patients. A multivariate analysis identified the pretreatment PSA level (p⬍0.0001) and the disease stage (p⫽0.0125) to be associated with the bDFR. Urethral stricture and epididymitis were observed in 16% and 4% of the patients. Transit grade I incontinence was noted in 0.8% of the patients. The majority of men (86%) who had erections prior to therapy managed to preserve their erectile function. Conclusion: HIFU appears to be both an effective and well tolerated procedure for men with localized prostate cancer, especially those with low- and intermediate-risk. POD-01.05 The advanced learning curve in robotic-assisted laparoscopic radical prostatectomy: a multi-institutional survey Lavery HJ1, Ahlering T2, Tewari A3, Smith JA4, Shalhav A5, Albala D6, Wiklund P7, Costello AJ8, Palmer KJ1, Shah K1, Thaly R1, Patel V1 1 Center for Robotic and Computer-Assisted Surgery, Ohio State University, Columbus, OH, USA; 2University of California at Irvine, CA, USA; 3Cornell University, NY, USA; 4Vanderbilt University, Nashville, TN, USA; 5University of Chicago,Chicago, IL, USA; 6Duke University, Durham. NC, USA; 7Karolinska Institutet, Sweden; 8University of Melbourne, Melbourne, Australia Introduction: Several studies have attempted to define the learning curve associated with robotic-assisted laparoscopic prostatectomy (RALP). These studies have focused on the acquisition of skills in novice robotic surgeons but basic proficiency, however, cannot be equated with satisfactory patient outcomes. We collected data from experienced high volume robotic surgeons in an attempt to define an ‘advanced’ learning curve. Methods: High volume, experienced robotic surgeons completed a questionnaire designed at the Ohio State University assessing basic to advanced techniques. Results: Nine institutions participated in the study accounting for a total of 6276. Parameters assessed included: surgeon experience (mean 460 cases, range 325-
1500), total operative and console time (mean 165/105 minutes, respectively), median time to ‘basic proficiency’ (25 cases), challenging cases (50 cases) and surgical outcomes were satisfactory (continence, margins and potency) after 100, 200 and 200 procedures, respectively. Conclusions: Basic proficiency can be achieved at 25 cases and satisfactory outcomes regarding continence, margins and potency at 100-200 cases. POD-01.06 Phase II trial of weekly docetaxel and complete androgen blockade prior to radical prostatectomy in high-risk localized prostate cancer patients Go´mez Veiga FJ1, Sousa A2, Alcaraz A3, Areal J4, Hannaoui N5, Aparicio LA6, ´ n P9, Font Mellado B7, Gallardo E8, Gasco 10 A 1 Hospital Juan Canalejo, Servicio de Urologı´a, A Corun ˜ a, Spain; 2Hospital Comarcal de Monforte, Servicio de Urologı´a, Monforte, Spain; 3Hospital Clinic, Servicio de Urologı´a, Barcelona, Spain; 4Hospital Germans Trias i Pujol, Servicio de Urologı´a, Badalona, Spain; 5Hospital Parc Tauli, Servicio de Urologı´a, Sabadell, Spain; 6Hospital Juan Canalejo, Servicio de Oncologı´a Me´dica, A Corun ˜ a, Spain; 7ICHMO, IDIBAPS Hospital Clinic, Servicio de Oncologı´a Me´dica, Barcelona, Spain; 8Hospital Parc Tauli, Servicio de Oncologı´a Me´dica, Sabadell, Spain; 9Hospital Clinic, Servicio de Oncologı´a Me´dica, Barcelona, Spain; 10Instituto Catala ´n de Oncologı´a, Hospital Germans Trias i Pujol, Servicio de Oncologı´a Me´dica, Badalona, Spain Introduction: Patients with high-risk localized prostate cancer have an increased risk of positive margins and recurrence after radical prostatectomy. Neoadjuvant hormonotherapy has not shown a survival benefit prior to surgery. Docetaxel-based chemotherapy improves survival in hormone refractory prostate cancer. These data support the investigation of multimodality approaches to improve the aggressive behavior of high-risk localized prostate cancer. The main objective of this study was to assess the pathologic complete response (pCR) rate. Secondary objectives were clinical activity, toxicity profile, time to progression and survival. Material and Methods: Patients with clinical stage T1-2 (⫹ Gleason ‡ 7 (4⫹3) and/or PSA ‡ 20 ng/mL) and T3 prostate cancer received 3 cycles of docetaxel (35 mg/m2 i.v. days 1, 8 and 15, every 28 days) concomitant with a depot goserelin (10.8 mg sc) plus flutamide (750 mg po
UROLOGY 70 (Supplment 3A), September 2007