Prostate cancer with a normal PSA — is it an insignificant tumour?

517 PROSTATE

CANCER

INSIGNIFICANT

WITH

A

NORMAL

PSA

Klinikum, Urology, Karlsruhe,

INTRODUCTION

& OBJECTIVES:

procedure

screening

frequency

and clinical importance

between

INCIDENCE, HISTOLOGY AND FOLLOW-UP OF UNSUSPECTED PROSTATIC CANCER IN PATIENTS UNDERGOING RADICAL, CYSTOPROSTATECTOMY FOR BLADDER CANCER Rigaud J., Tiguert R., Lacombe L., Fradet Y. CIIUQ-L’HBtel-Dieu

In the era of PSA the question

of the so-called PSA-negative All patients

receiving

the

PCA.

radical

Of 1537 patients receiving PSA was available.

They were analysed

radical prostatectomy

in 1493 patients

127 (8%) of them had a PSA lower than 4

ngiml and 37 (2,4%) even lower than 2 ng/ml. PCA was mainly diagnosed prostate biopsy because of a suspicious

DRE. Only 221127 patients (I 7%) were by TURP, and 10 of them showed

as an incidental

carcinoma

residual cancer in the histology

after radical prostatectomy.

no

On the over hand,

35% (441127) of the patients with a PSA &4ng/ml histologically

showed capsular

disease (‘pT3). 125 of the 127 patients underwent pelvic lymph node

dissection prior to radical retropubic

prostatectomy

and in 4% (5/l 27) regional

lymph node metastases were found. One of these 5 patients had a G2 tumour, the others G3 or G4 turnouts. CONCLUSIONS: is still important

Despite the high sensitivity in tumour

screening.

Unsuspected prostatic cancer in patients undergoing radical cystoprostatectomy for bladder cancer was frequent and its incidence increases with age. Most of these cancers were organ-confined and well differentiated. However, prostate cancer had a little influence on specific mortality in patients treated by cystoprostatectomy for bladder cancer. CONCLUSIONS:

of PSA to predict PCA, the DRE

PSA-negative

PCA is not a harmless

cancer, because in one third of the patients the cancer is not organ-confined

and

4% even show regional lymph node involvement.

P28 pRosTA7EcA1scu1:NOR TREATMENT Friday,March 14,15.30-17.00 hrs, fktom N113

519 BIOPSIES AT THE BASE OF THE PROSTATE THE INVOLVEMENT OF SEMINAL VESICLES Raverv V.I. Dumonceau 0.‘. Messas Hermieu J.‘. Boccon-Gibod L.’

CORRELATE

A.‘, Toublairc

WITH

M.‘. Boccon-Ciibod

‘Bichat Hospital, Urology, Paris, France, ‘Bichat Hospital. France. ‘Trousseau Hospital, Pathology. Paris, France

Pathology.

I-.‘,

I’.

I I

N

Paris.

PSA (ngiml)

I

SV-

I

63

333

15 (5-71)

14.6 (0.5-24)

NBP

38.8%

39.3%

LTCI

17.2%

17%

Negative Biopsies at the Base

4%

40%

Capsular Effraction

29%

6%

6.9

6.8

Gleason Score CONCLUSIONS: vs+.

Negative biopsies

European

Supplements

Urology

at the base correlate

2 (2003) No. 1,

pp.

132

with a low risk of

S.‘. Salter I<.‘. V&t/

1 . Poffock B.‘. Bradshaw

P’. flerman

7.’

INTRODUCTION & OBJECTIVES: To evaluate the kinetics ofPSA response in prostate cancer patients treated by intensity-modulated radiotherapy (IMRT) with or without daily stereotactic ultrasound target localization during the treatment course. MATERIAL & METHODS: Inclusion criteria were: (a) sequential tomotherapeutic fMRT treatment with curative intent for clinically localixd prostate cancer: (b) minimum treatment dose 70 Gy (mean total dose 75. I Gy, range 70.2 to 80 Gy); (c)at least one followup PSA value; (d) minimum clinical follow-up 4 months. Of 60 patients treated between 2199 and 3102, 38 patients were aligned for their fMRT treatment using the BATT” daily stereotactic ultrasound target localization device (Nomos Corp., Sewickley, PA). We determined the time to reach PSA cut-off values of ‘1.0, ~0.5 and ~0.2 ng/ml, the percentage of patients below the respective cut-off values during follow-up and the correlation of PSA response with use of the BAT device. As potential covariates, pre treatment PSA. Gleason score, tnmour stage, prior hornnine treatment and diagnose\ of ihebctes were analyaed.

i

sv+ .

Cavanaugh

OF

L TfISCSA. Radiation Oncology, San Antonio. United State\ of America. ‘UTHS(‘SA. ‘UTHSCSA. Radioloev. San Medical Phvsics. San Antonio. United States of America. Antonio. United States of America. ‘UTHSCSA. Epide&fogy and Biostatist& San 4ntonio. United States of America

MATERIAL & METHODS: 396 patients were submitted to RP for a clinically localized prostate cancer diagnosed using either a 6-core or a IO-core biopsy protocol. At the pathological examination of the RP specimens. 16% SVt were found. We studied in both groups SV+ and SV-, the median preoperative PSA level, the number of positive biopsies (NPB), the length of tissue core invaded by cancer (LTCI), the positivity of biopsies at the base, the capsular status at biopsy evaluation, Gleason score. .

520

FOLLOWING INTENSITY-MODULATED PSA KINETICS RADIOTHERAPY FOR PROSTATE CANCER: THE IMPACT DAILY STEREOTACTIC ULTRASOUND TARGETING

INTRODUCTION & OBJECTIVES: The involvement of seminal vesicles (SV) in the radical prostatectomy (RP) specimen leads to a high risk of postoperative biological progression. We evaluated weather the biopsy protocol can predict the tumoural spread within SV (SV+).

RESULTS:

Canada

RESULTS: Unsuspected prostatic cancer was observed in 55 patients (I 8%)of the population. According to age stratification c 50 years, 50 to 59 years, 60 to 69 years, 70 to 79 years and ?80 years, incidence of unsuspected prostatic cancer was 4%, 12%, 19%, 24% and I I”/ respectively. Dtgital rectal examination of the prostate before surgery was normal in 49 cases (89%). In 39 cases (71%) tumour was organ-confined (stage pT2), pelvic lymph nodes were involved in 5 cases (9%) Gleason score ~7 was observed in 39 cases (71%) and Gleason score -7 in 10 cases (18%). With a mean follow-up of 35 months (2-160) 45.3% of the population was alive at 5 years, A progression of prostate cancer was observed in 2 patients (4%) and they were treated by androgen deprivation. Of the 22 deaths, only 1 was due to prostate cancer.

by

diagnosed

Quebec,

MATERIAL & METHODS: From January 1983 to November 2001, 305 patients underwent radical cystoprostatectomy for transitional cell carcinoma, None of these patients had a diagnosis of prostate cancer before surgery. Mean age of population was 65 years (32 - 91). Incidence of prostate cancer according to age. pathological stage. Gleason score and specific cause of death were reviewed for each patient.

prostatectomy

tumour stage, grading and lymph node involvement.

RESULTS:

de Quebec, Urology,

INTRODUCTION & OBJECTIVES: The aim of this study was to evaluate the incidence. pathological findings and influence on mortality of unsuspected prostatic cancer in patients undergoing radical cystoprostatectomy for bladder cancer.

often

(DRE) is still necessary as a routine

for prostate cancer (PCA). Our goal was to determine

& METHODS:

the preoperative

surpassing

518

AN

D.

I 1189 and 12/2001 were evaluated retrospectively.

concerning

IT

Germany

erases whether the digital rectal examination

MATERIAL

IS

TUMOUR?

Bader P., Miiller J., Huber R.D., Echtle D., Frohneberg Stadtisches

-

II

RESULTS: During hmited follow-up (mean 479 days; 133.1261 days), 43, 34, and 23 patients reached PSA cut-off values of 1.0, 0.5 and 0.2 ng;ml, respectively. In the cohort of patients treated by fMRT with ultrasound targeting, 789% and 63% r&ched PSA cut-off values of I .O and 0.5 ngiml. compared with 59.1% and 45.5% of patients treated without BAT. In patients treated with ultrasound targeting. Kaplan M&r curves to reach PSA cutoff values were statistically significantly different for PSA ~1 .O (P=O.OOOl, logrank) and PSA ~0.5 (P=O.O015, logrank), as was mean time to fall below PSA I.0 and 0.5 (P=O.O059 and P=O.O44), respectively. Kaplan-Meier comparison of subpopulations, defined by chosen covariates showed no significant difference except use of daily ultrasound targeting (logrank). , CONCLUSIONS: Post treatment PSA half-life differed significantly in patients treated by fMRT with or without daily ultrasound prostate targeting. A significantly higher percentage of oatients treated wine ultrasound tareetine reached orosnosticallv favourablv PSA cut-off levels during limited &low-up. Thus: the&sent siudyindicatcs that more’nrecise daily prostate targeting achieves a prognostically~signiticant treatment goal earlier ;n follow-up. While the observed higher oercentaee of oatients with favourable interim PSA sueeest improved outcomes foli&vin’g IMRTkith daily ultrasound targeting, the clinical be& of reaching low PSA levels earlier remains unknown. Long-term outcome data will be needed to establish early PSA kinetics as a potential prognostic parameter.