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PROSTATE VOLUME REDUCTION WITH DUTASTERIDE PRIOR TO MAPPING BIOPSIES
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THE JOURNAL OF UROLOGY®
and (+) to (-) in 10 (38%). Overcalling was due to artifactual tissue tears and undercalling was due to missed cauterized/crushed tumor cells. LN status: Positive LN were identified only by CP review in 2/208 (1%) of RP, with agreement in all others. CONCLUSIONS: Considerable interobserver variation exists between CP and LP evaluation of RP samples that could affect accrual of patients to clinical trials and impact the prognostication and management of prostate cancer. Source of Funding: Sanofi Avantis
159 DISCREPANCY BETWEEN LOCAL AND CENTRAL PATHOLOGICAL REVIEW FOR RADICAL PROSTATECTOMY SPECIMENS Kentaro Kuroiwa*, Fukuoka, Japan; Taizo Shiraishi, Tsu, Japan; Seiji Naito, Fukuoka, Japan; Clinicopathological Research Group for Localized Prostate Cancer INTRODUCTION AND OBJECTIVE: Regarding radical prostatectomy (RP) specimens, interobserver reproducibility of Gleason score (GS) and other pathological features has not been well studied. We investigated the clinical value of reevaluation of RP specimens by dedicated uropathologists. Methods: Patients with clinically localized (cT1c-3) prostate cancer who underwent RP between 1997 and 2005 were enrolled onto the Clinicopathological Research Group for Localized Prostate Cancer registry. Two central uropathologists (K.K. and T.S) reviewed both biopsy and RP specimens of 2023 patients without preoperative hormonal therapy (central review; CR). As for prostatectomy specimens, GS and the existence of extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph nodes involvement (LNI) and positive surgical margin (SM) were recorded and compared with those on original pathological reports (local review; LR). GS in each patient was assigned according to the 2005 International Society of Urological Pathology consensus and categorized into four groups as 2-4, 5-6, 7 and 8-10. Data of GS, ECE, SVI, LNI, SM, and organ confined disease (OCD) were available in 1781, 1630, 1639, 1923, 1381 and 1592 patients. RESULTS: The distribution of LR GS was 3.7% (2-4), 31.8% (56), 48.9% (7) and 15.5% (8-10), which was changed to 0.1%, 25.8%, 64.3% and 9.8% by a central review, respectively. The exact correlation rate of GS between LR and CR was 66.1%. Gleason patterns 1 or 2 were included in 265 (14.9%) patients in LR GS, compared to 17 (1.0%) patients in CR GS. Of 67 and 567 patients with LR GS 2-4 and 5-6, 36 (53.7%) and 249 (43.9%) patients were upgraded to GS 7 or more by CR. Of 871 patients with LR GS 8-10, 32 (3.7%) patients were upgraded to GS 8-10 by CR. The exact correlation rate of ECE, SVI, LNI, SM and OCD between LR and CR was 82.5%, 97.6%, 99.7%, 87.4% and 83.8%, respectively. Of 528 LR ECE (+) patients 157 (29.7%) were CR ECE (-), whereas 129 of 1102 (11.7%) LR ECE (-) patients were CR ECE (+). Of 546 LR SM (+) patients 85 (15.6%) were CR SM (-), whereas 113 of 1033 (10.9%) LR SM (-) patients were CR SM (+). As for OCD, 106 of 1031(10.3%) LR OCD patients and 152 of 561 (27.1%) LR non-OCD patients were finally decided as non-OCD and OCD by CR. CONCLUSIONS: Not only GS but also other pathological features were significantly changed by the dedicated central pathological review, which may affect the outcomes of each pathological category. The data indicate the central pathological review is crucial for RP specimens from multiple institutions. Source of Funding: None
160 PROSTATE VOLUME REDUCTION WITH DUTASTERIDE PRIOR TO MAPPING BIOPSIES Daniel J. Tandberg, E David Crawford, Paul B Arangua, Kathyrn F. Sullivan*, Al Barqawi, Paul D Maroni, Colin I. O’Donnell, Aurora, CO INTRODUCTION AND OBJECTIVE: Prostate volume reduction is desirable in certain subsets of men undergoing targeted focal
Vol. 181, No. 4, Supplement, Sunday, April 26, 2009
therapy (TFT) for prostate cancer (PCa) including brachythearpy and cryotherapy. An increasing number of men are undergoing saturation or 3 dimensional mapping biopsies (MBx) to evaluate the extent of PCa prior to deciding on a treatment regimen, e.g. TFT or surviellence. Large prostates in this population were deemed to be secondary to benign prostatic hypertrophy (BPH) and not PCa. In our experience, prostate size is related to post biopsy complications, e.g., urinary retention and bleeding. We began treating men with large volume prostates with 0.5 mg of dutasteride daily prior to MBx. METHODS: From 2005 until present 146 men have had Mbx at our institution. Men with enlarged prostates were treated with dutasteride to reduce prostate volume before Mbx. Prostate volumes were evaluated with TRUS at baseline and after treatment. RESULTS: 39 men received dustasteride prior to MBx. The mean prostate volume was 55.1cc (SD 17.6) prior to dutasteride therapy and 38.3 cc (SD 10.9) after therapy. The average treatment time was 19 weeks (SD 15.6). The average reduction in volume size was 16.7cc (SD 11.9) or an average decrease of 28.0% in prostate volume. The graph below shows prostate volume change (in cc) before and after dutasteride treatment by length of treatment (in weeks). It is further categorized by initial gland size: a49cc, 50cc - 69cc, and q70cc. The graph enables the clinician to determine the length of treatment needed to reduce the prostate gland to the desired size based on initial prostate volume. CONCLUSIONS: Most of the trials demonstrating prostate volume reduction with a 5- alpha reductase inhibitor have been performed in men with lower urinary tract symptoms and defined prostate volumes. The MTOPS trial demonstrated a consistent volume reduction of about 25% in men with both small (<25cc) as well as large prostates (>40cc) when treated with finasteride (Kaplan, SA, et al J Urol volume 180, 10301033, 2008). The current trial is one of the first reviews to demonstrate volume reduction in men with PCa taking dutasteride over a varied length of time. The graph presented will aid the clinician in determining the length of therapy needed to reach a desired volume reduction. Source of Funding: None
Prostate Cancer: Epidemiology & Natural History (I) Podium 6 Sunday, April 26, 2009
8:00 am - 10:00 am
161 AGE- AND RACE-SPECIFIC RESULTS OF A LARGE COMMUNITY BASED PROSTATE CANCER SCREENING STUDY Kimberly A Roehl*, Saint Louis, MO; Angel Desai, William J Catalona, Chicago, IL INTRODUCTION AND OBJECTIVE: There are limited published epidemiologic data on age- and race-specific results of communitybased prostate cancer screening programs, and these data would be useful for epidemiologic studies comparing screening results in different populations. The objective of this study was to determine the age-and race-specific prostate cancer detection rates in a large communitybased prostate cancer screening program in St. Louis, Missouri from 1989-2001. METHODS: Our PSA- and DRE-based screening protocol involving a study that enrolled more than 35,000 men and lasted for 12 years has been published previously (Smith DS, et al, Cancer 80:1852, 1997). Herein, we examined the age- and race-specific prostate cancer detection rates at the initial screening visit and on serial screening visits. RESULTS: Overall prostate cancer detection rates by race are 5.1% for African-American men on initial screen versus 3.0% in Caucasian men. The rates are 11.6% and 10.0%, respectively based on serial screening. CONCLUSIONS: Our screening population included a relatively larger proportion of younger and smaller proportion of older AfricanAmerican men than Caucasian men. Age-specific prostate cancer
THE JOURNAL OF UROLOGY®
and (+) to (-) in 10 (38%). Overcalling was due to artifactual tissue tears and undercalling was due to missed cauterized/crushed tumor cells. LN status: Positive LN were identified only by CP review in 2/208 (1%) of RP, with agreement in all others. CONCLUSIONS: Considerable interobserver variation exists between CP and LP evaluation of RP samples that could affect accrual of patients to clinical trials and impact the prognostication and management of prostate cancer. Source of Funding: Sanofi Avantis
159 DISCREPANCY BETWEEN LOCAL AND CENTRAL PATHOLOGICAL REVIEW FOR RADICAL PROSTATECTOMY SPECIMENS Kentaro Kuroiwa*, Fukuoka, Japan; Taizo Shiraishi, Tsu, Japan; Seiji Naito, Fukuoka, Japan; Clinicopathological Research Group for Localized Prostate Cancer INTRODUCTION AND OBJECTIVE: Regarding radical prostatectomy (RP) specimens, interobserver reproducibility of Gleason score (GS) and other pathological features has not been well studied. We investigated the clinical value of reevaluation of RP specimens by dedicated uropathologists. Methods: Patients with clinically localized (cT1c-3) prostate cancer who underwent RP between 1997 and 2005 were enrolled onto the Clinicopathological Research Group for Localized Prostate Cancer registry. Two central uropathologists (K.K. and T.S) reviewed both biopsy and RP specimens of 2023 patients without preoperative hormonal therapy (central review; CR). As for prostatectomy specimens, GS and the existence of extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph nodes involvement (LNI) and positive surgical margin (SM) were recorded and compared with those on original pathological reports (local review; LR). GS in each patient was assigned according to the 2005 International Society of Urological Pathology consensus and categorized into four groups as 2-4, 5-6, 7 and 8-10. Data of GS, ECE, SVI, LNI, SM, and organ confined disease (OCD) were available in 1781, 1630, 1639, 1923, 1381 and 1592 patients. RESULTS: The distribution of LR GS was 3.7% (2-4), 31.8% (56), 48.9% (7) and 15.5% (8-10), which was changed to 0.1%, 25.8%, 64.3% and 9.8% by a central review, respectively. The exact correlation rate of GS between LR and CR was 66.1%. Gleason patterns 1 or 2 were included in 265 (14.9%) patients in LR GS, compared to 17 (1.0%) patients in CR GS. Of 67 and 567 patients with LR GS 2-4 and 5-6, 36 (53.7%) and 249 (43.9%) patients were upgraded to GS 7 or more by CR. Of 871 patients with LR GS 8-10, 32 (3.7%) patients were upgraded to GS 8-10 by CR. The exact correlation rate of ECE, SVI, LNI, SM and OCD between LR and CR was 82.5%, 97.6%, 99.7%, 87.4% and 83.8%, respectively. Of 528 LR ECE (+) patients 157 (29.7%) were CR ECE (-), whereas 129 of 1102 (11.7%) LR ECE (-) patients were CR ECE (+). Of 546 LR SM (+) patients 85 (15.6%) were CR SM (-), whereas 113 of 1033 (10.9%) LR SM (-) patients were CR SM (+). As for OCD, 106 of 1031(10.3%) LR OCD patients and 152 of 561 (27.1%) LR non-OCD patients were finally decided as non-OCD and OCD by CR. CONCLUSIONS: Not only GS but also other pathological features were significantly changed by the dedicated central pathological review, which may affect the outcomes of each pathological category. The data indicate the central pathological review is crucial for RP specimens from multiple institutions. Source of Funding: None
160 PROSTATE VOLUME REDUCTION WITH DUTASTERIDE PRIOR TO MAPPING BIOPSIES Daniel J. Tandberg, E David Crawford, Paul B Arangua, Kathyrn F. Sullivan*, Al Barqawi, Paul D Maroni, Colin I. O’Donnell, Aurora, CO INTRODUCTION AND OBJECTIVE: Prostate volume reduction is desirable in certain subsets of men undergoing targeted focal
Vol. 181, No. 4, Supplement, Sunday, April 26, 2009
therapy (TFT) for prostate cancer (PCa) including brachythearpy and cryotherapy. An increasing number of men are undergoing saturation or 3 dimensional mapping biopsies (MBx) to evaluate the extent of PCa prior to deciding on a treatment regimen, e.g. TFT or surviellence. Large prostates in this population were deemed to be secondary to benign prostatic hypertrophy (BPH) and not PCa. In our experience, prostate size is related to post biopsy complications, e.g., urinary retention and bleeding. We began treating men with large volume prostates with 0.5 mg of dutasteride daily prior to MBx. METHODS: From 2005 until present 146 men have had Mbx at our institution. Men with enlarged prostates were treated with dutasteride to reduce prostate volume before Mbx. Prostate volumes were evaluated with TRUS at baseline and after treatment. RESULTS: 39 men received dustasteride prior to MBx. The mean prostate volume was 55.1cc (SD 17.6) prior to dutasteride therapy and 38.3 cc (SD 10.9) after therapy. The average treatment time was 19 weeks (SD 15.6). The average reduction in volume size was 16.7cc (SD 11.9) or an average decrease of 28.0% in prostate volume. The graph below shows prostate volume change (in cc) before and after dutasteride treatment by length of treatment (in weeks). It is further categorized by initial gland size: a49cc, 50cc - 69cc, and q70cc. The graph enables the clinician to determine the length of treatment needed to reduce the prostate gland to the desired size based on initial prostate volume. CONCLUSIONS: Most of the trials demonstrating prostate volume reduction with a 5- alpha reductase inhibitor have been performed in men with lower urinary tract symptoms and defined prostate volumes. The MTOPS trial demonstrated a consistent volume reduction of about 25% in men with both small (<25cc) as well as large prostates (>40cc) when treated with finasteride (Kaplan, SA, et al J Urol volume 180, 10301033, 2008). The current trial is one of the first reviews to demonstrate volume reduction in men with PCa taking dutasteride over a varied length of time. The graph presented will aid the clinician in determining the length of therapy needed to reach a desired volume reduction. Source of Funding: None
Prostate Cancer: Epidemiology & Natural History (I) Podium 6 Sunday, April 26, 2009
8:00 am - 10:00 am
161 AGE- AND RACE-SPECIFIC RESULTS OF A LARGE COMMUNITY BASED PROSTATE CANCER SCREENING STUDY Kimberly A Roehl*, Saint Louis, MO; Angel Desai, William J Catalona, Chicago, IL INTRODUCTION AND OBJECTIVE: There are limited published epidemiologic data on age- and race-specific results of communitybased prostate cancer screening programs, and these data would be useful for epidemiologic studies comparing screening results in different populations. The objective of this study was to determine the age-and race-specific prostate cancer detection rates in a large communitybased prostate cancer screening program in St. Louis, Missouri from 1989-2001. METHODS: Our PSA- and DRE-based screening protocol involving a study that enrolled more than 35,000 men and lasted for 12 years has been published previously (Smith DS, et al, Cancer 80:1852, 1997). Herein, we examined the age- and race-specific prostate cancer detection rates at the initial screening visit and on serial screening visits. RESULTS: Overall prostate cancer detection rates by race are 5.1% for African-American men on initial screen versus 3.0% in Caucasian men. The rates are 11.6% and 10.0%, respectively based on serial screening. CONCLUSIONS: Our screening population included a relatively larger proportion of younger and smaller proportion of older AfricanAmerican men than Caucasian men. Age-specific prostate cancer