- Email: [email protected]
S44 SENTINEL LYMPH NODE DISSECTION FOR CLINICALLY LOCALIZED PROSTATE CANCER: COMPARISON BETWEEN TWO TECHNIQUES
of positive surgical margins (PSM). The objective of this study is to evaluate the surgical margin status in patients undergoing RARP for low, intermediate, and high-risk prostate cancer (PCa). Material & Methods: The records of n=3500 men who underwent RARP from February 2006 to December 2011 were retrospectively reviewed. A total of n=1028 patients were identified as having a low risk PCa (Gleason ≤ 6, PSA < 10 ng/ml, T1c-T2a), n=1420 an intermediate (Gleason 7, PSA10–20 ng/ml, T2b) and n=734 a high risk PCa (Gleason >7, PSA >20 ng/ml, >T2b). The parameters analyzed included PSM rates according to low risk PCa, intermediate risk PCa, high risk PCa and pathologic stage. Results: The overall PSM rate was 8.17%. PSM was evident in 1.62% of low risk patients, 2.85% of intermediate risk and 3.51% of high risk PCa patients. According to pathologic stage, PSM were noted in 2.87% of pT2 cases, 17.29% of pT3 cases and 79.54% of pT4 cases. Conclusions: Our findings suggest that patients with a low or intermediate risk PCa undergoing RARP from experienced surgeons exhibit an excellent surgical margin status. In patients with a high-risk PCa or a ≥ pT3 pathologic stage, the surgical margin status can be surely considered as acceptable.
S42
Surgical, oncologic and continence outcomes in patients with high grade prostate cancer (Gleason score ≥8) undergoing roboticassisted radical prostatectomy. An analysis of 321 consecutive cases
Table 1: Genotype and allele frequencies of MIF polymorphisms among the cases and controls Cases (n=61)a
S43
Macrophage migration inhibitory factor gene -173*C polymorphism and risk of prostate cancer
Razzaghi M., Mazloomfard M., Lotfi B. Laser application in medical sciences research center, Shahid Beheshti University of Medical Science, Dept. of Urology, Tehran, Iran Introduction & Objectives: The role of chronic inflammation in cancers has been established previously. Macrophage migration inhibitory factor is an important regulator of inflammation. The aim of this study was to investigate the potential association between MIF-173 G/C polymorphism and incidence of prostate cancer. Material & Methods: Analysis of polymorphic variants for MIF was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in 61 subjects with prostate cancer and 71 controls. Results: The frequency of MIF-173 *C allele was 17.2% in prostate cancer patients and 9.2% in healthy individuals (P = 0.07, OR = 0.5, 95% CI = -0.04-1.1). (Table 1)The frequency of MIF-173 GC+CC genotype in prostate cancer patients was not correlated with Gleason score, T stage and lymph node involvement (p=0.3, 0.08 and 0.2). Patients with metastatic disease had higher frequency of MIF-173 *C genotype. (Table 2)
Eur Urol Suppl 2012;11(4):142
P-valueb
OR (95% CI)c
MIF -173 G>C (%) GG 42 (68.9) GC 17 (27.9) CC 2 (3.3)
58 (81.7) 13 (18.3) 0
0.1
Ref. 0.4 (-0.2-1.0) -
GC+CC
19 (31.1)
13 (18.3)
0.09
0.6 (-0.09-1.3)
G allele C allele
101 (82.8) 129 (90.8) 0.07 21 (17.2) 13 (9.2)
Ref. 0.5 (-0.04-1.1)
The observed frequencies among the prostate cancer and control subjects were in agreement with the Hardy-Weinberg equilibrium (X2=0.39, p=0.5 and X2=0.38, p=0.5)bTwo-sided chi-square test for either genotype distributions or allele frequencies between the cases and controls.cOdds ratios (ORs) were obtained from a logistic regression model a
Table 2: Frequency distributions among Gleason Scores and clinical stages of prostate cancer between the genotypes of the MIF polymorphisms
Labanaris A.P., Poth S., Zugor V., Schuette A., Wagner C., Witt J.H. Prostate Center Northwest, St. Antonius Medical Center, Dept. of Urology and Pediatric Urology, Gronau, Germany Introduction & Objectives: Robot-assisted radical prostatectomy (RARP) has become profoundly popular and with the expanding experience obtained with it, the selection criteria for the procedure have also widened and included more challenging cases. The aim of this study is to assess the surgical and oncologic outcomes in patients with a Gleason score 8 or higher prostate cancer (PCa) undergoing RARP. Material & Methods: The records of n=3500 men who underwent RARP from February 2006 to December 2011 were retrospectively reviewed. A total of n=321 (9,17%) patients were identified as having a Gleason score ≥8. Results: The median age of the patients was 66.04 years and the median operative time was 148.36 min. Minor complications were noted in 21.5% of cases, major in 3.12% and the length of catheterisation was 5.9 days. The median PSA values were 17.16 ng/ml, an organ-confined disease was encountered in 35.51% of cases, extraprostatic extension in 64.68%, positive surgical margins in 17.18% and positive lymph nodes in 17.81%. At 12 months, 92.8% of the patients were continent. Disease-specific mortality in the follow-up period was evident in 0.93% cases and biochemical progression in 31.46%. Conclusions: Our findings suggest that although RARP in patients with a Gleason score ≥8 is a safe surgical procedure with limited complications and good functional results. Nevertheless, a significant portion of these patients will exhibit lymph node metastasis, positive surgical margins and biochemical progression within 1 year. Despite these results, RARP may play an important role in the multimodal treatment approach needed.
Controls (n=71)a
GG n=42 (%)
GC+CC n=19 (%)
16 (38.1) 16 (38.1) 3 (7.1) 1 (2.4) 2 (4.8) 4 (9.5)
3 (15.8) 5 (26.3) 1 (5.3) 3 (15.8) 2 (10.5) 5 (26.3)
PSA (ng/ml) <10 10-20 20-30 30-40 40-50 >50 Gleason sum <7 ≥7 Clinical stage T T1 T2 T3-T4
22 (52.4) 20 (47.6)
7 (36.8) 12 (63.2)
19 (45.2) 15 (35.7) 8 (19)
3 (15.8) 11 (57.9) 5 (26.3)
N+ M+
4 (9.5) 7 (16.7)
4 (21.1) 9 (47.4)
P value
0.008
0.3 0.08
0.2 0.025
OR (95% CI) Ref. 0.45 (-0.97-1.9) 0.5 (-1.8-2.8) 2.09 (0.4-3.8) 1.39 (-0.4-3.2) 1.55 (0.1-3.0) Ref. 0.5 (-0.4-1.5) Ref. 1.32 (0.04-2.6) 1.20 (-0.2-2.6)
a
-
Odds ratios (ORs) were obtained from a logistic regression model Conclusions: MIF-173 *C polymorphisms correlates with higher incidence of prostate cancer
a
S44
Sentinel lymph node dissection for clinically localized prostate cancer: comparison between two techniques
Kolev N.1, Kotsev R.1, Genadiev T.1, Dunev V.1, Tonchev P.2, Atanasov B.1, AlShargabi F.1, Stratev S.1 1 G. Stranski University Hospital, Dept. of Urology, Pleven, Bulgaria, 2G. Stranski University Hospital, Dept. of Surgery, Pleven, Bulgaria Introduction & Objectives: The lymph node metastasis is an important prognostic factor in prostate cancer. The aim of this prospective study was to compare two methods of sentinel lymph node detection (SLN): radioisotope γ probe guided method and methylene blue dye method in patient undergoing radical prostatectomy (RP). Material & Methods: A cohort of 41 men with intermediate- to high-risk prostate cancer underwent open RP and standard pelvic lymphadenectomy (sPLND). In the first group of 25 patients 99 mTc-labeled nanocolloid was used as radioactive tracer and injected transrectaly 24 hours before operation. A portable γ-probe for radioisotope sentinel lymph node dissection (SLND) was used intraoperatively. In second group in 16 other patients a blue dye was injected immediately preoperatively and sentinel lymph nodes (SLN) dissection was applied. SPLND was performed before RP to all patients. Results: Twenty-four (96%) versus three (18.7%) of patients had pelvic SLN detected by radioisotope and a blue dye methods in the two groups respectively (p<0.05). Nine (36 %) patients in first group had lymph nodes (LN) metastasis, and 8 of these had SLN metastasis (89% sensitivity, one false negative SLN biopsy). In second group 5 (31%) patients had LN metastasis, and 2 of these had metastasis in dissected SLN (40 % sensitivity, 3 false negative SLN biopsy). In first group 16 had normal LN, 17 with normal SLN biopsies (94% specificity in radioisotope guided group). In second group 11 patients had negative LN, 14 with SLN negative biopsy (78% specificity in blue-dye guided group). Conclusions: The radioisotope guided method offers a higher sensitivity and specificity and is therefore preferable method for SLND.Blue-dye technique for detection of SLN has demonstrated low sensitivity and cannot be recommended as a method for SLND in prostate cancer patients.
S42
Surgical, oncologic and continence outcomes in patients with high grade prostate cancer (Gleason score ≥8) undergoing roboticassisted radical prostatectomy. An analysis of 321 consecutive cases
Table 1: Genotype and allele frequencies of MIF polymorphisms among the cases and controls Cases (n=61)a
S43
Macrophage migration inhibitory factor gene -173*C polymorphism and risk of prostate cancer
Razzaghi M., Mazloomfard M., Lotfi B. Laser application in medical sciences research center, Shahid Beheshti University of Medical Science, Dept. of Urology, Tehran, Iran Introduction & Objectives: The role of chronic inflammation in cancers has been established previously. Macrophage migration inhibitory factor is an important regulator of inflammation. The aim of this study was to investigate the potential association between MIF-173 G/C polymorphism and incidence of prostate cancer. Material & Methods: Analysis of polymorphic variants for MIF was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in 61 subjects with prostate cancer and 71 controls. Results: The frequency of MIF-173 *C allele was 17.2% in prostate cancer patients and 9.2% in healthy individuals (P = 0.07, OR = 0.5, 95% CI = -0.04-1.1). (Table 1)The frequency of MIF-173 GC+CC genotype in prostate cancer patients was not correlated with Gleason score, T stage and lymph node involvement (p=0.3, 0.08 and 0.2). Patients with metastatic disease had higher frequency of MIF-173 *C genotype. (Table 2)
Eur Urol Suppl 2012;11(4):142
P-valueb
OR (95% CI)c
MIF -173 G>C (%) GG 42 (68.9) GC 17 (27.9) CC 2 (3.3)
58 (81.7) 13 (18.3) 0
0.1
Ref. 0.4 (-0.2-1.0) -
GC+CC
19 (31.1)
13 (18.3)
0.09
0.6 (-0.09-1.3)
G allele C allele
101 (82.8) 129 (90.8) 0.07 21 (17.2) 13 (9.2)
Ref. 0.5 (-0.04-1.1)
The observed frequencies among the prostate cancer and control subjects were in agreement with the Hardy-Weinberg equilibrium (X2=0.39, p=0.5 and X2=0.38, p=0.5)bTwo-sided chi-square test for either genotype distributions or allele frequencies between the cases and controls.cOdds ratios (ORs) were obtained from a logistic regression model a
Table 2: Frequency distributions among Gleason Scores and clinical stages of prostate cancer between the genotypes of the MIF polymorphisms
Labanaris A.P., Poth S., Zugor V., Schuette A., Wagner C., Witt J.H. Prostate Center Northwest, St. Antonius Medical Center, Dept. of Urology and Pediatric Urology, Gronau, Germany Introduction & Objectives: Robot-assisted radical prostatectomy (RARP) has become profoundly popular and with the expanding experience obtained with it, the selection criteria for the procedure have also widened and included more challenging cases. The aim of this study is to assess the surgical and oncologic outcomes in patients with a Gleason score 8 or higher prostate cancer (PCa) undergoing RARP. Material & Methods: The records of n=3500 men who underwent RARP from February 2006 to December 2011 were retrospectively reviewed. A total of n=321 (9,17%) patients were identified as having a Gleason score ≥8. Results: The median age of the patients was 66.04 years and the median operative time was 148.36 min. Minor complications were noted in 21.5% of cases, major in 3.12% and the length of catheterisation was 5.9 days. The median PSA values were 17.16 ng/ml, an organ-confined disease was encountered in 35.51% of cases, extraprostatic extension in 64.68%, positive surgical margins in 17.18% and positive lymph nodes in 17.81%. At 12 months, 92.8% of the patients were continent. Disease-specific mortality in the follow-up period was evident in 0.93% cases and biochemical progression in 31.46%. Conclusions: Our findings suggest that although RARP in patients with a Gleason score ≥8 is a safe surgical procedure with limited complications and good functional results. Nevertheless, a significant portion of these patients will exhibit lymph node metastasis, positive surgical margins and biochemical progression within 1 year. Despite these results, RARP may play an important role in the multimodal treatment approach needed.
Controls (n=71)a
GG n=42 (%)
GC+CC n=19 (%)
16 (38.1) 16 (38.1) 3 (7.1) 1 (2.4) 2 (4.8) 4 (9.5)
3 (15.8) 5 (26.3) 1 (5.3) 3 (15.8) 2 (10.5) 5 (26.3)
PSA (ng/ml) <10 10-20 20-30 30-40 40-50 >50 Gleason sum <7 ≥7 Clinical stage T T1 T2 T3-T4
22 (52.4) 20 (47.6)
7 (36.8) 12 (63.2)
19 (45.2) 15 (35.7) 8 (19)
3 (15.8) 11 (57.9) 5 (26.3)
N+ M+
4 (9.5) 7 (16.7)
4 (21.1) 9 (47.4)
P value
0.008
0.3 0.08
0.2 0.025
OR (95% CI) Ref. 0.45 (-0.97-1.9) 0.5 (-1.8-2.8) 2.09 (0.4-3.8) 1.39 (-0.4-3.2) 1.55 (0.1-3.0) Ref. 0.5 (-0.4-1.5) Ref. 1.32 (0.04-2.6) 1.20 (-0.2-2.6)
a
-
Odds ratios (ORs) were obtained from a logistic regression model Conclusions: MIF-173 *C polymorphisms correlates with higher incidence of prostate cancer
a
S44
Sentinel lymph node dissection for clinically localized prostate cancer: comparison between two techniques
Kolev N.1, Kotsev R.1, Genadiev T.1, Dunev V.1, Tonchev P.2, Atanasov B.1, AlShargabi F.1, Stratev S.1 1 G. Stranski University Hospital, Dept. of Urology, Pleven, Bulgaria, 2G. Stranski University Hospital, Dept. of Surgery, Pleven, Bulgaria Introduction & Objectives: The lymph node metastasis is an important prognostic factor in prostate cancer. The aim of this prospective study was to compare two methods of sentinel lymph node detection (SLN): radioisotope γ probe guided method and methylene blue dye method in patient undergoing radical prostatectomy (RP). Material & Methods: A cohort of 41 men with intermediate- to high-risk prostate cancer underwent open RP and standard pelvic lymphadenectomy (sPLND). In the first group of 25 patients 99 mTc-labeled nanocolloid was used as radioactive tracer and injected transrectaly 24 hours before operation. A portable γ-probe for radioisotope sentinel lymph node dissection (SLND) was used intraoperatively. In second group in 16 other patients a blue dye was injected immediately preoperatively and sentinel lymph nodes (SLN) dissection was applied. SPLND was performed before RP to all patients. Results: Twenty-four (96%) versus three (18.7%) of patients had pelvic SLN detected by radioisotope and a blue dye methods in the two groups respectively (p<0.05). Nine (36 %) patients in first group had lymph nodes (LN) metastasis, and 8 of these had SLN metastasis (89% sensitivity, one false negative SLN biopsy). In second group 5 (31%) patients had LN metastasis, and 2 of these had metastasis in dissected SLN (40 % sensitivity, 3 false negative SLN biopsy). In first group 16 had normal LN, 17 with normal SLN biopsies (94% specificity in radioisotope guided group). In second group 11 patients had negative LN, 14 with SLN negative biopsy (78% specificity in blue-dye guided group). Conclusions: The radioisotope guided method offers a higher sensitivity and specificity and is therefore preferable method for SLND.Blue-dye technique for detection of SLN has demonstrated low sensitivity and cannot be recommended as a method for SLND in prostate cancer patients.