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UP-1.140: Gleason Score Rise in Recurrent Prostate Cancer after Previous Prostate Cancer Therapy?
UNMODERATED POSTER SESSIONS
UP-1.138 Validity of Partin Tables in the Asian Population Lau WKO, Singh S, Lee SJ Department of Urology, Singapore General Hospital, Singapore Introduction and Objective: We review the validity of 1997 and 2001 Partin tables for ability to predict pathological stage in our local population. Materials and Methods: Retrospective review of all patients who met the inclusion criteria for Partin tables prediction and underwent radical prostatectomy for clinically localized prostate cancer in our institution from October 1998 to November 2008. Predictive accuracy of 1997 and 2001 Partin tables were evaluated using receiver operating characteristics (ROC) analysis. Results: Data for 267 patients was reviewed. Mean age was 65.5 year old. The Area Under Curve (AUC) for predicting organ confined disease (OCD), established capsular penetration (ECP), seminal vesicle involvement (SVI) and lymph node involvement (LVI) using 1997 Partin tables were 0.702, 0.621, 0.738 and 0.716 respectively. The corresponding AUC using 2001 Partin tables were 0.666, 0.570, 0.797 and 0.768 respectively. Conclusions: Partin tables remain a valid pathological stage prediction tool in our Asian population. The 1997 Partin tables have better predictive accuracy compared to the updated 2001 version. UP-1.139 Can Assessment of ICTP Reduce Number of Bone Scans in Prostate Cancer (Cap) Patients? Hanus M1, Matouskova M1, Dudkova´ V2, Tejckova E2, Rehak J3 1 Urocentrum Prague, Prague, Czech Republic; 2PET Centre, Dept. of Nuclear Medicine, Homolka Hosp., Prague, Czech Republic; 3SCaC Prague, Prague, Czech Republic Introduction and Objective: Results of blood serum assessment of ICTP in a group of 605 have been evaluated and compared with other currently used markers in our follow up regimen. Presented longitudinal study using monitoring of ICTP since January 2002 was aimed to explore ICTP test as a possible tool for reduction of number bone scans. Materials and Methods: Since 2002 all patients suffering from CaP have been followed up at our clinic in accordance with the standard algorithm, including ICTP (C-terminal cross-linked telopeptide of type I collagen), PSA, ALP, initial bone
S214
scan, X-ray and CT ev. NMR). In patients on a prolonged hormonal suppression DEXA (densitometry) has been added. Till December 2008 7256 ICTP tests were evaluated and compared with the above examinations. Patients suffering from localized or locally advanced cancer (T1-T4 Nx M0) had an average ICTP level 5,31 ug/l opposite to those with generalized disease (T1-4 Nx M1b) where an average value was 14.53 ug/l. It should be kept in mind that longer immobilization, fractures, orthopedic surgery usually lead to ICTP elevation so that the patient should be asked on that. Also the treatment with bisphosphonates remarkably reduces the level of ICTP. Conclusions: Analysis of obtained results has confirmed that monitoring of ICTP can allow, in experienced hands, to significant reduction of the number of performed bone scans. In case that the level of ICTP does not exceed 7.0 ug/l bone scan should be omitted. On the other side ICTP elevation in spite of low PSA should be the reason to search very carefully for possible bone metastases. The paper goes into details.
Results: There are 126 patients who have been isolated with complete data set for analysis. showing recPCa after n ⫽ 35 (S); n ⫽ 22 (R); n ⫽ 33 (HA); n ⫽ 36 (HIFU). Gleason “i“ was: 7 (4-9) in (S); 6.5 (4-8) in (R); 7 (4-9) in (HA); 7 (5-10) in (HIFU). PSAi was: 11.7 (S); 11.5 (R); 16.5 (HA); 10.3 (HIFU). PSA at recPCa therapy was: 1.8 (0.19-9.6) in (S); 7 (1.2-30) in (R); 9.5 (0.5-507) in (HA); 2.1 (0.25-36) in (HIFU). Gleason at recPCa therapy was: 7(3-9) in (S); 7(5-10) in (R); 9 (6-10) in (HA); 7 (4-9) in (HIFU). Conclusion: Histo-pathological prostatic biopsy analysis of therapies as (S/R/HA/ HIFU) is possible, Gleason score can be determined. “Mechanical” local therapies (S/HIFU) did show neither problems in histological analysis or Gleason score interpretation nor a Gleason increase in recPCa (disease did not get more aggressive in time). Hormonal ablation (HA) as radiation therapy (R) showed both signs of Gleason shift to higher grades! Whether this is due to cell selection by therapy (iatrogenic) or due to negative case selection (statistics) should be subject to further studies.
UP-1.140 Gleason Score Rise in Recurrent Prostate Cancer after Previous Prostate Cancer Therapy? Chaussy C, Thu ¨ roff S Klinikum Mu ¨ nchen Harlaching, Dept. of Urology, Munich, Germany
UP-1.141 Development of a Seminal Vesicle Invasion Index on Multidetector CT versus MRI for Preoperative Assessment of Seminal Vesicle Invasion in Prostate Cancer: A Prospective Study Bolton DM2, Lawrentschuk N2, Esler S1, Liodakis P1 1 Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia; 2Departments of Urology and Radiology, University of Toronto, Toronto, ON, Canada
Introduction and Objective: Prostate cancer (PCa) therapy can be performed by radical surgery (S), radiation therapy (R), hormonal ablation (HA) or high intensity focused ultrasound (HIFU). After all of these therapies, cancer suspicion of PCa recurrence leads to a restaging of the patient. Prostatic biopsies are the most important staging tool. Their histological analysis gives a topographic, volume and aggressiveness analysis of the current PCa stage of the patient. Further on, these biopsies can be compared to the primary staging biopsies. Histo-pathological differences between primary and recurrent PCa biopsies might help to understand impact of different therapeutic modalities on disease development. Materials and Methods: Analysis out of the prospective Harlaching database: Patients with prostatic biopsies with Gleason scoring before and after (S/R/HA/ HIFU), coming for therapy of recurrent PCa (recPCa) have been included into the analysis. PSAi, Tumorvolume, Gleason for primary as recurrence therapy was analyzed.
Introduction and Objective: In prostate cancer, preoperative identification of seminal vesicle invasion (SVI) is important for staging and prognosis and may modify treatment selection and planning. The purpose of this study was to compare contemporary multidetector CT (MDCT), with endorectal MR and surgical pathology, to determine the accuracy of delineating SVI in patients with intermediate to high risk prostate cancer. Our secondary aim was to develop a standardized evaluation system for interpreting SVI with MDCT reporting. Materials and Methods: This was a prospective, single-institution cross-sectional study. Patients with histologically-diagnosed prostate carcinoma, had MDCT and MR imaging before radical prostatectomy. Inclusion criteria were a prostate specific
UROLOGY 74 (Supplment 4A), October 2009
UP-1.138 Validity of Partin Tables in the Asian Population Lau WKO, Singh S, Lee SJ Department of Urology, Singapore General Hospital, Singapore Introduction and Objective: We review the validity of 1997 and 2001 Partin tables for ability to predict pathological stage in our local population. Materials and Methods: Retrospective review of all patients who met the inclusion criteria for Partin tables prediction and underwent radical prostatectomy for clinically localized prostate cancer in our institution from October 1998 to November 2008. Predictive accuracy of 1997 and 2001 Partin tables were evaluated using receiver operating characteristics (ROC) analysis. Results: Data for 267 patients was reviewed. Mean age was 65.5 year old. The Area Under Curve (AUC) for predicting organ confined disease (OCD), established capsular penetration (ECP), seminal vesicle involvement (SVI) and lymph node involvement (LVI) using 1997 Partin tables were 0.702, 0.621, 0.738 and 0.716 respectively. The corresponding AUC using 2001 Partin tables were 0.666, 0.570, 0.797 and 0.768 respectively. Conclusions: Partin tables remain a valid pathological stage prediction tool in our Asian population. The 1997 Partin tables have better predictive accuracy compared to the updated 2001 version. UP-1.139 Can Assessment of ICTP Reduce Number of Bone Scans in Prostate Cancer (Cap) Patients? Hanus M1, Matouskova M1, Dudkova´ V2, Tejckova E2, Rehak J3 1 Urocentrum Prague, Prague, Czech Republic; 2PET Centre, Dept. of Nuclear Medicine, Homolka Hosp., Prague, Czech Republic; 3SCaC Prague, Prague, Czech Republic Introduction and Objective: Results of blood serum assessment of ICTP in a group of 605 have been evaluated and compared with other currently used markers in our follow up regimen. Presented longitudinal study using monitoring of ICTP since January 2002 was aimed to explore ICTP test as a possible tool for reduction of number bone scans. Materials and Methods: Since 2002 all patients suffering from CaP have been followed up at our clinic in accordance with the standard algorithm, including ICTP (C-terminal cross-linked telopeptide of type I collagen), PSA, ALP, initial bone
S214
scan, X-ray and CT ev. NMR). In patients on a prolonged hormonal suppression DEXA (densitometry) has been added. Till December 2008 7256 ICTP tests were evaluated and compared with the above examinations. Patients suffering from localized or locally advanced cancer (T1-T4 Nx M0) had an average ICTP level 5,31 ug/l opposite to those with generalized disease (T1-4 Nx M1b) where an average value was 14.53 ug/l. It should be kept in mind that longer immobilization, fractures, orthopedic surgery usually lead to ICTP elevation so that the patient should be asked on that. Also the treatment with bisphosphonates remarkably reduces the level of ICTP. Conclusions: Analysis of obtained results has confirmed that monitoring of ICTP can allow, in experienced hands, to significant reduction of the number of performed bone scans. In case that the level of ICTP does not exceed 7.0 ug/l bone scan should be omitted. On the other side ICTP elevation in spite of low PSA should be the reason to search very carefully for possible bone metastases. The paper goes into details.
Results: There are 126 patients who have been isolated with complete data set for analysis. showing recPCa after n ⫽ 35 (S); n ⫽ 22 (R); n ⫽ 33 (HA); n ⫽ 36 (HIFU). Gleason “i“ was: 7 (4-9) in (S); 6.5 (4-8) in (R); 7 (4-9) in (HA); 7 (5-10) in (HIFU). PSAi was: 11.7 (S); 11.5 (R); 16.5 (HA); 10.3 (HIFU). PSA at recPCa therapy was: 1.8 (0.19-9.6) in (S); 7 (1.2-30) in (R); 9.5 (0.5-507) in (HA); 2.1 (0.25-36) in (HIFU). Gleason at recPCa therapy was: 7(3-9) in (S); 7(5-10) in (R); 9 (6-10) in (HA); 7 (4-9) in (HIFU). Conclusion: Histo-pathological prostatic biopsy analysis of therapies as (S/R/HA/ HIFU) is possible, Gleason score can be determined. “Mechanical” local therapies (S/HIFU) did show neither problems in histological analysis or Gleason score interpretation nor a Gleason increase in recPCa (disease did not get more aggressive in time). Hormonal ablation (HA) as radiation therapy (R) showed both signs of Gleason shift to higher grades! Whether this is due to cell selection by therapy (iatrogenic) or due to negative case selection (statistics) should be subject to further studies.
UP-1.140 Gleason Score Rise in Recurrent Prostate Cancer after Previous Prostate Cancer Therapy? Chaussy C, Thu ¨ roff S Klinikum Mu ¨ nchen Harlaching, Dept. of Urology, Munich, Germany
UP-1.141 Development of a Seminal Vesicle Invasion Index on Multidetector CT versus MRI for Preoperative Assessment of Seminal Vesicle Invasion in Prostate Cancer: A Prospective Study Bolton DM2, Lawrentschuk N2, Esler S1, Liodakis P1 1 Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia; 2Departments of Urology and Radiology, University of Toronto, Toronto, ON, Canada
Introduction and Objective: Prostate cancer (PCa) therapy can be performed by radical surgery (S), radiation therapy (R), hormonal ablation (HA) or high intensity focused ultrasound (HIFU). After all of these therapies, cancer suspicion of PCa recurrence leads to a restaging of the patient. Prostatic biopsies are the most important staging tool. Their histological analysis gives a topographic, volume and aggressiveness analysis of the current PCa stage of the patient. Further on, these biopsies can be compared to the primary staging biopsies. Histo-pathological differences between primary and recurrent PCa biopsies might help to understand impact of different therapeutic modalities on disease development. Materials and Methods: Analysis out of the prospective Harlaching database: Patients with prostatic biopsies with Gleason scoring before and after (S/R/HA/ HIFU), coming for therapy of recurrent PCa (recPCa) have been included into the analysis. PSAi, Tumorvolume, Gleason for primary as recurrence therapy was analyzed.
Introduction and Objective: In prostate cancer, preoperative identification of seminal vesicle invasion (SVI) is important for staging and prognosis and may modify treatment selection and planning. The purpose of this study was to compare contemporary multidetector CT (MDCT), with endorectal MR and surgical pathology, to determine the accuracy of delineating SVI in patients with intermediate to high risk prostate cancer. Our secondary aim was to develop a standardized evaluation system for interpreting SVI with MDCT reporting. Materials and Methods: This was a prospective, single-institution cross-sectional study. Patients with histologically-diagnosed prostate carcinoma, had MDCT and MR imaging before radical prostatectomy. Inclusion criteria were a prostate specific
UROLOGY 74 (Supplment 4A), October 2009