Page 7 - CUA2018 Abstracts - Oncology-Bladder

2018 CUA AbstrACts

Poster Session 10: Other Oncology II

June 26, 2018; 0800–0930

MP–10.1 Health System, Royal Oak , MI, United States; Clinical Affairs, Profound
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Educational needs of Canadian physicians in the management of Medical Inc., Toronto, ON, Canada
advanced prostate cancer Study Groups: Profound Medical Inc.
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Brita Danielson , Christina Canil , Jason Izard , Anil Kapoor , Sandeep Introduction: Magnetic reonance imaging (MRI)–guided transurethral ultra-
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Sehdev , Jean–Baptiste Lattouf , Kim Chi , Fred Saad , Marni Robertson , sound ablation (TULSA) is a new technology for prostate tissue ablation. It
Laura Park–Wyllie , Alan So 8 emits directional ultrasound to ablate a volume shaped to patient–specific
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1 Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada; The anatomy using active MRI thermometry feedback control. We present a
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Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Kingston 36–month followup on a multicentre, prospective, phase 1 study of TULSA
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Health Sciences Centre, Queen’s University, Kingston, ON, Canada; St. in patients with localized prostate cancer (PCa).
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Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada; Centre Methods: Thirty patients with biopsy–proven PCa (T1c–T2a, prostate–
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Hospitalier de l’Université de Montréal, Montreal, QC, Canada; BC Cancer specifc antigen [PSA] ≤10 ng/ml, Gleason Score 3+3, ≤3+4 in Canada
Agency, University of British Columbia, Vancouver, BC, Canada; Medical only) were treated. TULSA was delivered with 3 mm safety margins. Primary
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Affairs, Janssen Inc, Toronto, ON, Canada; Prostate Centre at Vancouver endpoints were safety and feasibility. Secondary endpoints were biochemi-
General Hospital, University of British Columbia, Vancouver, BC, Canada cal, histological, and quality of life changes.
Introduction: The treatment landscape in metastatic castration–resistant Results: Median age was 69 years (interquartile range [IQR]) 67–71) and
prostate cancer (mCRPC) is rapidly evolving, and as a result the role of PSA 5.8 ng/ml (IQR 3.8–8.0), with 80% low– and 20% intermediate–risk
physicians is also changing. Many urologists and radiation oncologists are PCa. TULSA time was 36 minutes (IQR 24–44) and prostate volume (PV)
now managing patients with mCRPC, a role traditionally served by medical 44 cc (IQR 38–48). Spatial control of ablation was ±1.3 mm. Adverse
oncologists. Physician education is critical, given the increase of treatment events included urinary tract infections (UTIs) (10 patients), acute reten-
options, earlier indications for therapy, and sequencing possibilities. This tion (eight), and epididymitis (one), with no rectal injuries or fistulae.
study aims to investigate which educational topics are most critical to Pre–TULSA International Prostate Symptom Score (IPSS) of 8 (5–13) and
Canadian physicians treating mCRPC. International Index of Erectile Function (IIEF) of 13 (6–28) returned to 6
Methods: A 59–item questionnaire was developed by a multidisciplinary (4–10) at 3 months and 13 (5–25) at 12 months, and 7 (4–11) and 8 (2–23)
steering committee to measure aspects of mCRPC management, including at 36 months, respectively. Median PSA decreased 87% at one month
educational needs and preferred learning formats. The survey was delivered with nadir of 0.5 ng/ml (0.2–0.8), stabilized to 0.8 ng/ml (0.4–1.6) at 36
to 93 physicians (urologists, radiation oncologists, medical oncologists) months (n=22). MRI at 12 months shows 88% (83–95%) PV reduction.
actively involved in the treatment of mCRPC. Twelve–month biopsy showed disease in 55% of patients, clinically sig-
Results: The survey responses were received from April 17 to May 17, 2017, nificant in 31% of patients. Five patients underwent salvage prostatectomy,
with a response rate of 53% (49 respondents). Most physicians were urolo- one patients salvage radiotherapy, and one pt MRI–guided laser ablation. At
gists/urologic oncologists (55%), followed by medical oncologists (33%) 36 months, 1/13 patients with negative 12–month biopsy had 3+3 disease;
and radiation oncologists (10%). Physicians identified their most important 1/9 remaining patients with positive 12–month biopsy upstaged to 3+4,
treatment goals for mCRPC patients to be improved quality of life (90%) and 4/9 downstaged with 3+3 or negative biopsy.
and overall survival (78%). The top two educational topics selected were Conclusions: Three–year followup MRI–guided TULSA appears to provide
sequencing strategies (71%) and individualization of therapy (65%). The precise, minimally invasive near whole–gland ablation for patients with
preferred format was expert round tables or live lectures, with fewer prefer- localized PCa with low morbidity and without precluding salvage therapy. A
ring web–based platforms or live case–based presentations. 110–patient, multicentre trial evaluating efficacy of more complete whole–
Conclusions: The recent increase in novel treatment options for mCRPC has gland ablation is underway.
resulted in both opportunities and challenges in management. This treat-
ment landscape is reflected in the results of the survey, which showed the MP–10.3
highest preference for education in sequencing strategies and individualiza- Use of a molecularly enhanced grading system in T1 bladder
tion of therapy. Despite the trend of physician education moving to a more cancer: A decision analysis
digital platform, physicians still value face–to–face methods for learning. Marian Wettstein , Mohammed Shurrab , Alexandre Zlotta , Girish Kulkarni 1
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1 Division of Urology, Department of Surgery, Princess Margaret Hospital
MP–10.2 and University Health Network, University of Toronto, Toronto, ON, Canada
Magnetic resonance imaging–guided transurethral ultrasound Introduction: Accurate grading is crucial in T1 bladder cancer (BC) since
ablation in patients with localized prostate cancer: Three–year it is the most important prognostic factor for progression to muscle–inva-
outcomes of a prospective, phase 1 study sive BC (MIBC). The 1973 WHO grading system suffered from significant
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Joseph Chin , James Relle , Malcolm Dewar , Khalil Hetou , Timur Kuru , interobserver variability (IV), but was able to stratify T1 BC patients into
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Gencay Hatiboglu , Ionel Valentin Popeneciu , Jason Hafron , Matthias Grade 2 and 3. Its successor, the currently used 2004 WHO grading system,
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Roethke , Maya Mueller–Wolf , Zahra Kassam , Robert Staruch , Mathieu uniformly assigns high–grade to all T1 BC patients and is, therefore, free of
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Burtnyk , David Bonekamp , Heinz–Peter Schlemmer , Sascha Pahernik 2 IV, but also valuable prognostic information. Molecularly enhanced grading
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1 Departments of Urology and Radiology, Western University, London Health systems (MEGS) may be able to stratify T1 BC into two subgroups in accor-
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Sciences Centre, London, ON, Canada; Departments of Radiology and dance with the 1973 WHO grading system while being virtually free of IV.
Urology, German Cancer Research Center (DKFZ), University Hospital, Methods: We constructed a Markov microsimulation with individual–level
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Heidelberg, Heidelberg, Germany; Department of Urology, Beaumont sampling from distributions to compare the quality–adjusted survival among
S118 CUAJ • June 2018 • Volume 12(6Suppl2)
© 2018 Canadian Urological Association