Page 11 - CUA2018 Abstracts - Oncology-Prostate

Poster session 1: Prostate Cancer I

UP–1.4 Results: A total of 3214 men aged 50 and above were included in this
Disparity in public funding of therapies for metastatic castrate– study. Mean age was 65+9.8 years; 68% were white, 63.7% were living
resistant prostate cancer across Canadian provinces with a spouse, and 86.8% were born in the U.S. Figs. 1 and 2 demonstrate
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Dixon Woon , Thenappan Chandrasekar , Lorne Aaron , Naveen Basappa , the percentage of men having a PSA test and having a discussion with
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Kim Chi , Henry Conter , Brita Danielson , Sebastien Hotte , Shawn their physician regarding PSA testing, respectively. Table 1 (available at
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Malone , Fred Saad , Bobby Shayegan , Laura Park–Wyllie , Robert https://cua.guide/) presents the multivariable logistic regression analyses
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Hamilton 1 predicting which patients underwent a PSA test and which patients had
1 Princess Margaret Hospital, University of Toronto, Toronto, ON, a PSA discussion with their physician. These analyses show that age,
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Canada; Service d–Urologie and Centre de la Prostate, Hôpital Charles education, income, living with a spouse, and past military service sig-
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LeMoyne, Longueuil, QC, Canada; Cross Cancer Institute, University nificantly predict PSA discussion and PSA testing. Being born in the U.S.
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of Alberta, Edmonton, AB, Canada; BC Cancer Agency, University of and Hispanic race also predict PSA discussion.
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British Columbia, Vancouver, BC, Canada; William Osler Health System, Conclusions: Older, more educated men with higher income, with a his-
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University of Western Ontario, Brampton, ON, Canada; Juravinski tory of military service, and who live with a spouse were more likely to
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Cancer Centre, McMaster University, Hamilton, ON, Canada; The undergo PSA testing. Furthermore, these factors, in addition to Hispanic
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Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Centre race and being U.S.–born, were associated with having a discussion with
Hospitalier de l’Université de Montréal, University of Montreal, Montreal, a physician about PSA testing. Despite the USPSTF recommendations
QC, Canada; Medical Affairs, Janssen Inc., Toronto, ON, Canada and international guidelines, this study demonstrates that specific patient
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Introduction: Treatment using abiraterone acetate, enzalutamide, caba- characteristics impact whether patients are screened for PCa in the real
zitaxel, and radium–223 (Ra–223) improve overall survival and qual- world. Importantly, known risk factors, such as obesity and black race,
ity of life for patients with metastatic castrate–resistant prostate cancer do not seem to influence the results.
(mCRPC). However, despite their proven benefits, access to these thera-
pies is not equal across Canada. UP–1.6
Methods: We describe provincial differences in access to approved Mean of maximum standardized uptake value from positron
mCRPC therapies. Data sources include the pan–Canadian Oncology emission tomography imaging: A possible predictive parameter
Drug Review database, provincial cancer care resources, and correspon- for locally advanced prostate cancer
dence with pharmaceutical companies. Khalil Hetou , Glenn Bauman , Jonathan Thiessen , Madeleine Moussa,
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Results: Both androgen receptor–axis–targeted therapies (ARATs) abi- Irina Rachinsky , Zahra Kassam , Stephen Pautler , Malcolm Dewar ,
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raterone acetate plus prednisone, and enzalutamide are funded by prov- Ting Yim Lee 2,3,4 , John Valliant , Aaron Ward , Joseph Chin 1,2
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inces in both the pre–and post–chemotherapy setting, however, sequential 1 Department of Urology, Western University and Lawson Health
ARAT use is not allowed. ‘Sandwich’ therapy, where one ARAT is used Research Institute, London, ON, Canada; Department of Oncology,
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pre–chemotherapy and a second is used upon progression on chemother- Western University and Lawson Health Research Institute, London,
apy is funded in Ontario (ON), Alberta, New Brunswick, Prince Edward ON, Canada; Department of Medical Imaging, Western University and
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Island (PEI), and Newfoundland & Labrador. Ra–223 is funded in ON, Lawson Health Research Institute, London, ON, Canada; Department
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Quebec (QC), British Columbia (BC), Saskatchewan, and Manitoba to of Medical Biophysics, Western University and Lawson Health Research
varying degrees: ON allows Ra–223 either pre– or post–chemo (not both); Institute, London, ON, Canada; Department of Pathology, Western
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QC allows Ra–223 post–chemo unless chemo is not tolerated; BC allows University and Lawson Health Research Institute, London, ON, Canada;
Ra–223 if other life–prolonging mCRPC therapies have been received or 6 Department of Chemistry and Chemical Biology, McMaster University,
ineligible. Cabazitaxel is funded in all provinces post–docetaxel, except Hamilton, ON, Canada
QC and PEI. Cabazitaxel is not funded as first–line treatment for mCPRC, Study Groups: Canadian Institutes of Health Research (CIHR), Ontario
after progression on an ARAT in the post–chemo setting, or in combina- Institute for Cancer Research, Smarter Imaging Program – Prostate (OICR).
tion with agents. Introduction: We acquired imaging data for men with prostate cancer
Conclusions: While all provinces have access to docetaxel and ARATs, using molecular agents [18F]–DCFpyl (targeted against prostate–specific
sandwiching sequential ARATs with docetaxel is funded in select membrane antigen [PSMA]) and [18F]–flurocholine ([18F]–FCH). Mean
provinces. Ra–223 and cabazitaxel access is not ubiquitous across standardized uptake value (SUV max) was calculated for each case. In
Canada. Such inequalities in access to life–prolonging therapies could addition to tumour location and extent information, we investigated the
lead to disparities in survival and quality of life among patients with mean SUV max as a possible predictive marker for locally advanced
mCRPC. Further research should quantify inter–provincial variation in prostate cancer.
outcomes and cost that may result from variable access. Methods: We examined 23 patients who had [18F]–FCH and 16 patients
who received [18F]–DCFpyl positron emission tomography (PET) imaging
UP–1.5 pre–prostatectomy (see figure for example of PET imaging in T2 and T3
What patient factors predict prostate–specific antigen testing patients using both tracers). Mean SUV max was calculated for each case.
among men aged 50 and above? We examined the association of mean SUV max values with pre–biopsy
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Hanan Goldberg , Zachary Klaassen , Thenappan Chandrasekar , PSA and final pathological staging, as well as tumour percentage in the
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Christopher Wallis , Jaime Omar Herrera Caceras , Dixon Woon , Girish final prostatectomy specimens.
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Kulkarni , Robert Hamilton , Nathan Perlis , Antonio Finelli , Alexandre Results: There were 23 patients in the [18F]–FCH cohort; mean pre–
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Zlotta , Neil Fleshner 1 biopsy prostate–specific antogen (PSA) was 5.9 (standard deviation [SD]
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1 Surgical Oncology, Urology Division, Princess Margaret Cancer Centre, 0.7). Almost half (47.8%) had pT3, and 52.2% had pT2 on final pathol-
Toronto, ON, Canada ogy. Mean SUV max in patients with pT3 group (5.52, SD 0.7) was higher
Introduction: Prostate–specific antigen (PSA) screening for early detection than in patients with pT2 with mean SUV max 3.24 (SD 0.35) (p=0.12).
of prostate cancer (PCa) is a controversial issue, especially since the U.S. Higher tumour percentages were not associated with mean SUV max
Preventive Services Task Force (USPSTF) recommendation against screen- values in this group. Mean PSA among patients with pT3 disease was
ing (2012). We analyzed which patient factors predicted PSA screening 7.42 (SD 1.1) vs. 4.3 (SD 0.73) among patients with pT2 disease in this
receipt and physician–patient shared decision–making. group (p=0.018). There were 16 patients in the [18F]–DCFpyl cohort;
Methods: This was a cross–sectional study, using the Health Information mean pre–biopsy PSA was 8.9 (SD 1.57). pT3 disease was present in
National Trends Survey (HINTS, 4th Ed.), a population–based survey of peo- 37.5% and 62.5% had pT2 disease. Mean SUV max in patients with pT3
ple living in the U.S. from 2011–2014. Eligible individuals were men aged (12.53, SD 5.55) was higher than in patients with pT2 (2.62, SD 0.52)
50 and above. Two specific questions were analyzed: whether the patient (p=0.038). Higher tumour percentages were not associated with mean
has ever had a PSA test and if any doctor has discussed this test with him. SUV max values. Mean PSA among patients with pT3 disease was 14.5
CUAJ • June 2018 • Volume 12(6Suppl2) S69