Page 13 - CUA2018 Abstracts - Oncology-Prostate

Poster session 1: Prostate Cancer I

UP–1.10 showing a Prostate Imaging Reporting and Data System (PIRADS) category
4Kscore and PCA3 tests concordance in predicting positive 4 or 5 lesion within the prostate. Patients underwent site–directed MRI
biopsy for clinically significant prostate cancer fused CT–guided biopsies through a transgluteal approach. Biopsy results
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Dixon Woon , Jaime Omar Herrera Cáceres , Sai Vangala , Hanan Goldberg , and immediate and 30–day complication rates were recorded.
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Thenappan Chandrasekar , Zachary Klaassen , Robert Hamilton , Girish Results: The biopsies were well–tolerated by all patients. No patient expe-
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Kulkarni , Antonio Finelli , Alexandre Zlotta , Neil Fleshner 1 rienced an immediate or 30–day complication. Of the 45 patients, 28 had
1 Department of Surgical Oncology, Division of Urology, University Health previous negative biopsies and 17 had biopsies harbouring low–volume
Network, Toronto, ON, Canada Gleason 6 disease. Of the 28 patients with previous negative biopsies, 13
Introduction: Prostate–specific antigen (PSA) is widely used for prostate patients had positive CT–guided biopsies revealing Gleason 6 disease in
cancer (PCa) diagnosis and management. It has a relatively poor specific- four patients and Gleason ≥7 in nine patients. Of the 17 patients with low–
ity in detecting clinically significant PCa, especially when PSA is between volume Gleason 6 disease, 10 patients had CT–guided biopsies showing
2.5 and 10. To avoid unnecessary biopsy, new tests such as the 4Kscore prostate cancer; seven patients with Gleason 6 disease and three patients
(4K) and PCA3 tests have been proposed as novel biomarkers for clinical with Gleason ≥7 prostate cancer. In patients with PIRADS 5 lesions, we
significant PCa detection. We aimed to: 1) assess the concordance rate detected cancer in 68% (13/19) of which, four had Gleason 6 disease
of these biomarkers in predicting clinical significance PCa; and 2) evalu- and nine had Gleason ≥7 disease.
ate which test has better accuracy and, hence, more reliable in guiding Conclusions: MRI fused cone beam CT–guided biopsy of the pros-
decisions when they are not in concordance. tate appears to be technically feasible with a reasonable safety pro-
Methods: A retrospective study of patients who had both tests performed file. Additional experience will be required to further delineate the
at our institution, from August 1, 2016 to August 1, 2017 was performed. safety and diagnostic accuracy of this novel method of prostate biopsy.
PCA3 of <35 and 4Kscore of <7.5% were considered negative results.
We assessed the diagnostic performance of these biomarkers when they UP–1.12
were in concordance (high–risk group: double positive or low–risk group: Salvage high–intensity focused ultrasound for recurrent localized
double negative); and when they were not in concordance (Group 1: radiorecurrent prostate cancer: Intermediate–term results from
PCA3–positive, 4K–negative; Group 2: PCA3–negative, 4K–positive). a large, single–centre cohort
Results: A total of 52 patients had both tests performed; 31 patients had a Malcolm Dewar , Haider Abed , Khalil Hetou , Khurram Siddiqui , Joseph
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PCA3 threshold of <35 (negative), and 18 patients had a 4Kscore of <7.5% Chin 1
(negative). Thirty patients’ (57.7%) test results were in concordance; of 1 Urology, Western University, London, ON, Canada
these,12 men were in the low–risk group (double negative), and 16 men Introduction: Biochemical failure (BF) following radiotherapy (RT) for
were in high–risk group (double positive). All patients in the low–risk localized prostate cancer (PCa) can be due to localized recurrence alone.
group who had biopsy were negative for significance disease. Seven of 11 Prostate salvage high–intensity focused ultrasound (sHIFU) ablation may
men (63.6%) in the high–risk group who had biopsy were found to have be potentially curative for these men. We present intermediate–term fol-
significance disease (one Gleason 4+4, five Gleason 3+4, one Gleason lowup of a large cohort from a single centre.
3+3 based on Epstein criteria). Twenty–two patients’ (42.3%) test results Methods: Between April 2006 and March 2017, 87 men with biopsy–
were non–concordance. Five men were in Group 1, where PCA3 was proven locally recurrent PCa underwent whole gland sHIFU using the
positive and 4K was negative, and 100% of them had a negative biopsy Sonablate 400 device. Data on oncological control, adverse effects, and
when performed. Seventeen men were in Group 2, where PCA3 was quality of life were collected prospectively. Mean age was 70 years at
negative and 4K was positive; 37.5% (3/8) were found to have clinically salvage. Seventy–three men had prior external beam RT and 13 had low
significant PCa (one Gleason 4+5, two Gleason 3+4). dose rate brachytherapy. Median pre–salvage prostate–specific antigen
Conclusions: This study showed that a significant number of patients (PSA) was 3.77 ng/ml (interquartile range [IQR] 2.72) and prostate volume
(42.3%) had non–concordance results when both PCA3 and 4K were 23.2 ml (IQR 9.2). Baseline biopsy (bx) showed International Society of
performed. When not in concordance, the PCA3 test seemed to have a Urological Pathology (ISUP) grades 1–5 in 13, 20, 14, 14, and five men,
higher rate of false positive result, whereas when the 4K test was positive, respectively, while Gleason grade could not be determined in the other 21
it had a positive predictive value of 37.5% for clinically significance PCa. bx. Nineteen had received androgen–deprivation therapy (ADT) prior to
Therefore, when the results are not in concordance, the 4K test should salvage treatment. Kaplan–Meier method and binomial logistic regression
have more weight in the clinical decisions. analysis on IBM SPSS version 23 were used for analysis.
Results: Median followup was 50.2 months. Six–month bx was positive for
UP–1.11 PCa in 21/65 men (32%). Eight–year rates of biochemical recurrence–free
Magnetic resonance imaging fused cone beam computed survival (BRFS), freedom from ADT, overall survival, and disease–specific
tomography–guided biopsy of prostate: Early experience of novel survival (DSS) were 16.7±6.4%, 68.0±7.7%, 79.3±5.1%, and 88.9±4.5%,
biopsy method respectively (Fig. 1; available at https://cua.guide/). Binary logistic regres-
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Michael Di Lena , Jason Izard , Robert Siemens , Michael Leveridge , sion analysis did not reveal factors significantly predictive for BF. Only five
Alexandre Menard 2 men had no treatment–related adverse event (AE), however, the major-
1 Department of Urology, Queen’s University, Kingston, ON, Canada; ity (83%) were Clavien 1 or 2 (9%). Two patients (2%) had Clavien 3,
2 Department of Radiology, Queen’s University, Kingston, ON, Canada both being rectourethral fistulae. At six months, IPSS increased a median
Introduction: Real–time 3D fluoroscopy guidance using a computed of three points, International Index of Erectile Function (IIEF–5) scores
tomography (CT) fused to a magnetic resonance imaging (MRI) can proj- dropped 8.5 points among previously potent men, but Short–form 36 (SF
ect an MRI–detected lesion onto the screen of a cone beam CT scan. This 36) scores were unchanged.
allows an operator to advance a needle directly into the software–gener- Conclusions: sHIFU is a safe and viable option for localized radiorecur-
ated lesion using real–time fluoroscopy to confirm biopsy needle place- rent PCa in carefully selected men, with meaningful freedom from or
ment within the lesion. To date, there have been limited reports on the use deference of ADT use and good DSS.
of this new technology for prostate biopsies. We prospectively assessed
the safety and feasibility of MRI fused cone beam CT–guided prostate
biopsies.
Methods: We retrospectively identified 45 patients who had either neg-
ative transrectal ultrasound–guided prostate biopsy (TRUSP) or TRUSP
biopsies showing small–volume Gleason 6 disease with a clinical sus-
picion of higher–volume, higher–grade disease. All patients had an MRI
CUAJ • June 2018 • Volume 12(6Suppl2) S71