Page 2 - CUA2018 Abstracts - Oncology-Prostate

Podium session 1: Prostate Cancer

POD–1.3 between 1995 and 2014. Cox proportional hazards regression was used
Metastatic castrate–resistant prostate cancer treatment to compare incidence of a PCa diagnosis, metastatic PCa, Gleason score
algorithm: A shifting paradigm 8–10 PCa, and PCa mortality among 5ARI users (n=4571), α–blocker users
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Shawn Malone , Geoffrey Gotto , Fred Saad , Kim Chi , Naveen Basappa , (n=7764), and non–users (n=11 677).
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Henry Conter , Brita Danielson , Sebastien Hotte , Laura Park–Wyllie , Results: In comparison with both non–users and α–blocker users, 5ARI
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Huong Hew , Bobby Shayegan 7 users had >35% lower risk of a PCa diagnosis; α–blocker users had
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1 The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; 11% lower risk of a PCa diagnosis compared with non–users. Overall,
2 Southern Alberta Institute of Urology, University of Calgary, Calgary, there was no significant increase in metastatic PCa and PCa mortality
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AB, Canada; Centre Hospitalier de l’Université de Montréal, University of among 5ARI and α blocker users (p>0.05 for both drugs), but approxi-
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Montreal, Montreal, QC, Canada; BC Cancer Agency, University of British mately a 30% higher risk of Gleason score 8–10 cancer (adjusted haz-
Columbia, Vancouver, BC, Canada; Cross Cancer Institute, University of ard ratio [aHR] 1.37; 95% confidence interval [CI] 1.03–1.82; p=0.03
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Alberta, Edmonton, AB, Canada; William Osler Health System, University and aHR 1.28; 95% CI 1.03–1.59; p=0.02, respectively) compared with
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of Western Ontario, Brampton, ON, Canada; Juravinski Cancer Centre, non–users.
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McMaster University, Hamilton, ON, Canada; Medical Affairs, Janssen Conclusions: 5ARI use was associated with lower risk of a PCa diagnosis.
Inc., Toronto, ON, Canada Risk of high–grade PCa was higher among both 5ARI users and α–blocker
Introduction: With a growing number of treatment options available for users compared with non–users; however, this did not translate into higher
metastatic prostate cancer, physicians are now able to sequence mul- risk of PCa mortality. These results provide reassurance for BPH patients
tiple lines of therapies over the course of their patient’s disease. The on 5ARI therapy.
Genitourinary Research Consortium (GURC) identified a need to incorpo-
rate emerging trial evidence to develop a treatment algorithm to support POD–1.5
physicians who treat advanced prostate cancer . Salvage cryoablation for recurrent prostate cancer following
Methods: A national working group of uro–oncologists, medical oncol- radiation therapy: Long–term outcomes from a combined
ogists, and radiation oncologists examined clinical trial evidence and analysis of two centres
subsequently engaged in consensus discussions to develop a practice Michael Metcalfe , Joseph Chin , Khurram Siddiqui , Malcolm Dewar ,
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algorithm for the treatment and management of patients with metastatic Khalil Hetou , John Ward , Louis Pisters 1
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castrate–resistant prostate cancer. 1 Urology, MD Anderson Cancer Center, Houston, TX, United States;
Results: Drawing upon the evidence from the COU–301, COU–302, 2 Urology, Western University, London, ON, Canada
PREVAIL, AFFIRM, TAX 327, TROPIC, and ALSYMPCA trials, the algorithm Introduction: There is a paucity of long–term data on the outcomes of sal-
(Fig. 1; available at https://cua.guide/) streams patients into a treatment vage cryotherapy for locally recurrent prostate cancer following radiation
pathway with accompanying sequencing of lines of therapy. All patients therapy (RT). We aimed to investigate long–term outcomes by performing
should be offered clinical trials, if available. Lines of therapy include vari- an analysis of case series from two centres.
ous sequences of androgen receptor (AR)–targeted agents, chemotherapy, Methods: Patients undergoing salvage cryotherapy for biopsy–proven,
and radium–223, and consider patient risk status, medical comorbidities, localized radiorecurrent prostate cancer (RRPCa) from 1990–2004 were
and toxicity profiles of therapy. prospectively accrued. Preoperative characteristics, perioperative morbid-
Conclusions: The emergence of new therapies in metastatic prostate can- ity, and postoperative data were reviewed from a prospectively main-
cer provide physicians with sequencing possibilities and opportunities tained database. The primary outcomes were overall survival (OS) and
for individualizing therapy. The GURC practice algorithm is a tool to disease–specific survival (DSS). Secondary outcomes were metastasis–free
support the management of advanced metastatic prostate cancer. Further survival (MFS), freedom from castrate–resistant prostate cancer (CRPC),
research may involve assessment of outcomes and economic analyses to and freedom from androgen–deprivation therapy (ADT).
determine the value of these algorithms in the community and academic Results: A total of 268 patients were identified, with a median followup
settings. Since the algorithm was nationally developed and designed to of 10.3 years. One hundred ninety–nine (74.3%) experienced complica-
reflect evidence–based and expert–consensus practice recommendations, tions, including 381 Clavien I–II events and 55 Clavien III events. At 10
it is possible some provinces will have funding policies that are incongru- years, 69% had freedom from ADT, 76% had freedom from CRPC, and
ent with the algorithm. In such cases, the variation of treatment access the MFS rate was 76%. The 10–year DSS rate was 81%, and the 10–year
across provinces can be further examined. OS rate was 77%. Pre–salvage prostate–specific antigen level of >5 ng/
mL was associated with an increased risk of developing CRPC, but was
POD–1.4 not associated with MFS, DSS, or OS (Figs. 1, 2). The use of neoadjuvant
Prostate cancer incidence and mortality in Saskatchewan men ADT was associated with decreased MFS and improved OS and DSS, but
on 5α–reductase inhibitors and α–blockers for benign prostatic did not affect freedom from CRPC (p<0.05).
hyperplasia (1995–2014) Conclusions: Salvage cryotherapy for RRPCa provides long–term freedom
Maria van Rompay , Gayatri Ranganathan , Philip Kantoff , Keith Solomon , from ADT and CRPC and MFS, DSS and OS with acceptable morbidity.
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Jennifer Lund , John McKinlay , Curtis Nickel 6 Salvage cryotherapy is, therefore, a viable treatment option for localized
1 New England Research Institutes, Watertown, MA, United States; RRPCa. Prospective trials are required for validation.
2 Memorial Sloan Kettering Cancer Center , Weill Cornell Medical
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College, New York, NY, United States; Boston Children’s Hospital, POD–1.6
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Harvard Medical School, Boston, MA, United States; Department of A prospective multicentre study comparing multi–parametric
Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, MRI (mp–MRI), F–18–choline (FCH) and Ga–68–PSMA PET/CT
NC, United States; Massachusetts General Hospital, Harvard Medical in patients being considered for salvage radiation therapy after
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School, Boston, MA, United States; Department of Urology, Queen’s radical prostatectomy
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University, Kingston, ON, Canada Frédéric Pouliot , Ur Metser , Glenn Bauman , Andrew Weickhardt , Ian
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Study Groups: Funded by NIH National Institute on Aging Award Number Davis , Rod Hicks , Shonit Punwani , Sue Chua , Andrew Scott , Louise
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R01AG038453. Emmett 9
Introduction: Our objective was to investigate prostate cancer (PCa) inci- 1 Université Laval, Quebec, QC, Canada; University of Toronto, Toronto,
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dence, severity (grade and metastases), and mortality among men using ON, Canada; London Health Sciences Centre, London, ON, Canada;
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5α–reductase inhibitors (5ARIs) with or without α–blockers (α–blockers) 4 Austin Health, Melbourne, Australia; Eastern Health, Melbourne,
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for benign prostatic hyperplasia (BPH) . Australia; Peter MacCallum Cancer Centre, Melbourne, Australia;
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Methods: We conducted a retrospective 20–year cohort study in 249 7 University College London Hospital, London, United Kingdom; Royal
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986 Saskatchewan male patients aged 40–89 years diagnosed with BPH
S52 CUAJ • June 2018 • Volume 12(6Suppl2)