Page 6 - CUA2018 Abstracts - Oncology-Prostate

Poster session 1: Prostate Cancer I

MP–1.6 and sRP, respectively. Compared with sCryo, sRP was associated with
Prostate cancer incidence and mortality among men using statins higher 10–year freedom from ADT (64.7±3.7% vs. 42.7± .8%; p=0.002)
and non–statin lipid–lowering medications in Saskatchewan, and from CRPC (74.5±3.5% vs. 56.5±5.3%; p=0.02). No significant dif-
1990–2014 ferences were noted for 10–year OS (74.7±3.2% vs. 75.4±3.7%; p=0.55)
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Maria van Rompay , Keith Solomon , Gayatri Ranganathan , Philip or DSS (84.5±2.7% vs. 92.0±2.5%; p=0.06) (Fig. 1; available at https://
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Kantoff , John McKinlay , Curtis Nickel 5 cua.guide/). Urinary incontinence was more frequent with sRP (128/212
1 New England Research Institutes, Watertown, MA, United States; Boston [60.4%] vs. 74/176 [42.0%]; p<0.001), and was more likely to be severe
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Children’s Hospital, Harvard Medical School, Boston, MA, United States; (71/221 [32.1%] vs. 5/176 [2.8%]; p<0.001). Lower urinary tract symp-
3 Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, toms occurred more commonly after sCryo (48.1% vs. <5%; p<0.001). De
New York, NY, United States; Massachusetts General Hospital, Harvard novo erectile dysfunction occurred in 99/114 (86.8%) and 29/30 (96%)
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Medical School, Boston, MA, United States; Department of Urology, treated with sRP and sCryo, respectively (p=0.13).
Queen’s University, Kingston, ON, Canada. Conclusions: sRP and sCryo are viable options for select men with radio-
Study Groups: Funded by National Institutes of Health National Institute recurrent localized prostate cancer, with similar long–term survival, but
on Aging under Award Number R01AG038453. differing morbidity profiles.
Introduction: We sought to rigorously test the hypothesis, which was
based on previous small, short–duration and biased studies, that choles- MP–1.8
terol–lowering drugs (statins and non–statin lipid–lowering medications External validation of the novel 2014 ISUP Gleason grading
[NSLLM]) have an effect on prostate cancer (PCa) risk (incidence and groups in a large, contemporary, Canadian cohort
severity) in men. Helen Davis Bondarenko , Marc Zanaty , Sabrina Harmouch , Raisa
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Methods: A retrospective cohort study of men with no history of PCa Pompe , Daniel Liberman , Naeem Bhojani , Pierre Karakiewicz , Kevin
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diagnosis was conducted by abstracting prescription and health service Zorn , Assaad El–Hakim 2
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records for 249 986 men aged 40–89 years covered by Saskatchewan 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal
Health between January 1, 1990 and December 31, 2014 and compar- Health Centre, Montreal, QC, Canada; Urology, Hopital Sacré Coeur
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ing first–time statin and NSLLM users with age–matched non–users and de Montréal, Montreal, QC, Canada; Martini–Clinic, Prostate Cancer
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glaucoma medication users (control for healthcare utilization bias) for Centre, University Hospital Hamburg–Eppendorf, Hamburg, Germany.
PCa incidence, metastases at diagnosis, and PCa mortality over 25 years Introduction: Since its introduction, the Gleason score (GS) has been the
using survival analysis. most universally accepted grading system for prostate cancer (PCa). After
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Results: In comparing statin users to non–users, a weak association was multiple revisions, the original GS, which consisted of 25 possibilities,
detected with increased PCa incidence (adjusted hazard ratio [HR] 1.07; evolved to a traditional three–tiered Gleason grading (TGG). Due to the
95% confidence interval [CI] 1.02–1.12) that disappeared when statin lack of granularity in the TGG strata, in 2013, Pierorazio et al introduced
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users were compared with glaucoma medication users. In contrast, sub- a novel five–tiered gleason grading groups (GGG), suggesting better dis-
stantial protective associations were observed between statin use and crimination and finer definition of risk based on biochemical recurrence
metastatic PCa and PCa mortality (adjusted HRs 0.69; 95% CI 0.61–0.79, (BCR) outcomes. More specifically, there was a distinct separation of the
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and 0.73; 95% CI 0.66–0.81, respectively), which were stronger when intermediate TGG (7), into GGG 2 (3+4) and GGG 3 (4+3), as well as the
compared with glaucoma medication users. Similar associations were high risk TGG into GGG 4 (8) and GGG 5 (9,10). We sought to test the
found between NSLLM and PCa incidence, severity, and mortality. discriminant ability of the GGG for predicting BCR after robot–assisted
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Conclusions: Our analyses provide the most comprehensive findings to radical prostatectomy (RARP) in a large, contemporary, Canadian cohort.
date that statins may reduce the risk of metastatic PCa and PCa mortality, Methods: A total of 621 patients who underwent RARP in two major
and the first to demonstrate that NSLLM have similar effects, supporting Canadian centres were identified in a prospectively maintained Canadian
a cholesterol–based mechanism. database between 2006 and 2016. Followup endpoint was BCR. Log–rank
test, univariable and multivariable Cox regression analyses were used.
MP–1.7 Results: Mean followup was 27.9 months. All five ISUP GGG indepen-
Salvage radical prostatectomy vs. salvage cryotherapy for dently predicted BCR. Statistically significant differences in BCR rates
localized radiorecurrent prostate cancer: Comparative long– were found between GGG 2 and GGG 3 strata (p<0.001). No statisti-
term outcomes cally significant differences in BCR rates were found between GGG 4
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Malcolm Dewar , Timothy Lyon , Jeffrey Karnes , Haider Abed , Khalil and GGG 5 strata (p= 0.3). Relative to GGG 1, GGG 2, GGG 3, GGG
Hetou , Joseph Chin , Stephen Boorjian 2 4 and GGG 5 yielded a 1.10, 3.44–, 4.18–, and 4.74–fold hazard ratio
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1 Urology, Western University, London, ON, Canada; Urology, Mayo (HR) difference, respectively.
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Clinic, Rochester, MN, United States Conclusions: This population–based Canadian cohort study confirms the
Introduction: Some men with biochemical failure following radical radio- added discriminant property of the novel ISUP grading, specifically for
therapy for prostae cancer (PCa) remain with clinically localized disease. GGG 2 and GGG 3 strata. No difference, however, was observed between
Salvage radical prostatectomy (sRP) and salvage cryotherapy (sCryo) can GGG 4 and GGG 5 likely due to the lower number of patients in these
lead to durable recurrence–free survival. There is paucity of long–term groups. As such, after external validation, the 2014 ISUP GGG appears
comparative outcomes between them. We compared mature data from to retain clinical prognostic significance in a Canadian population.
two large, single–centre cohorts. References:
Methods: Men undergoing salvage treatment at two academic centres 1. Gleason DF, Mellinger GT. Prediction of prognosis for prostatic
between 1988 and 2004 were identified and prospectively collected data adenocarcinoma by combined histological grading and clinical
were compared. One centre performed sRP and the other performed staging. J Urol 1974;111:58–64. https://doi.org/10.1016/S0022–
sCryo. Functional outcomes were assessed at one year. Outcomes were 5347(17)59889–4
overall (OS) and disease–specific survival (DSS), freedom from castrate– 2. Pierorazio PM, Walsh PC, Partin AW, et al. Prognostic Gleason
resistant prostate cancer (CRPC) and from androgen deprivation therapy grade grouping: Data based on the modified Gleason scoring sys-
(ADT), and treatment–related adverse effects. Data were compared using tem. BJU Int 2013;111:753–60. https://doi.org/10.1111/j.1464–
the Kaplan–Meier method. 410X.2012.11611.x
Results: A total of 251 men underwent sRP and 187 were treated with 3. Pompe RS, Davis–Bondarenko H, Zaffuto E, et al. Population–based
sCryo. Men undergoing sCryo were older than those undergoing sRP validation of the 2014 ISUP Gleason grade groups in patients treated
(median 69 vs. 65.8 years; p<0.001). Presalvage prostate–specific antigen with radical prostatectomy, brachytherapy, external beam radia-
(PSA) values and Gleason scores were similar. Median followup was 105 tion, or no local treatment. Prostate 2017;77:686–93. https://doi.
(interquartile range [IQR] 100.3) and 118 months (IQR 136.6) for sCryo org/10.1002/pros.23316
S64 CUAJ • June 2018 • Volume 12(6Suppl2)