Page 8 - CUA2018 Abstracts - Oncology-Prostate

Poster session 1: Prostate Cancer I

MP–1.11 However, there is still limited Canadian data on its outcomes. Herein, we
Prognostic factors in radium–223 treatment: An early Canadian, update the largest RARP experience in Canada, focusing on oncological
single–centre experience and functional outcomes.
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Samer Traboulsi , Fred Saad , Daniel Taussky , Jean–Baptiste Lattouf , Methods: Prospective data from 1034 cases of RARP performed by two
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Jean–Paul Bahary , Maroie Barkati , Guila Delouya 2 staff surgeons (KCZ, AE) at a single academic centre were collected from
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1 Department of Surgery, Division of Urology, Université de Montréal, October 2016 to June 2017. Preoperative characteristics and postopera-
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Montreal, QC, Canada; Department of Radiation Oncology, Université tive surgical, pathological, functional, and oncological outcomes were
de Montréal, Montreal, QC, Canada assessed up to 72 months postoperative.
Introduction: We tested known prognostic factors, such as prostate– Results: Median followup (interquartile range) was 30 months (12–48).
specific antigen (PSA), alkaline phosphatase levels (ALP), hemoglobin D’Amico risk distribution was 26.1% low–, 59.8% intermediate–, and
levels (Hb), Eastern Cooperative Oncology Group (ECOG) performance 14.1% high–risk. Median operative time was 170 minutes (145–200),
status, and other hematological parameters. blood loss was 200 mL (150–300), and the postoperative hospital stay
Methods: A total of 68 patients were treated at our centre. The first 24 was one day (1–1). Transfusion rate was only 1.4%. Intraoperative com-
patients were treated under clinical trials. We tested known prognostic plications rate was 3.8%. There was a total of 32 (3.1%) major postop-
factors from the ALSYMPCA trial, as well as other prognostic factors erative complications (Clavien III–IV) and 138 (13.3%) minor compli-
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known to have an influence on metastatic castrate–resistent prostate can- cations (Clavien I–II). A total of 630 patients were staged pT2 (64.2%)
cer (mCRPC). PSA, ALP, Hb, and white blood count at baseline before with a positive surgical margin (PSM) rate of 15.7% (99). Three hundred
the start of radium–223 were tested for their prognostic value for overall forty–nine patients were staged pT3 (35.6%), of which 39.0% (136) had
survival (OS) with the Kaplan–Meier method; comparisons were made a PSM. One patient was staged pT4 (Table 1; available at https://cua.
using the log–rank test. guide/). Urinary continence (defined as 0 pads/day) returned at three, six,
Results: The median age was 71 years. The median time from diagnosis 12, and 24 months for 71.9%, 82.1%, 88.5%, and 91.2% of patients,
to the first cycle of radium–223 was 99.5 months (interquartile range respectively. Potency rates (defined as successful penetration) were 25.3%,
[IQR] 52–129) and the median followup was eight months (IQR 3.3– 32.0%, 43.5%, and 50.1% at three, six, 12, and 24 months, respectively.
16.8). Overall, 50% of patients completed the planned six cycles, 12% Biochemical recurrence (BCR) occurred in 114 patients (11.0%) and free-
received five cycles, and 16% received only one cycle. At the time of dom from BCR was significantly associated with D’Amico risk (Fig. 1;
analysis, 60% of patients had died. The number of cycles received was available at https://cua.guide/). Forty–six patients (4.4%) had hormono-
a strongly predictive for OS. While median survival for all patients was therapy, while 136 patients (13.2%) were referred for salvage radiotherapy.
13.6 months, patients who completed all six cycles had a median survival Conclusions: This updated study shows comparable results to other high–
of 18.8 months, and those who completed 1–3 cycles had a median volume centres. RARP appears to be safe with acceptable surgical, onco-
survival of only two months (p=0.001). Patients who had an ECOG of logical, and functional outcomes.
0–1 received a median of six radium–223 cycles (IQR 3.75–6) compared
to those with an ECOG ≥2, who received a median of four cycles (IQR MP–1.13
2–6) (p=0.02). Median OS for patients with baseline ECOG of 0–1 was Optimization of the ISUP five–tier Gleason grading system in a
16.4 months vs. 9.5 months for ECOG ≥2 (p=0.037). Furthermore, OS for cohort of localized prostate cancer patients undergoing radical
patients with a Hb level >120 g/l (n=35) vs. those with a Hb ≤120 g/l was prostatectomy in Quebec, Canada
18.0 and 8.3 months, respectively (p=0.005) and OS for patients with an Michel Wissing , Ginette McKercher , Saro Aprikian , Ana O’Flaherty ,
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ALP >107 U/l vs. ALP <107 U/l was 15.2 and 12.9 months, respectively Fred Saad , Michel Carmel , Louis Lacombe , Mathieu Latour , Nadia
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(p=0.026). Baseline laboratory values were compared to values before the Ekindi–Ndongo , Bernard Têtu , Valérie Thibodeau , Simone Chevalier ,
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fourth cycle; median increase in PSA was 55%. An increase <55% was Armen Aprikian , Fadi Brimo 10
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associated with a median OS of 20.8 months vs.9.3 months for an increase 1 Urology, McGill University Health Centre, Montreal, QC, Canada;
by >55% (p=0.02). Variations in ALP were not prognostic for OS (p=0.2). 2 Oncology, McGill University, Montreal, QC, Canada; Surgery, Université
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Conclusions: Median survival was 13.6 month in our cohort, a result de Montreal, Montreal, QC, Canada; Surgery, Université de Sherbrooke,
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comparable the ALSYMPCA trial (14.9 months), and less than an open– Sherbrooke, QC, Canada; Surgery, Université Laval, Laval, QC, Canada;
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label, single–arm phase 3b trial (16 months). Patients need to be carefully 6 PROCURE, Mont–Royal, QC, Canada; Pathology and Cell Biology,
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selected using known prognostic factors for mCRPC, especially ECOG Université de Montreal, Montreal, QC, Canada; Pathology, Université
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performance status, that can be used to reliably select patients potentially de Sherbrooke, Sherbrooke, QC, Canada; Pathology, Université Laval,
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able to complete the recommended six cycles of radium–223. Laval, QC, Canada; Pathology, McGill University, Montreal, QC, Canada
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References: Introduction: We compared the ISUP five–tier Gleason Grading Groups
1. Parker C, Nilsson S, Heinrich D, et al. Alpha emitter radium 223 and (GGG) to the previous scoring system, and postulated further optimiza-
survival in metastatic prostate cancer. N Engl J Med 2013;369:213– tion of the GGG system.
23. https://doi.org/10.1056/NEJMoa1213755 Methods: Data were collected prospectively in the PROCURE Biobank, a
2. Saad F, Carles J, Gillessen S, et al. Radium–223 and concomitant cohort of prostate cancer (PCa) patients undergoing radical prostatectomy
therapies in patients with metastatic castration–resistant prostate can- in academic centres in Quebec between 2007 and 2013. Total specimen
cer: An international, early access, open–label, single–arm, phase evaluation was standardized and Gleason scoring was performed by four
3b trial. Lancet Oncol 2016;17:1306–16. https://doi.org/10.1016/ genitourinary pathologists. Treatment failure was defined as detectable
S1470–2045(16)30173–5 and increasing prostate–specific antigen (PSA) levels or initiation of sec-
ondary non–adjuvant therapy. Analyses were conducted using the Kaplan–
MP–1.12 Meier method, log–rank tests, and the Harrell’s concordance index (HCI)
Update on the largest Canadian robotic–assisted radical for Cox proportional hazards models.
prostatectomy (RARP) experience: Oncological and functional Results: A total of 1857 patients were included; median followup time was
outcomes of 1034 RARP cases with six–year followup five years. Five–year treatment failure rates were 8.4%, 22.3%, 46.0%,
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Félix Couture , Côme Tholomier , Marc Zanaty , Khaleb Ajib , Assaad 66.7%, and 84.3% for GGG1–5 (Fig. 1; available at https://cua.guide/),
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El–Hakim , Thomas Martin , Kevin Zorn 1 respectively. As expected, failure rates were lower in patients with Gleason
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1 Department of Surgery, CHUM Section of Urology, Université de 3+4 (GGG2) than 4+3 (GGG3) tumours (p<0.001). Primary Gleason pat-
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Montréal, Montreal, QC, Canada; Department of Urology, McGill tern (4 or 5) was also relevant in GGG5 (Gleason 9/10, five–year failure
University Health Centre, Montreal, QC, Canada rates 81.9 vs. 96.8%; p=0.010) (Fig. 2; available at https://cua.guide/).
Introduction: Robotic–assisted radical prostatectomy (RARP) is now Patients in GGG2 with a tertiary Gleason 5 pattern had higher treatment
the predominant surgical approach to treat localized prostate cancer. failure rates than other GGG2 patients (p<0.001), but similar rates com-
S66 CUAJ • June 2018 • Volume 12(6Suppl2)