Page 9 - CUA2018 Abstracts - Oncology-Prostate

Poster session 1: Prostate Cancer I

pared to patients in GGG3 without tertiary pattern (p=0.634). The same MP–1.15
observation was made for patients in GGG3 (p=0.020 and p=0.930, Psychosocial adaptation to a prostate cancer diagnosis in a
respectively) (Fig. 3; available at https://cua.guide/). The accuracy of cohort of radical prostatectomy patients in Quebec, Canada
Gleason scoring improved with the new GGG (HCI 0.746 vs. 0.694), Michel Wissing , Ginette McKercher , Saro Aprikian , Ana O’Flaherty ,
1
1
1
1
but was further improved when upgrading patients in GGG2/3 with a Fred Saad , Michel Carmel , Louis Lacombe , Simone Chevalier , Marc
5
1
3
4
tertiary Gleason 5 pattern to GGG3/4 (HCI 0.753), and by dividing GGG5 Hamel , Armen Aprikian 1,2
6
patients based on their primary Gleason pattern (HCI 0.754) (Table 1; 1 Urology, McGill University Health Centre, Montreal, QC, Canada;
available at https://cua.guide/). 2 Oncology, McGill University, Montreal, QC, Canada; Surgery, Université
3
Conclusions: The five–tier GGG system improved the accuracy for predict- de Montreal, Montreal, QC, Canada; Surgery, Université de Sherbrooke,
4
ing treatment failure in our cohort of localized PCa patients. It may be Sherbrooke, QC, Canada; Surgery, Université Laval, Laval, QC, Canada;
5
further optimized by dividing GGG5 based on primary Gleason pattern, 6 Psychosocial Oncology, McGill University Health Centre, Montreal, QC,
and by upgrading GGG2–3 tumours with a tertiary Gleason 5 pattern. Canada
Introduction: Psychosocial adaptation significantly affects the quality of
MP–1.14 life of cancer patients, but has rarely been studied in men diagnosed with
Variation in the predictive and clinical utility of urinary prostate cancer (PCa).
biomarkers, PCA3 and T2ERG, in a large, multicentre study Methods: Data were collected from self–administered questionnaires in
Padraic O’Malley , David Golombos , Patrick Lewicki , Paul Christos , the PROCURE Biobank, a prospective cohort of patients with localized
4
2,3
3
1,3
Ian Thompson , Arul Chinnaiyan , John Wei , Scott Tomlins , Martin PCa who underwent surgery in one of four academic centres in Quebec
6
5
6
6
Sanda , Mark Rubin , Christopher Barbieri , Douglas Scherr 3 between 2007 and 2013. Relative risk ratios (RRR) were calculated using
7
8
3
2
1 Urology, Dalhousie University, Halifax, NS, Canada; Urology, Stony multinomial logistic regression.
Brook University Hospital, Stony Brook, NY, United States; Urology, Weill Results: A total of 93% (1861/2003) of PROCURE patients returned the
3
Cornell Medical College, New York, NY, United States; Healthcare Policy questionnaire. Median age was 62 years; the majority was white (92.9%)
4
and Research, Weill Cornell Medical College, New York, NY, United and had a post–secondary education (60.7%). Most patients reported
States; Urology, University of Texas Health Sciences at San Antonio, San having accepted the diagnosis (89.0%) and were satisfied with the com-
5
Antonio, TX, United States; Urology, University of Michigan, Livonia, MI, munication of the diagnosis (71.2%). Satisfaction was lower in young
6
United States; Urology, Emory University School of Medicine, Atlanta, patients (RRR 0.82; p=0.009) and patients receiving their diagnosis by
7
GA, United States; Pathology, Weill Cornell Medical College, New York, telephone (RRR 0.41; p=0.001), but high in patients informed by their
8
NY, United States family doctor/urologist (83.5%, 76.7%, respectively; p<0.001). Patients
Study Groups: Early Detection Research Network. satisfied with the communication had a higher acceptance of the diagno-
Introduction: In men with prostate–specific antigen (PSA) <4 ng/mL and sis (RRR 1.3; p=0.005) and less feelings of fear, despair, denial, doubts,
men less than 55 years of age, the value of prostate cancer screening strat- revolt, and isolation, and difficulties in performing daily tasks, sleep-
egies are unclear. It is unknown whether urinary biomarkers for prostate ing and/or concentrating (p<0.05). Most patients (89.2%) preferred to
cancer (PCa) have added predictive and clinical utility to clinical risk receive information about PCa and its treatment at the time of diagnosis,
calculators in these men. We sought to examine the added predictive while only 63.4% said they received such information during this consult.
and clinical utility to clinical risk calculators for urinary biomarkers in Patients found physical activity (62.3%), breathing exercises (44.5%),
prediction of PCa in younger men and men with lower PSA values. music (32.8%), faith (30.3%), and muscle relaxation (30.1%) the five
Methods: Demographics, Prostate Cancer Prevention Trial (PCPT) v2.0 risk most helpful coping strategies. Music and faith were more helpful for
scores, biomarker data (PCA3 and T2ERG), and biopsy pathology features ethnic minorities, support groups and psychological help for younger,
were prospectively collected from 718 men as part of the Early Detection highly educated patients.
Research Network (EDRN). Predictive utility was determined by genera- Conclusions: This study stresses the importance of urologists/family doc-
tion of receiver operating curves and comparison of area under the curve tors communicating a PCa diagnosis directly to their patients. Patients
(AUC) values for the baseline multivariable PCPT model and for models may benefit from individually tailored interventions to facilitate their
containing biomarker scores. Clinical utility was determined by decision overall coping.
curve analysis across multiple clinical thresholds for the various models.
Results: PCA3 and T2ERG added predictive utility for prediction of PCa UP–1.1
when combined with the PCPT risk calculator (Table 1, Fig. 1; available Pre–procedural rectal screening for ciprofloxacin–resistant
at https://cua.guide/). This utility was seen in men both less than and organisms reduces rates of febrile urinary tract infection post–
above the age of 55 years and men with PSA values below and above 4 transrectal ultrasound–guided prostate biopsy
ng/mL. PCA3 and T2ERG added clinical utility in men both below and Bernard Ho , Ali Huda , Noor Rehman , Alyssandra Chee–a–tow ,
1
1
1
1
above the age of 55 years and men with PSA values below and above 4 Martha Pokarowski , Kevin Leung , Mariam Mir , Alicia Sarabia , Frank
1
1,2
1,2
1
ng/mL across a wide range of thresholds (20–80%) compared to PCPT Papanikolaou 1,2
alone, biopsy all, and biopsy none strategies (Fig. 2; available at https:// 1 Credit Valley Hospital, Trillium Health Partners, Mississauga, ON,
cua.guide/). Limitations include smaller number of young men (n=143) Canada; University of Toronto, Toronto, ON, Canada.
2
and men with PSA <4 ng/mL (n=192). The post–hoc and subgroup analysis Introduction: Fluoroquinolones like ciprofloxacin are commonly given
nature limits findings to being hypothesis generating. prophylactically to patients undergoing transrectal ultrasound–guided
Conclusions: As novel biomarkers are discovered, both predictive and (TRUS) prostate biopsies. However, the rise of ciprofloxacin–resistant
clinical utility should be established across demographically diverse bacteria has also caused the rise of post–biopsy febrile urinary tract infec-
cohorts. tions (UTI). These infections are associated with morbidity, mortality,
1
and significant monetary costs. 2–4 We believe that screening for carriage
of ciprofloxacin–resistant organisms with rectal swabs pre–biopsy will
significantly reduce the incidence of post–biopsy febrile UTI.
Methods: From 2012–2015, we compared the infection rates and demo-
graphic data of 593 prospectively swabbed TRUS biopsy patients to a
retrospective cohort of 967 non–swabbed TRUS biopsy patients. The pri-
mary outcome was the rate of febrile UTI in both groups. The prevalence
of ciprofloxacin–resistant enteric organisms amongst swabbed patients
and risk factors for carriage of these organisms were also determined.
Data was prospectively gathered via questionnaire prior to the biopsy.
CUAJ • June 2018 • Volume 12(6Suppl2) S67