Page 10 - CUA2019 Abstracts - Oncology-Prostate

Podium session 3: Prostate Cancer

we compared the diagnostic accuracy between FDG-PET/CT and bone in the post-MRI group. There was no difference in pathologic T stage, N
scintigraphy to determine if FDG-PET/CT alone can be used as a staging stage, and positive margin rates.
procedure for Gleason 8 PCa. Conclusions: With widespread use of mpMRI, patients on AS are treated
Methods: Between 2010 and 2016, 261 patients with Gleason 8 PCa at earlier. However, further followup will be needed to see if this earlier
biopsy were staged by a bone scan and FDG-PET/CT at CHU de Québec. identification and treatment of clinically significant disease ultimately
We compared the accuracy of the two imaging modalities, taking inter- results in a plateau in long-term treatment-free survival.
modality agreement as truth standard. In case of disagreement, biopsy of
lesions or re-imaging were used as reference standards. POD-3.5
Results: A total of 157, 97, and seven patients had Gleason 8, 9, and
10, respectively, at biopsy and 33 of 261 patients had bone metastases at Comparison of salvage prostatectomy vs. salvage ablative therapy
diagnosis. Median prostate-specific antigen (PSA) was 8, 2, and 157 for for biopsy-proven radio-recurrent localized prostate cancer 2
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M0 vs. M1 patients. FDG-PET/CT identified 33 bone metastatic patients Victor A. McPherson , Shiva M. Nair , Amy L. Tin , Malcolm Dewar ,
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vs. 26 for bone scintigraphy. Sensitivity, specificity, positive predictive Khurram Siddiqui , Daniel D. Sjoberg , Andrew Vickers , James Eastham ,
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value, and negative predictive value for FDG-PET/CT were 100%, 99%, Joseph Chin
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92%, and 100%, respectively, compared to 79%, 98%, 84%, and 97% Surgery; Urology, Memorial Sloan Kettering Cancer Center, New York,
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for bone scintigraphy. Of eight patients who had positive FDG-PET/CT NY, United States; Surgery; Urology, University of Western Ontario,
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but negative bone scintigraphy, seven were assigned as true positives. London, ON, Canada; Epidemiology and Biostatistics, Memorial Sloan
No patient with a positive bone scan and a negative FDG-PET/CT had Kettering Cancer Center, New York, NY, United States
metastasis diagnosed. Introduction: After radiation therapy for prostate cancer, there is a 15–20%
Conclusions: For patients with Gleason 8 PCa at biopsy, FDG-PET/CT is recurrence rate. Patients with localized recurrence are candidates for sal-
accurate and superior to bone scintigraphy for bone metastases detection. vage therapy, however, there is no clear consensus on modality. Registries
FDG-PET/CT can, therefore, be used alone to stage these cancers preop- at Memorial Sloan Kettering Cancer Center (MSKCC) and University of
eratively in order to identify very high-risk PCa without compromising Western Ontario (UWO) were used to compare salvage radical prosta-
bone metastases detection. tectomy (SRP), and two salvage ablation (SA) therapies: cryotherapy and
Reference high-frequency focused ultrasound (HIFU).
1. Lavallée E, Bergeron M, Buteau FA, et al. Increased prostate cancer Methods: Data from two registries were retrospectively analyzed.
glucose metabolism detected by 18F-fluorodeoxyglucose positron SRP was performed at MSKCC, while SA was used at UWO. An equiva-
emission tomography/computed tomography in localized Gleason lence test for metastasis-free survival (MFS) was used for cryotherapy and
8–10 prostate cancers identifies very high-risk patients for early HIFU; there was no difference (p=0.3) and thus data were combined. A
recurrence and resistance to castration. Eur Urol Focus 2018. [Epub total of 444 patients were available for analysis; however, due to differ-
ahead of print]. https://doi.org/10.1016/j.euf.2018.03.008 ences in treatment groups, propensity score methodology was used to
identify a cohort of 378 patients with more similar pre-salvage prostate-
specific antigen (PSA), Gleason grade, and radiation treatment.
POD-3.4 Results: Forty-eight patients died of disease and median followup time for
Widespread use of multiparametric magnetic resonance imaging survivors was 6.0 years from salvage treatment (interquartile range [IQR]
in an active surveillance cohort results in earlier identification 3.0, 9.7); 88 developed metastasis, and median followup time was 4.6
and treatment of clinically significant prostate cancer years from therapy (IQR 2.3, 7.9). There were no differences between SA
Alice Yu , Timothy Baloda , Eduoard Nicaise , Andrew Gusev , Amirkasra and SRP in cancer-specific survival (CSS; hazard ratio [HR] 1.02; 95%
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Mojtahed , Mukesh Harisinghani , Douglas Dahl , Matthew Wszolek , confidence interval [CI] 0.51, 2.06; p=0.9) or MFS (HR 0.71; 95% CI 0.44,
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Anthony Zietman , Adam Feldman 1 1.13; p=0.15). Among 377 patients with data, 143 received hormonal
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1 Urology, Massachusetts General Hospital, Boston, MA, United States; treatment after salvage, with higher rates of androgen-deprivation therapy
2 Radiology, Massachusetts General Hospital, Boston, MA, United States; (ADT) in SA (HR 1.42; 95% CI 0.97, 2.08; p=0.068); this did not reach
3 Radiation Oncology, Massachusetts General Hospital, Boston, MA, conventional levels of statistical significance.
United States Conclusions: This analysis of two independent registries of salvage therapy
Introduction: Multiparametric magnetic resonance imaging (mpMRI) has for radio-recurrent prostate cancer identified no difference in CSS or MFS
led to improved detection of clinically significant prostate cancer and between SRP and SA. However, there was some evidence of a lower risk
is now increasingly used in active surveillance (AS) patients. However, of ADT with SRP. Therefore, SRP and SA have comparable oncological
most AS cohorts in the literature were described prior to widespread use outcomes, but the analysis is limited by differences between cohorts,
of mpMRI. Our investigation compares outcomes in AS in the pre- and which may not be fully accounted for by propensity score analysis.
post-MRI era at our institution.
Methods: We used an institutional database of 1295 men who started AS POD-3.6
between September 1996 and December 2016. The cohort was divided
into pre- and post-MRI era, with the cutoff in January 2014, when mpMRI Impact of bone-targeted therapies in patients with chemotherapy-
was routinely incorporated into our AS protocol. Clinical outcomes were naive metastatic castration-resistant prostate cancer on
compared using Wilcoxon rank sum and Chi-square tests. Treatment-free enzalutamide: A post-hoc analysis of PREVAIL 4 4
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survival was analyzed using Kaplan-Meier plots. Fred Saad , Neal D. Shore , Karim Fizazi , Joyce Steinberg , Janet Kim ,
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Results: All patients (251) in the post-MRI era had at least one mpMRI Ping Lin , Katharina Modelska , Tomasz M. Beer
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performed compared to 5.3% (55/1044) of those enrolled earlier. There Centre Hospitalier de l’Université de Montréal/CRCHUM, Montréal, QC,
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was no significant difference in baseline prostate-specific antigen (PSA) Canada; Carolina Urologic Research Center, Myrtle Beach, SC, United
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(p=0.36) or Gleason score (GS) (p=0.395). Mean time to followup in States; Institut Gustave Roussy, University of Paris-Sud, Villejuif, France;
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the post-MRI era was 3.0±0.9 years compared to 8.0±5.1 years in Astellas Pharma Inc., Northbrook, IL, United States; Pfizer Inc., San
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the pre-MRI era. At two years, 21.8% of patients in the post-MRI era Francisco, CA, United States; OHSU Knight Cancer Institute, Oregon
were treated as compared 15.7% in the pre-MRI era. By Kaplan-Meier, Health and Science University, Portland, OR, United States.
patients in the post-MRI group had a shorter time to treatment (1.5 vs. Funding: Astellas Pharma Inc. and Medivation LLC, a Pfizer Company.
2.8 years; p<0.001) (Fig. 1). Among those treated, 288 underwent radi- Medical writing and editorial support: Complete HealthVizion.
cal prostatectomy (RP). On surgical pathology, 4.2% of patients in the Introduction: Enzalutamide (ENZA) prolongs radiographic progression-
pre-MRI group had GS 8 or 9 disease, 59.0% had GS 7, and 36.8% had free survival (rPFS) and overall survival (OS) in men with chemotherapy-
GS 6 disease. This is compared to 0%, 75.0%, and 25.0%, respectively, naive metastatic castration-resistant prostate cancer (mCRPC). Men with
mCRPC are at high risk of developing bone metastases; skeletal complica-
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S121