Page 12 - CUA2019 Abstracts - Oncology-Prostate

2019 CUA AbstrACts

Poster Session 10: Prostate Cancer II

July 1, 2019; 0730–0900

MP-10.1 Methods: AS patients followed at the Manitoba Prostate Centre from
Median five-year oncological outcomes of salvage high-intensity January 1, 2004 to December 31, 2015 were identified by a retrospective
focused ultrasound for prostate cancer recurrences after primary electronic chart review. AS patients were divided into low-risk, favourable
radiotherapy intermediate-risk, and unfavourable intermediate-risk groups according to
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Shiva M. Nair , Max Peters , Haider Abed , Jochem van der Voort van Zyp , National Comprehensive Cancer Network (NCCN) guidelines based on
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Marieke van Son , Joseph Chin 1 their initial biopsy. Poor pathological outcomes included: upgrading to
1 Division of Urology, Department of Surgery, University of Western Ontario, Grade Group (GG) 3–5 on final surgical pathology, positive surgical mar-
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London, ON, Canada; Department of Radiotherapy, University Medical gins, and a composite adverse pathology variable defined as GG 3–5,
Centre Utrecht, Utrecht, Netherlands extracapsular extension, seminal vesicle invasion, or positive lymph nodes.
Introduction: Recurrent prostate cancer after primary radiotherapy occurs, Multivariable logistic regression was used to identify predictors of poor
especially in higher-risk groups. Local recurrence can be treated using pathological outcomes.
salvage therapy, thereby deferring subsequent non-curative systemic treat- Results: A total of 270 PCa patients were included. Median overall fol-
ments. Tumour control results of salvage high-intensity focused ultrasound lowup was 72 months (interquartile range [IQR] 28–119). prostate-specific
(HIFU) at median five years followup are reported. antigen density (PSAD) >0.15 was a significant predictor of upgrading to
Methods: From April 2006 to March 2017, patients with histologically GG 3–5 (odds ratio [OR] 10.96; 95% confidence interval [CI] 1.32–91.15),
confirmed recurrent prostate cancer were treated using whole-gland salvage positive surgical margins (OR 4.86; 95% CI 1.10–21.50), and the composite
HIFU (Sonablate, whole gland). Bone scan and computed tomography were adverse pathology variable (OR 13.89; 95% CI 2.24–86.05). There were no
negative for clinical metastatic disease. Data before salvage HIFU was significant differences between RP pathological outcomes between low-risk,
collected to predict oncological outcomes. Overall survival (OS), prostate favourable intermediate-risk, and unfavourable intermediate-risk groups.
cancer-specific survival (PCSS), and metastases-free survival (MFS) were Conclusions: Among AS patients who underwent RP, PSAD >0.15 was a
calculated using the Kaplan-Meier method. Cox regression was used to consistent predictor of poor pathological outcomes. Among patients who
assess predictive factors for OS. received RP, there were similar adverse pathological outcomes at the time
Results: Eighty-seven patients with complete data were analyzed. Median of RP. Our findings suggest that select patients with intermediate-risk disease
followup was 65 months (interquartile range [IQR] 36–122). Median age may be safely managed with AS.
before salvage was 71 years (IQR 66–74), median prostate-specific antigen
(PSA) pre-salvage 3.8 ng/ml (IQR 2.3–5.1), and median PSA nadir post-HIFU MP-10.3
0.44 (IQR 0.04–1.41). Most patients had Charlson comorbidity score 4 Improving quality of prostate cancer surgery by providing feedback
(31%), 5 (33.3%), or 6 (18.4%);14.9% had primary Gleason 6 before radia- to surgeons: The Surgical Report card (SuRep) study
tion and 78.2% Gleason 7 or greater. Five-year OS was 83% (confidence Ravi Kumar , Luke T. Lavallée , Christopher Morash , Ilias Cagiannos ,
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interval [CI] 75–92), PCSS was 89% (CI 82–97), and MFS was 85% (CI Dean Fergusson , David Sands , Sonya Cnossen , Ranjeeta Mallick ,
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77–94). Pre-salvage PSA predicted overall mortality in univariate analysis Michael Horrigan , Dawn Stacey , Rodney H. Breau 1,2
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(p<0.0001), but not in multivariate analysis. Fifty-one patients (58.6%) were 1 Division of Urology, Department of Surgery, The Ottawa Hospital,
androgen-deprivation therapy (ADT)-free at last followup, with a median University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research
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time to ADT at 118 months (CI 84 – 210). Institute, Ottawa, ON, Canada; Faculty of Health Sciences, University of
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Conclusions: Salvage HIFU can achieve high OS, PCSS, and MFS in the Ottawa, Ottawa, ON, Canada
medium-term in appropriately selected patients with radio-recurrent pros- Introduction: Goals of radical prostatectomy include complete tumour resec-
tate cancer. Urologists should include this in the options discussed for tion and optimization of urinary and erectile function. In this Surgical Report
localized radio-recurrent disease, especially in men who may not be suit- card (SuRep) study, we aimed to monitor cancer, urinary, and sexual out-
able for salvage radical prostatectomy. comes and provide surgeons with report cards assessing their performance.
Methods: Prospective radical prostatectomy patients at The Ottawa Hospital
MP-10.2 consented for participation in SuRep. All eight prostate cancer surgeons
Predictors of poor pathological outcomes following radical also consented to participation. Feasibility goals for the study were 95%
prostatectomy among patients initially on active surveillance for patient enrollment, with 70% participation at 12 months. Patient-reported
intermediate-risk and low-risk prostate cancer outcomes were assessed using validated questionnaires (Expanded Prostate
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Justin Oake , Premal Patel , Jeffery W. Saranchuk , Darrel E. Drachenberg , Cancer Index Composite [EPIC] and EQ-5D). The patient data was analyzed
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Jay Nayak 1 and report cards were provided to surgeons every four months starting one
1 Section of Urology, University of Manitoba, Winnipeg, MB, Canada; year after the first patient was enrolled.
2 Department of Urology, University of Miami, Miami, FL, United States Results: During the study period, 422 of 436 (97%) radical prostatectomy
Introduction: Active surveillance (AS) is a means to avoid treatment-asso- patients participated in the study. Followup data was available for 356
ciated morbidity in men with low-risk prostate cancer (PCa) and select (84%) patients at 12 months following surgery. Two-hundred and ten (50%)
men with intermediate-risk PCa. We sought to determine predictors of patients were included in the first year (pre-report card) and 212 (50%)
poor pathological outcomes among AS patients who underwent radical patients in the second year (post-report card). Baseline characteristics were
prostatectomy (RP). Our secondary objective was to compare pathologi- similar in the pre- and post-report card cohorts. Almost all patients were
cal and biochemical outcomes between subgroups of intermediate-risk continent (98%) and the majority were potent (61%) prior to surgery. Nerve-
vs.low-risk disease. sparing surgery increased from 148 (70%) pre-report card to 173 (82%)
post-report card. There was a non-statistically significant increase in the
S148 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)
© 2019 Canadian Urological Association