Page 3 - CUA2019 Abstracts - Oncology-Prostate

2019 CUA Abstracts

study, we sought to evaluate the prevalence and predictors of depressive of advanced prostate cancer. A larger, multicentre, prospective study is
symptoms in a large, contemporary, prospectively collected sample of needed to validate these findings.
newly diagnosed men with prostate cancer. This paper has a figure, which may be viewed online at:
Methods: Data from the current study were drawn from the RADICAL https://2019.cua.events/webapp/lecture/111
PC study, a parent prospective cohort study conducted across 13 sites in
Canada. Men with a diagnosis of prostate cancer within 12 months were MP-4.8
recruited. Depressive symptoms were evaluated using the nine-item ver-
sion of the Patient Health Questionnaire. To evaluate predictors of depres- Prostate Cancer Patient Empowerment Program (PC-PEP)
sive symptoms, a logistic regression model was constructed, including addresses multidimensional needs of men undergoing radical
biological, psychological, and social predictor variables. prostatectomy 1,2,3 2 2 2
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Results: Data from 1440 patients were available at the time of this analy- Robert Rutledge , Gabriela Ilie , Gregory Bailly , David Bell , Ross Mason ,
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sis. Of these, 108 (7.5%) endorsed clinically significant burden of depres- Ricardo A. Rendon , Melanie Keats , Scott Grandy , Joseph G. Lawen
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sive symptoms. Having a pre-existing diagnosis of depression or anxiety Radiation Oncology, Dalhousie University, Halifax, NS, Canada; Urology,
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disorder increased risk of depressive symptoms at the time of evaluation Dalhousie University, Halifax, NS, Canada; Community Health and
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(odds ratio [OR] 4.12; p<0.001). Above and beyond this, greater comor- Epidemiology, Dalhousie University, Halifax, NS, Canada; School of Health
bid conditions (OR 1.20; p=0.03), poorer functional status (OR 5.78; and Human Performance, Dalhousie University, Halifax, NS, Canada
p<0.001), and smoking (OR 3.27; p=0.001) also predicted depressive Introduction: A Maritime-wide study of over 400 prostate cancer sur-
symptoms. Higher education (OR 0.48; p=0.03) and being retired (OR vivors who completed a comprehensive online quality of life survey
0.57; p=0.04) were protective against depression. Despite having univari- showed 70% of these men reported sexuality/intimacy and relationship
ate associations with depression, stage of disease and income did not have issues, 50% were suffering moderate to severe urinary symptoms, and
independent predictive value in our multivariate model. 15–20% report problems of insomnia, fatigue, emotional distress, relation-
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Conclusions: Our multicentre study of newly diagnosed prostate can- ship difficulties, and many other issues. Of grave concern, 17% of our
cer patients confirms the presence of clinically significant depressive sample are categorized as suffering from clinical depression or troubling
symptoms in a contemporary and sizeable sample of men. Early in their anxiety. Fewer than 20% have attended a prostate cancer support group.
cancer trajectory, men with prostate cancer are burdened by not only To address these many issues directly, we created a Patient Empowerment
the extent of their illness but also by many other interacting variables, Program (PEP) to be delivered pre-surgery to educate and teach the men
some modifiable and others not. Clinicians should be vigilant to screen and partners life skills/habits aimed at improving their fitness levels and
for depression in those patients with poor social determinants of health quality of life, and to decrease treatment-related side effects.
and concomitant disability. Methods: The PEP program was created based on a review of the pre-
habilitation literature, expert opinion, and the experience of the lead
investigators. The 28-day program includes: 1) informational empower-
MP-4.7 ment (e.g., how to navigate the medical system); 2) strength and aerobic
Investigating the impact of a lower testosterone threshold personalized training by a physiologist; 3) pelvic floor training; 4) medita-
on castration-resistant progression in patients on continuous tion (EEG and heart rate variability [HRV] biofeedback); 5) relationship/
androgen-deprivation therapy connection teaching; 6) co-participant support; and 7) daily multimedia
Maylynn Ding , Taehyoung Lee , Richard D. Di Lena , Bobby Shayegan reminders via text, emails, and video/webcasts.
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1 Michael G. DeGroote School of Medicine, McMaster University, Results: To date, in our first cohort of 30 men participating in the program,
Hamilton, ON, Canada; Surgery, Urology Service, Memorial Sloan we have 100% compliance with the pre-intervention assessments, which
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Kettering Cancer Center, New York, NY, United States; Surgery, Division include: 1) 20–30 minutes quality of life online multidimensional survey;
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of Urology, McMaster University, Hamilton, ON, Canada 2) fitness testing (six-minute walk, sit to stand, flexibility, balance); and 3)
Introduction: We aimed to determine if a lower testosterone level, below assessment of stress levels through EEG and HRV monitoring.
the previously accepted castration level of <50 ng/dL, has an impact Conclusions: A multidimensional patient empowerment program may
on time to progression to castration-resistant prostate cancer (CRPC) in improve quality of life and multiple other domains of health in men under-
patients on continuous androgen-deprivation therapy (ADT). going radical prostatectomy. Preliminary results (pre- vs.post-intervention
Methods: This is a single-centre, retrospective review of prospectively col- outcomes, compliance rates, focus group evaluation) will be submitted
lected data on 156 consecutive patients who initiated continuous ADT at prior to the late-breaking abstract deadline.
a tertiary centre from 2006–2017. Serum prostate-specific antigen (PSA) Reference
and testosterone levels were routinely assessed every three months after 1. Ilie G, Bradfield JA, Bell D, et al. A longitudinal examination of the
initiation of ADT. Patients were stratified based on absolute testoster- impact of treatment modality on relationship satisfaction and mental
one levels measured at six and nine months following ADT initiation. health quality of life outcomes in a Maritime sample of prostate
Progression to CRPC was assessed using the Kaplan-Meier method and cancer survivors (under review PLOS Medicine, 2019).
compared with the log-rank test.
Results: A total of 116 patients were included in the analysis. Median MP-4.9
age at diagnosis was 68 years old (interquartile range [IQR] 61, 78) and
median PSA prior to initiation of ADT was 18 ng/mL (IQR 8.7, 51.3). A Canadian consensus forum on the management of patients
Median followup was 48 months (IQR 30.5, 62.5); 41.4% of all patients with advanced prostate cancer 3 4
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were CRPC-free at the date of last followup. In this study cohort, 71.6% Fred Saad , Christina Canil , Antonio Finelli , Sebastien J. Hotte ,
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of patients achieved a one-year mean testosterone level <20 ng/dL; 21.6% Shawn Malone , Bobby Shayegan , Alan I. So , Lorne Aaron , Naveen S.
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achieved 20–32 ng/dL; 3.4% achieved 32–50 ng/dL; and 3.4% achieved Basappa , Henry J. Conter , Brita Danielson , Geoffrey Gotto , Robert
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≥50 ng/dL. Patients who achieved an absolute testosterone level of <20 J. Hamilton , Jason P. Izard , Anil Kapoor , Michael Kolinsky , Aly-Khan
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ng/dL at six months had a significantly increased time to CRPC (log- A. Lalani , Jean-Baptiste Lattouf , Christopher Morash , Scott C. Morgan ,
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rank p=0.025, median CRPC-free survival of 48 months [<20 ng/dL] vs. Tamim Niazi , Krista L. Noonan , Michael Ong , Ricardo A. Rendon ,
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24 months [≥20 ng/dL]) (Fig. 1). Likewise, patients with a nine-month Sandeep Sehdev , Jeffrey M. Spodek , Huong Hew , Laura Park-Wyllie ,
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absolute testosterone level <20 ng/dL had a significantly increased time Kim N. Chi
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to CRPC (log-rank p=0.039, median CRPC-free survival 48 months [<20 2 Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada;
ng/dL] vs. 20 months [≥20 ng/dL]). 3 The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada;
Conclusions: Our study results support stricter testosterone control of Princess Margaret Cancer Centre, University of Toronto, Toronto, ON,
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<20 ng/dL in patients undergoing continuous ADT for the management Canada; Juravinski Cancer Centre, McMaster University, Hamilton, ON,
Canada; St. Joseph’s Healthcare, McMaster University, Hamilton, ON,
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S106 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)