Page 4 - CUA2019 Abstracts - Oncology-Prostate

Poster session 4: Prostate Cancer I

Canada; Prostate Centre at Vancouver General Hospital, University of Methods: Biobank specimens of all patients with undetect-
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British Columbia, Vancouver, BC, Canada; Service d-Urologie and Centre able PSA after radical prostatectomy (RP) who then devel-
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de la Prostate, Longueuil, QC, Canada; Cross Cancer Institute, University oped BCR (PSA ≥0.2) were included. Biobank samples were
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of Alberta, Edmonton, AB, Canada; William Osler Health System, analyzed for %fPSA. Patients were stratified according to the %fPSA cutoff
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University of Western Ontario, Brampton, ON, Canada; Southern of 15% (group 1: <15%, group 2: ≥15%). Multivariable logistic regression
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Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada; analysis was performed to predict covariates associated with a higher
11 Kingston Health Sciences Centre, Queen’s University, Kingston, ON, %fPSA. Cox proportional hazard models were performed to evaluate
Canada; Jewish General Hospital, McGill University, Montréal, QC, androgen-deprivation therapy (ADT)-free, metastasis-free, CRPC-free,
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Canada; BC Cancer Agency, University of British Columbia, Vancouver, cancer-specific (CSS) survival, and overall survival (OS).
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BC, Canada; Queen Elizabeth II Health Sciences Centre, Dalhousie Results: A total of 154 men were included (Table 1). Patients
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University, Halifax, NS, Canada; Scarborough Health Network, Toronto, in group 2 were more likely to receive ADT (42.9% vs. 24.8%;
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ON, Canada; Medical Affairs, Janssen Inc, Toronto, ON, Canada hazard ratio [HR] 2.3; 95% confidence interval [CI] 1.09–4.9;
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Introduction: The management of advanced prostate cancer (PCa) con- p=0.03), develop metastatic disease (21.4% vs. 7.9%; HR 8.16; 95%
tinues to evolve with the emergence of new diagnostic and therapeutic CI 1.59–41.77; p=0.04), and become castrate-resistant (14.3% vs. 4%;
strategies. As a result, there are multiple areas in this landscape with a HR 495; 95% CI 1.18–206521; p=0.04). Time from surgery to the start
lack of high-level evidence to guide practice. Consensus initiatives are of ADT was shorter in group 2 (38.2 months) vs. group 1 (45.1 months),
an approach to establishing practice guidance in areas where evidence (p=0.03). Time from surgery to metastasis was shorter in group 2 (28.4
is unclear. We conducted a Canadian-based consensus forum to address months) vs. group 1 (63.4 months) (p=0.018).
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key controversial areas in the management of advanced PCa. Conclusions: Patients with %fPSA of ≥15 were started on ADT earlier, and
Methods: A core scientific group of PCa physicians (n=8) identified they progressed to CRPC and metastatic stage earlier. %fPSA of ≥15 in the
controversial areas for discussion and developed an initial set of ques- setting of BCR after RP is an indicator of more aggressive disease and it can
tions, which were then reviewed and finalized with a larger group of 29 potentially be used as a simple and inexpensive biomarker. Unlike in the
multidisciplinary PCa specialists. The main areas of focus were: 1) non- diagnostic setting, a higher %fPSA ratio portends a worse clinical outcome.
metastatic castration-resistant prostate cancer (nmCRPC); 2) metastatic
castration-sensitive prostate cancer (mCSPC); 3) metastatic castration- MP-4.11
resistant prostate cancer (mCRPC); 4) oligometastatic prostate cancer; 5)
genetic testing in prostate cancer; and 6) imaging in advanced prostate Prostate Cancer Canada electronic Library for Improved Function
cancer. Questions were administered as a pre-meeting vote prior to the (eLIFT): The construction of the platform and initial analysis for
consensus discussion. Twenty-seven voting physicians participated in the patients’ satisfaction 2 1 1
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interactive forum and all voting was anonymous. The pre-determined Khalil Hetou , Kristin Tangen-Steffins , Shiva Nair , Khurram Siddiqui ,
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threshold for consensus was set at 74% (agreement from 20 of 27 par- Nelson Leong , Hon Leong , Chan Garson , Jennifer Goulart , Joseph Chin
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ticipating physicians). Urology, University of Western Ontario, London, ON, Canada; Radiation
Results: Consensus participants included uro-oncologists (n=13), medical Oncology, BC Cancer, Victoria Centre, Victoria, BC, Canada
oncologists (n=10), and radiation oncologists (n=4). Of the 64 questions, Prostate Cancer Canada
consensus was reached in 32 questions (n=5 unanimously). Consensus Introduction: A Movember/Prostate Cancer Canada joint initiative devel-
was more predominant in the areas of mCSPC, nmCRPC, sequencing of oped an online platform (electronic Library for Improved Function, eLIFT)
therapies, and mCRPC (Table 1). for patients planned to undergo prostate cancer (PCa) treatment. The
Conclusions: A Canadian consensus forum in PCa identified areas of platform includes video library tailored to treatment of choice. Herein, we
agreement in 50% of questions discussed. Areas of variability may rep- describe this tool and assess its impact on patients’ satisfaction, knowl-
resent opportunities for further research, education, and sharing of best edge, and self-efficacy.
practices. These findings reinforce the value of multidisciplinary consen- Methods: eLIFT included 22 videos in English and French. Content ranges
sus initiatives to optimize patient care. from “Overview of radical prostatectomy (RP)” to “Risks and bowel habit
This paper has a figure, which may be viewed online at: changes of radiotherapy (RT).” Others are generic (e.g., pelvic floor muscle
https://2019.cua.events/webapp/lecture/119 training). Two sites were involved: Patients at site A were to undergo RT,
Reference whereas patients at site B were to undergo RP. In both sites, the first
1. Gillessen S, Attard G, Beer TM, et al. Management of patients with group of patients recruited did not have access to eLIFT (standard of care
advanced prostate cancer: The report of the Advanced Prostate [SOC] and a subsequent group of patients were recruited with access
Cancer Consensus Conference (APCCC2017). Eur Urol 2018;73:178- to eLIFT. Questionnaires were based on validated quality of life (QoL)
211. https://doi.org/10.1016/j.eururo.2017.06.002 survey instruments (Expanded Prostate Cancer Index Composite [EPIC]
16, EQ-5D-5L, BI-B)
Results: Forty-four patients were recruited to SOC and 23 to eLIFT inter-
MP-4.10 vention at site A. Forty-three patients were recruited to SOC and 20 to
A high percent-free prostate-specific antigen in the setting of eLIFT at site B. At site A, 78% of patients in the eLIFT arm agreed strongly
biochemical recurrence after radical prostatectomy is associated that information given at time of consultation was helpful in improv-
with poorer outcomes: A validation study using prospectively ing their knowledge of urinary and bowel side effects and management
collected biobank specimens compared to 59% in the SOC arm; 7% in the eLIFT arm reported that
Dixon Woon , Hanan Goldberg , Jaime O. Herrera-Cáceres , Hina they experienced a side effect that they did not expect compared to
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Shiakh , Emily A. Whelan , Thenappan Chandrasekar , Guan Hee Tan , 32.4 % in the control arm. Sixty-four percent of patients in the eLIFT
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Khaled Ajib , Greg Nason , Omar Alhunaidi , Girish S. Kulkarni , Antonio group strongly agree that eLIFT was generally helpful in improving their
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Finelli , Robert Hamilton , Alexandre Zlotta , Neil E. Fleshner knowledge of urinary and bowel side effects, and 66% strongly agreed
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1 Surgical Oncology, University Health Network, Toronto, ON, Canada that eLIFT was generally helpful in improving management of urinary
Introduction: Our team previously conducted a retrospective study of and bowel side effects. Over 74% of patients in the eLIFT arm strongly
308 patients and found that percent of free prostate-specific antigen agreed the eLIFT was generally helpful in improving their knowledge of
(%fPSA) of ≥15 in the setting of biochemical recurrence (BCR) confers a urinary and bowel side effects.
more aggressive disease, manifesting in faster development of castrate- Conclusions: Survey analysis showed promising patient satisfaction and
resistant prostate cancer (CRPC), metastasis, and death. However, this empowerment results with eLIFT. This appears to be a good medium for
retrospective study has its intrinsic limitations, in particular, the %fPSA knowledge transfer and patient empowerment.
tests were performed at random and at various time points after BCR. To
validate our previous findings, we propose to use biobank specimens
collected prospectively when patients were first diagnosed with BCR.
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S107