Page 1 - CUA 2020_Onco_Prostate

2020 CUA ABSTRACTS

Podium Session 2: Oncology – Prostate

POD-2.1 Haven, CT, United States; Medicine, Washington University, Saint Louis,
7
8
Transrectal vs. transperineal prostate biopsy under local anesthesia: MO, United States; Medicine, Beth Israel Deaconess Medical Center/
9
Prospective comparative analysis of cancer detection, safety, and Dana-Farber Cancer Institute, Boston, MA, United States; Medicine,
tolerability at a single center Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA,
10
Pui Long Wilson Hung , Stacia Chun , Chiu Fung Tsang , Brian Ho , Ada United States; Medicine, University of Michigan, Ann Harbor, MI, United
1
1
1
1
11
1
Ng , Hok Leung Tsu , Wayne Lam 1 States; Urology, Johns Hopkins University School of Medicine, Baltimore,
1
12
1 Urology, Surgery, Queen Mary Hospital, The University of Hong Kong, MD, United States; Medicine, Memorial Sloan Kettering Cancer Center,
HK, Hong Kong New York, NY, United States
Introduction: Transrectal ultrasound-guided prostate biopsy under local Introduction: Current imaging modalities are suboptimal for the initial
anesthesia (LA-TRUSB) has been the standard for prostate cancer detection staging of men at risk of harboring occult metastatic prostate cancer (PCa).
for decades. Transperineal prostate biopsy under local anesthesia (LA-TPB) Prostate-specific membrane antigen (PSMA)-based imaging is considered
18
has emerged as an alternative office-based procedure to seek improve- highly promising for PCa detection. F-DCFPyL is a novel PSMA-targeted
ment in cancer detection and safety. This study aimed to compare the radiopharmaceutical for positron emission tomography (PET) that may
cancer detection rates, complications, and patient tolerability using patient- be useful in staging of patients with high-risk PCa. The diagnostic perfor-
18
reported outcome measure (PROM) questionnaires. mance of F-DCFPyL regarding regional and distant metastases has been
Methods: The patients included in our study underwent systematic previously reported. Here, we report on detection rates and the resulting
18
LA-TPB using a transperineal access device or standard LA-TRUSB from impact F-DCFPyL may have on staging of patients with high-risk PCa.
18
October 2018 to November 2019. Inclusion criteria were: serum prostate- Methods: F-DCFPyL PET/CT was evaluated in 252 men with high-risk
specific antigen (PSA) 4–20 ng/mL, age 55–80 years, and biopsy-naive. PCa who were planned for radical prostatectomy with lymphadenectomy
18
Exclusion criteria were: suspected tumor ≥cT3 on digital rectal examina- (RP-PLND). Based on TNM staging, F-DCFPyL PET/CT detection rates,
tion or medically unfit for treatment. Cancer detection and complications including lesion counts, were systematically analyzed: prostatic (T), pelvic
were recorded. A validated PROM was used to compare overall patient LN (N), extra-pelvic LN (M1a), bone (M1b), and other visceral organs/soft
tolerability and safety. tissue (M1c). Three central, blinded, and independent readers evaluated
18
Results: A total of 146 of 215 patients who underwent biopsy were eligible. the F-DCFPyL scans.
Median age was 68 years. Mean presenting PSA was 7.3 ng/mL. One Results: At study entry, 97% and 99% of all evaluable patients had no
hundred and four (48.4%) patients underwent LA-TRUSB and 111(51.6%) known nodal or metastatic disease, respectively, based on standard cross-
18
had LA-TPB. More prostate cancers (p=0.209) and clinically significant sectional imaging. Of these, F-DCFPyL PET/CT staged 37 (14.7%) patients
cancer (p=0.534) were detected with LA-TPB; 46% of LA-TPB patients with N1 disease and 27 (10.7%) patients with M1 disease (one [0.4%] M1a,
had cancer detected in anterior prostate. None of the LA-TPB patients was 23 [9.1%] M1b, and three [1.2%] M1c). In total, 56 (22%) patients were
18
complicated with sepsis (vs. 5.8% in TRUSB; p=0.012) or urinary tract infec- upstaged to N1 or M1 disease by F-DCFPyL. The positive predictive value
18
tion with bacteriuria (vs. 10.6% in TRUSB; p<0.001). Mean International of F-DCFPyL based on histopathological validation for pelvic LNs was
Index of Erectile Function (IIEF-5) change immediately after biopsy was 86.7% (95% confidence interval [CI] 70–95). Only one patient in cohort A
18
2.60 in LA-TRUSB and 6.81 in LA-TPB (p=0.004). There was no statistically underwent a biopsy of a F-DCFPyL detected spinal M1 finding and was
significant difference in pain scores, urinary retention rate, IPSS change, positively confirmed by histopathology.
sexual satisfaction, or bowel and psychological functions. Conclusions: A total of 22% of high-risk PCa patients planned for RP-PLND
18
Conclusions: Office-based LA-TPB was a well-tolerated procedure com- had regional or distant metastatic lesions detected on F-DCFPyL PET/
18
pared to standard LA-TRUSB, with comparable cancer detection rates CT. These results suggest the potential utility of F-DCFPyL PET/CT in the
and the ability to prevent post-biopsy sepsis. However, erectile function staging of men with newly diagnosed high risk PCa to develop optimized
could be affected in the initial period following LA-TPB, and patients should treatment paradigms. NCT02981368.
be counselled carefully before the procedure.
POD-2.3
POD-2.2 A prospective provincial prostate specific membrane antigen-
Prospective, phase 2/3, multicenter study of prostate-specific positron emission tomography (PET) registry for recurrent prostate
membrane antigen-targeted positron emission tomography cancer (PREP): Preliminary results of lesion detection rates and
imaging in prostate cancer patients (OSPREY): Detection rates of PET-directed changes in clinical management
2
3
3
1,8
regional and distant metastases at initial staging by 18F-DCFPyL L.K. Joseph Chin , Ur Metser , Antonio Finelli , Laurence H. Klotz , Anil
5
4
6
7
PET/CT Kapoor , Katherine Zukotynski , Luke T. Lavallée , Marlon Hagerty , Wei
8
2
1
3
4
Frédéric Pouliot , Peter Carroll , Stephan Probst , Kenneth J. Pienta , Stephen Liu , Glenn Bauman 8
5
6
7
8
P. Rowe , Lawrence Saperstein , Barry Siegel , Akash Patnaik , Mark A. 1 Division of Urology, Department of Surgery, Western University, London,
2
9
Preston , Ajjai Shivaram Alva , Michael A. Gorin , Michael J. Morris 12 ON, Canada; Department of Medical Imaging, University of Toronto, Toronto,
10
11
3
1 Surgery, CHU de Québec-Université Laval, Quebec City, QC, ON, Canada; Division of Urology, Department of Surgery, University of
4
2
Canada; Urology, University of California San Francisco, San Francisco, Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery,
5
3
CA, United States; Medicine, Jewish General Hospital, Montreal, QC, McMaster University, Hamilton, ON, Canada; Department of Medicine and
6
Canada; Urology, Johns Hopkins University School of Medicine, Baltimore, Radiology, McMaster University, Hamilton, ON, Canada; Division of Urology,
4
7
MD, United States; Radiology, Johns Hopkins University School of Medicine, Department of Surgery, University of Ottawa, Ottawa, ON, Canada; Radiation
5
Baltimore, MD, United States; Medicine, Yale School of Medicine, New Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON,
6
S28 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)
© 2020 Canadian Urological Association