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Poster 9: Oncology – Prostate

MP-9.8 controversial. This study is limited by the inability to conduct pathological
Pathological Gleason grade group 1 in Black men — implications and metastatic staging review, especially in cases where undergrading or
for renaming it “not cancer” in high-risk populations overstaging are suspected.
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Evan Kovac , Courtney Berg , Matthew DeMasi , Amjad Alwaal , Robert References
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Weiss 1 1. Anderson BB, Oberlin DT, Razmaria AA, et al. Extraprostatic exten-
1 Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, sion is extremely rare for contemporary Gleason score 6 pros-
United States; Division of Urology, Case Western Reserve University, tate cancer. Eur Urol 2017;72:455-60. https://doi.org/10.1016/j.
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Cleveland, OH, United States eururo.2016.11.028
Introduction: Many have suggested reclassifying Gleason grade group 1 2. Hassan O, Han M, Zhou A, et al. Incidence of extraprostatic
1-3
(GG1) as “not cancer;” however, the metastatic potential of pathological extension at radical prostatectomy with pure Gleason score 3 +
(p) GG1 has not been widely studied in high-risk men. Thus, we sought to 3 = 6 (grade group 1) cancer: Implications for whether Gleason
compare features of pGG1 prostate cancer (PCa) in Black and White men. score 6 prostate cancer should be renamed “not cancer” and for
Methods: The National Cancer Institute’s Surveillance, Epidemiology selection criteria for active surveillance. J Urol 2018;199:1482-7.
and End Results (SEER) database was queried to identify all White and https://doi.org/10.1016/j.juro.2017.11.067
Black men who underwent primary radical prostatectomy (RP) with pelvic 3. Ross HM, Kryvenko ON, Cowan JE, et al. Do adenocarcinomas
lymph node dissections (PLND) from 2006–2016. Patients were patho- of the prostate with Gleason score (GS) ≤6 have the potential to
logically staged according to the American Joint Committee on Cancer’s metastasize to lymph nodes? Am J Surg Pathol 2012;36:1346-52.
7th edition (2010) and assigned a Gleason score in accordance with https://doi.org/10.1097/PAS.0b013e3182556dcd
the 2005 International Society of Urological Pathology (ISUP) grading
system. Rates of pT3a, pT3b, pT4, pN1, and clinical M+ disease were MP-9.9
calculated. Other variables analyzed included prostate-specific antigen The effect of prostate cancer center proximity on patient
(PSA) at diagnosis, age, and year of RP. Non-parametric testing was used outcomes and treatment type selection
to compare differences between White and Black men. Patients with Waleed Shabana , Vahid Mehrnoush , Neda Ghaffari-Marandi , Kristi
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incomplete grading or staging information were excluded. Dolcetti , Hazem Elmansy , Kevin Ramchandar , Edwin Long , Ahmed
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Results: We identified 27 367 men (21 223 White and 6143 Black) who Zakaria , Ahmed Kotb , Walid Shahrour 1
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underwent RP and PLND from 2006–2016 with pGG1 PCa. The median 1 Northern Ontario School of Medicine, Thunder Bay, ON, Canada
age range was 60–64 years and 55–59 years for White and Black men, Introduction: Access to a cancer center and a urology service may be
respectively. The median PSA at diagnosis was 5.1 (interquartile range critical for diagnosing and managing prostate cancer while it is still cur-
[IQR] 4–6.8) and 5.2 (IQR 4.2–7.2) for White and Black men, respect- able. The purpose of this study is to determine the relationship between
ively. Rates of pT3a, pT3b, and T4 in White men were 4.4%, 0.5%, and proximity to the cancer center to presentation and treatment selection.
0.07%, respectively, compared to 4.5%, 1.3%, and 0.5% for Black men, Methods: Between 2010 and 2017, a cohort of 959 patients diagnosed
respectively. Rates of T3b and T4 were statistically higher in Black men with prostate cancer was retrospectively reviewed. The baseline demo-
(p<0.01 for both). Rates of pN1 and M+ were exceedingly low in both graphics, postal code, round trip time to the cancer center, clinical staging,
groups and were not statistically different (Table 1). prostate-specific antigen (PSA) at diagnosis, pathological data obtained
Conclusions: Black men with pGG1 PCa have low but statistically during biopsy, staging investigations, selected treatment option, and fol-
higher rates of locally advanced disease when compared to White men. lowup data were reported. The cohort was divided into two groups: those
Metastatic rates are exceedingly low and similar between the groups. living above and those living below 300 km from our center. The dis-
Renaming GG1 to “not cancer” in high-risk populations is, therefore, tance between the patient’s home and the hospital, as well as the clinical
stage, Gleason score, PSA, pathological staging, and treatment modality
selected, were statistically analyzed.
MP-9.8. Table 1. Clinical and pathological features of Results: The mean distance from patient residence to hospital was 115.7
Gleason grade group 1 prostate cancer in White and km. There was a significant correlation between PSA at diagnosis and dis-
Black men who underwent primary radical prostatectomy tance to the hospital (p<0.001, Correlation coefficient=0.16). The median
between 2006–2016 PSA at diagnosis was 8.8 ng/dl vs. 13.6 ng/dl between patient group ≤300
White Black p km compared to patient group >300 km (Table 1). The percentage of
Gleason 6 patients was significantly lower in the group that lived >300
(n=21 223) (n=6143) km (13.6% vs. 21.4%, p=0.002) (Table 2). The initial diagnosis of meta-
Age at diagnosis, years, n (%) <0.01 static prostate cancer was found to be significantly higher in the group
<55 4460 (21) 2064 (34) that lived >300 km from the treatment center (22.3% vs.15.3%, p=0.02).
55–59 4875 (23) 1574 (26) The choice of radical prostatectomy as a treatment modality was found
60–64 5100 (24) 1267 (21) to be significantly higher in the group that lived >300 km away from the
treatment center (69.9% vs. 54.4%, p=0.0005).
65–69 4277 (20) 918 (15) Conclusions: Distance from urologists and cancer centers plays a signifi-
≥70 2511 (12) 320 (5) cant role in the presentation and treatment of prostate cancer. PSA was
Year of diagnosis, n (%) <0.01 found to increase for every km the patient is away from the urologist.
2006–2010 5306 (25) 3702 (60) Distance was a factor in the choice of radical prostatectomy compared
2011–2016 15917 (75) 2441 (40) to radiation, likely secondary to the reduction in travelling.
Median PSA at diagnosis, 5.1 (4–6.8) 5.2 (4.2–7.2) <0.01
ng/dL (IQR) MP-9.9. Table 1. Correlation between distance and PSA
Pathological T-stage, n (%)
T3a 932 (4.4) 279 (4.5) 0.6 PSA at diagnosis Number of positive cores
T3b 110 (0.5) 82 (1.3) <0.01 Correlation p Correlation p
T4 14 (0.07) 31 (0.5) <0.01 coefficient (r) coefficient (r)
Pathological N1, n (%) 36 (0.2) 14 (0.2) 0.4 Distance 0.163 <0.001* 0.075 0.059
Clinical M+, n (%) 12 (0.05) 6 (0.09) 0.3 Spearman’s rank correlation coefficient. *Statistically significant at p≤0.05.
CUAJ • June 2022 • Volume 16, Issue 6(Suppl1) S91