Page 94 - CUA Absracts 2022_Fulldraft

2022 CUA Abstracts

MP-9.9. Table 2. Relation between PSA, Gleason, DRE, 2. Marra G, Valerio M, Emberton M, et al. Salvage local treat-
ments after focal therapy for prostate cancer. Eur Urol Oncol
number of positive cores, and distance 2019;2:526-38. https://doi.org/10.1016/j.euo.2019.03.008
Characteristics Distance
≤300 km >300 km p MP-9.12
PSA at diagnosis ng/dl 8.8 13.6 A survey of Canadian urologists’ and radiologists’ perspectives
median(range) (0.4–2704.0) (2.3–5901.0) <0.0001* regarding the use of prostate magnetic resonance imaging in
Gleason grade, n (%) biopsy-naive patients 1 1 1
Douglas Cheung , Alexis Lund , Lisa J. Martin , Maria Komisarenko ,
1
G6 144 (21.4) 22 (13.6) 0.02* Nathan Perlis , Masoom Haider , Antonio Finelli 1
1
2
>G6 528 (78.6) 140 (86.4) 1 Division of Urology, Department of Surgery, Princess Margaret Cancer
2
Clinical stage, n (%) Centre, University Health Network, Toronto, ON, Canada; Department
T1c 295 (75.4) 43 (69.4) 0.3 of Medical Imaging, Mount Sinai Hospital, Toronto, ON, Canada
>T1c 96 (24.6) 19 (30.6) Support: Prostate Cancer Canada/Canadian Cancer Society (Grant
Diagnosis, n (%) #707044)
Introduction: Evidence and guidelines now support the use of magnetic
Localized 625 (84.7) 153 (77.7) 0.02* resonance imaging (MRI) in biopsy-naive men to improve detection
Metastatic 113 (15.3) 44 (22.3) of clinically significant prostate cancer (PCa), decrease overdiagnosis
RP for localized PCa, n (%) of insignificant PCa, and avoid biopsy in low-risk cases. However, the
No 340 (54.4) 107 (69.9) 0.0005* demand for MRI will be difficult to meet within the Canadian universal
Yes 285 (45.6) 46 (30.1) healthcare system.
Methods: Separate surveys were developed for urologists and radiologists
c 2 : Chi-squared test. *Statistically significant at p≤0.05. in Canada to assess perspectives on the use of pre-biopsy MRI, barriers
to implementation, and to explore options for streamlining high- and
MP-9.10 low-risk patients. After iterative development, bilingual surveys were dis-
tributed from June to September 2021.
Salvage partial gland ablation for recurrent prostate cancer Results: Respondents included 175 urologists and 84 radiologists
following primary treatment with partial gland ablation: (Table 1); 61% of urologists expected an increase of >50% in MRI vol-
Functional and oncological outcomes umes for their biopsy-naive patients. Currently, only 19% of respondents
1
1
1
1
Yazan Qaoud , Jaime Herrera-Caceres , Roman Bass , Katherine Lajkosz , request MRI for over half of their patients vs. 59% who anticipate they
Mohamad Baker Berjaoui , Raj Tiwari , Nathan Perlis , Neil E. Fleshner 1 will do so in the future. Most respondents (89%) felt that some high-risk
1
1
1
1 Division of Urology, Department of Surgery, University Health Network, patients could proceed directly to biopsy if they were sufficiently high-
Toronto, ON, Canada risk, but this varied by prostate-specific antigen (PSA) threshold, palpable
Introduction: Although salvage radical prostatectomy (sRP) is a well- extra-prostatic extension, and risk calculator score. For urologists and
described salvage option in cases of primary partial gland ablation (pPGA) radiologists combined, the highest-rated barriers to MRI were inadequate
the evidence supporting salvage PGA (sPGA) is limited. We report infrastructure, reimbursement, and volume/expertise. Most also agreed
1,2
the oncological and functional outcomes of patients treated with sPGA that there would be increased system-level costs, although patients would
following initial treatment with pPGA. have reduced discomfort and complications; 66% of urologists felt that
Methods: We performed a retrospective review of patients at three pre-biopsy MRI would lead to a long delay (1–3 months) in PCa diagnosis
medical centers between 2005 and 2017. Oncological outcomes were compared to only 27% of radiologists.
assessed using biochemical recurrence (BCR) and biopsy-proven recur- Conclusions: The implementation of MRI for the diagnosis of PCa in
rence (BPR). Functional outcomes were described using the International biopsy-naive patients will substantially impact the Canadian healthcare
Prostate Symptom Score (IPSS), International Index of Erectile Function system, with the majority of urologists expecting that they will order
(IIEF), and rates of urinary incontinence (use of >1 pad/day). MRI for more than half their patients. However, most respondents agreed
Results: We identified 25 patients who underwent sPGA. High-intensity
focused ultrasound (HIFU) was the main modality used. The median age
and prostate-specific antigen (PSA) level at baseline were 65 years (inter- MP-9.12. Table 1. Respondent characteristics of
quartile range [IQR] 52–77) and 7.46 ng/mL (IQR 1–25), respectively. At urologists and radiologists
BPR following pPGA, the majority of patients (42%) had PCa grade group
4 disease. The median length of followup from pPGA to last followup was Urologists Radiologists
27.3 months (IQR 14.6–86.3). Following sPGA, 13/25 patients (52%) had Number of respondents 175 84
BCR with a median time to recurrence of 14 months (IQR 2.5–82.15) and Response rate 175/953 (18.4%) 84/2499 (3.4%)
recurrence-free survival (RFS) of 24.5 months (95% confidence interval
[CI] 15.3–NR). Of those 13 patients, four had sRP, four had salvage Geographical location
radiotherapy, three were managed with active surveillance, one had a Alberta & BC 25 (14.3%) 33 (39.3%)
third PGA, and one was managed with androgen deprivation therapy Ontario 93 (53.1%) 28 (33.3%)
(ADT). The mean change from baseline to last followup in IPSS and IIEF
scores was +1.3 (p=0.66) and -2.3 (p=0.32), respectively; 9% of patients Quebec 44 (25.1%) 20 (23.8%)
had urinary incontinence at baseline, with only one additional patient Atlantic Canada 13 (7.4%) 3 (3.6%)
developing incontinence following sPGA. Years in practice
Conclusions: After undergoing two PGA procedures, results from our
cohort demonstrate a favorable oncological outcome in 50% of patients 1–10 years 68 (38.9%) 50 (59.5%)
after a median length of followup of 27.3 months, with non-significant >10 years 97 (55.4%) 34 (40.5%)
effects on functional outcomes. Type of practice
References
1. Herrera-Caceres J, Woon DTS, Goldberg H, et al. Salvage pros- Academic 99 (56.6%) 55 (65.5%)
tatectomy after focal therapy: Single-center experience. J Urol Non-academic 73 (41.7%) 29 (34.5%)
2018;199:e49. https://doi.org/10.1016/j.juro.2018.02.187
S92 CUAJ • June 2022 • Volume 16, Issue 6(Suppl1)