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Poster 9: Oncology – Prostate

that some high-risk patients could be streamlined directly to biopsy to
conserve limited resources. Finally, barriers in MRI infrastructure, reim-
bursement, and expertise remain to be addressed.
MP-9.13
Statin use and survival in men receiving androgen-ablative
therapies for advanced prostate cancer: A systematic review
and meta-analysis of cohort studies
Viranda Jayalath , Roderick Clark , Katherine Lajkosz , Neil E. Fleshner ,
1
1
1
1,2
Laurence Klotz , Robert J. Hamilton 1,2
1,3
1 Division of Urology, Department of Surgery, University of Toronto,
Toronto, ON, Canada; Division of Urology, Department of Surgery,
2
University Health Network, Toronto, ON, Canada; Division of Urology,
3
Department of Surgery, Sunnybrook Hospital, Toronto, ON, Canada
Introduction: Evidence supports a role for statins in improving survival in
advanced prostate cancer (PCa), particularly among men on androgen-abla-
tive therapies. We systemically reviewed and meta-analyzed the relationship
between statin use and survival among men with PCa on androgen depriva-
tion therapy (ADT) or androgen receptor-axis-targeted therapies (ARATs).
Methods: Six databases were searched from inception to May 18, 2021, MP-9.14. Figure 1. Positive hereditary cancer test results.
for studies reporting on post-diagnostic statin use and survival outcomes
(hazard ratios [HRs]). Two authors independently abstracted all data.
Study quality was assessed using the Newcastle-Ottawa Scale. The pri- a Chi-squared test was used to compare hereditary cancer gene carriers
mary outcomes included overall mortality (OM) and prostate cancer- identified through each model of care.
specific mortality (PCSM). Summary estimates pooled multivariable HRs Results: In 2020, of 77 patients were referred; 29 and 48 underwent HCT
with 95% confidence intervals (CIs) using the generic inverse variance in oncology and genetics clinics, respectively. In 2021, of 230 patients
method with random-effects modeling. Heterogeneity was assessed and were referred; 135 and 95 underwent HCT in oncology and genetics
quantified. A priori subgroup and sensitivity analyses were undertaken, clinics, respectively. HCT identified carriers of 10 different hereditary
and publication bias was evaluated. Confidence in the evidence was cancer genes (Figure 1). Of patients tested in the genetics clinic, 10.3%
assessed using GRADE. were identified as carriers, while 13.5% of patients tested in oncology
Results: Twenty-five cohorts of 119 878 men (64 717 statin users [54%]) clinics were identified as carriers (p=0.46). When HCT was initiated in
with over 74 416 mortality events were included. Post-diagnostic statin the oncology clinic, results were disclosed to patients an average of 71
use was associated with a 27% reduction in the risk of OM (19 cohorts, days from referral, compared to 129 days for those with HCT through
HR 0.73, 95% CI 0.66–0.82, I =83%) and a 35% reduction in the risk of the genetics clinic (p<0.001).
2
PCSM (14 cohorts, HR 0.65, 95% CI 0.58–0.73, I =74%), with significant Conclusions: HCT volumes have increased since guidelines became avail-
2
heterogeneity in both estimates. Subgroup analyses identified a PCSM able for Ontario PCa patients. A multidisciplinary approach to HCT was
advantage of statins for men on ARATs compared to ADT (HR 0.40, associated with faster time to results. Further study is needed to evaluate
95%CI 0.30–0.55 vs. HR 0.68, 95% CI 0.60–0.76, p-difference <0.01). the impact of HCT on PCa management and patient perspectives on
Confidence in the overall evidence was “low” for both outcomes. HCT delivery.
Conclusions: Post-diagnostic statin use reduced both overall and pros- References
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MP-9.14 in ATM and BRCA1/2 are associated with grade reclassifica-
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testing criteria at Princess Margaret Cancer Centre 2019;75:743-9. https://doi.org/10.1016/j.eururo.2018.09.021
Emily Thain , Miran Kenk , Raymond Kim , Neil E. Fleshner 4 3. Mota JM, Barnett E, Nauseef J, et al. Platinum-based chemother-
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1 Familial Cancer Clinic, Princess Margaret Cancer Centre, Toronto, ON, apy in metastatic prostate cancer with alterations in DNA damage
Canada; Department of Surgical Oncology, Princess Margaret Cancer repair genes. J Clin Oncol 2019;37(15 suppl):abstr 5038. https://
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Centre, Toronto, ON, Canada; Department of Medical Oncology, doi.org/10.1200/JCO.2019.37.15_suppl.5038
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Princess Margaret Cancer Centre, Toronto, ON, Canada; Division of 4. de Bono J, Mateo J, Fizazi K, et al. Olaparib for metastatic castra-
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Urology, Princess Margaret Cancer Centre, Toronto, ON, Canada tion-resistant prostate cancer. N Engl J Med 2020;382:2091-2102.
Introduction: Hereditary cancer genetic testing (HCT) has become a https://doi.org/10.1056/NEJMoa1911440
significant component of prostate cancer (PCa) management, and can 5. Pritzlaff M, Tian Y, Reineke P, et al. Diagnosing hereditary can-
identify other cancer risks, as well as at-risk relatives. Despite new cer predisposition in men with prostate cancer. Genet Med
1-5
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certain patients with PCa, there are limited data on how these patients 6. Ontario Health-Cancer Cancer Ontario 2021 Hereditary Cancer
6
can optimally access HCT and genetic counselling. At the Princess Testing Eligibility Criteria: Version 2, September 2021. Available
7
Margaret Cancer Centre (PM), we implemented PCa HCT based on CCO at: https://www.cancercareontario.ca/en/guidelines-advice/types-
guidelines using two models: HCT initiated by a urologist/oncologist/ of-cancer/70161. Accessed January 9, 2022
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PM genetics clinic. inherited cancer genetics and therapeutic clinical trials in pros-
Methods: A retrospective review was conducted to assess the imple- tate cancer: A white paper from the Germline Genetics Working
mentation of CCO PCa HCT guidelines at the PM. PCa patients who Group of the Prostate Cancer Clinical Trials Consortium. JCO
underwent HCT in 2020 and 2021 were reported. A two-tailed t-test Precis Oncol 2018;PO.18.00060. https://doi.org/10.1200/
was used to compare testing timelines for the two models of care, and PO.18.00060
CUAJ • June 2022 • Volume 16, Issue 6(Suppl1) S93