Page 10 - [Podium Sessions] CUA 2022 Annual Meeting Abstracts

2022 CUA Abstracts

POD-3.3 POD-3.3. Table 2. Postoperative outcomes
Predictors of adverse outcomes for patients with high-
risk and very high-risk prostate cancer undergoing radical Outcome Total (n=702)
prostatectomy: Results from the Canadian High-risk Prostate PSA
Cancer Collaboration <0.1 510 (72.6%)
2
3
4
Aurinjoy Gupta , Syed Mustafa , Rodney H. Breau , Jonathan Izawa , Ross
1
6
2
Mason , Fred Saad , Bobby Shayegan , Alan I. So , Ricardo A. Rendon 2 ≥0.1 165 (23.5%)
5
7
1 Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Unknown 27 (3.8%)
2 Department of Urology, Dalhousie University, Halifax, NS, Canada; Gleason score
3 Division of Urology, University of Ottawa, Ottawa, ON, Canada;
4 Division of Urology, Western University, London, ON, Canada; Division 7 382 (54.4)
5
6
of Urology, Université de Montréal, Montreal, QC, Canada; Division of 8–10 299 (42.6%)
Urology, McMaster University, Hamilton, ON, Canada; Department of Pathologic T stage
7
Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
Introduction: Radical prostatectomy (RP) for the management of patients T2 169 (24.1%)
with localized prostate cancer (PCa) has varied outcomes depending on T3a 311 (44.3%)
initial clinical risk group. Even within the same risk groups, the short- and >T3a 190 (27.1%)
long-term outcomes for patients undergoing treatment for high- and very
Pathologic N stage
N0 526 (74.9%)
POD-3.3. Table 1. Preoperative characteristics N+ 84 (12.0%)
Total (n=702) NX 92 (13.1%)
Age (mean & range) 63.4 (41–80) Surgical positive margins 272 (38.7%)
BMI (mean & range) 28.6 (17.0–42.8)
Grade group high-risk diseases are very variable. We describe predictors of adverse
<4 176 (25.1%) outcomes in patients undergoing RP for high- and very high-risk PCa.
Methods: This multi-institutional, retrospective study describes outcomes
4 349 (49.7%)
of patients from seven Canadian academic institutions who underwent RP
>4 172 (24.5%) for high-/very high-risk PCa. Primary endpoints were postoperative detect-
Preoperative PSA able prostate-specific antigen (PSA) (≥0.1 ng/mL), pathologic stage ≥T3a,
lymph node disease, development of metastases, and castrate-resistant
Preop. PSA <10 388 (55.3 %)
prostate cancer (CRPC). Logistic regression and Cox proportional-hazards
Preop. PSA 10–20 148 (21.1 %) models were used to identify prognostic indicators.
Preop. PSA ≥20 163 (23.2 %) Results: A total of 702 patients who underwent RP between 2005 and
2016 were evaluated. Preoperative characteristics are shown in Table 1.
Clinical T stage
Short-term outcomes included postoperative detectable PSA, pathological
T1–T2a 452 (64.4%) T stage ≥3a, and lymph node involvement. Predictors of postoperative
T2b–T2c 153 (21.8%) detectable PSA and pathological lymph node involvement are shown in
Figures 1 and 2, respectively. Postoperatively, 17.7 % of patients were no
T3a 61.0 (9.0%)
longer high-/very high-risk; 38.9% of Gleason scores were downgraded,
>T3a 12 (1.7%) while 18.7 % were upgraded. Postoperative outcomes are shown in
Clinical N stage Table 2. Undetectable PSA was achieved in 72.6% (510) of patients,
development of metastases occurred in 10.4%, and development of CRPC
cN0 400 (57.0%)
in 5.7%, with 5.3% all-cause mortality at a median followup of 3.6 years.
cN+ 11 (1.6%) Development of metastases was predicted by clinical node involvement
cNX 291 (41.5%) (hazard ratio [HR] 4.39, p<0.05), pathological node involvement (HR
2.08, p<0.05), and detectable postoperative PSA (HR 5.79, p<0.001). The
Biopsy cores
same features were predictive of CRPC, with clinical node involvement
Percentage tissue involved (mean) 41.18 being the strongest predictor (HR 10.7, p<0.01).
Core density (mean) 0.53 Conclusions: When evaluating patients preoperatively, PSA ≥20 ng/mL is
the biggest risk factor for detectable postoperative PSA. Extended pelvic
Surgical approach
lymph node dissection was protective against postoperative detectable
Open prostatectomy 258 (36.8%) PSA. Clinical and pathological node-positive status, as well as detectable
Robotic prostatectomy 297 (42.3%) postoperative PSA, are strongly predictive for the development of metasta-
ses and CRPC. We hypothesize that in the era of novel therapies, patients
Extra-radical prostatectomy 118 (16.8%)
with these risk factors should be considered for escalated treatment.
Pelvic lymph node dissection
No PLND 96 (13.7%)
Standard PLND 494 (70.4%)
Extended PLND 107 (15.2%)
Nodes removed (mean & range) 8.3 (0–48)
Complications
Any complications 135 (19.2%)
Clavien ≥3 72 (10.3%)
S14 CUAJ • June 2022 • Volume 16, Issue 6(Suppl1)