892 OUTCOMES OF PATIENTS WITH PATHOLOGIC LYMPH NODE METASTASES TREATED WITH RADICAL PROSTATECTOMY; THE PROGNOSTIC VALUE OF PREOPERATIVE RADIOGRAPHIC LYMPHADENOPATHY

Abstract

INTRODUCTION AND OBJECTIVES: Management of patients (pts) with CRPC remains a challenge in clinical practice. METHODS: A survey was performed from Dec 2009 to May 2010 among urologists and oncologists in France (FR), Germany (DE), Italy (IT), Spain (ES), and the UK concerning the management of prostate cancer (PC) pts. We report on characteristics of the CRPC population and their current treatment regime. Pt characteristics were derived from a pt record form completed by physicians. RESULTS: A total of 191 urologists (52% academic institutions) and 157 medical/clinical oncologists completed the survey. 40% (n 1405) of pts had CRPC and of these 35% (n 487) had metastatic CRPC. CRPC pts had a mean age of 71 years, 35% were current or ex-smokers and 10% had a family history of PC. The majority of CRPC pts had 2 co-morbidities, primarily hypertension (64%) and diabetes (33%). Bone metastases were most common (77%), followed by liver (35%) and lung (26%). The majority of physicians believed that pts would stop responding to initial hormone therapy between 19–24 months. 58% and 49% of CRPC pts terminated the 1 and 2 treatment regimen due to disease progression. 85% of physicians considered PSA the most important method to assess disease progression. After failure of initial luteinizing hormone releasing hormone agonist (LHRHa) defined by elevated PSA, 49% of all European physicians opted to change to LHRHa antiandrogen (AA) or to another LHRHa (20%) (Figure). A switch from one LHRHa to another LHRHa is common in DE (29%), FR (26%) and IT (24%). In all countries, CRPC pts who required chemotherapy, would initially receive this without LHRHa (Figure). CONCLUSIONS: From this EU survey, 40% of all PC pts seen in daily practice have CRPC, which develops approximately after 19–24 months on LHRHa. When CRPC pts fail initial LHRHa, most European physicians add AA or switch to another LHRHa, and if CRPC pts undergo chemotherapy, this is usually given without LHRHa. Based upon the literature, LHRHa treatment should be maintained during chemotherapy [Manni et al. J Clin Oncol 1988; 6(9):1456–66; Taylor CD et al. J Clin Oncol 1993;11:2167–72; Heidenreich et al. Guidelines on prostate cancer. EAU; April 2010] Source of Funding: Astellas Pharma Europe