Long‐term assessment of adverse cardiovascular events in men receiving intermittent androgen deprivation therapy following radical prostatectomy

MP29-11 INCIDENCE OF CARDIOVASCULAR EVENTS IN MEN WITH BCR FOLLOWING A RADICAL PROSTATECTOMY: ADT VERSUS NO ADT

Objective To explore the influencing factors and correlation of positive surgical margin (PSM) and biochemical recurrence (BCR) in men after robot-assisted radical prostatectomy (RALP). Methods The clinical data of 190 patients with local or locally advanced prostate cancer who underwent RALP by single surgeon in the Department of Urology of Changhai Hospital from January 2016 to September 2017 were collected. Age was (67.5±6.9) years old; median body mass index (BMI), preoperative PSA, prostate weight were 24.2 kg/m2 (16.6-34.2 kg/m2), 15.0 ng/ml (1.41-393.94 ng/ml) and 36.9 g (8.65-207.58 g) respectively. The group of surgical margin was divided into negative surgical margin, apex-only PSM, base-only PSM as well as apex and base PSM. Characteristics between patients stratified by surgical margin or BCR were compared using χ2 test. The influencing factors of PSM were analyzed by logistic regression. Cox regression was used for the analysis of predictive factors of BCR. Log-rank test and Kaplan-Meier curves were used for comparing the BCR rate between the groups of surgical margin. Results Of all the 190 enrolled patients, total PSM rate was 24.7% (47/190), apex-only PSM rate was 13.2 % (25/190), base-only PSM rate was 5.8% (11/190), apex and base PSM rate was 5.8 % (11/190). Multivariate analysis showed the independent predictive factors influencing PSM were preoperative PSA (P=0.048) and pathological stage (P=0.004 ). The median follow-up period was 7.3 months (0.9-26.6 months) and BCR happened in 19.5% (37/190) patients. The rates of BCR were 15.4% (22/143), 16.0% (4/25), 27.3% (3/11) and 72.7% (8/11) in the patients with negative surgical margin, apex-only PSM, base-only PSM and both apex and base PSM respectively. Log-rank test revealed that the rate of BCR in patients with apex and base PSM was higher than that in patients with negative surgical margin (P<0.001) or patients with apex-only PSM(P=0.002). Cox analysis indicated that higher preoperative PSA (P=0.040), higher pathological stage (P=0.041) and higher pathological Gleason score (P=0.004) were the independent predictors of BCR. PSM was not a predictive factor of BCR (P=0.257). Conclusions Preoperative PSA and pathological stage are the influencing factors of PSM. Higher preoperative PSA, higher pathological stage and higher pathological Gleason Score are the predictive factors of BCR. PSM may not be a predictive factor of BCR. The relationship between PSM and BCR needs further study. Key words: Prostatic neoplasms; Radical prostatectomy; Robot; Positive surgical margin; Biochemical recurrence

1497 OVERSTAGING HIGH-RISK PROSTATE CANCER MAY LEAD TO OVERTREATMENT: RESULTS FROM THE SEARCH DATABASE

Preface Currently, there are many wellestablished therapeutic options for early prostate cancer, and therefore, it is difficult for both urologists and patients to choose the optimal treatment. It is essential for urologists to counsel their patients according to reliable information about the advantages and disadvantages of each therapeutic option. We picked the topic for this issue, “Characteristics and management of erectile dysfunction after various treatments for prostate cancer,” because erectile dysfunction (ED) is one of the most frequent adverse events encountered in the management of prostate cancer. We invited six specialists to review each therapeutic option: radical prostatectomy, laparoscopic radical prostatectomy, robot-assisted laparoscopic radical prostatectomy, external beam radiotherapy, brachytherapy, and androgen deprivation therapy (ADT). Among these modalities, surgical interventions tend to induce a quick drop in erectile function with slow postoperative recovery. Early postoperative rehabilitation has been introduced, aiming at the early recovery of ED. On the contrary, radiation therapy tends to maintain the patient’s erectile function for a while after treatment but it gradually decreases. ADT may compromise not only the erectile function but also the libido level, and may result in significant deterioration of the patient’s quality of life. We hope these reviews will help urologists to counsel their patients with regards to decision-making in the management of early prostate cancer.

Objective To report on the surgical, oncological and early functional outcomes of robot-assisted radical prostatectomy (RARP) at our tertiary care centre, as there is a scarcity of reports on outcomes of robotic surgery from the Middle East. Patients and methods We reviewed the electronic health records for patients undergoing RARP between 2013 and 2019 at the American University of Beirut Medical Center. We collected patients’ demographics and preoperative oncological factors including prostate-specific antigen (PSA), clinical oncological stage, and World Health Organization (WHO) grade. PSA persistence, biochemical recurrence (BCR) and positive surgical margin (PSM) were reported. Complications were categorised by Clavien–Dindo grade. Moreover, the postoperative oncological outcomes including the rates of adjuvant and salvage androgen-deprivation therapy (ADT) and external-beam radiation therapy (EBRT), chemotherapy, and metastasis were reported. Additionally continence and potency results were retrieved. Results For the designated period, 250 patients underwent RARP of which 182 (72.8%) underwent lymph node dissection. The median (interquartile range) anaesthesia time was 330 (285–371) min and the estimated blood loss was 200 (200–300) mL. The overall complication rate was 8%, with 2% Clavien–Dindo Grade III–IV complications. The PSM and BCR rates were 21.6% and 6.4%, respectively. Adjuvant ADT and EBRT was administered to 7.2% of the patients. Functional data was available for 112 patients. Continence was 68%, 82% and 97% of the patients at 3, 6 and 12 months, respectively. For 65 patients who had bilateral nerve sparing potency was 37%, 60% and 83% at 3, 6 and 12 months, respectively. Conclusion This is the largest RARP series from the Middle East. The surgical, oncological and functional outcomes are consistent with those published in the literature. This confirms the safety and efficacy of applying robotic technology in our region during the implementation phase. Abbreviations: ADT: androgen-deprivation therapy; AJCC: American Joint Committee on Cancer; AUBMC: American University of Beirut Medical Center; BCR: biochemical recurrence; CPT: Current Procedural Terminology; EBRT external beam radiation therapy; IQR, interquartile ranges; LOS: length of stay; PLND: pelvic lymph node dissection; PSM: positive surgical margin; (O)(RA)RP, (open) (robot-assisted) radical prostatectomy

Radical prostatectomy is the most cost-effective primary treatment modality for men diagnosed with high-risk prostate cancer

Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

MP82-15 DOES EARLY ANDROGEN DEPRIVATION THERAPY AFTER BIOCHEMICAL RECURRENCE FOLLOWING RADICAL PROSTATECTOMY INCREASE OVERALL SURVIVAL? RESULTS FROM SEARCH

Minimally Invasive Radical Prostatectomy

MP45-12 PTEN LOSS AND DIFFUSIVE KI67 PREDICT BIOCHEMICAL RECURRENCE OF LOCALIZED PROSTATE CANCER AFTER RADICAL PROSTATECTOMY: A VALIDATION COHORT STUDY

130 Background: To describe metastasis-free survival (MFS) in patients with biochemical recurrence following radical prostatectomy (RP), and to define clinical prognostic factors for metastasis. Methods: From our institutional database, 1,408 patients underwent primary RP between 2005 and 2011. Of these, 267 patients who had biochemical recurrence (two consecutive PSA ≥ 0.2 ng/mL) and had post-biochemical recurrence follow-up greater than 12 months were used as the study cohort. As an initial management for biochemical recurrence, salvage radiotherapy (SRT) combined with or without androgen deprivation therapy (ADT) was administered to 186 patients, while 33 patients received salvage ADT alone. Remaining 48 patients had been observed without any treatments. We estimated MFS using the Kaplan–Meier method, and investigated factors influencing the risk of metastasis using Cox proportional hazards regression. Results: Median follow-up after RP was 6.0 years, and after biochemical recurrence was 4.2 years. At last follow-up, 28 of 267 patients (10.5%) had developed metastasis, while 5-year MFS rate was 88.6%. No one developed metastasis in patients under observation. SRT resulted in an improved 5-year MFS rate (89.3% vs. 76.7%; p =0.022) compared with salvage ADT alone. This inferiority of salvage ADT alone compared with salvage SRT was marginally significant in the multivariate analysis (hazard ratio [HR] 2.24; 95% confidence interval [CI] 0.93–5.36; p = 0.071). Gleason score ≥8 (HR 4.10; 95% CI 1.77–9.51; p = 0.001) and seminal vesicle invasion (HR 2.37; 95% CI 1.06–5.30; p = 0.036) were significantly associated with MFS in the multivariate analysis. Conclusions: In patients undergoing prostatectomy, MFS after biochemical recurrence is variable and is most strongly influenced by Gleason score and seminal vesicle invasion. These parameters serve to stratify patients into different risk groups with respect to metastatic progression. Salvage ADT alone should be used with caution with select patients.

Is immediate adjuvant radiotherapy necessary for men with positive surgical margin after robotic-assisted radical prostatectomy?

PD43-05 PROSPECTIVE COMPARISON OF OPEN VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER: ANALYSIS OF 1806 CONSECUTIVE MEN TREATED IN A UNIVERSAL HEALTHCARE SYSTEM

Timing of Androgen Deprivation Treatment for Men with Biochemical Recurrent Prostate Cancer in the Context of Novel Therapies.

Radical prostatectomy remains the primary treatment for localized prostate cancer (PCa). Despite its use for over two decades, the benefits of robot-assisted radical prostatectomy (RARP) remain unclear. We evaluated the surgical, functional, and oncological outcomes between RARP and open radical retropubic prostatectomy (RRP). This prospective cohort study included men who underwent radical prostatectomy between March 2016 and April 2020. We excluded patients who received preoperative androgen-deprivation therapy, had an initial prostate-specific antigen level of >50 ng/mL, had a clinical T stage of ≥T3b, and those aged under 50 or over 80 years. The primary outcome was the 90-day complication rate. Surgical and oncologic outcomes were compared. Continence and potency recovery were depicted using Kaplan-Meier curves and assessed using the log-rank test. To balance baseline characteristics, stabilized inverse probability of treatment weighting (sIPTW) was used. Among the 1,306 patients assessed, 1,055 were included after exclusion and adjustment using the sIPTW (RARP, n=835; RRP, n=220), with a median follow-up of 39 months. The RARP group had a significantly lower 90-day complication rate than the RRP group (8.9% vs. 26.4%; p<0.001). The RARP group showed significantly better surgical outcomes, including estimated blood loss and surgical margins. At 36 months, the pad-free rates were 86.1% and 88.4% for the RARP and RRP groups, respectively (log-rank test, p=0.642). Potency recovery was superior in the RARP group (11.4% vs. 5.2%; log-rank test, p=0.001). Biochemical recurrence (RARP, 23.7%; RRP, 27.9%; p=0.246) and rates of additional treatment (RARP, 23.5%; RRP, 28.1%; p=0.202) were not different. Single-institution study is a potential limitation. The findings indicate that RARP is associated with a better safety profile and surgical outcomes without compromising short-term oncologic outcomes than RRP. While continence recovery was comparable between the methods, RARP may offer superior potency recovery.