MP09-11 TRENDS IN SURGICAL MANAGEMENT OF HIGH-RISK PROSTATE CANCER: EVIDENCE OF AN EVOLVING TREATMENT PARADIGM

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2016MP09-11 TRENDS IN SURGICAL MANAGEMENT OF HIGH-RISK PROSTATE CANCER: EVIDENCE OF AN EVOLVING TREATMENT PARADIGM Jeffrey Tosoian, Debasish Sundi, Brian Chapin, R. Jeffrey Karnes, Emmanuel Antonarakis, Meera Chappidi, Ridwan Alam, Stephanie Glavaris, Kamyar Ghabili, Mohamad Allaf, Trinity Bivalacqua, Kenneth Pienta, Phuoc Tran, Edward Schaeffer, and Ashley Ross Jeffrey TosoianJeffrey Tosoian More articles by this author , Debasish SundiDebasish Sundi More articles by this author , Brian ChapinBrian Chapin More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , Emmanuel AntonarakisEmmanuel Antonarakis More articles by this author , Meera ChappidiMeera Chappidi More articles by this author , Ridwan AlamRidwan Alam More articles by this author , Stephanie GlavarisStephanie Glavaris More articles by this author , Kamyar GhabiliKamyar Ghabili More articles by this author , Mohamad AllafMohamad Allaf More articles by this author , Trinity BivalacquaTrinity Bivalacqua More articles by this author , Kenneth PientaKenneth Pienta More articles by this author , Phuoc TranPhuoc Tran More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and Ashley RossAshley Ross More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2298AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Traditionally considered unsuitable for surgery, a growing body of literature suggests that men with high-risk prostate cancer (PCa) may derive significant benefit from local therapy, either alone or as part of a multimodal approach. As such, management of high-risk PCa is increasingly viewed as a multi-disciplinary effort. We sought to examine management trends in men with high-risk PCa presenting to a tertiary care institution, with particular focus on the contemporary era. METHODS The prospectively-maintained Johns Hopkins radical prostatectomy (RP) database contains baseline, treatment, and outcome data for all men undergoing RP for PCa. We identified men with high risk (HR, defined as: cT3a, PSA >20 ng/mL, or Gleason score 8-10) and very high risk (VHR, defined as: cT3b-T4, primary Gleason pattern 5, more than 4 biopsy cores with Gleason score 8-10, or multiple HR features) cancers. The proportion of the RP population represented by higher-risk (i.e. HR or VHR) disease was compared across time periods (2001-2005, 2006-2010, 2011-present). Retrospective records were reviewed to determine use of additional therapies and enrollment in clinical trials in the contemporary era (2011-present). RESULTS From 2001 to present, 15,429 men underwent RP for PCa at our institution. The proportion of the surgically treated population composed of higher-risk cancers increased from 5.1% in 2001-2005 to 7.6% in 2006-2010 and 13.5% from 2011 to present (p<0.001). Since 2011, the annual proportion of men who underwent RP for higher-risk disease has steadily increased (chronologically 6.9%, 11.5%, 15.6%, 18.2%, 20.2%; p<0.001). Similarly, the annual proportion of men treated in the context of pre-surgical clinical trials increased as well (0%, 0%, 4.7%, 8.2%, 17.3%; p<0.001). During median follow-up of 13.4 months (IQR 6.2-25.7), 36.6% of the cohort received one or more additional therapies after surgery (26%, 25%, and 6% of men were treated with radiation therapy, androgen deprivation therapy, and docetaxel, respectively). The likelihood of requiring additional therapy was significantly higher in men with VHR as compared to HR disease (54% vs. 31%, p<0.001). CONCLUSIONS Treatment patterns over a 15-year period suggest increasing use of surgery in the management of higher-risk cancers, particularly over the last five years. Contemporary assessment of treatment outcomes in the context of various management strategies will help to facilitate counseling of men presenting with high-risk disease and establish point estimates from which to power clinical trials. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e97-e98 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jeffrey Tosoian More articles by this author Debasish Sundi More articles by this author Brian Chapin More articles by this author R. Jeffrey Karnes More articles by this author Emmanuel Antonarakis More articles by this author Meera Chappidi More articles by this author Ridwan Alam More articles by this author Stephanie Glavaris More articles by this author Kamyar Ghabili More articles by this author Mohamad Allaf More articles by this author Trinity Bivalacqua More articles by this author Kenneth Pienta More articles by this author Phuoc Tran More articles by this author Edward Schaeffer More articles by this author Ashley Ross More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...