MP53-13 FREEDOM FROM ANDROGEN DEPRIVATION AND RADIOTHERAPY THERAPY AFTER UPFRONT MINIMALLY INVASIVE SURGERY FOR HIGH-RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) III1 Apr 2017MP53-13 FREEDOM FROM ANDROGEN DEPRIVATION AND RADIOTHERAPY THERAPY AFTER UPFRONT MINIMALLY INVASIVE SURGERY FOR HIGH-RISK PROSTATE CANCER Pol Servian Vives, Amit Patel, David Eldred-Evans, Declan Cahill, Christian Brown, Ben Challacombe, and Mathias Winkler Pol Servian VivesPol Servian Vives More articles by this author , Amit PatelAmit Patel More articles by this author , David Eldred-EvansDavid Eldred-Evans More articles by this author , Declan CahillDeclan Cahill More articles by this author , Christian BrownChristian Brown More articles by this author , Ben ChallacombeBen Challacombe More articles by this author , and Mathias WinklerMathias Winkler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Up front tailor-made wide excision surgery is sometimes offered to men as part of combined modality treatment with adjuvant radiotherapy +/- androgen deprivation therapy (ADT) for high risk and non-metastatic prostate cancer. Particularly young men want to avoid long periods of ADT which is required for primary radiotherapy treatment. Upfront surgery is therefore seen as a reasonable alternative to achieve cure without ADT. We prospectively assessed short term PSA recurrence rates, the need for adjuvant radiotherapy and ADT. METHODS 278 patients with high risk PCa (47.5% were locally advanced), underwent laparoscopic or robotic radical prostatectomy with pelvic lymphadenectomy from July 2007 to July 2016 at three inner London tertiary referral centres. D′Amico criteria (cT2c, PSA>20, Gleason grade 8-10) were used to define high risk. Supersensitive PSA measurements were used. PSA recurrence was defined as two tests results above 0.02. Kaplan-Meier survival estimates were generated. A small number of patients were offered radiotherapy +/- ADT for undetectable PSA nadir based on the presence of pathological risk factors. Some patients were randomised to the RADICALS study(CRUK/07/008). Uni and multivariate analysis was performed on all available variables. Kaplan-Meier estimates were calculated. Cox multivariate regression analysis was computed to identify pre- and post-operative factors associated with PSA recurrence. RESULTS Median follow up was 34 months (range 0.9-98 months). Of all patients 55.4% did not have PSA recurrence, 38.1% required radiotherapy and 25.2% ADT. Positive margins (p=0.014)and tumour volume (p=0.041) were independently predictive of PSA recurrence. Tumour volume >4cm3 may be predictive of almost certain biochemical recurrence with supersensitive PSA. 5 year free recurrence survival was 51% globally and 50.3% and 18.4% for tumour volume <4cm3 and >4cm3 respectively. CONCLUSIONS Young men may have a high chance to avoid ADT (75% in three years) if treated with surgery alone or in combination with radiotherapy. Tumour volume in addition to margin status is a strong predictor of biochemical recurrence in high risk prostate cancer. Since tumour volume can now be obtained pre-operatively with later generation CAD (computer-aided design) software it could be a meaningful pre-operative risk stratification tool for treatment selection and new study designs. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e718 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Pol Servian Vives More articles by this author Amit Patel More articles by this author David Eldred-Evans More articles by this author Declan Cahill More articles by this author Christian Brown More articles by this author Ben Challacombe More articles by this author Mathias Winkler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...