Biochemical Recurrence-free Rates Research Articles

Apalutamide for High-Risk Localized Prostate Cancer Following Radical Prostatectomy (Apa-RP).

Approximately 25% to 50% of patients with high-risk localized prostate cancer experience biochemical recurrence (BCR) within 2 years of radical prostatectomy. The Apa-RP study (NCT04523207) investigated whether adjuvant apalutamide plus androgen deprivation therapy (ADT) in high-risk patients who have undergone radical prostatectomy improved BCR-free survival. Apa-RP was a multicenter, open-label, single-arm, phase 2 study conducted in community urology practices in the US. High-risk patients who had radical prostatectomy received 12 cycles of apalutamide (240 mg daily; 28-day cycles) plus ADT. The primary end point was BCR-free survival. Secondary end points included testosterone recovery (≥150 ng/dL) and safety. One hundred eight patients were enrolled; median age was 66.0 years (range 46.0-77.0 years). Median preoperative PSA and baseline testosterone were 7.6 ng/mL (range 2.2-62.7 ng/mL) and 340.0 ng/dL (range 43.0-939.0 ng/dL), respectively. The BCR-free rate at 24 months (12 months after completion of planned therapy) was 100% (90% CI 93-100). Serum testosterone recovery rate (≥50 and ≥150 ng/dL) 12 months after treatment completion was 96% (95% CI 88-98) and 77% (95% CI 66-85), respectively. Overall, 107 (99%) patients experienced treatment-emergent adverse events, with 24 (22%) experiencing grade 3 to 4 events. In Apa-RP, BCR-free survival was 100% with 77% of patients having testosterone recovery (≥150 ng/dL) within 12 months of actual treatment completion and a manageable safety profile. These results provide proof of concept that treatment intensification with 12 cycles of apalutamide plus ADT could become an option for patients with high-risk localized prostate cancer who have undergone radical prostatectomy. ClinicalTrials.gov Identifier: NCT04523207.

(153) Laparoscopic Radical Prostatectomy with the Simultaneous Implant of a Penile Prosthesis: Penile Length Preservation After 10 years Follow Up

Abstract Introduction The preservation of the full dimensions of the penis is an important consideration for improving patients' compliance for the treatment after prostatectomy. We performed twenty laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) in order to preserve the full length of the penis and to improve patients' satisfaction in 2013. Objective Objective of the study is to evaluate the ten years follow up of this unique series in the world. Oncological and functional results were analyzed. Methods From June 2013 to June 2014, 20 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis) and RP laparoscopic. Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each 1 year thereafter. The main outcome measures were biochemical recurrence-free rate, penile length, and quality of life. Results 15 patients mean age 71 range 66–75 were reached at the 10-year follow-up-1 died of acute infarction 10 years after surgery, 1 died of disease 7 years after surgery; 3 lost to followup. Partners had mean age 60 with range 37–71 years. Mean preoperative PSA 9.3 (6.3–13.7) at 10 years 0.08 (range 0.01–1.2); Pre-surgical IIEF 11 (range 9–14) to 10 years 23 (range 22–25). 10-year partner satisfaction rating had increased from 8 post-surgical to 7. Penis size unchanged after 10 years: surgery day 9 cm (range: 8.5–9.5) at 10 years 8.8 range (8–9.5). Conclusions In our cases, the simultaneous extraperitoneal laparoscopic surgery of radical prostatectomy and penile prosthesis implantation is an interesting option to offer to selected and highly motivated patients. Preservation of the size of the penis, the possibility of resuming normal sexual activity 21 days after surgery, partner satisfaction and oncological safety with a 10-year follow-up make it a surgical technique to be proposed in clinical practice if performed by a team with experience in prosthetic surgery. Disclosure No.

Novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation and long-term outcomes for a single surgeon

Although novel techniques for avoiding incontinence during robot-assisted radical prostatectomy have been developed, long-term oncological outcomes are unknown. The objective of this study was to determine the long-term oncological outcomes and functional outcomes of novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation for a single surgeon. Data from 100 patients who underwent structure-preserving prostatectomies performed by a single surgeon were retrospectively analyzed. The median console time was 123 min. Bilateral nerve-sparing was performed in 43% of patients underwent, and 57% underwent unilateral nerve-sparing surgery. Most patients (96%) reached complete pad-zero urinary continence by one year after surgery. Satisfactory erectile function was achieved in 97% of patients who underwent bilateral nerve-sparing surgery, and 80% of patients who underwent unilateral nerve-sparing surgery. The surgical margin was positive for 25% of patients, and the biochemical recurrence-free rate at 5 years was 77%. The cancer-specific survival rate was 100% during the median follow-up period of 4.5 years. Clavien-Dindo grade III complications occurred in 1% of cases. The outcomes for novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation were similar to previously reported oncological outcomes, with satisfactory functional outcomes. This operative method may be useful for patients who are eligible for nerve-sparing surgery.

Maintenance of castration with concomitant relugolix and apalutamide (Apa) in patients with high-risk localized prostate cancer (HR-LPC): 1 year update.

e17094 Background: Androgen deprivation therapy (ADT) is a mainstay in the management of prostate cancer (PC). We assessed the efficacy of achieving and maintaining castrate testosterone (T) levels when combining relugolix, an oral gonadotropin-releasing hormone antagonist, concomitantly with Apa, an androgen receptor inhibitor. The single-arm, open-label, multicenter, phase 2 Apa-RP study evaluates the biochemical recurrence-free rate in patients with HR-LPC following radical prostatectomy (RP) who received 12 months of adjuvant Apa and ADT (main study). A substudy was added to assess whether the approved maintenance dose of relugolix with concomitant Apa maintained castration. Study results of the 28-day coadministration of relugolix + Apa showed that all evaluable patients achieved and maintained castration at standard relugolix dose and were transitioned into the main study (Brown et al. Target Oncol. 2022). Herein, we report longer term data of T levels and safety findings in the substudy patients who received relugolix + Apa for 1 year. Methods: Patients (n = 12) with HR-LPC (PSA ≥20 ng/mL or Gleason score ≥8) received a loading dose of relugolix (360 mg) at substudy initiation (Day -14) followed by the standard, approved relugolix dose (120 mg/d) for 13 days. Starting on Day 1, patients received relugolix + Apa (240 mg/d) for 28 days, with substudy completion on Day 28. These patients transitioned to the main study and received relugolix + Apa for a total of 1 year. T levels (castrate level defined as < 50 ng/dL) were measured at baseline (Day -14), Day 1, Day 28, and then every 3 months. Results: Of the 12 patients who continued onto the main study, 1 withdrew and another was noncompliant with therapy and subsequently withdrew but maintained castration while on therapy. Of the 10 patients who successfully completed therapy, 100% maintained castration during 1 year of concomitant therapy with relugolix + Apa . No patient required dose modification of relugolix. Median T level was 10.0 ng/dL after 1 year of treatment. One month after treatment discontinuation, 8/10 (80%) patients saw recovery of their T (T ≥50 ng/dL). Treatment-emergent adverse events (TEAEs) occurred in all 12 patients (100%). TEAEs were consistent with known safety profiles for each drug administered separately. Conclusions: During the 12 months of concomitant relugolix + Apa administration, all patients who completed therapy maintained castrate T levels without relugolix dose modification. All but 2 patients had T recovery within 30 days of therapy discontinuation. These data support long-term T suppression with relugolix + Apa at standard doses. Subsequent T levels will be reported upon final analysis of the main study. Clinical trial information: NCT04523207 .

Different lymph node dissection ranges during radical prostatectomy for patients with prostate cancer: a systematic review and network meta-analysis

ObjectiveThe purpose of this network meta-analysis was to compare the effectiveness and adverse effects of limited, standard, extended, and super-extended pelvic lymph node dissection (PLND) following radical prostatectomy.MethodsThis study followed the PRISMA 2020 statement. Clinical trials were searched from three electronic databases, including PubMed, the Cochrane Library, and Embase from the database’s inception to April 5, 2022. The lymph node-positive rate, biochemical recurrence-free rate, lymphocele rate, thromboembolic rate, and overall complication rate were compared by meta-analysis. Data analyses were performed using R software based on the Bayesian framework.ResultsSixteen studies involving 15,269 patients were included. All 16 studies compared the lymph node-positive rate; 5 studies compared the biochemical recurrence-free rate; 10 studies compared the lymphocele rate; 6 studies compared the thromboembolic rate, and 9 studies compared the overall complication rate. According to Bayesian analysis, the lymph node-positive rate, lymphocele rate, and overall complication rate were significantly associated with the extension of the PLND range. The limited, extended, and super-extended PLND templates showed a similar but lower biochemical recurrence-free rate and a higher thromboembolic rate than the standard template.ConclusionsThe extension of the PLND range is associated with an elevated lymph node-positive rate; however, it does not improve the biochemical recurrence-free rate and correlates with an increased risk of complications, especially lymphocele. The selection of the PLND range in clinical practice should consider the oncological risk and adverse effects.Trial registrationPROSPERO (CRD42022301759).

Pentafecta outcomes of robotic laparoscopically assisted radical prostatectomy during the initial experience in a university hospital

BackgroundRobotic laparoscopically assisted radical prostatectomy (RARP) is an option for the treatment of localized prostate cancer. The objective of the present study was to evaluate the pentafecta outcomes (biochemical recurrence, continence, potency, surgical complications and surgical margins) in patients undergoing RARP during the initial experience in a university hospital.MethodsThis is a retrospective study of patients who had RARP for localized prostate adenocarcinoma at a university hospital from August 2013 to October 2019 to evaluate pentafecta outcomes (biochemical recurrence, continence, potency, surgical complications and surgical margins). Data were collected and stored via Microsoft Office Excel program and analyzed using SPSS Software, version 20.0.ResultsOne hundred and sixty-three RARP were performed, the mean age is 64.16 ± 6.54 years, PSA 6.20 (IQR = 4.91–8.95) ng/dl, BMI 27.14 (IQR = 24.22–29.26) kg/m2, D’Amico risk classification was 35 (22.3%) low risk, 81 (51.6%) intermediate risk and 41 (26.1%) high risk. One hundred and fifty-four patients entered the analysis of pentafecta with a rate of 38.3% reaching this outcome. Complications: Twenty-three (14.1%) patients had minor complications (Clavien I and II) and eight patients had major complications (Clavien IIIa, IIIb and IVa). Surgical margins were negative in 69.9% of patients. The biochemical recurrence-free rate was 89.5%. The overall continence rate was 93.5%, and the potency rate was 63.5%. Multivariate analysis showed that T2 patients are 2.7 times more likely to achieve pentafecta outcome than patients ≥ T3 (p < 0.05), while younger age and lower BMI data were found as a protective factor with RR of 0.95 and 0.94, respectively.ConclusionsPreliminary pentafecta outcome of RARP in this university hospital is promising.

Retrospective Analysis of Clinical Outcomes of Stereotactic Body Radiation Therapy for Localized Prostate Cancer at an Asian Cancer Specialist Centre.

The current treatment options for localized prostate cancer are radical prostatectomy and external beam radiotherapy (EBRT) with stereotactic body radiation therapy (SBRT) gaining interest as a treatment option compared to standard fractionation radiation therapy. This present study is a retrospective study evaluating the correlations between the biochemical efficacy, and treatment toxicity in SBRT for localized prostate cancer. All organ-confined prostate cancer patients treated with SBRT from 2010 to 2018, at Beacon Hospital, Malaysia were included in this study. Patient demographics, dosimetric parameters, and disease information were retrospectively collected. The primary endpoint was biochemical recurrence-free survival assessed using the Phoenix definition (Nadir + 2 ng/mL). Toxicity outcomes were scored using the Radiation Therapy Oncology Group scale. Fourty-nine patients who met the inclusion criteria (5 low-, 13 intermediate- and 31 high-risk according to the D'amico Risk Classification) received SBRT. The most common dose regime was 34-35Gy in 5 fractions (n=18). Other dose regimes were 24Gy in 3 fractions and 25-33Gy in 5 fractions. Median follow-up was 45.4 months. The median pre-treatment prostate-specific antigen (PSA) was 11.22 ng/mL, which decreased to a median PSA of 0.1 ng/mL by 2 years post-treatment. Out of the 49 cases, only 1 case of biochemical recurrence occurred, yielding a 3- and 5-year overall survival of 100%, and a 3- and 5- year biochemical recurrence-free rate of 100% and 95.2%. Acute grade III urinary toxicities occurred in 1 (2%); whereas acute grade I urinary and rectal toxicities were seen in 22 (44.9%) and 7 (14.3%) patients respectively. Grade I and grade III late rectal toxicities occurred in 3 and 1 patients respectively, while 3 and 1 patient reported late grade I and III urethral stricture respectively. SBRT for clinically-localized and locally advanced prostate cancer provided promising outcomes with low toxicity and good biochemical control.

Clinical significance of limited and extended pelvic lymph node dissection during robot-assisted radical prostatectomy for patients with localized prostate cancer: A retrospective, propensity score matching analysis.

We investigated the diagnostic and therapeutic benefits of limited or extended pelvic lymph node dissection during a robot-assisted radical prostatectomy for localized prostate cancer. Diagnostic and therapeutic benefits were assessed according to the rates of pN1 and biochemical recurrence, respectively. The primary outcome was the biochemical recurrence-free rate, and secondary outcomes included the diagnostic and therapeutic benefits of pelvic lymph node dissection. A total of 534 patients were analyzed. Out of the 534 patients, 207 (38.8%) received limited pelvic lymph node dissection while 134 (25.1%) received extended dissection. There were 297 patients with a Briganti index ≥5%. Extended dissections yielded significantly more resected lymph nodes (p < 0.0001), and 72.2% of cases of pN1 were located outside the obturator. The incidence rate of pN1 was 6.1%, and performance of extended lymph node dissection was an independent predictor for pN1 (odds ratio 9.0, 95% confidence interval 2.5-33.1). The rate of biochemical recurrence was 14.9%, and Cox proportional hazards regression analysis of the propensity score matched population revealed that patients with high or very-high risk tended to benefit from limited lymph node dissection (hazard ratio 8.4, 95% confidence interval 0.8-82.3) while the therapeutic benefit of extended dissection was unclear by comparison. Extended pelvic lymph node dissection significantly improves diagnostic accuracy; however, the therapeutic benefit of pelvic lymph node dissection was not observed in this study.

Clinical outcome in metastatic prostate cancer after primary radiotherapy

PurposeTo describe a local radio-oncological treatment for patients with prostate cancer that metastasized to either the lymph nodes or distant regions.Methods and materialsWe included 133 patients with prostate cancer that displayed either distant metastases (DM) or lymph node metastases alone (NM) and were treated between 2004 and 2019. All patients underwent computed tomography and a bone scan or 18F- or prostate-specific membrane antigen-targeted positron emission tomography. Patients received local external beam radiation therapy to the prostate to achieve local control (60–81.4 Gy to the prostate, and 45–50.4 Gy to pelvic lymph nodes), with either the 3D conformal (4-field box) or volumetric modulated arc therapy technique. A urologist prescribed additional therapy.ResultsWe included 51 patients with DM and 82 patients with NM. The mean follow-up was 42 months for all patients. The groups were similar in T stage, initial prostate-specific antigen, histology, androgen deprivation therapy, age, treatment techniques, and prescribed doses, but different in lymph node inclusion and follow-up times. In the NM and DM groups, the 5‑year biochemical recurrence-free rates were 52% and 24%, respectively (p < 0.0001); the 5‑year disease-specific survival rates were 92% and 61%, respectively (p = 0.001); and the 5‑year OS rates were 77% and 48%, respectively (p = 0.01). The groups had similar acute and late gastrointestinal and genitourinary side effects, except that late genitourinary side effects occurred significantly more frequently in the NM group (p = 0.01).ConclusionsDM was associated with significantly worse outcomes than NM. The long-term survival of patients with metastatic prostate cancer was low.

Comparative effectiveness of low-dose-rate brachytherapy with or without external beam radiotherapy in favorable and unfavorable intermediate-risk prostate cancer

We compared clinical outcomes associated with seed brachytherapy (SEED-BT) alone and SEED-BT plus external-beam radiotherapy (EBRT) for intermediate-risk prostate cancer using propensity score-matched analysis. From 2006 to 2011, 993 patients diagnosed with intermediate-risk were treated with either SEED-BT alone (n = 775) or SEED-BT plus EBRT (n = 158) at 3 tertiary hospitals. In the propensity score-matched analysis (102 pairs), median follow-up was 95 months (range 18–153 months). The 8-year biochemical recurrence-free rate (bRFR) was significantly better with SEED-BT alone than with combined radiotherapy (93.3% vs. 88.4%; HR 0.396; 95% CI 0.158–0.991). Grade 2 or greater late genitourinary toxicities were significantly fewer with SEED-BT alone than with combined radiotherapy (21.0% vs. 33.2%; HR 0.521; 95% CI 0.308–0.881). Similarly, grade 2 or greater late gastrointestinal toxicities were significantly fewer with SEED-BT alone (0% vs. 12.2%; HR 0.125; 95% CI 0.040–0.390). For the unfavorable intermediate-risk subgroups, SEED-BT alone yielded a significantly better bRFR than the combined radiotherapy (HR 0.325; 95% CI 0.115–0.915). SEED-BT alone might be a better disease-management plan than SEED-BT plus EBRT for intermediate-risk prostate cancer regardless of favorable and unfavorable characteristics.

Biochemical control of the combination of cyclooxygenase-2 inhibitor and 125 I-brachytherapy for prostate cancer: Post hoc analysis of an open-label controlled randomized trial.

To evaluate the use of cyclooxygenase-2 inhibitors in patients receiving low-dose-rate brachytherapy for prostate cancer. A total of 310 patients with prostate cancer (cT1c-3aN0M0) who received low-dose-rate brachytherapy between May 2010 and July 2013 were enrolled and allocated to one of the two treatment groups (tamsulosin alone 0.2mg/day for 6months vs tamsulosin 0.2mg/day for 6months plus celecoxib 200mg/day for 3months). The primary end-point was the chronological change in international prostate symptom score, and the number of patients was assessed for the primary end-point. Biochemical recurrence-free, cancer-specific survival and overall survival rates 5years after the last patient received low-dose-rate brachytherapy were retrospectively examined. The median follow-up period after low-dose-rate brachytherapy was 72.0months (range 3-99months). A total of 12 (3.9%) patients experienced biochemical recurrence. The biochemical recurrence-free rate in the celecoxib group (5-year biochemical recurrence-free rate 98.5%) was significantly better (log-rank test P=0.023, 95% confidence interval 0.07-0.63, hazard ratio 0.20) than that in the tamsulosin group (5-year biochemical recurrence-free rate 93.4%). None of the patients died from prostate cancer. However, 14 (4.5%) patients died of other causes. No significant difference was observed in terms of overall survival between the celecoxib and tamsulosin groups. The combination of cyclooxygenase-2 inhibitor and low-dose-rate brachytherapy can contribute to a better biochemical control of prostate cancer.

238 A case series of patients underwent laparoscopic extra-peritoneal radical prostatectomy with simultaneous implant of penile prosthesis: focus on penile length preservation

There are many grey zones in the field of penile rehabilitation after radical prostatectomy. One of the most important aspect for improve the patient’s compliance to the treatment is the preservation of the full dimensions of the penis after surgery. We show the first cases series of patients treated by laparoscopic extra-peritoneal radical prostatectomy (RP) and simultaneous penile prostheses implantation (PPI), in order to preserve the full length of the penis and improve patients' satisfaction. From June 2013 to June 2014, 10 patients underwent simultaneous PPI (AMS “inibizone”), how shown in Figure 1 and RP by the same surgeon at the same Centre. Patients were evaluated with urological visits, dedicated questionnaires and instrumentation before surgery, at the hospital discharge and on day 21-28, each 3 months for the first year and each 6 months after. The main outcome measures were oncological (biochemical recurrence free rate), functional (penile length) and QoL.

MP22-19 PREDICTION AND STRATIFICATION OF THE BIOCHEMICAL RECURRENCE IN PATIENTS WITH HIGH-RISK PROSTATE CANCER AFTER LOW DOSE RATE PERMANENT SEED IMPLANTATION

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy1 Apr 2018MP22-19 PREDICTION AND STRATIFICATION OF THE BIOCHEMICAL RECURRENCE IN PATIENTS WITH HIGH-RISK PROSTATE CANCER AFTER LOW DOSE RATE PERMANENT SEED IMPLANTATION Yu Ozawa, Masanori Hasegawa, Noriaki Santo, Yasuto Yagi, Toru Nishiyama, Ryo Yabusaki, Keisuke Aoki, Ken Nakamura, Choichiro Ozu, Kazuhito Toya, Masanori Yorozu, and Shiro Saito Yu OzawaYu Ozawa More articles by this author , Masanori HasegawaMasanori Hasegawa More articles by this author , Noriaki SantoNoriaki Santo More articles by this author , Yasuto YagiYasuto Yagi More articles by this author , Toru NishiyamaToru Nishiyama More articles by this author , Ryo YabusakiRyo Yabusaki More articles by this author , Keisuke AokiKeisuke Aoki More articles by this author , Ken NakamuraKen Nakamura More articles by this author , Choichiro OzuChoichiro Ozu More articles by this author , Kazuhito ToyaKazuhito Toya More articles by this author , Masanori YorozuMasanori Yorozu More articles by this author , and Shiro SaitoShiro Saito More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.730AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment of high-risk prostate cancer (PCa) remains challenging for urologists. The present study was undertaken to identify risk factors for the biochemical recurrence (BCR) in patients with high-risk PCa who underwent low dose rate permanent seed implantation brachytherapy with iodine-125 (LDR). METHODS Medical records of 335 patients with high-risk PCa identified by NCCN risk stratification treated with LDR during the period of 2004-2015 at our institution have been reviewed. All patients received extra beam radiation therapy after LDR. Possible risk factors assessed for the future BCR included age, PSA, prostate volume, histological findings of biopsy specimens, neoadjuvant hormone therapy and local extent of disease evaluated by pelvic MRI. BCR free survival rates were constructed using the Kaplan-Meier method. Risk factors for BCR were evaluated by the log-rank test and multivariate Cox proportional hazard model with a stepwise selection procedure. RESULTS The Kaplan-Meier analysis showed that the 5- or 10-year BCR free survival rates were 86.7%, and 78.8%, respectively. Multivariate analysis demonstrated that grade group 5 (Hazard ratio; HR 3.75, p<0.01), cT3 (HR 2.03, p<0.04), PSA >20ng/ml (HR 2.45, p<0.05) and no neoadjuvant hormone therapy (HR 2.16, p<0.05) were significant prognostic factors. The patients were stratified into a good-risk group (0 or 1 risk factor), intermediate-risk group (2 risk factors), and poor-risk group (3 risk factors). There were significant differences in the BCR free survival among the groups; p<0.01 for low- vs. intermediate-risk group, and p<0.01 for intermediate- vs. high-risk group. The 5- or 10-year BCR free survivals rates were 92.4%, 83.1%, and 75.3%, 72.5%, and 26.7%, 26.7% in good-, intermediate-, and poor-risk patients, respectively. CONCLUSIONS These results indicate that grade group 5, cT3, PSA >20ng/ml and no neoadjuvant hormone therapy were independent risk factors for the BCR in patients with high-risk PCa treated with LDR. The combination of these factors may be helpful to identify candidates for additional treatments to control disease progression. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e280 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Yu Ozawa More articles by this author Masanori Hasegawa More articles by this author Noriaki Santo More articles by this author Yasuto Yagi More articles by this author Toru Nishiyama More articles by this author Ryo Yabusaki More articles by this author Keisuke Aoki More articles by this author Ken Nakamura More articles by this author Choichiro Ozu More articles by this author Kazuhito Toya More articles by this author Masanori Yorozu More articles by this author Shiro Saito More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP53-13 IS THE CANCER OF THE PROSTATE RISK ASSESSMENT SCORE A VALID TOOL TO PREDICT BIOCHEMICAL RECURRENCE, METASTASIS AND DEATH AFTER RADICAL PROSTATECTOMY IN LATIN AMERICAN PATIENTS?

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2018MP53-13 IS THE CANCER OF THE PROSTATE RISK ASSESSMENT SCORE A VALID TOOL TO PREDICT BIOCHEMICAL RECURRENCE, METASTASIS AND DEATH AFTER RADICAL PROSTATECTOMY IN LATIN AMERICAN PATIENTS? Rubén Bengió, leandro Arribillaga, Hernán García Onto, Javier Epelde, Esteban Cordero, Verónica Bengió, and Ruben. H Bengió Rubén BengióRubén Bengió More articles by this author , leandro Arribillagaleandro Arribillaga More articles by this author , Hernán García OntoHernán García Onto More articles by this author , Javier EpeldeJavier Epelde More articles by this author , Esteban CorderoEsteban Cordero More articles by this author , Verónica BengióVerónica Bengió More articles by this author , and Ruben. H BengióRuben. H Bengió More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1684AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical prostatectomy is an effective modality of treatment of localized prostate cancer at all levels of risk. However, the recurrence of the disease has been described in more than 40% of the patients after radical prostatectomy. Therefore, to determine the risk of disease and thus trying to Stratify it is essential in these tumors. Thus, various tools for predicting postoperative evolution have been developed and subsequently validated in several studies. In 2011, the University of California, San Francisco proposed the Cancer of the Prostate Risk Assessment Score (CAPRA-S), which uses clinical and pathological information in order to predict progression of an easy and reasonable way. The aim of the present study is to perform external validation to determine whether the Cancer of the Prostate Risk Assessment score (CAPRA-S) predicts biochemical recurrence, metastasis and death for prostate cancer after radical prostatectomy in Latin American population. METHODS 216 patients were studied. Probability of score to predict biochemical recurrence after radical prostatectomy was analyzed by Cox proportional method. Biochemical recurrence, metastasis and cancer specific free survival was determinate by Kaplan method. Exactitude of CAPRA-S score to predict biochemical recurrence, metastasis and death by prostate cancer was made in accordance with Harrells concordance index. RESULTS median follow up was 74 months. Biochemical recurrence index increase proportionally with the increment of CAPRA-S score. In the stratification of patients in low, intermediate or high risk, biochemical recurrence free rate were 85%, 54% and 4% respectively. Concordance index (C-Index) to biochemical progression, metastasis and death by prostate cance were 0.85, 0.90 and 0.90 respectively. CONCLUSIONS CAPRA-S score is an easily applicable tool and had high predictive exactitude to determinate biochemical recurrence, metastasis and death by prostate cancer in our population. Concordance Index in these variables was higher than 0.85. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e708-e709 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Rubén Bengió More articles by this author leandro Arribillaga More articles by this author Hernán García Onto More articles by this author Javier Epelde More articles by this author Esteban Cordero More articles by this author Verónica Bengió More articles by this author Ruben. H Bengió More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Case Series of Patients Who Underwent Laparoscopic Extraperitoneal Radical Prostatectomy with the Simultaneous Implant of a Penile Prosthesis: Focus on Penile Length Preservation.

PurposeThere are many grey areas in the field of penile rehabilitation after radical prostatectomy (RP). The preservation of the full dimensions of the penis is an important consideration for improving patients' compliance for the treatment. We present the first case series of patients treated by laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) in order to preserve the full length of the penis and to improve patients' satisfaction.Materials and MethodsFrom June 2013 to June 2014, 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis) and RP. Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each 6 months thereafter. The main outcome measures were biochemical recurrence-free rate, penile length, and quality of life.ResultsTen patients (mean age of 61 years; completed the study follow-up period (median, 32.2 months). No difference was found between the time of surgery and the 2-year follow-up evaluation in terms of penile length. The pre-surgery 36-Item Short Form Health Survey (SF-36) median score was 97. Patients were satisfied with their penile implants, and couples' level of sexual satisfaction was rated median 8. The median postoperative SF-36 score was 99 at 3 months follow-up.ConclusionsLaparoscopic extraperitoneal RP surgery with simultaneous PPI placement seems to be an interesting possibility to propose to motivated patients for preserving the length of the penis and improving their satisfaction.

Intrafascial versus interfascial nerve sparing in radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis

The present study aimed to systematically evaluate the effectiveness and safety of the intrafascial and interfascial nerve sparing (ITR-NS and ITE-NS) radical prostatectomy. PubMed, Embase, and Cochrane Library databases were searched for eligible studies. Meta-analysis with random-effects model was performed. Six comparative trials were selected and embraced in this research, including one randomized controlled trial, three prospective comparative trials, and two retrospective comparative trials. With regard to perioperative parameters, no significant association of operative time, blood loss, transfusion rates, duration of catheterization, and hospital stay existed between ITR-NS and ITE-NS. With respect to the functional results, ITR-NS had advantages in terms of both continence and potency recovery compared with ITE-NS. In reference to the oncologic results, the ITR-NS showed lower overall positive surgical margin (PSM) compared with ITE-NS but pT2 PSM and biochemical recurrence free rates were similar to the two surgical types. This study demonstrates that ITR-NS has better continence at 6 mo and 36 mo and better potency recovery at 6 mo and 12 mo postoperatively, regardless of the surgical technique. The cancer control of ITR-NS was also better than that of ITE-NS. This may be explained by the fact that patients in ITE-NS group present higher risk cancer than patients in ITR-NS group.

PD10-02 TIME TO BIOCHEMICAL RECURRENCE (BCR) IN PATIENTS WITH LOCALIZED HIGH-RISK PROSTATE CANCER (PC) TREATED WITH NEOADJUVANT ANDROGEN BLOCKADE (NAB) PRIOR TO RADICAL PROSTATECTOMY (RP): RESULTS OF A POOLED ANALYSIS OF THREE PHASE 2 TRIALS

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I1 Apr 2017PD10-02 TIME TO BIOCHEMICAL RECURRENCE (BCR) IN PATIENTS WITH LOCALIZED HIGH-RISK PROSTATE CANCER (PC) TREATED WITH NEOADJUVANT ANDROGEN BLOCKADE (NAB) PRIOR TO RADICAL PROSTATECTOMY (RP): RESULTS OF A POOLED ANALYSIS OF THREE PHASE 2 TRIALS Rana McKay, Bruce Montogomery, Wanling Xie, Zhenwei Zhang, Glenn Bubley, Daniel Lin, Mark Preston, Quoc-Dien Trinh, Andrew Wagner, Elahe Mostaghel, Philip Kantoff, Peter Nelson, Mary-Ellen Taplin, and Adam Kibel Rana McKayRana McKay More articles by this author , Bruce MontogomeryBruce Montogomery More articles by this author , Wanling XieWanling Xie More articles by this author , Zhenwei ZhangZhenwei Zhang More articles by this author , Glenn BubleyGlenn Bubley More articles by this author , Daniel LinDaniel Lin More articles by this author , Mark PrestonMark Preston More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Andrew WagnerAndrew Wagner More articles by this author , Elahe MostaghelElahe Mostaghel More articles by this author , Philip KantoffPhilip Kantoff More articles by this author , Peter NelsonPeter Nelson More articles by this author , Mary-Ellen TaplinMary-Ellen Taplin More articles by this author , and Adam KibelAdam Kibel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.565AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite local therapy, a significant portion of men with high-risk PC develop progressive disease. NAB prior to RP is an approach that can potentially maximize survival outcomes in a subset of patients with localized disease. The objective of this pooled analysis was to evaluate the time to BCR in patients treated with NHT pre-RP. METHODS This analysis included patients enrolled on three neoadjuvant trials at three institutions: Dana-Farber/Brigham and Women's Cancer Center, University of Washington, and Beth Israel Deaconess Medical Center. Study 08295 evaluated 3 months of either 1) a luteinizing hormone-releasing hormone agonist (LHRHa) + dutasteride, 2) LHRHa + dutasteride + bicalutamide, or 3) LHRHa + dutasteride + bicalutamide + ketoconazole. Study 09107 evaluated either 1) 12 weeks of abiraterone acetate (AA) and 24 weeks of a LHRHa or 2) 24 weeks of AA and 24 weeks of a LHRHa. Study 12089 evaluated 6 months of 1) enzalutamide or 2) enzalutamide + LHRHa + dutasteride. BCR is defined as a prostate specific antigen (PSA) >=0.2 ng/mL, which is confirmed, or need for salvage radiation therapy or androgen deprivation therapy. The distributions of time to BCR are estimated using the Kaplan Meier method. RESULTS This analysis included 72 patients (total patient cohort 133): 57% (n=41) enrolled on 09107, 38% (n=27) enrolled on 12089, and 6% (n=4) enrolled on 08295. Overall, median follow-up was 3.4 years from RP. Prior to initiation of NAB, 12 patients (17%) had clinical T3 disease and median PSA was 8.3 ng/mL. The majority of patients had Gleason 8-10 disease (n=46, 64%). Median age at RP was 59. Eleven patients (16%) had tumor measuring <= 0.5 cm at largest diameter at RP. Four patients (6%) had a pathologic complete response (pCR). Positive margins, extraprostatic, seminal vesicle or lymph node involvement was present in 9 (13%), 39 (56%), 43 (61%), and 8 (11%) patients, respectively. Twenty-three patients (32%) experienced a BCR and the 3-year BCR free rate was 70% (57%-80%). No patient with a pCR or tumor measuring <= 0.5 cm experienced a BCR. Five patients (7%) developed metastatic disease and there was one death related to PC. CONCLUSIONS NAB results in cases with little or no residual tumor. Metrics of efficacy other than survival are needed; in this subset analysis of patients with available PSA data, we demonstrate that patients with minimal residual tumor and pCR have not experienced BCR. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e199 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Rana McKay More articles by this author Bruce Montogomery More articles by this author Wanling Xie More articles by this author Zhenwei Zhang More articles by this author Glenn Bubley More articles by this author Daniel Lin More articles by this author Mark Preston More articles by this author Quoc-Dien Trinh More articles by this author Andrew Wagner More articles by this author Elahe Mostaghel More articles by this author Philip Kantoff More articles by this author Peter Nelson More articles by this author Mary-Ellen Taplin More articles by this author Adam Kibel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Subclassification of high-risk clinically organ-confined prostate cancer for early cancer-specific mortality after radical prostatectomy

High-risk clinically localized prostate cancer is seen in a highly heterogeneous population with a wide variation of clinical aggressiveness and a novel subclassification for the better prediction of clinical outcomes is needed. The aim of this study is to validate a modified D'Amico risk criteria for substratification of high-risk prostate cancer with regard to the prediction of biochemical recurrence, clinical progression-free survival or prostate cancer-specific mortality after radical prostatectomy. We conducted a retrospective multicenter cohort study including 461 clinically organ-confined (cT1-2), D'Amico high-risk prostate cancer patients who underwent radical prostatectomy with pelvic lymph node dissection. The modified criteria subclassified D'Amico high-risk patients into high-risk (n=189, single high-risk parameter and two low-risk parameters) and very high-risk (n=272, at least one more intermediate or high-risk parameter in addition to the qualifying high-risk parameter) groups. Biochemical recurrence-free survival, clinical progression-free survival, prostate cancer-specific mortality and overall survival were analyzed. The very high-risk group, compared with high-risk group, had significantly poorer biochemical recurrence (5- and 10-year biochemical recurrence-free rates: 52.8 vs 73.9% and 42.1 vs 61.7%, respectively, P <0.0001), clinical progression-free survival (5- and 10-year survivals: 91.8 vs 98.2% and 80.5 vs 98.2%, respectively, P=0.0013) and prostate cancer-specific mortality (5- and 10-year mortalities: 2.5 vs 0.0% and 6.7 vs 0.0%, respectively, P =0.0124). D'Amico high-risk patients can achieve very favorable outcomes unless they are classified as very high risk. Our novel subclassification method is very simple and useful for better patient counseling and decision-making in the pretreatment setting.

Robotic-assisted Laparoscopic Radical Prostatectomy From a Single Chinese Center: A Learning Curve Analysis

To investigate the learning curve of robotic-assisted laparoscopic radical prostatectomy (RALP) and analyze whether a surgeon's prior surgical experience has effects on the surgery. From April 2012 to August 2015, 3 surgeons performed RALP on 355 consecutive patients with prostate cancer. Among these cases, 184 were by surgeon A with prior open experiences, 92 by surgeon B with both open and laparoscopic experiences, and 79 by surgeon C with laparoscopic experiences only. Perioperative, oncological, and functional outcomes were evaluated and compared between surgeons. Learning curve patterns were evaluated to determine the number of cases to reach plateau. Marked difference was observed in operative time among the 3 groups (all P <.05). Length of hospital stay was also statistically significant (all P <.001), except for that between Group B and Group C (P = .739). Continence at 1-year and 6-month postoperatively was better in Groups B and C compared with Group A (P <.001). Intraoperative blood loss, pathologic stage, positive surgical margin, biochemical recurrence-free rate, and other pathological findings showed no statistical significance between the groups. The number of cases required to reach plateau may vary for surgeons with different surgical experiences. Different early surgical background may affect the perioperative parameters of novice RALP surgeons. Previous laparoscopic experiences may provide additional advantage in learning curve parameters compared with surgeons with open experiences only. A better overall continence for laparoscopic surgeons requires further validation.

Development and internal validation of a multivariable prediction model for biochemical failure after whole-gland salvage iodine-125 prostate brachytherapy for recurrent prostate cancer

BackgroundLocalized recurrent prostate cancer after primary radiotherapy can be curatively treated using salvage iodine-125 (125I) brachytherapy. Selection is hampered by a lack of predictive factors for cancer control. This study aims to develop and internally validate a prognostic model for biochemical failure (BF) after salvage 125I brachytherapy. Methods and MaterialsWhole-gland salvage 125I brachytherapy patients were treated between 1993 and 2010 in two radiotherapy centers in the Netherlands. Multivariable Cox regression was performed to assess the predictive value of clinical parameters related to BF (Phoenix-definition [prostate-specific antigen [PSA]-nadir + 2.0 ng/mL]). Missing data were handled by multiple imputation. The model's discriminatory ability was assessed with Harrell's C-statistic. Internal validation was performed using bootstrap resampling (2000 data sets). Goodness-of-fit was evaluated with calibration plots. All analyses were performed using the recently published TRIPOD (Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) statement. ResultsAfter median followup of 74 months (range 5–138), 43 of a total 62 patients developed BF. In multivariable analysis, disease-free survival interval (DFSI) after primary therapy and pre-salvage prostate-specific antigen doubling time (PSADT) were predictors of BF: corrected hazard ratio (HR) 0.99 (95% confidence interval 0.97–0.999; p = 0.04) and 0.94 (95% confidence interval 0.89–0.99; p = 0.03), both for a 1-month increase (optimism-adjusted C-statistic 0.70). Calibration was accurate up to 36 months. Of patients with PSADT >30 months and DFSI >60 months, 36-month biochemical disease-free survival was >75%. Every 12-month increase in DFSI will allow 3-month decrease in PSADT while maintaining the same biochemical recurrence-free rates. ConclusionsWe have presented results from a cohort of patients undergoing salvage 125I-brachytherapy. Our data show that better selection of patients is possible with the DFSI and PSADT.