Biochemical Recurrence In Men Research Articles

Post-diagnostic metformin and statin use and risk of biochemical recurrence in Veterans diagnosed with prostate cancer.

To evaluate the impact of post-diagnostic metformin or statin use and duration on risk of biochemical recurrence in a racially-diverse cohort of Veterans. The population consisted of men diagnosed with prostate cancer in the Veterans Health Administration and treated with either radical prostatectomy or radiation (Full cohort n = 65,759, Black men n = 18,817, White men n = 46,631, Other = 311). The association between post-diagnostic (1) metformin and (2) statin use with biochemical recurrence was assessed using multivariable, time-varying Cox Proportional Hazard Models for the overall cohort and by race. In a secondary analysis, metformin and statin duration were evaluated. Post-diagnostic metformin use was not associated with biochemical recurrence (multivariable-adjusted hazard ratio [aHR]: 1.01; 95% confidence interval [CI]: 0.94, 1.09), with similar results observed for both Black and White men. However, duration of metformin use was associated with a reduced risk of biochemical recurrence in the cohort overall (HR: 0.94; 95% CI: 0.92, 0.95) as well as both Black and White men. By contrast, statin use was associated with a reduced risk of biochemical recurrence (HR: 0.83; 95% CI: 0.79, 0.88) in the overall cohort as well as both White and Black men. Duration of statin use was also inversely associated with biochemical recurrence in all groups. Post-diagnostic metformin and statin use have the potential to prevent biochemical recurrence in men diagnosed with prostate cancer.

The 17-gene Genomic Prostate Score assay as a predictor of biochemical recurrence in men with intermediate and high-risk prostate cancer.

The validated 17-gene Oncotype DX Genomic Prostate Score® (GPS™) assay risk-stratifies prostate-cancer patients with localized disease. The assay has primarily been utilized in lower risk patients deciding between active surveillance versus definitive therapy. In this retrospective cohort study, we analyze the association of the GPS result with time to biochemical recurrence post-prostatectomy in patients with National Comprehensive Cancer Network® (NCCN) intermediate and higher risk prostate cancer. The 141 patients included in the study were from the NorthShore University HealthSystem diagnosed 2014-2019 with NCCN intermediate (n = 109) or higher risk (n = 32) prostate cancer, treated with radical prostatectomy 2015-2019. The association of GPS result with time to biochemical recurrence was evaluated using univariable and multivariable Cox proportional hazards models in 120 patients with unfavorable intermediate or higher risk. Median (interquartile range) follow-up time was 28 (20 to 38) months. The GPS result was significantly associated with time to biochemical recurrence as both a continuous and dichotomous variable in univariable (hazard ratio [HR] per 20 GPS units 2.36, 95% CI 1.45-3.80, p < 0.001; HR for GPS result 41-100 vs 0-40 3.28, 95% CI 1.61-7.19, p < 0.001) and in multivariable models accounting for NCCN risk group (HR per 20 GPS units 2.14, 95% CI 1.31-3.46, p = 0.003; HR for GPS result 41-100 vs 0-40 3.00, 95% CI 1.43-6.72, p = 0.003) or biopsy Gleason Score and diagnostic PSA or PSA density. These results indicate that the GPS assay was a strong predictor of biochemical recurrence after radical prostatectomy in this unfavorable intermediate and higher risk prostate cancer patient population.

PD60-10 A MORE EXTENDED PELVIC LYMPH NODE DISSECTION DECREASES RECURRENCE RATES IN SELECTED PROSTATE CANCER PATIENTS UNDERGOING RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 May 2022PD60-10 A MORE EXTENDED PELVIC LYMPH NODE DISSECTION DECREASES RECURRENCE RATES IN SELECTED PROSTATE CANCER PATIENTS UNDERGOING RADICAL PROSTATECTOMY Giorgio Gandaglia, Giuseppe Rosiello, Francesco Pellegrino, Antony Pellegrino, Marco Bandini, Andrea Salonia, Manuela Tutolo, Mario De Angelis, Gabriele Sorce, Elio Mazzone, Armando Stabile, Vito Cucchiara, Emanuele Zaffuto, Pierre I. Karakiewicz, Shahrokh F. Shariat, Vincenzo Mirone, Francesco Montorsi, and Alberto Briganti Giorgio GandagliaGiorgio Gandaglia More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Antony PellegrinoAntony Pellegrino More articles by this author , Marco BandiniMarco Bandini More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Manuela TutoloManuela Tutolo More articles by this author , Mario De AngelisMario De Angelis More articles by this author , Gabriele SorceGabriele Sorce More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Armando StabileArmando Stabile More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002645.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The impact of the pelvic lymph node dissection (PLND) on the outcome of patients with prostate cancer (pCa) is still a matter of debate. We hypothesized that the extent of PLDN on the risk of developing biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) varies according to patient baseline characteristics and the probability of lymph node involvement (LNI). METHODS: Overall, 2,542 patients with localized PCa treated with RARP with PLDN at a tertiary referral center between 2010 and 2021 were included. All patients underwent an anatomically-defined extended PLND which included at least the obturatory, external and internal iliac stations and was extended to the common iliac and presacral regions according to each patient profile. Kaplan-Meier analyses assessed time to BCR, which was defined as two consecutive PSA values ≥0.2ng/ml and rising. An interaction test assessed whether the impact of the number of nodes removed on BCR-free survival varied according to the risk of LNI calculated by the Briganti nomogram. RESULTS: Median age was 64 years. The median risk of LNI according to the Briganti nomogram was 10%. The median number of removed lymph nodes was 15 (IQR: 7-19) and LNI rate was 10%. Overall, 314 patients experienced BCR at a median follow-up of 36 months. The 5-year BCR-free survival rate was 74%. The impact of the number of nodes removed on BCR-free survival varied according to the LNI risk (p=0.03). A more extended PLND was associated with decreased rates of BCR in men with a risk of LNI between 11-20% and, above 20 nodes, in those with a risk >20%. Conversely, the effect of PLND was virtually null in those with a lower risk of LNI. CONCLUSIONS: The benefits associated with removing a higher number of nodes appears scarce in patients with low probability of LNI. Patients with a LNI risk >11% may benefit from more extended PLND due to decreasing probability of BCR. These patients represent the ideal candidates for prospective trials testing the role of PLND on patient outcomes. Source of Funding:. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1029 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giorgio Gandaglia More articles by this author Giuseppe Rosiello More articles by this author Francesco Pellegrino More articles by this author Antony Pellegrino More articles by this author Marco Bandini More articles by this author Andrea Salonia More articles by this author Manuela Tutolo More articles by this author Mario De Angelis More articles by this author Gabriele Sorce More articles by this author Elio Mazzone More articles by this author Armando Stabile More articles by this author Vito Cucchiara More articles by this author Emanuele Zaffuto More articles by this author Pierre I. Karakiewicz More articles by this author Shahrokh F. Shariat More articles by this author Vincenzo Mirone More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP51-16 THE RISK OF RECURRENCE IN CN1 PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY VARIES ACCORDING TO THE TYPE PREOPERATIVE STAGING. A COMPARISON BETWEEN 68GA-PSMA-PET VERSUS CONVENTIONAL IMAGING IN A LARGE, MULTI-INSTITUTIONAL STUDY

MP51-16 THE RISK OF RECURRENCE IN CN1 PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY VARIES ACCORDING TO THE TYPE PREOPERATIVE STAGING. A COMPARISON BETWEEN 68GA-PSMA-PET VERSUS CONVENTIONAL IMAGING IN A LARGE, MULTI-INSTITUTIONAL STUDY

Salvage hypofractionated accelerated versus standard radiotherapy for the treatment of biochemical recurrence after radical prostatectomy (SHARE): the protocol of a prospective, randomized, open-label, superiority, multi-institutional trial

BackgroundWhile several phase III trials have investigated the role of hypofractionated radiotherapy in the definitive treatment of localized prostate cancer, prospective data reporting the outcomes of hypofractionated radiotherapy in the postoperative treatment setting are sparse. Therefore, this study is designed to assess the efficacy and treatment-related toxicity of hypofractionated salvage radiotherapy for the treatment of biochemical recurrence in men who underwent radical prostatectomy. The primary objective of this trial is to investigate whether hypofractionated radiotherapy improves biochemical control compared with conventionally fractionated radiotherapy. In addition, treatment-related toxicity, quality of life, and survival will be evaluated as secondary endpoints.MethodsIn this prospective, randomized, multi-institutional trial (the SHARE study), patients with intermediate- or high-risk prostate cancer will be randomized to receive either hypofractionated radiotherapy (65 Gy in 2.5-Gy fractions) or conventionally fractionated radiotherapy (66 Gy in 2-Gy fractions). Prostate bed irradiation or elective pelvic nodal irradiation including the prostate bed will be performed using intensity-modulated radiotherapy and daily image guidance. Treatment efficacy will be assessed using the serum tumor marker prostate-specific antigen, and toxicity will be evaluated through both physician- and patient-reported outcomes. Quality of life will also be investigated.DiscussionThis study is designed to demonstrate whether hypofractionated radiotherapy is beneficial in terms of biochemical control and toxicity compared with standard salvage radiotherapy. If hypofractionated radiotherapy is shown to be superior to conventionally fractionated radiotherapy, it will mean that improved biochemical control can be achieved, accompanied by greater patient convenience and more efficient use of medical resources.Trial registrationClinicalTrials.gov NCT03920033. Registered on 18 April 2019

P1208 - The 17-gene Genomic Prostate Score® assay as a predictor of biochemical recurrence in men with intermediate- and high-risk prostate cancer

P1208 - The 17-gene Genomic Prostate Score® assay as a predictor of biochemical recurrence in men with intermediate- and high-risk prostate cancer

Intraprostatic calcification and biochemical recurrence in men treated with cesium-131 prostate brachytherapy

Baseline intraprostatic calcification (IC) has been shown to be associated with a higher rate of biochemical recurrence (BCR) in men treated with iodine-125 prostate brachytherapy (PB). We evaluated this association in a cohort of men treated with cesium-131 PB. We retrospectively reviewed the charts of all low- and intermediate-risk prostate cancer patients treated with cesium-131 PB +/- external beam radiotherapy (EBRT) at our institution from 2/2011 to 7/2018. Patients with < 24 months of follow up or those who received androgen deprivation therapy were excluded. Baseline IC status (defined as one or more ICs ≥ 5 mm) was determined on post-PB CT scans. Cox analysis was used to assess predictors of BCR and Kaplan-Meier survival curves were calculated. Two hundred and sixteen low- and intermediate-risk prostate cancer patients treated with cesium-131 PB +/- EBRT were included. Median follow up was 56.9 months (range 24.1-111.4). Overall, 76 (35.2%) patients had baseline IC and 140 (64.8%) did not. Baseline disease characteristics did not differ significantly between groups. On univariate Cox analysis, only risk group (p = 0.047) and initial PSA (p = 0.016) were significant predictors of BCR, whereas baseline IC was not (p = 0.11). The 5-year BCR-free survival in patients with versus without baseline IC was 97.7% versus 93.8% (p = 0.405), respectively. In a cohort of low- and intermediate-risk prostate cancer patients treated with cesium-131 PB, the rate of BCR in men with baseline IC was low and baseline IC was not associated with a higher risk of BCR.

Intraprostatic calcification and biochemical recurrence in men treated with Cs-131 prostate brachytherapy.

237 Background: Vigneault et al. reported that baseline intraprostatic calcification (IC) was associated with a higher risk of biochemical recurrence (BCR) in men treated with I-125 prostate brachytherapy (PB). Cs-131 has different physical properties than I-125. We assessed whether baseline IC was associated with BCR in men treated with Cs-131 PB. Methods: We retrospectively reviewed the records of all low-risk (LR), favorable intermediate-risk (FIR), and unfavorable IR (UIR) prostate cancer patients treated with Cs-131 PB +/- external beam radiotherapy (EBRT) from 2/2011 to 7/2018 at our institution. Patients who received hormone therapy or those with &lt; 24 months follow-up were excluded. Baseline IC status (defined as 1 or more ICs ≥ 5 mm) and characteristics were determined on post-PB CT scans. Baseline patient characteristics were compared via χ2, Mann–Whitney U, or Student’s t-test. Predictors of BCR (Phoenix definition) were analyzed via Cox proportional hazards model and Kaplan–Meier survival curves were generated. Results: Two hundred and sixteen LR, FIR, and UIR prostate cancer patients treated with Cs-131 PB +/- EBRT were included. Median follow up was 56.9 months (range 24.1–111.4 months). 76 patients (35.2%) had baseline IC and 140 patients (64.8%) did not. Baseline disease characteristics did not differ significantly between patients with vs. without ICs. In patients with baseline IC, the median number of ICs was 1 (range 1–3), median length of largest IC was 9.1 mm (range 5.0–33.1), and median peak density of largest IC was 884 Hounsfield units (range 283–1744). ICs were most commonly present in the midgland (88.2%) and central (97.4%) regions. On univariate Cox analysis of all baseline disease, treatment, and IC characteristics, only initial PSA (p = 0.016) and NCCN risk group (p = 0.047) were significant predictors of BCR, whereas baseline IC was not (p = 0.11). The 5-year BCR-free survival in patients with vs. without baseline IC was 97.7% vs. 93.8% (p = 0.40), respectively. Conclusions: In a cohort of LR and IR prostate cancer patients treated with Cs-131 PB, the rate of BCR in men with baseline IC was low and baseline IC was not associated with a higher risk of BCR.

Pathological features of prostate cancer in men treated with robot-assisted radical prostatectomy in the Middle East

Little is known about the pathological features of radical prostatectomy among men living in the Middle East. Although prostate cancer became the most common malignancy among males in some countries in the Middle East, the incidence is much lower compared to western populations. The aim of this study is to analyze pathological features and biochemical recurrence in men who underwentrobotic-assisted radicalprostatectomy(RARP) in Kuwait. The data on all RARP cases performed by a uro-oncologist (SA) were recorded. A comprehensive database was collected, including demographic, clinical, and pathological data. Between February 2014 and November 2019, 65 RARP cases were performed out of a total of 200 robotic urological procedures. The median follow-up was 41.5months [inter quartile range (IQR) 27.6-52.7]. Eleven (17%) complications occurred in 7 patients, 64% were early (< 30days post-operatively) and minor (Clavien I-II). Thirty-five (54%) patients had ≥ pT3 disease. Overall, 12 (18%) patients had a positive surgical margin (PSM), and all had ≥ pT3 disease. Potency and continence rates at 12months were 82% and 97%, respectively. The mean and SD of the hospital stay were 2.7 ± 1.1days. Biochemical recurrence (BCR) rate was 10%. Men with prostatic adenocarcinoma treated with RARP in Kuwait show a high incidence of pT3 disease. PSM and BCR rates were similar to multiple reports in the literature. To our knowledge, this is the first report of RARP pathological outcomes in the gulf cooperation council (GCC) region of the Middle East.

18F-fluciclovine PET or PSMA PET for prostate cancer imaging?

Data from a new study suggests that prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) imaging is superior to 18F-fluciclovine PET for detecting biochemical recurrence in men with prostate cancer. However, whether one of these radiotracers improves patient survival over the other is unknown and further research is needed to determine which has the greater effect.

Smoking history, intensity, and duration and risk of prostate cancer recurrence among men with prostate cancer who received definitive treatment

PurposeTo examine the association of smoking history and multiple measures of smoking intensity and duration with risk of biochemical recurrence in men treated for prostate cancer. MethodsWe conducted a prospective cohort study of 1641 men (773 ever-smokers) treated with radical prostatectomy or radiation between 2003 and 2010. The association between ever-smoking and risk of biochemical recurrence was examined using Cox Proportional Hazards models with adjustment for confounders. Among ever-smokers, we further assessed the association between multiple measures of smoking duration and intensity and risk of biochemical recurrence. ResultsIn the full cohort, we observed no association between ever-smoking and risk of biochemical recurrence. However, among ever-smokers, a smoking duration of greater than or equal to 10 years was significantly associated with biochemical recurrence (hazard ratio: 2.32, 95% confidence interval: 1.01, 5.33). Our results also suggested that greater than or equal to 10 pack-years of smoking may be associated with an increased risk of biochemical recurrence (hazard ratio: 1.75, 95% confidence interval: 0.97, 3.15). No association was observed between packs smoked per day or years since smoking cessation (among former smokers) and risk of biochemical recurrence. ConclusionSmoking duration is a significant predicator of biochemical recurrence among men with prostate cancer who are current or former smokers.

Identification and Characterization of Circulating Tumor Cells in Men Who have Undergone Prostatectomy for Clinically Localized, High Risk Prostate Cancer.

Approximately 15% of men with newly diagnosed prostate cancer have high risk features which increase the risk of recurrence and metastasis. Better predictive biomarkers could allow for earlier detection of biochemical recurrence and change surveillance and adjuvant treatment paradigms. Circulating tumor cells are thought to represent the earliest form of metastases. However, their role as biomarkers in men with high risk, localized prostate cancer is not well defined. Two to 5 months after prostatectomy we obtained blood samples from 37 patients with high risk, localized prostate cancer, defined as stage T3a or higher, Gleason score 8 or greater, or prostate specific antigen 20 ng/ml or greater. Circulating tumor cells were enumerated using a commercial platform. Matched tumor and single circulating tumor cell sequencing was performed. Circulating tumor cells were detected in 30 of 37 samples (81.1%) with a median of 2.4 circulating tumor cells per ml (range 0 to 22.9). Patients with detectable circulating tumor cells showed a trend toward shorter recurrence time (p=0.12). All patients with biochemical recurrence had detectable circulating tumor cells. Androgen receptor over expression was detected in 7 of 37 patients (18.9%). Patients with biochemical recurrence had more circulating tumor cell copy number aberrations (p=0.027). Matched tumor tissue and single circulating tumor cell sequencing revealed heterogeneity. We noted a high incidence of circulating tumor cell detection after radical prostatectomy and shorter time to biochemical recurrence in men with a higher circulating tumor cell burden and more circulating tumor cell copy number aberrations. Genomic alterations consistent with established copy number aberrations in prostate cancer were detectable in circulating tumor cells but often discordant with cells analyzed in bulk from primary lesions. With further testing in appropriately powered cohorts early circulating tumor cell detection could be an informative biomarker to assist with adjuvant treatment decisions.

The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy among men with Gleason score 7 prostate cancer.

Recently, a new prostate cancer (PC) grading system was introduced, where Gleason score (GS) 7 was divided into 3 + 4 = 7 and 4 + 3 = 7 due to the different prognoses associated with each tumor type. However, whether downgrading or upgrading from needle biopsy (NB) to radical prostatectomy (RP) affects oncologic outcomes is currently unknown. Herein, we investigated the prognostic impact of downgrading and upgrading from NB to RP among men with GS 7 PC. We retrospectively reviewed the medical records of 3003 patients with localized PC who underwent RP between 2005 and 2014. We included 692 patients with GS 7 PC on both NB and RP specimens. We analyzed the data using Kaplan-Meier methods and Cox proportional hazard models. Of the 692 patients enrolled in this study, 389 (56.2%) and 303 (43.8%) patients had RP GS 3 + 4 = 7 and RP GS 4 + 3 = 7 PC, respectively. On the basis of NB and RP GS, 264 (38.1%), 125 (18.1%), 142 (20.5%), and 161 (23.3%) patients were classified as 3 + 4/3 + 4, 4 + 3/3 + 4, 3 + 4/4 + 3, and 4 + 3/4 + 3, respectively. Kaplan-Meier curves showed significant differences in biochemical recurrence (BCR)-free survival across the groups (P < .001). In the multivariate analyses, these groups were significantly associated with BCR (4 + 3/3 + 4: hazard ratio [HR], 1.675; 3 + 4/4 + 3: HR, 1.908; and 4 + 3/4 + 3: HR, 2.699). Downgrading and upgrading from NB to RP was an independent predictor of BCR in men with GS 7 PC, which could be due to the amount of Gleason pattern 4.

Identification of seven long noncoding RNAs signature for prediction of biochemical recurrence in prostate cancer.

Accumulating evidence suggested that long noncoding RNAs (lncRNAs) possess a potential role in prostate cancer (PCa) diagnosis and prognosis. Rapid biochemical recurrence (BCR) is considered as a sign for clinical recurrence metastasis and PCa-specific mortality. Hence, the aim of the present study was to identify a lncRNA signature that can predict BCR of PCa accurately. Bioinformatics analysis, Kaplan–Meier analyses, Cox regression analyses, and Gene Set Enrichment Analysis (GSEA) were performed in a publicly available database with 499 PCa tissues and 52 matched normal tissues. A signature was identified. All these lncRNAs were differentially expressed between tumor and normal tissues and differentially expressed between high Gleason score and low Gleason score tissues. Furthermore, we developed a seven lncRNAs signature that can predict PCa BCR. Patients classified into low-risk group showed better BCR survival significantly than the patients in the high-risk group (hazard ratio = 0.32, 95% CI: 0.20–0.52, concordance index = 0.63). The area under the curve was 0.68 for BCR. The signature also had good discrimination for BCR in men with Gleason 7 PCa. In conclusion, our results suggest that the seven lncRNAs signature is a new biomarker of BCR and high risk in PCa. In addition, the individual lncRNA warrants further study to uncover the associated mechanisms of PCa progression and the signature could be used to design direct clinical trials for adjuvant therapy.

Effect of multimodal analgesia with paravertebral blocks on biochemical recurrence in men undergoing open radical prostatectomy

BackgroundRecent studies suggest that anesthetic technique during radical prostatectomy for prostate cancer may affect recurrence or progression. This association has previously been investigated in series that employ epidural analgesia. The objective of this study is to determine the association between the use of a multimodal analgesic approach incorporating paravertebral blocks and risk of biochemical recurrence following open radical prostatectomy. Patients and methodsUsing a prospective database of 3,029 men undergoing open radical prostatectomy by a single surgeon, we identified 2,909 men who received no neoadjuvant androgen deprivation and had at least 1 year of follow up. We retrospectively compared patients who received general analgesia with opioid analgesia (1999–2003, n = 662) to those who received general analgesia with multimodal analgesia incorporating paravertebral blocks (2003–2014, n = 2,247). The primary outcome was time to biochemical recurrence. Biochemical recurrence-free interval was assessed using the Kaplan-Meier technique and compared using a multivariate Cox-proportional hazards regression model. ResultsIn total, 395 patients (14%) experienced biochemical recurrence following radical prostatectomy, including 265 (12%) who received multimodal analgesia and 130 (20%) who did not (adjusted P = 0.27). After adjusting for age, race, body mass index, preoperative prostate specific antigen, grade, stage, perineural invasion, margin status, percent of tumor in the gland, and diameter of the dominant nodule, there was no difference in recurrence-free interval between groups (HR = 0.92, 95% CI: 0.73–1.17). ConclusionUse of a multimodal analgesic approach incorporating paravertebral blocks is not associated with a reduced risk of biochemical recurrence following radical prostatectomy.

Level of invasion into fibromuscular band is an independent factor for positive surgical margin and biochemical recurrence in men with organ confined prostate cancer

BackgroundThis study aimed investigate the effect of the level of invasion into fibromuscular band (FMB) of prostate on the positive surgical margin (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with organ-confined (pT2) prostate cancer.MethodsThe clinical and pathological data of 461 consecutive patients with pT2 prostate cancer were evaluated regarding the level of invasion into FMB. The relationship between levels of invasion into FMB and PSM / BCR was assessed.ResultsThe rate of PSM at an FMB level of at 2 was 18.8%, which was significantly greater than the rates at levels 0 (5.4%) and 1 (7.8%). The level of FMB (p = 0.007) and percentage of tumor volume (p = 0.012) were identified as independent factors predictive of a positive surgical margin in a multivariate analysis. The 5-year BCR-free survival rates for a level 0–1 FMB with negative surgical margin, level 0–1 FMB with positive surgical margin, level 2 FMB with negative surgical margin, and level 2 FMB with positive surgical margin were 96.6%, 86.4%, 85.6%, and 72.9%, respectively (p < 0.001). A level 2 FMB (p = 0.050), positive surgical margin (p = 0.001), and surgical Gleason score (p = 0.001) were identified as independent predictors of a BCR of pT2 prostate cancer.ConclusionsAmong patients with negative surgical margins, the surgical Gleason score and level of FMB independently affected the incidence of a BCR of pT2 prostate cancer. The level of FMB was an independent predictor of both a positive surgical margin and a BCR of pT2 disease. Accordingly, the level of FMB might help to further stratify the prognosis of patients with pT2 disease.

Positive surgical margins and biochemical recurrence following minimally-invasive radical prostatectomy \u2013 An analysis of outcomes from a UK tertiary referral centre

BackgroundPositive surgical margins are a strong prognostic marker of disease outcome following radical prostatectomy, though prior evidence is largely from a PSA-screened population. We therefore aim to evaluate the biochemical recurrence in men with positive surgical margins (PSM) after minimally-invasive radical prostatectomy (MIRP) in a UK tertiary centre.MethodsRetrospective study of men undergoing laparoscopic or robotic-assisted radical prostatectomy between 2002 and 2014. Men with positive surgical margins (PSM) were identified and their biochemical recurrence (BCR) rate compared with men without PSM. The primary outcome measures were BCR rates and time to BCR. Cox regression was used to estimate adjusted hazard ratios for biochemical recurrence rate (BCR), accounting for potential confounders.ResultsFive hundred ninety-two men were included for analysis. Pre-operative D’Amico risk stratification showed 37.5%, 53.3% and 9.3% of patients in the low, intermediate and high-risk groups, respectively. On final pathological analysis, the proportion of patients with local staging pT2, pT3a and pT3b was 68.8%, 25.2% and 6.1% respectively. Overall positive margin rate was 30.6%. On multivariate analysis, the only pre-operative factor associated with PSM was age >65years. Patients with PSM were more likely to have higher tumour volume and more advanced pathological local stage. The BCR rate was 10.7% in margin-positive patients and 5.1% in margin-negative patients, at median 4.4-year follow-up. Upon multivariate analysis, high pre-operative PSA and high Gleason group were the only significant predictors of BCR (P<0.05).ConclusionsIn comparison to patients with negative surgical margins, those with PSM do not translate into worse medium-term oncological outcomes in the majority of cases amongst our cohort. We found that high pre-operative PSA and high Gleason group were the only significant predictors of BCR.

Subcutaneous Adipose Tissue Characteristics and Risk of Biochemical Recurrence in Men with High Risk Prostate Cancer

Obesity has become a worldwide epidemic. The interaction of obesity and excess adipose tissue on cancer biology continues to be an area of interest. The purpose of this study was to assess subcutaneous adipose tissue characteristics by computed tomography (CT) as potential imaging biomarkers in patients with high risk prostate cancer receiving radiation treatment (RT). This retrospective study included 185 men with high risk prostate cancer (PSA>20 ng/mL, Gleason score ≥ 8, or clinical extraprostatic extension) treated between 2001 and 2012. All patients received definitive, dose-escalated external beam RT along with a course of neoadjuvant, concurrent, and adjuvant androgen deprivation therapy (ADT). Each patient also had a treatment planning CT that included the L4-L5 vertebral interface and prostate specific antigen (PSA) measurements for at least 1 year following RT. The subcutaneous adipose tissue was contoured on a single axial CT slice at the level of L4-L5. The average CT attenuation, in Hounsfield units (HU), of the structure was calculated and defined as SATHU. SATAREA was defined as the cross-sectional area of the structure (in cm2) that was then normalized by the square of patient height. Biochemical failure (BF) was defined as a PSA rise of 2 ng/mL from the nadir. Freedom from BF (FFBF) was calculated from start time of ADT using the Kaplan-Meier method. Estimates of FFBF were stratified by SATHU and SATAREA quartiles. Median follow-up was 5.3 years. The mean SATHU (± standard deviation) was -99.2 HU (±6.3 HU) and the mean SATAREA was 94.7 cm2/m2 (±42.3 cm2/m2). No significant differences of SATHU and SATAREA were observed among different races or age groups. The 5 and 8-year rates of FFBF across all patients were 82.1% and 74%, respectively. Patients in the lowest quartile of SATHU experienced significantly higher FFBF compared to the other quartiles (Q4 vs. Q1, p=0.029; Q4 vs. Q2, p=0.045; Q4 vs. Q3, p=0.045). No other differences in FFBF were observed between quartiles of SATAREA or other quartiles of SATHU. Using CT imaging as a novel prognostic biomarker, low attenuation of abdominal adipose tissue was associated with a lower rate of biochemical failure in patients with high risk prostate cancer. Further research is needed to elucidate the biological underpinnings of this clinical finding and the role adipose tissue plays in modulating oncologic behavior and outcomes.

Subcutaneous adipose tissue characteristics and the risk of biochemical recurrence in men with high-risk prostate cancer

Purpose/objective(s)To assess subcutaneous adipose tissue characteristics by computed tomography (CT) as potential imaging biomarkers predictive of biochemical recurrence in men with high-risk prostate cancer receiving radiotherapy (RT). Materials and methodsThis retrospective study included men with high-risk prostate cancer (PSA>20ng/ml, Gleason score ≥8, or clinical extraprostatic extension) treated between 2001 and 2012. All patients received definitive, dose-escalated external beam RT along with a course of neoadjuvant, concurrent, and adjuvant androgen deprivation therapy (ADT). Each patient also had a treatment planning CT that included the L4-L5 vertebral interface and prostate specific antigen (PSA) measurements for at least 2 years following RT. The subcutaneous adipose tissue was contoured on a single axial CT slice at the level of L4-L5. The average CT attenuation, in Hounsfield units (HU), of the structure was calculated and defined as SATHU. SATAREA was defined as the cross-sectional area of the structure (in cm2) that was then normalized by the square of patient height. Biochemical failure (BF) was defined as a PSA rise of 2ng/ml from the nadir. Freedom from BF (FFBF) was calculated from start time of ADT using the Kaplan-Meier method. Estimates of FFBF were stratified by SATHU and SATAREA quartiles. ResultsA total of 171 men met the inclusion criteria with a median follow-up of 5.6 years. The mean SATHU (±standard deviation) was −99.2HU (±6.1HU), and the mean SATAREA was 93.2cm2/m2 (±39.4cm2/m2). The 5- and 8-year rates of FFBF across all patients were 81.5% and 73.5%, respectively. Patients in the lowest quartile of SATHU experienced significantly higher FFBF compared to the other quartiles (Q4 vs. Q1, P = 0.017; Q4 vs. Q2, P = 0.045; Q4 vs. Q3, P = 0.044). No other differences in FFBF were observed between quartiles of SATAREA or other quartiles of SATHU. ConclusionLower subcutaneous adipose tissue density was associated with a lower rate of BF following RT with ADT for men with high-risk prostate cancer. Further research is needed to elucidate the biological underpinnings of this clinical finding and the role adipose tissue plays in modulating oncologic behavior and outcomes.

Defining predictors of early, intermediate, and late biochemical recurrence in men with clinically localized prostate cancer treated with minimally invasive radical prostatectomy.

113 Background: Follow up after radical prostatectomy should be tailored to clinical and pathologic characteristics. To determine predictive factors for early, intermediate and late biochemical recurrence (BCR) after minimally invasive radical prostatectomy (MIRP: lap and robot) in patients with localized prostate cancer (PCa). Methods: Prospective clinical, pathologic, and outcome data were collected for 6195 patients with cT1-3N0M0 PCa treated with MIRP at our institution from 2000 to 2016. None of them received neoadjuvant therapy. BCR was defined as PSA level greater than 0.2 ng/ml. Time to BCR was divided in terciles to identify variables associated with early ( &lt; 12 months), intermediate (12-36 months) and late BCR ( &gt; 36 months). Comparisons among groups were performed using ANOVA or Chi square test. Logistic regression models were built to determine risk factors associated with BCR at each time interval. Results: We identified 1148 (19%) patients with BCR. Median time to BCR was 24 months. Statistically significant differences were found between the groups concerning PSA preoperative, D’Amico risk, type of surgery, pT stage, pathological Gleason, positive margins and extracapsular extension. Multivariable logistic regression analysis showed preoperative PSA, positive nodes, positive surgical margins and laparoscopic surgery were associated with early BCR. Laparoscopic surgery was the only risk factor associated with intermediate term BCR. Significant predictors of late BCR included Gleason ≥ 7, ≥ pT3, positive surgical margins, lymph node dissection performance and laparoscopic surgery. Conclusions: Patients with high risk features like Gleason ≥ 7, ≥ pT3 and or positive surgical margins may develop late recurrence and deserve long term follow up. Identify patients with higher PSA and lymph node invasion has an important predictive role due to the risk of BCR within the first year. The association between laparoscopic technique and late BCR deserves further evaluation.