Higher Biochemical Recurrence Rates Research Articles

Perineural invasion as an independent predictor of biochemical recurrence in prostate cancer following radical prostatectomy or radiotherapy: a systematic review and meta-analysis

BackgroundAlthough numerous studies have shown that perineural invasion (PNI) is linked to prostate cancer (PCa) risk, the results have been inconsistent. This study aimed to explore the association between PNI and biochemical recurrence (BCR) in patients with PCa following radical prostatectomy (RP) or radiotherapy (RT).MethodsAccording to the PRISMA statement, we searched the PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI) and Wan Fang databases from inception to May 2017. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were extracted from eligible studies. Fixed or random effects model were used to calculate pooled HRs and 95% CIs according to heterogeneity. Publication bias was calculated by Begg’s test.ResultsUltimately, 19 cohort studies that met the eligibility criteria and that involved 13,412 patients (82-2,316 per study) were included in this meta-analysis. The results showed that PNI was associated with higher BCR rates in patients with PCa after RP (HR=1.23, 95% CI: 1.11, 1.36, p<0.001) or RT (HR=1.22, 95% CI: 1.12, 1.34, p<0.001). No potential publication bias was found among the included studies in the RP group (p-Begg = 0.124) or the RT group (p-Begg = 0.081).ConclusionsThis study suggests that the presence of PNI by histopathology is associated with higher risk of BCR in PCa following RP or RT, and could serve as an independent prognostic factor in patients with PCa.

Tertiary Gleason pattern in radical prostatectomy specimens is associated with worse outcomes than the next higher Gleason score group in localized prostate cancer

AimTo assess the predictive value of TGP on biochemical recurrence (BCR) and its association with clinicopathological outcomes in a large, multicenter cohort of patients with localized prostate cancer (PCa) treated with radical prostatectomy (RP). Materials and methodsRecords of 6,041 patients who were treated with RP between 2000 and 2011 for clinically nonmetastatic PCa were, retrospectively, analyzed from prospectively collected datasets. BCR-free survival rates were assessed using univariable and multivariable cox-regression analyses. ResultsMedian patient age was 61 years (interquartile range [IQR]: 57–66) with a median preoperative prostrate specific antigen of 6ng/ml (IQR: 4–9). Overall, 28% of patients had Gleason score (GS) 6, 0.3% GS 6 + TGP, 33% GS 7 (3 + 4), 0.2% GS 7 (3 + 4) + TGP, 22% GS 7 (4 + 3), 0.2% GS 7 (4 + 3) + TGP, 0.1% GS 8 and 0.4% GS 9 or 10.Median follow-up was 45 months (IQR: 31–57). Harboring a TGP was associated with higher rates of positive surgical margins, lymphovascular invasion, extraprostatic extension, and seminal vesicle invasion than their counterparts within the same GS group as well as in the next higher GS group (all P ≤ 0.05). At 5 years post-RP, BCR estimates were 5% for patients with GS 6, 13% for patients with GS 6 + TGP, 6% for patients with GS 7 (3 + 4), 22% for patients with GS 7 (3 + 4) + TGP, 16% for patients with GS 7 (4 + 3), 41% for patients with GS 7 (4 + 3) + TGP, 38% for patients with GS 8 (4 + 4) and 46% for patients with GS 9 or 10.Patients harboring a TGP had higher BCR rates than the patients in the next higher GS group: GS 6 + TGP vs. GS 7 (3 + 4), HR = 1.6, P = 0.02 and GS 7 (3 + 4)+TGP vs. GS 7 (4 + 3), HR = 1.4, P = 0.03. Patients with a TGP in the GS 7 (4 + 3) group had comparable BCR rates as patients with GS = 8 (P = 0.4) and GS 9 to 10 (P = 0.2).On multivariable analysis that adjusted for the effects of preoperative prostrate specific antigen, nodal involvement, positive surgical margin, extraprostatic disease (pT3a), seminal vesicle invasion (pT3b) and different institution, harboring a TGP showed higher risk of developing BCR within the same GS group and comparable risk of developing BCR with the next higher GS group. ConclusionPatients with TGP at RP have adverse clinicopathological features when compared to their counterparts in the same and the next higher GS group without TGP. Risk of developing BCR increases with the presence of TGP within the same GS group. This risk seems to be comparable between patients with TGP and their counterparts in the next higher GS group without TGP.Knowledge of TGP in RP specimens is likely to improve risk stratification, patient counseling and follow-up scheduling. Further prospective studies that control significant clinical endpoints such as metastasis and mortality are necessary for more significant predictions.

Association of PTEN expression with biochemical recurrence in prostate cancer: results based on previous reports.

PurposeAmong men, prostate cancer (PCa) is one of the most commonly diagnosed cancers and the leading cause of cancer death worldwide. Phosphatase and tension homolog (PTEN) acts as a negative regulator of the phosphatidylinositol 3-kinase (PIK3)/Akt pathway and suppresses tumor progression. Meanwhile, PTEN is frequently deleted in PCa. Identifying the specific molecular markers of biochemical recurrence (BCR) in PCa patients is critical in clinical practice. Our systematic review summarizes the evidence about the PTEN expression and BCR rate in PCa patients.MethodsTo clarify the impact of PTEN expression on the PCa BCR rate, a systematic review and meta-analysis was performed by searching the PubMed, Embase, and Web of Science databases, to identify the relevant literature. The analysis of pooled data was performed with Stata 12. The combined odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were evaluated by the fixed-effects or random-effects models. The combined sensitivity and publication bias were also estimated.ResultsIn total, nine articles containing ten independent cohort studies, including 2,154 cases with positive expression of PTEN and 1,006 PTEN deletion cases, were deemed eligible for the meta-analysis. Overall, the positive expression of PTEN was associated with a significantly lower BCR rate (OR =0.521, 95% CI: 0.431–0.630). Subgroup analysis stratified by race revealed that in multiple races (OR =0.215, 95% CI: 0.072–0.648) and Caucasian (OR =0.469, 95% CI: 0.373–0.591) races, positive expression of PTEN showed a significant association with lower BCR rate. Subgroup analysis also showed the significant result in different sample sizes.ConclusionPTEN deletion has a relationship with a higher BCR rate in PCa compared with positive expression of PTEN.

Bladder Neck Contracture Following Radical Retropubic versus Robotic-Assisted Laparoscopic Prostatectomy

Introduction: Radical retropubic prostatectomy (RRP) and robotic-assisted laparoscopic prostatectomy (RALP) are co-standard surgical therapies for localized prostatic adenocarcinoma. These surgical modalities offer similar outcomes; however, lower rate of bladder neck contracture (BNC) is amongst the touted benefits of RALP. The differences between approaches are largely elucidated through multiple-surgeon comparisons, which can be biased by differential experience and practice patterns. We aimed to eliminate inter-surgeon bias through this single-surgeon comparison of BNC rates following RRP and RALP. Materials and Methods: We retrospectively reviewed all RRPs and RALPs performed by one surgeon over 4 years. We compared clinical characteristics, intraoperative and postoperative outcomes. Results: RRP patients had more advanced cancer and a higher biochemical recurrence rate. No significant differences were noted between groups in rates of anastomotic leakage, BNC, or 12-month postoperative pad-free continence. Conclusion: RRP offers similar outcomes to RALP with regard to postoperative urinary extravasation, urinary continence, and BNC.

PD15-06 IMPACT OF TUMOR LOCATION ON BIOCHEMICAL RECURRENCE OF PT3 PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2017PD15-06 IMPACT OF TUMOR LOCATION ON BIOCHEMICAL RECURRENCE OF PT3 PROSTATE CANCER KIMIHARU TAKAMATSU, Kazuhiro Matsumoto, Kazunori Shojo, Shinya Morita, Kazunobu Shinoda, Takeo Kosaka, Ryuichi Mizuno, Toshiaki Shinojima, Eiji Kikuchi, Akira Miyajima, and Mototsugu Oya KIMIHARU TAKAMATSUKIMIHARU TAKAMATSU More articles by this author , Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Kazunori ShojoKazunori Shojo More articles by this author , Shinya MoritaShinya Morita More articles by this author , Kazunobu ShinodaKazunobu Shinoda More articles by this author , Takeo KosakaTakeo Kosaka More articles by this author , Ryuichi MizunoRyuichi Mizuno More articles by this author , Toshiaki ShinojimaToshiaki Shinojima More articles by this author , Eiji KikuchiEiji Kikuchi More articles by this author , Akira MiyajimaAkira Miyajima More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3288AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of the zonal origin of cancer on the prognosis after radical prostatectomy has been controversial. We investigated the influence of tumor location (anterior vs. posterior) on biochemical recurrence (BCR) after laparoscopic radical prostatectomy (LRP). METHODS We reviewed 1082 patients undergoing LRP between 2005 and 2015, among whom there were 544 patients with pathological data on the location of the index tumor who did not receive neoadjuvant/adjuvant therapy. We defined the largest lesion as the index tumor if there were several masses. BCR was defined as PSA > 0.2 ng/mL. Differences of the BCR rate between groups were examined by Kaplan-Meier analysis and the Cox proportional hazards model. RESULTS There were 234 patients (43%) with an anterior tumor and 310 patients (57%) with a posterior tumor. The anterior group had less T3 disease (61 patients, 26%) than the posterior group (111 patients, 36%) and a Gleason score of 4+4 or more was less frequent in the anterior group (24 patients, 10%) than in the posterior group (60 patients, 19%), although the differences were not significant. During a median follow-up period of 5.0 years, 75 patients (14%) experienced BCR. As shown in Figure 1, there was no significant difference of the BCR rate between patients with T2 disease and those with anterior T3 disease (hazard ratio: 1.29, 95% CI: 0.58-2.92, p=0.528), while their 5-year BCR-free survival rates were 91% and 89%, respectively. Patients with posterior T3 disease had a higher BCR rate than those with anterior T3 disease (hazard ratio: 1.88, 95% CI: 0.85-4.13, p=0.118). Their 5-year BCR-free survival rates were 90% and 79%, respectively. CONCLUSIONS These results indicate that anterior index tumors are more likely to have favorable pathological characteristics. Especially in patients with T3 disease, anterior tumors are associated with a lower BCR rate after LRP. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e284-e285 Advertisement Copyright & Permissions© 2017MetricsAuthor Information KIMIHARU TAKAMATSU More articles by this author Kazuhiro Matsumoto More articles by this author Kazunori Shojo More articles by this author Shinya Morita More articles by this author Kazunobu Shinoda More articles by this author Takeo Kosaka More articles by this author Ryuichi Mizuno More articles by this author Toshiaki Shinojima More articles by this author Eiji Kikuchi More articles by this author Akira Miyajima More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The effect of Rapid Access Prostate Clinics on the outcomes of Gleason 7 prostate cancer: does earlier diagnosis lead to better outcomes?

Rapid Access Prostate Clinics (RAPC) were introduced in Ireland by the National Cancer Control Programme bringing about expedited referral pathways and increased detection rates of prostate cancer. Lower Gleason (G) grade at diagnosis due to RAPC has been previously reported but grade at prostatectomy has not been assessed. The aim of this study was to assess the impact of RAPC on the outcomes of patients with G7 disease on radical prostatectomy (RP). A retrospective analysis was carried out of all RPs performed over a 9-year period (2006-2014). Outcomes for G7 prostatectomies were compared before and after the introduction of the RAPC, with a further sub-analysis of G4+3 versus G3+4. The primary outcome was biochemical recurrence (BCR). Other outcomes were adjuvant/salvage radiotherapy, extra prostatic extension, positive surgical margins, seminal vesicle involvement and tumour stage. In total, 240 RPs were performed with 167 cases graded G7 (70 graded G4+3 and 97 graded G3+4). Since the introduction of RAPC the proportion of G4+3 compared to G3+4 has increased from 37.9 to 42%. There was no statistical difference in outcomes for G4+3 treated before and after the introduction of RAPC. G4+3 was associated with higher rates of BCR (24.4 vs. 0%, p<0.0001, radiotherapy (41.1 vs. 4.8%, p<0.0001) and worse histological features than G3+4. Despite the benefits in diagnosis of prostate cancer brought about by RAPC in Ireland, this has not translated to a lower grade for surgically treated patients. There has been no improvement in outcomes especially for higher grade G4+3 disease.

Radical prostatectomy neutralizes obesity-driven risk of prostate cancer progression

IntroductionObesity negatively affects several prostate cancer (PCa) outcomes, including mortality to PCa. However, the validity of several such associations is still under debate, including its effect on pathological stage at radical prostatectomy (RP) and subsequent biochemical recurrence (BCR), which represents the focus of this study. MethodsWe relied on patients with PCa treated with RP at the Martini-Klinik Prostate Cancer Center between 2004 and 2015. First, multivariable logistic regression analyses tested for association between obesity and non–organ-confined disease (≥pT3 or pN1). Second, multivariable Cox regression analyses examined obesity effect on BCR. Last, in a propensity score–matched cohort, Kaplan-Meier analyses assessed BCR-free survival according to body mass index (kg/m2) (BMI) strata (≥30 vs.<25). ResultsOf 16,014 individuals, 2,403 (15%) men were obese (BMI≥30). Median follow-up was 36.4 months (interquartile range: 13.3–60.8). Obese patients were more likely to harbor non–organ-confined disease at final pathology (odds ratio = 1.27; 95% CI: 1.13–1.43; P<0.001) but did not have higher BCR rates (hazard ratio = 0.98; 95% CI: 0.86–1.11; P = 0.7). Similarly, BCR-free survival was not different between obese and nonobese men, after propensity score matching (log rank P = 0.9). ConclusionObesity (BMI ≥30) might predispose to higher rates of non–organ-confined disease at RP. However, obesity was not an independent predictor of BCR after surgery. Consequently, the unfavorable effect of obesity on PCa might be limited to local spread of the disease and might be neutralized after RP.

Pathologic Reporting of the Surgical Margin after Radical Prostatectomy: Considerations for Improving Oncologic Prognostication

Positive surgical margins (PSM) after radical prostatectomy have been identified as an adverse pathological feature predictive of higher rates of biochemical recurrence, distant metastasis, and cancer-specific mortality compared to negative margins.

Predictors of biochemical recurrence in pT3b prostate cancer after radical prostatectomy without adjuvant radiotherapy.

Men with pathologic evidence of seminal vesicle invasion (SVI) at radical prostatectomy (RP) have higher rates of biochemical recurrence (BCR) and mortality. Adjuvant radiotherapy (XRT) has been shown to increase freedom from BCR, but its impact on overall survival is controversial and it may represent overtreatment for some. The present study, therefore, sought to identify men with SVI at higher risk for BCR after RP in the absence of adjuvant XRT. We identified 180 patients in our institutional database who underwent RP from 1990 to 2011 who had pT3bN0-1 disease. The Kaplan-Meier method was used to estimate freedom from BCR for the overall cohort and substratified by Gleason score, PSA, surgical margin status, and lymph node positivity. Cox Proportional Hazards models were used to determine demographic and histopathological factors predictive of BCR. Time-dependent ROC curve analysis was conducted to assess the ability of the UCSF-CAPRA score to predict BCR. Median age was 64 years, and 52.8% of patients were preoperative D'Amico high risk. At RP, 41.4% had a positive surgical margin (PSM), and 12.2% had positive lymph nodes (LN). The most common sites of PSM were the peripheral zone (56.8%) and the apex (32.4%). Positive bladder neck margin (HR = 7.01, P = 0.035) and PSA 10-20 versus ≤10 (HR = 1.63, P = 0.047) predicted higher BCR in multivariable analyses. Median follow-up was 26 months, and 2-, 3-, and 5-year BCR-free rates were 56.1%, 49.0%, and 39.5%. Log rank tests showed that freedom from BCR was significantly less for Gleason 9-10, PSA >20, PSM, and N1 patients. The area under curve (AUC) for CAPRA in predicting BCR was 0.713 at 2 years, 0.692 at 3 years, and 0.641 at 5 years. Increasing CAPRA score was associated with an increased risk of BCR (HR = 1.33, P < 0.001). pT3b prostate cancer is a heterogeneous disease commonly associated with several high-risk features. Stratifying men with SVI by prognostic features (i.e., Gleason, PSA, node status, surgical margin status) and using these features to augment the CAPRA score will improve identification of those at higher risk for BCR that should be strongly considered for adjuvant XRT.

Pretreatment Neutrophil-to-Lymphocyte Ratio

The pretreatment neutrophil-to-lymphocyte ratio (NLR) is reportedly associated with the clinical outcomes of many cancers. However, it has not been widely investigated whether the pretreatment NLR is associated with the pathological characteristics of prostate cancer (PCa) and biochemical recurrence in PCa patients receiving radical prostatectomy (RP).In this cohort study, a total of 1688 PCa patients who had undergone RP were analyzed retrospectively, and a subset of 237 of these patients were evaluated to determine the relationship between pretreatment NLR and biochemical recurrence. Patients were divided into a high-NLR group (NLR ≥2.36) and a low-NLR group (NLR < 2.36) according to the pretreatment NLR. The association between the pretreatment NLR and pathological stage and lymph node involvement was evaluated using logistic regression analysis. Time of biochemical recurrence was determined using the Kaplan–Meier method. Cox's proportional hazard regression model was used to compare the time of biochemical recurrence between the groups.As compared with patients in the low-NLR group, those in the high-NLR group had an increased risk of pT3–4 disease (odds ratio (OR), 1.883; 95% confidence interval (CI), 1.419–2.500; P < 0.001), and a 1.7-fold increased risk of lymph node involvement (OR, 1.685; 95% CI, 1.101–2.579; P = 0.016). For the subset of 237 patients, those with a high NLR showed a significantly shorter median biochemical recurrence-free survival time (51.9 months) than those with a low NLR (76.5 months; log-rank test, P = 0.019). However, multivariate analysis indicated that the NLR was not an independent predictor of biochemical recurrence (hazard ratio, 1.388; 95% CI, 0.909–2.118; P = 0.129).Our findings suggest that the pretreatment NLR may be associated with pathological stage and lymph node involvement in PCa patients receiving RP, and that PCa patients with a high NLR may have a higher rate of biochemical recurrence following RP than those with a low NLR.

Prostate carcinoma with positive margins at radical prostatectomy: role of tumour zonal origin in biochemical recurrence.

To assess the influence of tumour zonality on biochemical recurrence (BCR) after radical prostatectomy (RP) with a histologically confirmed positive surgical margin (PSM). Data from 382 patients that underwent RP with either transition zone (TZ) or peripheral zone (PZ) tumours involving PSMs between 1998 and 2010 were retrieved from the Abbott West Australian Prostatectomy Database. Statistical analysis was used to evaluate the relationship of various tumour clinicopathological parameters, e.g. zonal origin of tumour, tumour volume, Gleason score, and stage to the development of BCR RESULTS: There were 51 TZ and 331 PZ tumours with PSMs identified. The TZ tumours compared with PZ tumours were larger (median 5.67 vs 3.64 mL, P < 0.001), more frequently lower grade (Gleason score 6 33% vs 5%, P < 0.01), organ confined (51% vs 35.6%, P = 0.073), and preferentially involved the bladder neck (49% vs 6%, P < 0.001). Tumour zonality was not associated with BCR for the entire cohort. TZ and PZ tumours had similar 5-year BCR-free survival rates (58% vs 63%, P = 0.691) and comparable time to development of BCR (14.4 vs 19.2 months, P = 0.346). On univariate analysis, preoperative PSA level, PSM at the bladder neck, tumour volume, Gleason score (P < 0.001) and tumour stage were independent predictors of BCR for the entire cohort. On multivariate analysis tumour volume and Gleason score retained significance as independent predictors of BCR. Tumour zonality was not directly associated with BCR. Of the patients who received adjuvant therapy, the incidence of BCR was similar for TZ and PZ tumours (58% vs 67%, P = 0.077), although TZ tumours failed significantly earlier (mean 4.4 vs 16.4 months, P = 0.037). PSA recurrence in patients with histologically confirmed PSMs after RP is independent of the zonal location of the index tumour. However, tumour zonal origin may have an indirect influence on PSA relapse, as TZ tumours tend to be of large volume and more likely involve the bladder neck margin, both risk factors for BCR. Bladder neck margin involvement is associated with higher rates of BCR than other sites of PSMs. The preoperative identification of TZ tumours might aid surgical planning with appropriate alteration of RP technique to incorporate wider surgical margins at the bladder neck. Adjuvant radiotherapy appears to be associated with adverse outcome for TZ tumours, a novel finding which warrants further investigation.

PD43-10 VARIATION IN SURGICAL TREATMENT OF PROSTATE CANCER IN AFRICAN AMERICAN PATIENTS

METHODS: We identified patients with D’Amico low and intermediate risk prostate cancer undergoing RARP between June 2008 and June 2014 by a single high volume surgeon (DIL). We then compared clinical, pathological, oncological, and functional outcomes between AA to non-African American patients. We defined continence as zero pads or one “security” pad per day. Potency was defined as erections strong enough for penetration that were also reported as satisfactory. RESULTS: The study consisted of 1,849 patients, of which 181 (9.8%) were AA. AA patients had a younger median age (58 v. 60 years old, p1⁄40.04), higher BMI (28.2 v. 27.4, p1⁄40.005), higher preoperative PSA (5.2 v. 4.6, p<0.001), and higher proportion of clinical Gleason score 4þ3 (15.7% v. 8.6%, p1⁄40.009). There was no difference in pathologic Gleason score, pathologic stage, extra-capsular extension, seminal vesicle invasion, lymph node involvement, and positive surgical margins. However, AA experienced higher rates of biochemical recurrence (1.3% v. 20.5% p<0.001), which remained significant even on multivariate analysis. At 24month follow-up, similar rates of potencywere achievedby both AA & non-AA (52.4% v. 65.2% p1⁄40.13). At 12 month follow-up, similar rates of continencewere achieved by both AA and non-AA (92.8% v. 96.2%p1⁄40.09); however, log rank test revealed that AAwere slower to recover continence (p<0.001). By 24 months, “trifecta” was achieved by 61% of non-AA, but only 44.1% of AA (p<0.001). CONCLUSIONS: African Americans had a greater risk of biochemical recurrence after RARP compared to non-AA. Although similar rates of functional outcomes were achieved, AA were slower to recover continence and less likely to achieve “trifecta” status.

PD43-09 ONCOLOGICAL AND FUNCTIONAL OUTCOMES FOR AFRICAN AMERICANS UNDERGOING ROBOTIC ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 2015PD43-09 ONCOLOGICAL AND FUNCTIONAL OUTCOMES FOR AFRICAN AMERICANS UNDERGOING ROBOTIC ASSISTED RADICAL PROSTATECTOMY Eugene Pietzak, Sylvia Yu, Jeremy Bonzo, Benjamin Katz, and David I. Lee Eugene PietzakEugene Pietzak More articles by this author , Sylvia YuSylvia Yu More articles by this author , Jeremy BonzoJeremy Bonzo More articles by this author , Benjamin KatzBenjamin Katz More articles by this author , and David I. LeeDavid I. Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2568AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several studies have shown African Americans (AA) are more likely to experience decisional regret after Robotic Assisted Radical Prostatectomy (RARP). Our objective was to determine if AA experience differs in regards to oncological and functional outcomes after RARP. METHODS We identified patients with D'Amico low and intermediate risk prostate cancer undergoing RARP between June 2008 and June 2014 by a single high volume surgeon (DIL). We then compared clinical, pathological, oncological, and functional outcomes between AA to non-African American patients. We defined continence as zero pads or one “security” pad per day. Potency was defined as erections strong enough for penetration that were also reported as satisfactory. RESULTS The study consisted of 1,849 patients, of which 181 (9.8%) were AA. AA patients had a younger median age (58 v. 60 years old, p=0.04), higher BMI (28.2 v. 27.4, p=0.005), higher preoperative PSA (5.2 v. 4.6, p<0.001), and higher proportion of clinical Gleason score 4+3 (15.7% v. 8.6%, p=0.009). There was no difference in pathologic Gleason score, pathologic stage, extra-capsular extension, seminal vesicle invasion, lymph node involvement, and positive surgical margins. However, AA experienced higher rates of biochemical recurrence (1.3% v. 20.5% p<0.001), which remained significant even on multivariate analysis. At 24 month follow-up, similar rates of potency were achieved by both AA & non-AA (52.4% v. 65.2% p=0.13). At 12 month follow-up, similar rates of continence were achieved by both AA and non-AA (92.8% v. 96.2% p=0.09); however, log rank test revealed that AA were slower to recover continence (p<0.001). By 24 months, “trifecta” was achieved by 61% of non-AA, but only 44.1% of AA (p<0.001). CONCLUSIONS African Americans had a greater risk of biochemical recurrence after RARP compared to non-AA. Although similar rates of functional outcomes were achieved, AA were slower to recover continence and less likely to achieve “trifecta” status. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e894-e895 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Pietzak More articles by this author Sylvia Yu More articles by this author Jeremy Bonzo More articles by this author Benjamin Katz More articles by this author David I. Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP53-04 SIGNIFICANT INTER-INSTITUTIONAL VARIATIONS IN RACIAL DISPARITIES AMONG AFRICAN-AMERICAN MEN ELIGIBLE FOR PROSTATE CANCER ACTIVE SURVEILLANCE

MP53-04 SIGNIFICANT INTER-INSTITUTIONAL VARIATIONS IN RACIAL DISPARITIES AMONG AFRICAN-AMERICAN MEN ELIGIBLE FOR PROSTATE CANCER ACTIVE SURVEILLANCE

BMI is associated with larger index tumors and worse outcome after radical prostatectomy.

To investigate the impact of body mass index (BMI) on tumor characteristics and biochemical recurrence (BCR) after radical prostatectomy (RP) for prostate cancer (PCa) in Japanese men. We evaluated data from consecutive patients who had undergone RP. Data analyzed included age, preoperative serum PSA, prostatic volume, BMI (continuous or categorized (≤ 25 kg/m(2)) values), clinical and pathological findings including index tumor volume (ITV), and current status in areas such as smoker or nonsmoker and presence or absence of diabetes. We analyzed association between BMI and BCR, especially based on ITV using univariate and multivariate analysis. We analyzed data from a total of 703 patients. The median follow-up time was 38.4 months. BCR was diagnosed in 154 patients (21.9%) at a median of 9.7 months postoperatively. Multivariate linear regression analysis adjusted for preoperative variables showed a significant positive association between BMI and ITV (continuous BMI: P=0.002; categorical BMI: P<0.001, respectively), especially for higher-grade tumors (Gleason score ≥ 7). Cox proportional hazards analysis showed a significant association between continuous BMI and BCR after surgery (preoperative variables, hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.02-1.16, P=0.008), independent of clinical and pathological findings. In patients with high-risk cancer, the positive association between BMI and BCR was strengthened (preoperative variables, continuous BMI, HR 1.16, 95% CI 1.07-1.26, P<0.001; categorical BMI, HR 2.11, 95% CI 1.29-3.45, P=0.003, respectively). Greater BMI significantly correlates with higher rates of BCR after surgery; BMI is a preoperative variable associated with high-grade ITV. Our results suggest that the biological environment created by greater BMI may contribute to increasing tumor aggressiveness.

Obesity and Long-Term Survival after Radical Prostatectomy

Obesity is a modifiable risk factor associated with worse outcomes for many cancers, yet implications for prostate cancer are not well understood. Notably the impact of body mass index on long-term survival after treatment is unclear. We performed a retrospective cohort study on a large series of men who underwent radical prostatectomy to assess the impact of obesity on long-term biochemical recurrence-free survival, prostate cancer specific survival and overall survival. Between 1982 and 2012, 11,152 men underwent radical prostatectomy at a single tertiary referral center. Patients were stratified according to body mass index as normal weight (body mass index less than 25kg/m(2)), overweight (body mass index 25 to less than 30 kg/m(2)), mild obesity (body mass index 30 to less than 35 kg/m(2)) and moderate/severe obesity (body mass index 35kg/m(2) or greater), comprising 27.6%, 56.0%, 14.1% and 2.3% of thecohort, respectively. Covariates included age, preoperative prostate specific antigen, surgery year, Gleason score, pathological stage, surgical margin and race. Predictors of biochemical recurrence-free survival, prostate cancer specific survival and overall survival were identified using Cox proportional hazard models. Median followup was 5 years (range 1 to 27). Actuarial 20-year biochemical recurrence-free survival for mild and moderate/severe obesity was 65% and 51%, respectively, compared to 76% for normal weight men (p ≤0.001). In a multivariate model obesity was a significant predictor of biochemical recurrence-free survival (mild HR 1.30, p = 0.002; moderate/severe HR 1.45, p=0.028) and overall survival (mild HR 1.41, p = 0.003; moderate/severe HR 1.81, p = 0.033). However, only mild obesity was significantly associated with prostate cancer specific survival (HR 1.51, p = 0.040), whereas moderate/severe obesity was not (HR 1.58, p = 0.356). Obese men have higher rates of biochemical recurrence than normal weight patients during long-term followup. Obesity at the time of surgery independently predicts overall survival and biochemical recurrence-free survival but not prostate cancer specific survival.

MP69-10 GLYCATED HEMOGLOBIN (HBA1C) LEVELS ARE INDEPENDENTLY ASSOCIATED WITH UNFAVOURABLE PROSTATE CANCER AND DISEASE RECURRENCE AFTER RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVES: Previous studies have shown that diabetic patients diagnosed with prostate cancer (PCa) and treated with radical prostatectomy (RP) may be at higher risk of harbouring unfavourable PCa at final pathology. We hypothesized that glycated haemoglobin (HbA1c) levels, regardless of a previous diagnosis of diabetes, may be associated with adverse PCa features and higher risk of recurrence after RP. METHODS: The study included 1,249 patients treated with RP for clinically localized PCa between 2008 and 2011 at a single tertiary care center. Pre-operative HbA1c was measured in all patients the day before surgery. Uniand multivariable logistic regression models tested the association between HbA1c and pathological stage, defined as extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node involvement (LNI). Univariable and multivariable Cox regression analyses evaluated the role of HbA1c in predicting biochemical recurrence (BCR), defined as PSA 0.2 ng/ml and rising. Covariates consisted of total PSA at diagnosis, biopsy Gleason sum and clinical stage. HbA1c was tested as both continuous and categorical variable, according to the WHO classification (namely 6.5%) RESULTS: Mean and median pre-operative HbA1c levels were 5.73 and 5.60%, respectively (range 4.0-10.8%). Overall, HbA1c was 6.5% in 643 (51.5%), 500 (40%) and 106 (8.5%) patients, respectively. According to patient medical history, 124 (9.9%) had a diagnosis of diabetes. Mean and median PSA were 12.3 and 6.8 ng/mL, respectively. Clinical stage was T1 in 54.7%, T2 in 30.4% and T3 in 14.9% of the patients. Biopsy Gleason sum was 6 in 58.2%, 7 in 30.1% and 8-10 in 11.7% of the patients. Median follow up was 34 months (range 1-118). At multivariable logistic regression analyses, after adjusting for PSA, clinical stage and biopsy Gleason sum, HbA1c was an independent predictor of SVI (OR 1.43; p1⁄40.003) and LNI (OR 1.38, p1⁄40.01). At multivariable Cox regression analyses, HbA1c categorized according to the WHO definition was independently associated with the risk of BCR (p1⁄40.02), after accounting for confounders. Patients with HbA1c >6.5% had a 2.01 higher risk of BCR as compared to those with HbA1c <5.7%, after accounting for all confounders. CONCLUSIONS: Increased levels of HbA1c are independently positively associated with more adverse pathological features and higher BCR rates. These results should be taken into account when diabetic patients are considered for curative treatments of PCa.

Risk factors of biochemical recurrence after radical prostatectomy : clinical analysis of 301 cases in a single-center

Objective To analyze the risk factors of biochemical recurrence after radical prostatectomy.Methods Data were prospectively collected for 301 consecutive patients undergoing radical prostatectomy between Jan.2001 and Feb.2010.The average patient age was 69 (ranged from 51 to 81) years.Of whom,26 cases were diagnosed after TURP,and 275 cases were diagnosed by prostate biopsy.135 cases were with Gleason score less than 7,while 166 cases were with higher Gleason score.There were 26 cases in clinical stage T1a-T1b(8.6％),while 91 cases in T1c(30.2％),64 cases in T2a(21.3％),100 cases in T2b (33.2％),12 cases in T2c(4.0％),8 cases in T3a(2.7％),respectively.These patients were divided into older group (aged more than 70 years) and younger group (aged less than 70 years).There was significant difference in PSA (P=0.003) between the two groups,while there was no difference between their Gleason score (P=0.138) and clinical stage (P=0.156).All radical prostatectomies were performed by three experienced surgeons through extraperitoneal approach.Patients who accepted radical prostatectomy in our center had higher PSA and Gleason score than that of the foreign cases.The differences between the two groups in the age,PSA,clinical stage,positive biopsy core rate were compared.Results By analyzing the data of these 301 patients,we found that PSA,age,clinical stage,positive biopsy core rate could affect the biochemical recurrence after radical prostatectomy in prostate cancer patients.Besides,elderly patients had significantly higher biochemical recurrence rate (93.0％) than younger patients (87.0％).Conclusions PSA,age,clinical stage,positive biopsy core rate are the risk factors of biochemical recurrence after radical prostatectomy.However,Gleason score had no significant effect on biochemical recurrence in prostate cancer patients. Key words: Prostatic neoplasms; Biochemical recurrence; Age; Radical prostatectomy

How significant is upgrade in Gleason score between prostate biopsy and radical prostatectomy pathology while discussing less invasive treatment options?

Objective.This study aimed to assess the oncological outcomes of patients experiencing an upgrade from their initial biopsy pathology, and to determine whether these tumours have characteristics resembling their initial biopsy Gleason score (GS) or final radical prostatectomy (RP) GS. Material and methods. Data on 632 patients undergoing open retropubic RP between January 1994 and May 2011 at Ankara University were investigated retrospectively. Data included age, preoperative prostate-specific antigen (PSA), clinical stage, biopsy GS, prostate volume, RP specimen GS, surgical margin positivity, pathological T stage and biochemical recurrence. Biochemical recurrence of GS concordant and upgraded tumours was compared. Results.GS concordance was found in 378 cases (59.8%) and GS upgrading was observed in 183 patients (28.9%). GS upgraded tumours were found to have higher biochemical recurrence rates than their corresponding concomitant GS group. Multivariate analysis revealed that serum PSA level, pathological T stage and GS upgrading were independent prognostic factors for biochemical recurrence. Age and prostate volume were not found to be independent prognostic factors. Conclusion. Upgrade in biopsy GS is a predictor for aggressive tumours with a higher risk for biochemical recurrence than concordant tumours. It may be observed in about a quarter of patients. As it was not possible to identify correctly those patients who may experience an upgrade in GS, patients who are candidates for less invasive treatment options must be informed about the risk of upgrading and the possibility of a worse clinical course.

1500 PROSTATE BIOPSY PERINEURAL INVASION IS NOT INDEPENDENTLY ASSOCIATED WITH POSITIVE SURGICAL MARGINS FOLLOWING OPEN RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized (VII)1 Apr 20131500 PROSTATE BIOPSY PERINEURAL INVASION IS NOT INDEPENDENTLY ASSOCIATED WITH POSITIVE SURGICAL MARGINS FOLLOWING OPEN RADICAL PROSTATECTOMY Benjamin Ristau, Jeffrey Tomaszewski, Yi-Fan Chen, Marnie Bertolet, Elen Woldemichael, and Joel Nelson Benjamin RistauBenjamin Ristau Pittsburgh, PA More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski Pittsburgh, PA More articles by this author , Yi-Fan ChenYi-Fan Chen Pittsburgh, PA More articles by this author , Marnie BertoletMarnie Bertolet Pittsburgh, PA More articles by this author , Elen WoldemichaelElen Woldemichael Pittsburgh, PA More articles by this author , and Joel NelsonJoel Nelson Pittsburgh, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2979AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Perineural invasion (PNI) on prostate biopsy (PB) is associated with extracapsular extension (ECE) in radical prostatectomy (RP) specimens. The presence of PNI on PB has led some to advocate resection of the ipsilateral neurovascular bundle (NVB) during surgery. We sought to determine if PB and RP PNI are independently associated with adverse pathological characteristics, positive surgical margins, higher BCR rates, and overall survival after primary treatment with RP. METHODS Prospectively collected data from 2500 patients treated with open RP by a single surgeon from 1999-2011 were reviewed. Patients were categorized into those with and without PNI on PB and RP specimens. Patients were risk stratified using pre-operative PSA level, Gleason grade, and clinical stage. In univariate and adjusted analyses, associations between PNI, clinicopathologic characteristics, and biochemical recurrence (BCR) rates were assessed. BCR was defined as two consecutive PSA levels of 0.2 ng/ml or greater or the use of any adjuvant therapy. RESULTS A bilateral nerve-sparing technique was used in 92% of patients. In unadjusted univariate analyses, PB PNI was significantly associated with Gleason score (p<0.001), clinical stage (p<0.001), positive surgical margins (p<0.001), ECE (p<0.001), seminal vesicle invasion (p<0.001), nodal status (p<0.001), and BCR (p < 0.001). On multivariate analysis, organ confinement (p<0.001), ECE (p<0.001), seminal vesicle invasion (p=0.022), and BCR (p=0.021) remained associated with biopsy PNI. Biopsy PNI was not associated with positive margins at RP (OR 1.3, 0.92-1.9; p=0.13), however the presence of PNI on RP specimens conferred a greater than 4 times increased risk of positive margins (OR 4.6, 2.3-9.2; p<0.001). Men with PNI on PB were 1.5 times more likely to experience BCR (OR 1.5, 1.1-2.0; p=0.021). PNI on PB or RP specimens was not associated with overall survival. CONCLUSIONS In men undergoing open RP for clinically localized prostate adenocarcinoma, PB PNI is associated with an increased risk of BCR. Despite NVB preservation in the majority of men, PNI on PB was not independently associated with positive surgical margins. The presence of PNI on PB should not preclude utilization of a nerve-sparing approach. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e615 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Ristau Pittsburgh, PA More articles by this author Jeffrey Tomaszewski Pittsburgh, PA More articles by this author Yi-Fan Chen Pittsburgh, PA More articles by this author Marnie Bertolet Pittsburgh, PA More articles by this author Elen Woldemichael Pittsburgh, PA More articles by this author Joel Nelson Pittsburgh, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...