Preoperative PSA Research Articles

LBA49_PR - Timing of radiotherapy (RT) after radical prostatectomy (RP): First results from the RADICALS RT randomised controlled trial (RCT) [NCT00541047

LBA49_PR - Timing of radiotherapy (RT) after radical prostatectomy (RP): First results from the RADICALS RT randomised controlled trial (RCT) [NCT00541047

91PD - Raman microscopy for the identification of an aggressive variant of prostate cancer, intraductal carcinoma of the prostate

BackgroundProstate cancer (PC), initially diagnosed on biopsies by pathologists, is the most frequent cancer in North American men. However, better tools are needed for pathologists to diagnose intraductal carcinoma of the prostate (IDC), an aggressive histopathological variant of PC for which therapeutic options are now available. Indeed, no technique or biomarker is clinically available to support the diagnosis of IDC. Raman spectroscopy (RS) provides a global molecular characterisation of the tissue by analysing how photons interact with the molecules present in the tissue. Indeed, we and other groups previously used RS to detect cancer from multiple organ types, machine learning classification models being employed to process the complex Raman data. MethodsWe used Raman micro-spectroscopy (RµS) to detect IDC on tissues from 483 first-line radical prostatectomies from three Canadian institutions. Following a rapid, standardized and low-cost protocol, we acquired an average of 7 Raman spectra per patient and generated classification models using machine learning technology. Importantly, models were trained with data from one institution before independent testing on the data from the other two institutions. ResultsThe three institutions included 272, 76 and 135 patients. Median age at diagnosis ranged from 61-62 years-old, with median pre-operative PSA ranging from 6.6-7.4 µg/L. Most patient had ≤3+4 Gleason score (60-80% of the specimens) and pT3-stage incidence was 31-55%. IDC was identified in 6-18% of the patients of each cohort. Overall, we acquired an average of 7 Raman spectra per patient. In the training cohort (N=272), RµS identified IDC with a sensitivity of 95%, a specificity of 94% and an accuracy of 94%. Results from the testing cohort were in a similar range, with sensitivities of 88 and 92%, specificities of 83 and 91% and accuracies of 85 and 91%. ConclusionsAs clinically available biomarkers of IDC have reported sensitivities/specificities of ∼80%, we here identified IDC with accuracies ≥85%. Since our classification model was trained on a cohort and independently tested on the other two, these are likely to be close to real life experience making clinical implementation a realistic outcome. Legal entity responsible for the studyThe authors. FundingCentre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM, continuum program) IVADO, Institut de valorisation des données. DisclosureAll authors have declared no conflicts of interest.

Management of low-risk prostate cancer in patients with enlarged glands and lower urinary tract symptoms: robotic total prostatectomy, a novel technique.

Low-risk prostate cancer (PCa) is primarily managed with Active Surveillance (AS). A subset of these patients have significantly enlarged glands and lower urinary tract symptoms (LUTS) recalcitrant to medical therapy. Radical treatment in this patient population risks compromise to both erectile function and continence. Therefore, our primary aim is to introduce a novel surgical technique, robotic total prostatectomy (RTP), for the management of severely enlarged prostate hyperplasia with concomitant suspicion of low-risk prostate cancer. After IRB approval and patient consultation/education, we performed RTP on 12 consecutive patients who presented with low-risk PCa and significantly enlarged prostate glands with LUTS. Inclusion criteria included patients with suspicion of low-risk malignancy, subjective/objective complaint of LUTS, and pre-operative prostate size > 60 g. Preoperative, perioperative and postoperative variables were studied in the following domains: surgical, oncologic, continence and erectile function. A total of 12 patients underwent RTP. Mean preoperative prostate volume and PSA was estimated at 96.96 g and 8.79, respectively. Surgical time, EBL and LOS was estimated at 180.8min, 189.6ml, and 2days, respectively. Post-operative variables confirmed resolution of LUTS (mean PVR 41.78/IPSS 8.3) and efficient oncologic control (mean PSA 0.04), with minimal compromise of sexual function. 100% continence was achieved at 3months. RTP is a novel, efficient surgical procedure for the treatment of patients with at-risk for low-grade malignancy and symptomatic LUTS in an enlarged gland. Expanding the indication to patients with low-risk malignancy, irrespective of prostate size may alleviate the adverse effects of radical treatment in this select subset of patients.

Investigating Association of PNI on Prostate Biopsy with Gleason Score Upgrading at Prostatectomy: a Multi-Institutional Study

Perineural invasion (PNI) is a histologic finding observed in up to 84% of patients with prostate cancer (PC), but with conflicting data regarding its prognostic significance. A recent, large, multi-institutional study of PC patients with pT2N0R0 disease found that PNI on histology was not an independent prognostic indicator of biochemical recurrence, but that PNI was associated with higher Gleason score and more diffuse disease within the prostate. We aim to assess whether PNI noted on prostate biopsy in apparently favorable-risk patients is associated with an increased risk of Gleason score upgrading at prostatectomy in patients found to have stage pT2N0M0 disease. We hypothesized that the presence of PNI on prostate biopsy would be associated with an increased risk of surgical Gleason score upgrading in this population. We identified 2,892 patients status post prostatectomy with pT2N0M0 PC from three different institutions diagnosed between 1/1/2008 and 12/31/2014. The electronic medical record was used to obtain age, biopsy and surgical PNI status, biopsy and surgical Gleason score, pre-operative PSA, surgical margin status, clinical and pathological staging, ethnicity, and year of diagnosis for each patient. Multivariable logistic regression (MVA) was used to evaluate for an association between PNI on prostate biopsy and Gleason score upgrading at surgery. Of the 2,892 patients studied, 14.5% (419/2,892) had PNI on biopsy. Of patients with PNI on biopsy, 21.5% (90/419) had Gleason score upgrading at resection, while 28.2% (699/2,473) of patients without PNI on biopsy had Gleason score upgrading at resection (p= 0.0047). On MVA, the odds ratio (OR) of Gleason upgrading at resection for patients with PNI on biopsy relative to patients without PNI on biopsy was 0.69 (p= 0.003, 95% confidence interval (CI) 0.53-0.87). The variables that were statistically significantly associated with Gleason upgrading at resection on MVA were age less than or equal to 60 years (p= 0.018, OR= 1.22, 95% CI 1.03-1.44), and pre-operative PSA greater than 4 ng/mL (p=0.015, OR 1.26, 95% CI 1.05-1.53). In post-prostatectomy patients with favorable-risk PC presence of PNI on initial prostate biopsy was not associated with Gleason score upgrading on resection. This may be due to the association of PNI with more diffuse disease, leading to increased tumor yield on biopsy, and thus more accurate overall grading on biopsy. These findings suggest that for patients with favorable-risk, clinically localized PC, biopsy PNI alone should not be a concern for more aggressive disease requiring pathologic confirmation or intervention. This may help guide treatment decision-making for men debating active surveillance, radiation, and surgery.

Nomograms to Predict the Probabilities of Adverse Features Indicated for Adjuvant Radiotherapy for Patients with Prostate Cancer That May Help to Individualize Initial Treatment Options

It is recommended that prostate cancer patients with positive margin(s)(PM) or extra-prostatic extension(EPE) after radical prostatectomy (RP) underwent adjuvant radiotherapy(RT). There is high level evidence supporting definitive RT as the primary treatment regimen as it was shown to be equivalent with RP. Predicting adverse features after surgery may help to individualize initial treatment options. The purpose of this study is to develop nomograms through the correlation of pretreatment PSA, clinical T stage and biopsy Gleason Score(GS) with adverse features such as EPE or PM that are commonly indicated for adjuvant RT. We analyzed 1921 RP patients between January, 2007 and December, 2019 at our hospital. Patients who had a history of neoadjuvant hormonal therapy, or transurethral resection of the prostate were excluded. All patients had a preoperative PSA level, biopsy GS, pelvic MRI and other examinations for staging. PSAmax level, clinical T stage (T2a/b, T2c, T3a, T3b), and biopsy GS (5 to 6, 3+4 = 7, 4 + 3 = 7, 8, 9 to 10) were recorded as preoperative predictors. These predictors were used in multivariable logistic regression analysis based nomograms to estimate the probabilities of EPE and PM after RP, respectively. The predictive accuracy and discriminative ability were determined by concordance index (C-index) and calibration curve. Analyses were performed with statistical software. A total of 1060 patients were eligible. Median age was 66(33-82) years.10.9% of the patients underwent open RP, 89.1% received laparoscopic RP, including 18 patients who received robot-assisted laparoscopic surgery. Preoperatively, 62.6% of patients had a PSA higher than 20 ng/mL; 83.1% were organ confined disease; and 76.6% had biopsy GS≤7. Postoperatively, 30.1% had PM, 54.3% had EPE. In addition, 48.7% (429/881) of patients who were clinically diagnosed with organ-confined disease(≤T2) were found to have EPE (≥T3) after surgery. As for the Gleason Score, 11.7%(95/812) of the patients who had biopsy GS< 8 had upgraded to 8 to 10 after surgery. Nomograms were developed for the predicted probabilities of having the indications of adjuvant radiation therapy (pathologically EPE disease or PM, respectively). The calibration curve for probabilities showed good agreement between prediction by nomogram and actual observation. The C-index of the nomograms for predicting for EPE disease, or PM were 0.70 and 0.76, respectively. The risk of having one of the indications of adjuvant radiation therapy increased with increases in predictors. Using clinic-pathological information, we produced nomograms which may accurately predict the probabilities of having indications for adjuvant radiation therapy after RP. Based on these nomograms, patients at high risk of having an indication of adjuvant RT may choose to receive definitive RT to avoid toxicities and therefore improve cost-effectiveness without compromising efficacy.

The Effect of Prostate Volume on Robotic-assisted Radical Prostatectomy

Objective: To investigate the effect ofprostate volume on robot-assisted radical prostatectomy.Methods: Clinical data of 75 patients underwent RARPin the Affiliated Hospital of Qingdao University wereretrospectively analyzed. The patients were dividedinto 3 groups according to size of prostate. A total of35 cases with prostate volume less than 30ml wererecorded as group 1, 27 cases with volume of 30 to50 ml were recorded as group 2, and 13 cases withvolume greater than 50ml were recorded as group3. Age, BMI, preoperative PSA, operation time,intraoperative bleeding volume, postoperative drainagevolume, indwelling time of catheter, indwelling time ofdrainage tube, total hospitalization time, pathologicalstage, surgical margin, urine control and biochemicalrecurrence were observed. Results: All operationswere performed under Da Vinci robot assistance, andno patient was transferred to open surgery. There wasno significant difference in age, preoperative PSA,BMI, operation time, intraoperative bleeding volume,postoperative drainage volume, indwelling time ofcatheter, total hospitalization time, pathological stage,rate of positive surgical margin and recovery of urinarycontinence between the groups. Indwelling time ofdrainage tube was longer in group with larger prostate,6.4 (±4.5) days in group 1, 6.3 (±2.9) days in group 2and 7.1 (±2.5) days in group 3. Gleason score was lowerin group with larger prostate, with statistical difference.Conclusion: Prostate volume had no significant effecton urinary control, rate of positive surgical margin andrecurrence after RARP. Gleason score of pathologicaltissue was lower and indwelling time of drainage tubewas longer in patients with larger prostate after RARP.Operation time and intraoperative bleeding volumeof large prostate patients underwent RARP need tobe further studied. RARP has certain advantages forpatients with large prostate.

Pseudogene Associated Recurrent Gene Fusion in Prostate Cancer

We present the functional characterization of a pseudogene associated recurrent gene fusion in prostate cancer. The fusion gene KLK4-KLKP1 is formed by the fusion of the protein coding gene KLK4 with the noncoding pseudogene KLKP1. Screening of a cohort of 659 patients (380 Caucasian American; 250 African American, and 29 patients from other races) revealed that the KLK4-KLKP1 is expressed in about 32% of prostate cancer patients. Correlative analysis with other ETS gene fusions and SPINK1 revealed a concomitant expression pattern of KLK4-KLKP1 with ERG and a mutually exclusive expression pattern with SPINK1, ETV1, ETV4, and ETV5. Development of an antibody specific to KLK4-KLKP1 fusion protein confirmed the expression of the full-length KLK4-KLKP1 protein in prostate tissues. The in vitro and in vivo functional assays to study the oncogenic properties of KLK4-KLKP1 confirmed its role in cell proliferation, cell invasion, intravasation, and tumor formation. Presence of strong ERG and AR binding sites located at the fusion junction in KLK4-KLKP1 suggests that the fusion gene is regulated by ERG and AR. Correlative analysis of clinical data showed an association of KLK4-KLKP1 with lower preoperative PSA values and in young men (<50 years) with prostate cancer. Screening of patient urine samples showed that KLK4-KLKP1 can be detected noninvasively in urine. Taken together, we present KLK4-KLKP1 as a class of pseudogene associated fusion transcript in cancer with potential applications as a biomarker for routine screening of prostate cancer.

The report of 3 cases rectal injury during radical prostatectomy

Objective To report the experience of rectal injury during laparoscopic radical prostatectomy(LRP). Methods The clinical data for 3 patients with iatrogenic rectal injury in LRP in our hospital between January 2015 and October 2018 were retrospectively analyzed. The data of these three patients were as follows: age 69-79 year, mean 74.3 year; BMI 25.6-28.6 kg/m2, mean 27.1 kg/m2; preoperative PSA 5.7-74.1 ng/ml, mean 32.7 ng/ml; prostate volume 55.2-80.3 ml, mean 65.3 ml; preoperative TMN stage T1b-3aN0M0, preoperative Gleason score 6-8. One patient received neoadjuvant hormonal therapy; one patient did HoLEP three month before LRP. Surgical method: When rectal injury was noted, we continued our dissection between the correct layers until prostatectomy was completed. Then the wound in the rectum was thoroughly checked and irrigated with diluted povidone iodine. The wound was trimmed according to the wound condition, and the suture was conducted by absorbable silk at three layers: the rectal mucosa layer, the outer layer of the rectal wall, the posterior layer of the fascia. Then we rinsed the wound with iodophor and completed the urethral reconstruction. Results The operative time was 138-210 min, mean 166.7 min, and repair time was 30-41 min, mean 34.3 min. The intraoperative blood loss was 110-215 ml, mean 158.3 ml. Rectal injury occurred during prostatic apical dissection in 1 patients, during dissection of Denonvilliers fascia in 2 patient. The size of the lesions was 1.0-1.5 cm, mean 1.2 cm. All of the rectal injuries were recognized during the operation, and three-layered sutures were used for the primary repair. None of the cases required ileostomy procedure. Diet recovery time was 6-7 d, mean 6.3 d. The duration of transurethral catheter insertion was 10-14 d, mean 12.3 d. The pathological stage was T2~3bN0M0, pathological Gleason score 6-9, and 1 case surgical margin positivity in the apical region of the prostate. No case occurred urorectal fistulas.2 cases received adjuvant androgen deprivation therapy. Conclusions Primary repair with laparoscopic three-layered suturing might be sufficient for the treatment of rectal injuries that occur during LRP if the lesion was small and the margin was clean. Key words: Prostatectomy; Laparoscope; Rectal injury

Down-Regulation of S100A8 is an Independent Predictor of PSA Recurrence in Prostate Cancer Treated by Radical Prostatectomy

Dysregulation of S100A8 is described in many different human tumor types, but its role in prostate cancer is unknown. To evaluate the clinical relevance of S100A8 expression in prostate cancer, a tissue microarray containing 13,665 tumors was analyzed by immunohistochemistry. Cytoplasmic S100A8 staining was compared to prostate cancer phenotype, patient prognosis and molecular features including TMPRSS2:ERG fusion status and deletions of PTEN, 3p, 5q and 6q. S100A8 immunostaining was typically seen in normal prostate tissue but lost in 60% of 9786 interpretable prostate cancers. In the remaining tumors, S100A8 was considered weak in 17.9%, moderate in 17.8% and strong in 5.4% of cases. Loss of S100A8 expression was linked to advanced tumor stage, high Gleason grade, positive nodal status, positive surgical margin and high preoperative PSA (P < .0001 each). In addition, loss of S100A8 expression was associated with TMPRSS2:ERG fusions (P < .0001), deletions of PTEN, 3p, and 6q (P < .005), and a high number of genomic deletions per tumor (P = .0009). Absence of S100A8 immunostaining was also linked to an elevated risk for early PSA recurrence (P < .0001). In a multivariate analysis limited to features that are preoperatively available, the prognostic impact of S100A8 expression (P < .0001) was independent of clinical stage, Gleason grade, and serum PSA level (P < .0001). Taken together, the results of our study demonstrate that complete loss of S100A8 expression is linked to adverse tumor features and predicts early biochemical recurrence in prostate cancer. S100A8 measurement, either alone or in combination might be of clinical utility in prostate cancers.

Factors Related to Biochemical Relapse in Patients Undergoing Radical Prostatectomy with Lymphadenectomy.

Objectives - Analyze the prevalence of biochemical recurrence (BCR) in patients submitted to radical prostatectomy with lymphadenectomy (RP-LD) the most prevalent clinical and pathological staging in the BCR and to correlate the sum of the Gleason score (GS) in the surgical specimen in patients who presented BCR. Method - Analysis of 100 patients diagnosed with prostate adenocarcinoma who performed RP-LD between 2013 to 2017. All subjects underwent transrectal prostate biopsy due to PSA or rectal examination and RP-LD. The lymphadenectomy considered in the study was the iliac-obturator, and the surgical pieces were analyzed to determine the pathological staging and its descriptors. All patients who had two or more PSA measurements &gt;0.2 ng/ml and who had undergone RP-LD were considered postoperative. Results -About 22% of the patients submitted to RP-LD presented BCR. Patients with BCR had a 59-76 age range, mean age of 66.27 years, and median age of 63.50 years. The most prevalent preoperative PSA in patients with BCR was between 10-20 ng/ml (40.90%) and the most prevalent clinical stage was cT2 (59.10%). Regarding the Gleason score, the BCR patients had the most prevalent 6 (36.37%) score in the biopsy and score 7 (4 + 3) (36.37%) in the surgical specimen. All patients (100%) with BCR presented perineural invasion, with pT3 staging (81.81%) and pN0 (77.28%) being the most prevalent in patients with BCR. Patients with BCR presented a correlation (p&lt;0.05) between the increase in the sum of pathological GS and the increase in pTN staging. Conclusion - All these variables were important in the determination of BCR in patients submitted to RP-LD, thus demonstrating the importance of this information in the analysis of the prognosis and in the follow-up of these patients.

Assessment of 5-year overall survival in bladder cancer patients with incidental prostate cancer identified at radical cystoprostatectomy.

To investigate the oncological impact of incidental prostate cancer (iPCa) found during radical cystoprostatectomy (RCP) on overall survival (OS) prognosis of urothelial carcinoma of the bladder (BCa). A total of 122 RCP cases resected between 2002 and 2012 at our center were included for study. Survival of BCa patient was compared using the Kaplan-Meier method and the log-rank test. Cox proportional hazards regression models were used to analyze the impact of iPCa on the 5-year overall mortality of BCa patients after RCP. Among the 122 BCa cases that underwent RCP, 38 cases (31.1%) had iPCa, in which, 17 cases (44.7%) were identified as clinically significant iPCa (csPCa). BCa patients with iPCa were older (71 vs 64years, p = 0.004) and had higher preoperative PSA level (3.1ng/mL vs 1.4ng/mL, p = 0.017) when compared to those without iPCa. Cases with iPCa showed a more favorable 5-year OS than cases without iPCa, although this difference did not reach statistical significance (p = 0.219). When excluding the higher risk cases with Gleason score (GS) ≥ 4 + 3 and/or preoperative PSA > 10ng/mL, BCa patients with iPCa showed a significantly longer OS than cases without iPCa on univariate analysis (p = 0.044), but not on multivariate analysis (p = 0.125). Our results demonstrated that the frequent findings of low-risk iPCa in BCa patients could indicate the potential possibility of shared pathogenesis pathways between iPCa and BCa. Future study with a larger cohort is warranted to validate this result.

Accuracy of the preoperative PSA level for predicting clinically significant incidental transitional zone-prostate cancer before endoscopic enucleation of very large adenoma.

To analyse the accuracy of high preoperative PSA levels for predicting transitional zone incidental PCa (TZ-PCa) in men with very large prostates. Perioperative data from 375 consecutive patients who underwent endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction between July 2013 and December 2018 were retrospectively reviewed. Patients were stratified into three groups according to the preoperative PSA level: low-PSA (< 4ng/mL), intermediate-PSA (4 ≤ PSA < 10ng/mL) and high-PSA (≥ 10ng/mL). Men in each group were propensity score matched by age, 5α-reductase inhibitor (5-ARI) use, prostate volume and mpMRI. The TZ-PCa incidence rate was retrospectively compared by preoperative PSA level in a propensity score model including all predetermined variables. Age, prostate volume, 5-ARI use were similar between patient groups. The median PSA levels in the low-, intermediate- and high-PSA groups were 3 [2.3; 3.4], 6.6 [5.3; 8.1] and 12.7 [11; 16.7] ng/mL, respectively. The median prostate volume was > 100 grams in all groups (108, 105 and 120cc, respectively). The T1a-Gleason 6 incidental TZ-PCa rate was statistically comparable between the three groups (3.4, 5.1 and 8.6% in the low-, intermediate- and high-PSA groups, respectively). The detection rate of clinically significant TZ-PCa was low for preoperative PSA levels > 4ng/mL (1.7%); with no difference between the intermediate- and high-PSA groups. In men with large glands, the clinically significant incidental TZ-PCa detection rate was similar regardless of the preoperative PSA level stratum. Such details may help with patient counselling during BPH surgical management.

Is there a role for testosterone replacement therapy in reducing biochemical recurrence following radical prostatectomy?

5085 Background: Historically, the use of testosterone replacement therapy (TRT) has not been recommended in men with a history of prostate cancer (PC). However, low testosterone levels are significantly associated with metabolic complications, decreased sexual function, and (more recently) high-grade PC. In 2009, in hopes of improving sexual function outcomes in men following radical prostatectomy (RP), we began treating low-risk patients with TRT. The current study examines the impact of TRT on biochemical recurrence (BCR). Methods: Between December 2009 and June 2018, a cohort of 850 patients underwent RP by a single surgeon. 152 (18%) men were postoperatively placed on TRT for recovery of sexual function. All data was prospectively collected and retrospectively analyzed. TRT patients were proportionately matched to 419 control patients by pathologic Gleason Grade Group (GGG) and stage. Univariate and multivariate comparisons were used to compare rates and time to BCR (two consecutive PSAs ≥ 0.2 ng/dl); Cox regression modeling was used to generate a survival function at the mean of covariates. Results: There were no statistically significant differences in preoperative PSA, age, prostate weight, pathologic GGG and stage between the control versus TRT groups. Median follow-up time was 3 years in both groups. 7/152 (4.6%) and 39/419 (9.3%) patients experienced BCR in the TRT versus control groups, respectively (unadjusted, p=0.068). In adjusted time to-analysis, TRT was an independent predictor of recurrence-free survival, after controlling for GGG, p-stage, preoperative FT and PSA. A patient on TRT was approximately 53% less likely to experience a BCR (OR: 0.534, 95%CI: 0.288-0.993). Conclusions: After accounting for pathologic GGG, stage, and other significant covariates, the use of TRT independently reduced recurrence post-RP. These results suggest the need for a multi-center randomized control trial.

Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis.

PurposeTo investigate whether whole pelvic radiotherapy (WPRT) improves biochemical relapse-free survival (bRFS) vs. prostate bed radiotherapy (PBRT) in prostate cancer patients receiving salvage radiotherapy (SRT) after radical prostatectomy.MethodsData from patients with prostate cancer who underwent SRT for biochemical recurrence between 2005 and 2012 in two academic institutions were retrospectively reviewed. Patients treated with WPRT in one hospital were compared with patients treated with PBRT in the other. Propensity scoring was performed to balance the characteristics of the different treatment groups, and bRFS was compared.ResultsData from a total of 191 patients were included in the analysis (WPRT, n = 108; PBRT, n = 83). The median follow-up period was 66 months. Prior to matching, patients who received WPRT had higher pathologic Gleason scores as well as a higher incidence of pre-SRT PSA levels >0.5 ng/mL and lower rates of concurrent androgen-deprivation therapy. Propensity score matching balanced these characteristics and generated a cohort comprising 56 patients from each group. In the matched cohort, the 5 year bRFS of the WPRT group was significantly higher than that of the PBRT group (65.9 vs. 42.2%, p = 0.017). Multivariate analysis revealed that WPRT was an independent prognostic factor for bRFS (hazard ratio: 0.45, 95% confidence interval: 0.26–0.75, p = 0.002). This benefit of WPRT on bRFS was maintained in subgroup analyses, especially in patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL.ConclusionsThese data suggest that, following radical prostatectomy, elective WPRT during SRT may improve bRFS compared with PBRT in selected patients. Patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL represent a potential subgroup who benefit most from receiving WPRT. Results of prospective randomized trials are awaited to confirm this finding.

The prognosis value of EphA3 and the androgen receptor in prostate cancer treated with radical prostatectomy.

BackgroundThis study aimed to preliminarily assess the relationship between erythropoietin‐producing hepatocellular carcinoma receptor A3 (EphA3) and androgen receptor (AR) protein expression levels and prognosis in prostate cancer (PCa) to better understand the role of EphA3 in the prognosis and progression of PCa.MaterialsWe investigated the expression of EphA3 and AR in human PCa by immunohistochemistry.ResultsEphA3 and AR were both significantly upregulated in PCa, with expression mainly localized to the nucleus. A high level of AR expression was found in 48.4% of 64 tumor samples, which was significantly more than in the adjacent tissue samples (15.6%) (P < 0.01). The percentage of samples expressing a high level of EphA3 was significantly greater in the PCa samples (54.7%) than in the adjacent tissue samples (20.3%) for the 64 tumors (P < 0.01). The high levels of EphA3 and AR expression in the PCa tissue samples were both correlated with the pathological stage, bladder and rectal invasion, distant metastasis, and preoperative PSA level (both P < 0.05). The survival time was significantly shorter in high levels of AR expression of patients. (P < 0.01). A high level of EphA3 in PCa patients suggests a poor prognosis (P < 0.05). Biochemical recurrence, distant metastasis, and the final scores of EphA3 and AR expression were significantly correlated with the prognosis of PCa (P < 0.05).ConclusionsIncreased EphA3 expression is an independent prognostic factor for a poor outcome and decreased survival in PCa.

PD45-10 IMPACT OF CLINICAL TUMOR STAGE AND PREOPERATIVE PSA-VALUE ON CANCER SPECIFIC SURVIVAL AND OVERALL SURVIVAL IN PATIENTS WITH GLEASON 9-10 ON PROSTATE BIOPSY.

INTRODUCTION AND OBJECTIVES:According to the d’Amico classification, high-risk prostate cancer (PCa)disease is defined as either preoperative PSA>20ng/ml, clinical tumor stage (cT) ≥T2c or biopsy...

Robot assisted radical prostatectomy in kidney transplant recipients: surgical, oncological and functional outcomes of two different robotic approaches.

ABSTRACTBackground:To date, few series on robot-assisted radical prostatectomy (RARP) in kidney transplant recipients (KTRs) have been published.Purpose:To report the experience of two referral centers adopting two different RARP approaches in KTRs. Surgical, oncological and functional results were primary outcomes evaluated in the study.Material and methods:We retrospectively analyzed data from 9 KTRs who underwent transperitoneal RARP or Retzius-sparing RARP for PCa from October 2012 to April 2016. Data were reported as median and interquartile range (IQR). Pre- and postoperative outcomes were compared by non-parametric Wilcoxon signed-rank test. Significant differences were accepted when p ≤ 0.05. Overall survival was assessed using Kaplan-Meier method.Results:Four KTRs underwent a T-RARP and 5 a RS-RARP. Patient median age was 60 (56-63) years. Charlson comorbidity index was 6 (5-6). Preoperative median PSA was 5.6 (5-15) ng / mL. Preoperative Gleason score (GS) was 6 in 5 patients, 7 (3 + 4) in 3, and 8 (4 + 4) in one. Pre- and postoperative creatinine were 1.17 (1.1; 1.4) and 1.3 (1.07; 1.57) mg / dL (p = 0.237), while eGFR was 66 (60-82) and 62 (54-81) mL / min / 1.73m2 (p = 0.553), respectively. One (11.1%) Clavien-Dindo grade II complication occurred. Two extended template lymphadenectomies were performed, both with nodal invasion. These two patients experienced a biochemical recurrence and were subjected to RT. Two patients (22.2%) had PSMs. Median follow-up was 42 months. Seven patients (77.8%) were continent, 5 (55.6%) were potent. Two (22.2%) patients died during follow-up for oncologic unrelated causes.Conclusions:Our series suggests that both RARP approaches are safe and feasible techniques in KTRs for PCa.

MP09-03 COULD A SPECIFIC PORTION OF D'AMICO INTERMEDIATE GROUP BE RECLASSIFIED AS A LOW RISK GROUP ACCORDING TO MULIPARAMETRIC MAGNETIC RESONANCE IMAGING?

INTRODUCTION AND OBJECTIVES:Various recent literature suggests that a negative multiparametric MRI (mpMRI) allows to rule out significant prostate cancer. The objective of our study was to investigate whether a specific portion of D'Amico intermediate risk group could be reclassified as low risk if the mpMRI is negative. We evaluated the histopathological results after radical prostatectomy (RP) in preoperative D'Amico intermediate risk patients that had a negative preoperative mpMRI.METHODS:We retrospectively identified 604 D'Amico intermediate risk patients and 355 low risk patients among 1,347 who underwent a preoperative mpMRI and radical prostatectomy in a single institution. Intermediate risk patients were sub-classified according to Gleason score, clinical stage and preoperative PSA level and the positivity of mpMRI. The final pathology from each RP specimen of each sub-classified group was compared with that of D'Amico low risk group. The MRIs were considered negative when no suspicious lesion was...

MP01-13 A HIGH PREOPERATIVE PSA LEVEL IS NOT ACCURATE TO PREDICT INCIDENTAL PROSTATE CANCER DETECTION IN PATIENT UNDERWENT ENDOSCOPIC ENUCLEATION OF THE PROSTATE FOR LARGE GLANDS.

INTRODUCTION AND OBJECTIVES:Incidental prostate cancer (IPCa) detection is estimated between 6 and 12% on open prostatectomy or morcellation sample chips analysis. High preoperative PSA level has b...

PT171 - A high preoperative PSA level is not accurate to predict incidental prostate cancer detection in patient underwent endoscopic enucleation of the prostate for large glands

PT171 - A high preoperative PSA level is not accurate to predict incidental prostate cancer detection in patient underwent endoscopic enucleation of the prostate for large glands