Primary Radical Prostatectomy Research Articles

Temporal trend in risk of prostate cancer death in men with favourable-risk prostate cancer.

Changes in work-up and histopathological assessment have caused stage and grade migration in men with prostate cancer (PCa). The aim of this study was to assess temporal trends in risk of PCa death for men with favourable-risk PCa managed with primary radical prostatectomy or observation. Men aged 75 or younger with Charlson Comorbidity index 0-1 diagnosed with favourable-risk PCa (T1-T2, prostate specific antigen [PSA] <20 ng/mL and Gleason score 6 or 7[3+4]) in the period 2000-2016 who were treated with primary radical prostatectomy or managed with observation in PCBaSe 4.0. Treatment groups were compared following propensity score matching, and risk of PCa death was estimated by use of Cox regression analyses. A total of 9,666 men were selected for each treatment strategy. The 7-year cumulative incidence of PCa death decreased in all risk and treatment groups. For example, the incidence in men diagnosed with low-risk PCa and managed with observation was 1.2% in 2000-2005, which decreased to 0.4% in 2011-2016. Corresponding incidences for men with intermediate-risk PCa managed with observation were 2.0% and 0.7%. The relative risk of PCa death was lower in men with low-risk PCa managed with radical prostatectomy compared to observation: in 2000-2005 hazard ratio (HR) 0.20 (95% confidence interval [CI] 0.10-0.38) and in 2011-2016 HR 0.35 (95% CI 0.05-2.26). Corresponding risks for men with intermediate-risk PCa were HR 0.28 (95% CI 0.16-0.47) and HR 0.21 (95% CI 0.04-1.18). The absolute risk reduction of radical prostatectomy compared to observation for men with low-risk PCa was 1% in 2000-2005 and 0.4% in 2011-2016, and for men with intermediate-risk PCa 1.1% in 2000-2005 and 0.7% in 2011-2016. Men diagnosed in 2011-2016 with low-risk and favourable intermediate-risk PCa have a similar relative benefit but smaller absolute benefit of curative treatment compared to men diagnosed in 2000-2005.

Population-based study of disease trajectory after radical treatment for high-risk prostate cancer.

To investigate long-term disease trajectories among men with high-risk localized or locally advanced prostate cancer (HRLPC) treated with radical radiotherapy (RT) or radical prostatectomy (RP). Men diagnosed with HRLPC in 2006-2020, who received primary RT or RP, were identified from the Prostate Cancer data Base Sweden (PCBaSe) 5.0. Follow-up ended on 30 June 2021. Treatment trajectories and risk of death from prostate cancer (PCa) or other causes were assessed by competing risk analyses using cumulative incidence for each event. In total, 8317 men received RT and 4923 men underwent RP. The median (interquartile range) follow-up was 6.2 (3.6-9.5) years. After RT, the 10-year risk of PCa-related death was 0.13 (95% confidence interval [CI] 0.12-0.14) and the risk of death from all causes was 0.32 (95% CI 0.31-0.34). After RP, the 10-year risk of PCa-related death was 0.09 (95% CI 0.08-0.10) and the risk of death from all causes was 0.19 (95% CI 0.18-0.21). The 10-year risks of androgen deprivation therapy (ADT) as secondary treatment were 0.42 (95% CI 0.41-0.44) and 0.21 (95% CI 0.20-0.23) after RT and RP, respectively. Among men who received ADT as secondary treatment, the risk of PCa-related death at 10 years after initiation of ADT was 0.33 (95% CI 030-0.36) after RT and 0.27 (95% CI 0.24-0.30) after RP. Approximately one in 10 men with HRLPC who received primary RT or RP had died from PCa 10 years after diagnosis. Approximately one in three men who received secondary ADT, an indication of PCa progression, died from PCa 10 years after the start of ADT. Early identification and aggressive treatment of men with high risk of progression after radical treatment are warranted.

Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part II: Treatment Delivery for Non-metastatic Biochemical Recurrence After Primary Radical Prostatectomy.

The summary presented herein covers recommendations on salvage therapy for recurrent prostate cancer intended to facilitate care decisions and aid clinicians in caring for patients who have experienced a recurrence following prior treatment with curative intent. This is Part II of a three-part series focusing on treatment delivery for non-metastatic biochemical recurrence (BCR) after primary radical prostatectomy (RP). Please refer to Part I for discussion of treatment decision-making and Part III for discussion of evaluation and management of recurrence after radiotherapy (RT) and focal therapy, regional recurrence, and oligometastasis. The systematic review that informs this Guideline was based on searches in Ovid MEDLINE (1946 to July 21, 2022), Cochrane Central Register of Controlled Trials (through August 2022), and Cochrane Database of Systematic Reviews (through August 2022). Update searches were conducted on July 26, 2023. Searches were supplemented by reviewing electronic database reference lists of relevant articles. In a collaborative effort between AUA, ASTRO, and SUO, the Salvage Therapy for Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance for the care of patients who experience BCR after initial definitive local therapy for clinically localized disease. Optimizing and personalizing the approach to salvage therapy remains an ongoing area of work in the field of genitourinary oncology and represents an area of research and clinical care that requires well-coordinated, multi-disciplinary efforts.

A US real-world study of treatment patterns and outcomes in localized or locally advanced prostate cancer patients

PurposeMen with localized or locally advanced prostate cancer (LPC/LAPC) are at risk of progression after radiotherapy (RT) or radical prostatectomy (RP). Using real-world data, we evaluated patient characteristics, treatment patterns, and outcomes in LPC/LAPC.MethodsOptum claims and electronic health records (EHR) data from January 2010 to December 2021 were queried for men with LPC/LAPC who received primary RT, RP, or androgen deprivation therapy alone within 180 days after diagnosis. Survival outcomes were analyzed using descriptive statistics and Kaplan–Meier curves. Real-world overall survival (rwOS) was compared in patients with and without evidence of disease (i.e., disease recurrence, metastasis, diagnosis of castration-resistant PC) at defined time points.Results61,772 and 62,361 men in claims and EHR cohorts met the inclusion criteria. Median follow-up was 719 and 901 days, respectively. Most men received primary RT (51.0% claims, 35.0% EHR) or RP (39.4% claims, 53.8% EHR). Survival was greatest among men treated with RP, followed by RT. Adjusted for age and comorbidity, rwOS was shorter among men with evidence of disease within 1, 3, 4, and 5 years after primary treatment than those without at the same time points.ConclusionReal-world claims and EHR data show that survival among men with LPC/LAPC differs by primary treatment and time point of disease recurrence thereafter. Poor outcomes in men with LPC/LAPC who progress early indicate an unmet medical need for more effective primary treatment. If validated for surrogacy, no evidence of disease at specific time points could represent an intermediate efficacy endpoint in future trials.

MRI lesion size is more important than the number of positive biopsy cores in predicting adverse features and recurrence after radical prostatectomy: implications for active surveillance criteria in intermediate-risk patients.

To determine associations between prostate cancer (PCa) tumor burden measured on biopsy or multiparametric magnetic resonance imaging (mpMRI) and outcomes in intermediate-risk (IR) International Society of Urological Pathology (ISUP) grade 2 men managed with primary radical prostatectomy (RP). This retrospective, multicenter study was conducted in eight referral centers. The cohort included IR PCa patients who had ISUP 2 at biopsy. We defined biopsy tumor burden as low/high based on the absence/presence of more than 25% positive cores. Tumor burden on imaging was defined as low/high based on maximum lesion diameter, <15 mm and ≥15 mm at mpMRI, respectively. The histological endpoint of the study was adverse features at RP, defined as ≥pT3a stage and/or lymph node invasion and/or ISUP ≥3 at final pathology. The clinical endpoint was biochemical recurrence (BCR) after RP. A total of 698 IR patients was included, of whom 335 (48%) had adverse features. In multivariate logistic regression analysis, there was no statistical association between tumor burden at biopsy and adverse features (p = 0.7). Tumor size ≥15 mm at mpMRI was significantly associated with adverse pathology (OR 1.65, 95%CI 1.14-2.39; p = 0.01). No significant association was observed between tumor burden at biopsy and BCR (p = 0.4). Tumor size ≥15 mm at mpMRI was significantly associated with BCR (HR 1.96, 95% CI 1.01-3.80; p = 0.04). Our data support extending the inclusion criteria to ISUP 2 men with >25% positive cores, provided they have a low tumor size at mpMRI (<15 mm). Prospective studies should be performed to validate these findings.

Oncologic Outcomes of Lymph Node Dissection at Salvage Radical Prostatectomy

Background: Lymph node invasion (LNI) represents a poor prognostic factor after primary radical prostatectomy (RP) for prostate cancer (PCa). However, the impact of LNI on oncologic outcomes in salvage radical prostatectomy (SRP) patients is unknown. Objective: To investigate the impact of lymph node dissection (LND) and pathological lymph node status (pNX vs. pN0 vs. pN1) on long-term oncologic outcomes of SRP patients. Patients and methods: Patients who underwent SRP for recurrent PCa between 2000 and 2021 were identified from 12 high-volume centers. Kaplan–Meier analyses and multivariable Cox regression models were used. Endpoints were biochemical recurrence (BCR), overall survival (OS), and cancer-specific survival (CSS). Results: Of 853 SRP patients, 87% (n = 727) underwent LND, and 21% (n = 151) harbored LNI. The median follow-up was 27 months. The mean number of removed lymph nodes was 13 in the LND cohort. At 72 months after SRP, BCR-free survival was 54% vs. 47% vs. 7.2% for patients with pNX vs. pN0 vs. pN1 (p &lt; 0.001), respectively. At 120 months after SRP, OS rates were 89% vs. 81% vs. 41% (p &lt; 0.001), and CSS rates were 94% vs. 96% vs. 82% (p = 0.02) for patients with pNX vs. pN0 vs. pN1, respectively. In multivariable Cox regression analyses, pN1 status was independently associated with BCR (HR: 1.77, p &lt; 0.001) and death (HR: 2.89, p &lt; 0.001). Conclusions: In SRP patients, LNI represents an independent poor prognostic factor. However, the oncologic benefit of LND in SRP remains debatable. These findings underline the need for a cautious LND indication in SRP patients as well as strict postoperative monitoring of SRP patients with LNI.

Salvage Radical Prostatectomy after Primary Focal Ablative Therapy: A Systematic Review and Meta-Analysis.

Focal therapy (FT) has been gaining popularity as a treatment option for localized intermediate-risk prostate cancer (PCa) due to the associated lower morbidity compared to whole-gland treatment. However, there is an increased risk of local cancer recurrence requiring subsequent treatment in a small proportion of patients. To conduct a systematic review and meta-analysis to better describe and analyze patient postoperative, oncologic, and functional outcomes for those who underwent salvage radical prostatectomy (sRP) to manage their primary FT failure. A systematic review was completed using three databases (PubMed, Embase, and CINAHL) from October to December 2021 to identify data on outcomes in patients who received sRP for cancer recurrence after prior focal treatment. 12 articles (482 patients) were included. Median time to sRP was 24 months. Median follow-up time was 27 months. A meta-analysis revealed a postoperative complication rate of 15% (95% CI: 0.09, 0.24), with 4.6% meeting criteria for a major complication Clavien (CG) grade ≥3. Severe GU toxicity was seen in 3.6% of the patients, and no patients had severe GI toxicity. Positive surgical margins (PSM) were found in 27% (95% CI: 0.19, 0.37). Biochemical recurrence (BCR) after sRP occurred in 23% (95% CI: 0.17, 0.30), indicating a BCR-free probability of 77% at 2 years. Continence (pad-free) and potency (ability to have penetrative sex) were maintained in 67% (95% CI: 0.53, 0.78) and 37% (95% CI: 0.18, 0.62) at 12 months, respectively. Our evidence shows acceptable complication rates and oncologic outcomes; however, with suboptimal functional outcomes for patients undergoing sRP for recurrent PCa after prior FT. Inferior outcomes were observed for salvage treatment compared to primary radical prostatectomy (pRP). More high-quality studies are needed to better characterize outcomes after this sequence of PCa treatments. We looked at treatment outcomes and toxicity for men treated with sRP for prior FT failure. We conclude that these patients will have significant detriment to genitourinary function, with outcomes being worse than those for pRP patients.

LBA02-09 EMBARK: A Phase 3 Randomized Study of Enzalutamide or Placebo Plus Leuprolide Acetate and Enzalutamide Monotherapy in High-risk Biochemically Recurrent Prostate Cancer

LBA02-09 EMBARK: A Phase 3 Randomized Study of Enzalutamide or Placebo Plus Leuprolide Acetate and Enzalutamide Monotherapy in High-risk Biochemically Recurrent Prostate Cancer

LBA02-09 EMBARK: A PHASE 3 RANDOMIZED STUDY OF ENZALUTAMIDE OR PLACEBO PLUS LEUPROLIDE ACETATE AND ENZALUTAMIDE MONOTHERAPY IN HIGH-RISK BIOCHEMICALLY RECURRENT PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023LBA02-09 EMBARK: A PHASE 3 RANDOMIZED STUDY OF ENZALUTAMIDE OR PLACEBO PLUS LEUPROLIDE ACETATE AND ENZALUTAMIDE MONOTHERAPY IN HIGH-RISK BIOCHEMICALLY RECURRENT PROSTATE CANCER Neal D. Shore, Murilo de Almeida Luz, Ugo De Giorgi, Martin Gleave, Geoffrey T. Gotto, Gabriel P. Haas, Miguel Ramirez-Backhaus, Antti Rannikko, Jamal Tarazi, Swetha Sridharan, Jennifer Sugg, Yiyun Tang, Ronald F. Tutrone, Balaji Venugopal, Arnauld Villers, Henry H. Woo, Fabian Zohren, and Stephen J. Freedland Neal D. ShoreNeal D. Shore More articles by this author , Murilo de Almeida LuzMurilo de Almeida Luz More articles by this author , Ugo De GiorgiUgo De Giorgi More articles by this author , Martin GleaveMartin Gleave More articles by this author , Geoffrey T. GottoGeoffrey T. Gotto More articles by this author , Gabriel P. HaasGabriel P. Haas More articles by this author , Miguel Ramirez-BackhausMiguel Ramirez-Backhaus More articles by this author , Antti RannikkoAntti Rannikko More articles by this author , Jamal TaraziJamal Tarazi More articles by this author , Swetha SridharanSwetha Sridharan More articles by this author , Jennifer SuggJennifer Sugg More articles by this author , Yiyun TangYiyun Tang More articles by this author , Ronald F. TutroneRonald F. Tutrone More articles by this author , Balaji VenugopalBalaji Venugopal More articles by this author , Arnauld VillersArnauld Villers More articles by this author , Henry H. WooHenry H. Woo More articles by this author , Fabian ZohrenFabian Zohren More articles by this author , and Stephen J. FreedlandStephen J. Freedland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003361.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Within 10 years of following definitive therapy for prostate cancer, ∼20–50% of patients experience biochemical recurrence (BCR) characterized by rising prostate-specific antigen (PSA) levels. Given that novel hormone therapy plus androgen deprivation therapy has shown improved survival in metastatic hormone-sensitive prostate cancer, the objective of EMBARK was to evaluate the efficacy and safety of enzalutamide plus leuprolide acetate (LA) and enzalutamide monotherapy, earlier in the disease course in patients with high-risk BCR. METHODS: EMBARK (NCT02319837) is a randomized, phase 3 study of patients with BCR after local therapy considered high-risk: PSA doubling time ≤9 months and PSA ≥2 ng/mL above nadir post-radiotherapy (RT) or ≥1 ng/mL after radical prostatectomy (RP)±postoperative RT. Patients were randomized (1:1:1) to enzalutamide 160 mg/day plus LA (double-blind), placebo plus LA (double-blind), or enzalutamide monotherapy (open-label). LA 22.5 mg was administered every 12 weeks. If the PSA was <0.2 ng/mL at Week 36, therapy was stopped and restarted when PSA was ≥2 ng/mL for patients with primary RP, and ≥5 ng/mL for patients without RP. The primary endpoint, determined by blinded, independent central review, was metastasis-free survival (MFS) with enzalutamide plus LA vs placebo plus LA. Key secondary endpoints were MFS of enzalutamide monotherapy vs placebo plus LA, time to PSA progression, time to antineoplastic therapy, and overall survival of enzalutamide monotherapy or enzalutamide plus LA vs placebo plus LA. RESULTS: A total of 1068 patients were eligible and randomized in the study. The primary hypothesis was that treatment intensification with enzalutamide is associated with improved MFS vs placebo. Results will be analyzed to determine if enzalutamide in combination with LA and enzalutamide monotherapy significantly improved MFS vs placebo with LA and demonstrated an acceptable safety profile consistent with previous randomized controlled trials. Data analysis is ongoing and detailed outcomes will be provided in the late-breaking submission. CONCLUSIONS: The results will address the hypothesis that in patients with high-risk BCR, enzalutamide plus LA and enzalutamide monotherapy were associated with improved MFS vs placebo plus LA. Source of Funding: Pfizer Inc. and Astellas Pharma Inc © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1190 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Neal D. Shore More articles by this author Murilo de Almeida Luz More articles by this author Ugo De Giorgi More articles by this author Martin Gleave More articles by this author Geoffrey T. Gotto More articles by this author Gabriel P. Haas More articles by this author Miguel Ramirez-Backhaus More articles by this author Antti Rannikko More articles by this author Jamal Tarazi More articles by this author Swetha Sridharan More articles by this author Jennifer Sugg More articles by this author Yiyun Tang More articles by this author Ronald F. Tutrone More articles by this author Balaji Venugopal More articles by this author Arnauld Villers More articles by this author Henry H. Woo More articles by this author Fabian Zohren More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement PDF downloadLoading ...

MP54-10 IMPACT OF URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY ON WORK STATUS, QUALITY OF LIFE AND TIME TO SURGICAL TREATMENT

You have accessJournal of UrologyCME1 Apr 2023MP54-10 IMPACT OF URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY ON WORK STATUS, QUALITY OF LIFE AND TIME TO SURGICAL TREATMENT Avery Braun, Samuel Washington, Janet Cowan, Matthew Cooperberg, Lindsay Hampson, and Peter Carroll Avery BraunAvery Braun More articles by this author , Samuel WashingtonSamuel Washington More articles by this author , Janet CowanJanet Cowan More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , Lindsay HampsonLindsay Hampson More articles by this author , and Peter CarrollPeter Carroll More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) after radical prostatectomy (RP) can impact quality of life, work status and need for additional surgery. We aim to characterize the cumulative incidence of SUI procedures and report changes in urinary function (UF) and bother (UB), physical function (PF) and work status 1 year after RP. METHODS: Men with prostate cancer (PCa) treated by primary RP (1998-2016) were selected from CaPSURE. SUI was defined as use of any urinary pads per day (ppd) 1 year after RP. SUI procedure was tracked by CPT codes for urinary sling and artificial sphincter. Patients reported work status (full-time paid, part-time paid, unpaid), UF and UB scores (0-100) using UCLA PCa Index and PF using SF36 Index. Associations of incontinence with changes in UF, UB and PF and work status were assessed (ANOVA). Lifetable estimates and Cox proportional hazards regression were used to evaluate risk of undergoing a SUI procedure. RESULTS: Of 2,989 men treated with RP, 664 (22%) reported SUI at 1 year. Mean age was 61 years. More men with SUI had ≥GG2, intermediate to high-risk disease and non-nerve sparing surgery (all p<0.01). Cumulative incidence of SUI procedures was 1.4% at 10 years after RP (0 ppd: 0,3%; 3+ ppd: 12.9%) with median time to intervention of 48 months (IQR 27, 84). SUI procedures comprised of 53% AUS, 24% slings, 9% both and 15% unspecified. Older age (HR 2.68 per 10 years, 95% CI 1.41-5.08, p<0.01) and number of ppd at 1 year (HR 3.20, 95% CI 2.27-4.50, p<0.01) were associated with higher risk of undergoing SUI procedure. UF scores declined significantly from 94 at baseline to 77 at 1 year after RP, while UB and PF remained stable. After RP, UF, UB and PF were inversely associated with increasing number of ppd from 0 to 3+ (all p<0.01). (Figure 1a) Incontinence status (SUI 15% vs no SUI 14%) was not associated with change from paid (FT or PT) to unpaid work at 1 year. QOL scores were not associated with work status. (Figure 1b). CONCLUSIONS: SUI at 1 year after RP may occur in up to 22% of patients; however, 10-year rate of SUI procedure was low at 1.4% with median time to intervention of 48 months. Incontinence affected urinary QOL but did not significantly impact work status. This information suggests that men with SUI after RP may continue to work and go under-treated despite impact on quality of life. Source of Funding: UCSF Goldberg-Benioff Program in Translational Cancer Biology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e757 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avery Braun More articles by this author Samuel Washington More articles by this author Janet Cowan More articles by this author Matthew Cooperberg More articles by this author Lindsay Hampson More articles by this author Peter Carroll More articles by this author Expand All Advertisement PDF downloadLoading ...

MP80-18 SURVIVAL AFTER RADICAL PROSTATECTOMY VS RADIATION THERAPY IN CLINICAL NODE POSITIVE PROSTATE CANCER PATIENTS: A MULTICENTRIC STUDY

MP80-18 SURVIVAL AFTER RADICAL PROSTATECTOMY VS RADIATION THERAPY IN CLINICAL NODE POSITIVE PROSTATE CANCER PATIENTS: A MULTICENTRIC STUDY

MP54-01 ASSOCIATION BETWEEN SOCIAL NEEDS AND PRIMARY TREATMENT CHOICE FOR LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP54-01 ASSOCIATION BETWEEN SOCIAL NEEDS AND PRIMARY TREATMENT CHOICE FOR LOCALIZED PROSTATE CANCER Jay Rollins, Rutul D. Patel, Kevin Labagnara, and Kara L. Watts Jay RollinsJay Rollins More articles by this author , Rutul D. PatelRutul D. Patel More articles by this author , Kevin LabagnaraKevin Labagnara More articles by this author , and Kara L. WattsKara L. Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Social Determinants of Health (SDH)–defined as the conditions where people are born, work, live, and age–impact patients’ access to resources and health outcomes in a variety of ways. Additionally, ethnic differences in primary treatment for prostate cancer have been demonstrated. We assessed the relationship between SDH score and primary treatment choice for localized prostate cancer in a diverse, urban patient population. METHODS: Using our institutional registry, we conducted a retrospective study of men diagnosed with prostate cancer between 2003–2022. Primary treatment choice–defined as either radiation therapy (RT) or radical prostatectomy (RP)–was abstracted with clinical variables. A validated SDH questionnaire, distributed over the past 5 years by our institution’s primary care department, provided self-reported demographics and patients’ concerns regarding specific social risks. Multivariable analyses controlling for age, PSA, and Gleason grade group at diagnosis were performed to analyze the association between SDH variables and primary treatment choice for localized prostate cancer. RESULTS: 217 patients completed the SDH questionnaire and met inclusion criteria; 118 (54%) and 99 (46%) received primary RT and RP, respectively. Median age was 64 years. The cohort was primarily non-Hispanic Black (43%) or Hispanic (41%), English-speaking (80%), and insured through Medicare (65%). Table 1 reports the results of binomial logistic regression models assessing the relationship between the variables of interest and primary treatment selection. Compared to White patients, patients of all other races/ethnicities were more likely to undergo prostatectomy (Non-Hispanic Black OR=9.54, p=0.04; Hispanic OR=9.55, p=0.04; Asian/Other OR=13.87, p=0.03). No specific SDH concern endorsed by patients was significantly associated with treatment choice (p>0.05 for all). CONCLUSIONS: Analysis of our cohort indicates that unmet social needs do not influence primary treatment selection for localized prostate cancer. This suggests the presence of other variables that contribute to racial/ethnic differences in treatment choice. Future studies are needed to investigate the social and cultural factors that influence how patients determine primary treatment for localized prostate cancer. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e753 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Rollins More articles by this author Rutul D. Patel More articles by this author Kevin Labagnara More articles by this author Kara L. Watts More articles by this author Expand All Advertisement PDF downloadLoading ...

MP61-03 COMPARING THE OUTCOMES OF ROBOTIC ASSISTED RADICAL PROSTATECTOMY IN BLACK AND WHITE MEN: EXPERIENCE OF A HIGH-VOLUME CENTER

You have accessJournal of UrologyCME1 Apr 2023MP61-03 COMPARING THE OUTCOMES OF ROBOTIC ASSISTED RADICAL PROSTATECTOMY IN BLACK AND WHITE MEN: EXPERIENCE OF A HIGH-VOLUME CENTER Jonathan Noel, Marcio Moschovas, Abdel Rahman Jaber, Marco Sandri, Travis Rogers, and Vipul Patel Jonathan NoelJonathan Noel More articles by this author , Marcio MoschovasMarcio Moschovas More articles by this author , Abdel Rahman JaberAbdel Rahman Jaber More articles by this author , Marco SandriMarco Sandri More articles by this author , Travis RogersTravis Rogers More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Global cancer incidence ranks Prostate Cancer (CaP) as the second highest overall, with Africa and the Caribbean having the highest mortality. Previous literature suggests disparities in CaP outcomes according to ethnicity, specifically functional and oncological are suboptimal in black men. However, recent data shows black men achieve post radical prostatectomy (RP) outcomes equivalent to white men in a universally insured system. Our objective is to compare outcomes of patients who self-identified their ethnicity as black or white undergoing RP at our institution. METHODS: From 2008 to 2017, 396 black and 4929 white patients underwent primary robotic-assisted radical prostatectomy (RARP) with a minimum follow-up of 5 years. Exclusion criteria were concomitant surgery and cancer status not available. A propensity score (PS) match was performed with a 1:1, 1:2, and 1:3 ratio without replacement. Primary endpoints were potency, continence recovery, biochemical recurrence (BCR), positive surgical margins (PSM), and post-operative complications. RESULTS: After PS 1:1 matching, 341 black vs. 341 white men with a median follow-up of approximately 8 years were analyzed. The overall potency and continence recovery at 12 months was 52% vs 58% (p=0.3) and 82% vs 89% (p=0.3), respectively. PSM rates was 13.4 % vs 14.4% (p=0.75). Biochemical recurrence and persistence PSA was 13.8% vs 14.1% and 4.4% vs 3.2% respectively (p=0.75).Clavien-Dindo complications (p=0.4) and 30-day readmission rates (p=0.5) were similar. CONCLUSIONS: In our study, comparing two ethnic groups with similar preoperative characteristics and full access to screening and treatment showed compatible RARP results. We could not demonstrate outcomes superiority in one group over the other. However, this data adds to the growing body of evidence that the racial disparity gap in prostate cancer outcomes can be narrowed if patients have appropriate access to prostate cancer management. It also could be used in counseling surgeons and patients on the surgical intervention and prognosis of prostate cancer in patients with full access to gold standard screening and treatment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e853 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Noel More articles by this author Marcio Moschovas More articles by this author Abdel Rahman Jaber More articles by this author Marco Sandri More articles by this author Travis Rogers More articles by this author Vipul Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

Choline PET/CT in recurrent prostate cancer.

Biochemical recurrence (BR) occurs in up to 40% of patients with prostate cancer (PCa) treated with primary radical prostatectomy (RP). Choline PET/CT may show, in a single-step examination, the site of tumor recurrence earlier than traditional imaging methods, particularly at low prostate-specific antigen (PSA) levels, thus influencing subsequent treatment. Patients with recurrent and non-metastatic prostate cancer (nmPCa), who were assessed with choline PET/CT, were included in the analysis. Based on imaging results, the following therapeutic strategies were chosen: radiotherapy to the prostatic bed, androgen deprivation therapy (ADT), and chemotherapy or stereotactic body radiotherapy (SBRT) to either the pelvic lymph nodes or distant metastases. We assessed the impact of age, PSA levels, Gleason score (GS), and adjuvant therapy on oncological outcomes. Data from 410 consecutive nmPCa patients with BR who underwent RP as primary treatment were analyzed. One hundred seventy-six (42.9%) patients had a negative choline PET/CT, and 234 (57.1%) patients resulted positive. In the multivariate analysis, only chemotherapy and PSA at recurrence were significant independent prognostic factors on overall survival (OS). In the PET-positive subgroup, the number of relapses, PSA post-prostatectomy, and chemotherapy impacted on OS. PSA (post-surgery and at recurrence) affected progression-free survival (PFS) in the univariate analysis. In the multivariate analysis, GS, the number of relapse sites, and PSA (post-surgery and at recurrence) were significant prognostic factors for disease-free survival (DFS). Choline PET/CT provides better accuracy than conventional imaging for the assessment of nmPCa with BR after prostatectomy, thereby enabling salvage strategies and improving quality of life.

Longitudinal analysis of persistent stress urinary incontinence after radical prostatectomy and time to definitive surgical treatment: Data from CaPSURE.

347 Background: Persistent urinary incontinence (UI) after radical prostatectomy (RP) can have significant impact on quality of life, return to work and need for additional surgery. We aim to characterize the long-term cumulative incidence of incontinence procedure and report changes in urinary function (UF), urinary bother (UB), and work status from time of RP to 1 year postop. Methods: Participants treated by primary RP (1990-2020) for prostate cancer enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry of 43 US urologic practices. UI was defined as self-reported use of &gt;1 pad per day at 1 year after RP. UI procedure was tracked with CPT codes for urinary sling and artificial urinary sphincter (AUS). Participants reported work status (full-time paid, part-time paid, unpaid) and urinary scores (0-100) using UCLA Prostate Cancer Index. Associations of incontinence with changes in urinary scores (t-test) were assessed. Lifetable estimates and Cox proportional hazards regression were used to evaluate the risk of undergoing a UI surgical procedure, with model adjustment for pre-treatment age and urinary dysfunction, surgical characteristics, and post-surgical radiation. Results: Of 5742 men treated with primary RP, 641 (11%) reported UI as defined above at 1 year post-RP. Mean age was 61 years. A larger proportion of individuals with UI underwent open RP (93% vs 7%) and non-nerve sparing (62% vs 38%). At 1 year post RP, score decline in UF (-42.6 vs -11.7) and UB (-25.5 vs -2.7) were significantly worse in the incontinent group (all p&lt;0.01). Cumulative incidence of incontinence procedures was 1.4% at 10 years with median time to UI-redirected procedure of 36 months (IQR 12, 74) after RP. Incontinence procedures comprised 52.4% AUS, 15.8% sling, 6.3% both, and 25.4% unspecified. UI (HR 10.6,95%CI 6.3-17.9), older age (per decade, HR 2.0, 95% CI1.3-3.0), history of voiding dysfunction (HR 6.1,95% CI 2.9-12.8) and receipt of radiation (adjuvant or salvage) (HR 2.4, 95% CI1.2-4.8)) were associated with undergoing incontinence procedure. Conclusions: UI at 1 year after RP may occur in up to 11% of surgical recipients. However, the rate of intervention remained low with 1.4% of the total cohort undergoing an incontinence procedure within 10 years. Incontinence affected urinary quality of life. Median time to UI procedure was 36 months. This information suggests that a significant number of men may have long – term, untreated incontinence and even those who undergo procedures to manage it may not have it in a timely fashion.

Long-Term Outcomes of Stereotactic Body Radiotherapy (SBRT) for Intraprostatic Relapse after Definitive Radiotherapy for Prostate Cancer: Patterns of Failure and Association between Volume of Irradiation and Late Toxicity.

The aim of this retrospective study was to assess the adverse effects and outcomes of salvage re-irradiation with stereotactic body radiotherapy (sSBRT) for local recurrence of prostate cancer (PCa) after definitive radiotherapy (RT). The study was focused on the adverse effects and prognostic factors for treatment toxicity, followed by an analysis of patterns of failure and survival. Patients treated with sSBRT between 2012 and 2020 at a tertiary institution were included. The exclusion criteria were a primary or salvage radical prostatectomy or a palliative sSBRT dose. Patients with oligorecurrence were eligible if all metastatic lesions were treated locally with curative intent. The Kaplan-Meier method was used to estimate time to grade ≥ 3 toxicity, local control (LC), freedom from distant metastases (FFDM), progression-free survival (PFS), biochemical control (BC) and overall survival (OS). The differences between groups (focal vs. whole-gland sSBRT) were compared using the log-rank test. The Cox proportional hazards model was used to assess prognostic factors for the listed endpoints. A total of 56 patients with a median age of 70.9 years and a median follow-up of 38.6 months were included in the analysis. The majority of them received local sSBRT only (45; 80.4%), while the rest were simultaneously treated for oligometastases (11; 19.6%). Overall, 18 (32.1%) patients experienced any grade ≥ 3 toxicity, including 1 (6.7%) patient who received focal sSBRT, and 17 (41.5%) patients treated with whole-gland sSBRT. The Planning Target Volume (per cc; HR 1.01; 95% CI 1-1.02; p = 0.025) and use of ADT (yes vs. no; HR 0.35; 95%CI 0.13-0.93; p = 0.035) were independent prognostic factors for the risk of grade ≥ 3 toxicity. The estimated rate of grade ≥ 3 adverse events was significantly higher (43.8% vs. 7.1% at 2 years; p = 0.006), and there was no improvement in the LC (92.9% vs. 85.3% at 2 years; p = 0.759) in patients treated with whole-gland sSBRT compared to focal sSBRT. The 2- and 5-year LC were 87.6% and 47.9%, respectively; the 2- and 5-year FFDM were 72.7% and 42.8%, respectively; and the 2- and 5-year PFS were 67.9% and 28.7%, respectively. The primary pattern of failure was distant metastasis. The sSBRT for local recurrence of PCa after definitive RT was associated with a high risk of severe grade ≥ 3 toxicity, which significantly increased with the volume and extent of re-irradiation.

Current Controversy and Developments Regarding the Cytoreductive Prostatectomy for Oligometastatic Prostate Cancer.

Oligometastatic prostate cancer is a term that is most often used to refer to limited sites of disseminated tumor growth following primary radical prostatectomy (RP) or radiotherapy (RT), while de novo oligometastatic is a term that is used to refer to prostate tumors that have disseminated to limited sites before definitive treatment. In patients with de novo oligometastatic prostate cancer, treatment planning must thus consider the need to manage the primary tumor and the associated distant lesions. Traditionally, resectioning primary metastatic tumors is not thought to offer significant benefits to affected patients while increasing their risk of surgery-related complications. Recent clinical evidence indicates that patients undergoing cytoreductive prostatectomy (CRP) may observe substantial enhancements in overall survival rates while not experiencing a noticeable decline in their quality of life. Nevertheless, based on the current body of evidence, it is deemed inadequate to justify revising clinical guidelines. Consequently, it is not advisable to propose CRP for patients with oligometastatic prostate cancer. The present review was compiled to summarize available data regarding the indications, functional outcomes, and oncological outcomes associated with cytoreductive radical prostatectomy to provide a robust and objective foundation that can be used to better assess the value of this interventional strategy from a clinical perspective.

Comparing the outcomes of robotic assisted radical prostatectomy in black and white men: Experience of a high-volume center.

Global cancer incidence ranks Prostate Cancer (CaP) as the second highest overall, with Africa and the Caribbean having the highest mortality. Previous literature suggests disparities in CaP outcomes according to ethnicity, specifically functional and oncological are suboptimal in black men. However, recent data shows black men achieve post radical prostatectomy (RP) outcomes equivalent to white men in a universally insured system. Our objective is to compare outcomes of patients who self-identified their ethnicity as black or white undergoing RP at our institution. From 2008 to 2017, 396 black and 4929 white patients underwent primary robotic-assisted radical prostatectomy (RARP) with a minimum follow-up of 5 years. Exclusion criteria were concomitant surgery and cancer status not available. A propensity score (PS) match was performed with a 1:1, 1:2, and 1:3 ratio without replacement. Primary endpoints were potency, continence recovery, biochemical recurrence (BCR), positive surgical margins (PSM), and post-operative complications. After PS 1:1 matching, 341 black vs. 341 white men with a median follow-up of approximately 8 years were analyzed. The overall potency and continence recovery at 12 months was 52% vs 58% (p=0.3) and 82% vs 89% (p=0.3), respectively. PSM rates was 13.4 % vs 14.4% (p = 0.75). Biochemical recurrence and persistence PSA was 13.8% vs 14.1% and 4.4% vs 3.2% respectively (p=0.75). Clavien-Dindo complications (p=0.4) and 30-day readmission rates (p=0.5) were similar. In our study, comparing two ethnic groups with similar preoperative characteristics and full access to screening and treatment showed compatible RARP results. We could not demonstrate outcomes superiority in one group over the other. However, this data adds to the growing body of evidence that the racial disparity gap in prostate cancer outcomes can be narrowed if patients have appropriate access to prostate cancer management. It also could be used in counseling surgeons and patients on the surgical intervention and prognosis of prostate cancer in patients with full access to gold-standard screening and treatment.

Functional Outcomes after Radiation Therapy or Radical Prostatectomy with Postoperative Radiation Therapy for High-Risk Prostate Cancer

<h3>Purpose/Objective(s)</h3> The use of radical prostatectomy (RP) for men with high-risk prostate cancer (PC) is increasing. RP is often utilized as a component of multi-modality therapy, as a method to intensify treatment. Many patients who undergo RP will subsequently require radiation therapy (RT), exposing patients to side effects from both treatments. While the side effects of RT and RP have been directly compared in previous studies, there is limited data comparing side effects of primary RT with those of patients undergoing RP and RT (RP/RT). We hypothesize that patients undergoing RP/RT for high-risk PC will experience significantly higher side effects than those undergoing primary RT. <h3>Materials/Methods</h3> We used the Surveillance Epidemiology and End Results (SEER) database with Medicare insurance claims to identify patients 66 years or older with primary high-risk PC who underwent RP, RT, or both between January 1, 2004 and December 31, 2013. High-risk PC was defined as disease meeting one or more of the following criteria: stage ≥ T3a, grade group ≥ 4, PSA >20. Outcomes of interest included treatment for urinary incontinence, urethral stricture, erectile dysfunction (ED), proctitis and cystitis at least 1 year after completion of primary prostate cancer treatment, which were captured using diagnosis and procedure codes. Rates of these endpoints were compared using cumulative incidence functions as well as cox proportional hazard models. Patients who were lost to follow up or died were censored at the time of their last encounter. <h3>Results</h3> The cohort included 17,649 patients, of which 15,399 were treated with primary RT (87.25%) and 2,250 were treated with RP/RT (12.75%). On multivariable analysis, compared to primary RT, RP/RT was associated with an increased risk of incontinence therapy [HR 1.907 (1.679-2.166)], stricture therapy [HR 1.865 (95% CI: 1.589-2.190)] and ED therapy [HR 2.869 (95% CI: 2.046-4.023)] after treatment for prostate cancer. Rates of therapy for cystitis or proctitis were not significantly different between these two groups. <h3>Conclusion</h3> For men with high-risk PC, treatment with RP/RT was associated with increased utilization of incontinence therapy, stricture therapy, and ED therapy after completion of prostate cancer treatment. With multiple curative treatment options and long duration of survival after treatment, the side effect profile of treatment is a major factor in determining the most appropriate course of treatment for an individual patient. Patients considering primary RP as a component of multimodality therapy for high-risk PC should be informed about the increased risk of side effects. Clinical trials are required to better evaluate this treatment paradigm.

Time to second biochemical recurrence as a prognostic indicator in postprostatectomy patients who undergo salvage radiation therapy: An RTOG 9601 based post hoc analysis.

The prognostic significance of a "second" biochemical recurrence (sBCR) after salvage radiation therapy (sRT) with/without hormonal therapy following primary radical prostatectomy in men with prostate cancer has not been examined. We hypothesized that a shorter time to sBCR will be associated with worse cancer control outcomes. The RTOG 9601 study included 760 patients with tumor stage pT2/T3, pN0, who had either persistently elevated prostate-specific antigen (PSA) postradical prostatectomy or developed subsequent biochemical recurrence with PSA levels between 0.2 and 4.0 ng/ml. All patients received sRT (with or without 2 years of Bicalutamide) from 1998 to 2015. For our study, we focused on 421 patients who had sBCR after sRT-which was defined as a PSA increase of at least 0.3 ng/ml over the first nadir. Patients were divided into two categories: early sBCR (n = 210) and late sBCR (n = 211) using median time to sBCR (3.51 years). All patients who experienced sBCR received salvage hormonal therapy. Competing-risk analysis was used to examine the impact of early versus late sBCR on prostate cancer specific mortality (CSM), after accounting for available covariates. The majority of patients were age 60 years or older (75.8%), had pT3 disease (74.8%), and Gleason score 7 (75.2%). Overall, 13.8% had persistent PSA initially after surgery. At 10 years, starting at the time of sBCR, CSM rate was 31.3% in the early sBCR group versus 20.0% in the late sBCR group. In competing-risk analysis, time to sBCR was an independent predictor of CSM, where patients with early sBCR had 1.7-fold higher CSM risk (p = 0.026) than their counterparts with late sBCR. Time to sBCR after sRT (with or without concomitant Bicalutamide) is a significant predictor of CSM following initial radical prostatectomy. This information can be used to guide subsequent treatments, and to counsel patients.