Received Radical Prostatectomy Research Articles

MP80-03 ORGASMIC FUNCTION AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VII1 Apr 2016MP80-03 ORGASMIC FUNCTION AFTER RADICAL PROSTATECTOMY Kefu Du, Chong Zhang, Angela Presson, Jonathan Tward, William Brant, and Christopher Dechet Kefu DuKefu Du More articles by this author , Chong ZhangChong Zhang More articles by this author , Angela PressonAngela Presson More articles by this author , Jonathan TwardJonathan Tward More articles by this author , William BrantWilliam Brant More articles by this author , and Christopher DechetChristopher Dechet More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2035AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We examined post-prostatectomy orgasmic function (OF) and assessed for potential predictors. METHODS Between 2005 and 2013, 499 men received radical prostatectomy and completed Expanded Prostate Cancer Index Composite, American Urological Association symptom score, and Sexual Health Inventory for Men questionnaires prospectively at baseline and at regular postoperative intervals. We used mixed effects logistic regression models to evaluate average differences in follow-up measures and interactions with time and reported odds ratio (OR) and 95% confidence interval (CI), with statistical significance evaluated at 0.05. RESULTS Median follow up was 36 months (range 5 to 61 months). Postoperative OF was worsened, the same, or improved in 300 (60.1%), 152 (30.5%), and 47 (9.4%) men, respectively. Recovery of OF plateaued at 15 to 21 months. Patients ≤ 50 years old were more likely to achieve good OF (OR for age ≤ 50 years vs. age 51 to 60 years = 3.40; CI 1.56-7.41; p = 0.001), but comparisons among age groups older than 50 years were not significant. Robotic status did not affect OF, whereas bilateral nerve sparing significantly improved the likelihood of good OF compared to non-nerve sparing (OR = 5.00; CI 1.61-15.6; p = 0.04). The odds for patients with poor preoperative OF to achieve good postoperative OF was only 8.2% of that for men with good preoperative OF (p < 0.001). The effect of age, nerve sparing status, and preoperative OF persisted in subgroup analysis of 356 patients with > 21 months follow up (all p < 0.002). Good postoperative OF was positively associated with good erectile function (EF) (OR = 43.7; CI 25.2-75.9; p < 0.001) and sexual desire (OR = 5.1; CI 3.8-6.8; p < 0.001) but negatively associated with moderate to severe urinary incontinence (OR = 0.32; CI 0.19-0.54; p < 0.001) and lower urinary tract symptoms (OR = 0.63; CI 0.47-0.84; p = 0.002). Patients who were bothered by their EF were also likely to be bothered by their OF (OR = 189; CI 107-336; p < 0.001). However, use of erectile aids was not significantly related to OF (p = 0.06-0.58). In subgroup analysis of men with > 21 months follow up who had poor postoperative EF, the association of age ≤ 50 years (OR = 3.849; CI 1.136-13.044; p = 0.03) and bilateral nerve sparing (OR = 3.268; CI 1.355-7.882; p = 0.008) with good OF persisted, suggesting their independent effect on OF apart from that on EF. CONCLUSIONS Orgasmic function is negatively impacted by radical prostatectomy and takes 15 to 21 months to recover. Predictors of orgasmic function include age, nerve sparing status, preoperative orgasmic function, erectile function, sexual desire, and urinary control and function. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1043-e1044 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Kefu Du More articles by this author Chong Zhang More articles by this author Angela Presson More articles by this author Jonathan Tward More articles by this author William Brant More articles by this author Christopher Dechet More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP50-12 THE IMPACT OF LOCAL TREATMENT ON OVERALL MORTALITY IN PATIENTS DIAGNOSED WITH PRIMARY METASTATIC PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: The role of local treatment (LT) in prostate cancer (PCa) patients with M1 disease at diagnosis is controversial. We set to test the hypothesis that the potential efficacy of such treatment on overall mortality (OM) is influenced by tumor characteristics, as well as patient general health status. We based our analyses on the National cancer database (NCDB), which captures 70% of newly diagnosed tumors in US. METHODS: We focused on 16,274 PCa patients diagnosed with M1 disease, between 2004 and 2011, within the NCDB database. Men receiving radical prostatectomy, and/or radiotherapy targeted to prostate were categorized as LT, everybody else was categorized as non-local treatment (NLT). Multivariable regression analysis (MVA) including tumor and patient characteristics was used to predict OM in patients that received NLT. To assess whether the benefit of LT was different by baseline risk, we tested the interaction between predicted OM risk and LT status. RESULTS: Overall, 719 (4.4%) of patients received LT. Patients with NLT tended to be older, had higher comorbidity, and harbored more aggressive tumors. (all p 1 vs 0, respectively), PSA (HR 1.003), biopsy Gleason (HR 1.4 for 8-10 vs. 7), clinical stage (HR 1.09 for cT3/4 vs cT1/2), and clinical M stage (HR 1.5, and 1.9 for M1b vs M1a and M1c vs M1a, respectively) were independent predictors of OM (all p<.001). These variables were use to predict OM (c-index 89%), and plot it against observed survival (figure). The interaction between predicted OM, and LT status was significant (p<.001), which implies that LT impact on OM is influenced by tumor and patient characteristics that were included in the MVA model. CONCLUSIONS: Men with M1 PCa at diagnosis might benefit from LT in terms of OM. However, this is true only for patients with relatively low tumor risk, and good general health condition. Our model can help deciding which patients can benefit from LT. Specifically, those with predicted 3-year OM risk <70% seem to benefit the most.

Nomograms for predicting Gleason upgrading in a contemporary Chinese cohort receiving radical prostatectomy after extended prostate biopsy: development and internal validation

The current strategy for the histological assessment of prostate cancer (PCa) is mainly based on the Gleason score (GS). However, 30-40% of patients who undergo radical prostatectomy (RP) are misclassified at biopsy pathologically. Thus, we developed and validated nomograms for the prediction of Gleason score upgrading (GSU) in patients who underwent radical prostatectomy after extended prostate biopsy in a Chinese population. This retrospective study included a total of 411 patients who underwent radical prostatectomy at our institute after having prostate biopsies between 2011 and 2015. The final pathologic GS was upgraded in 151 (36.74%) of the cases in all patients and 92 (60.13%) cases in men with GS=6. In multivariate analyses, the primary biopsy GS, secondary biopsy GS and obesity were predictive of GSU in the patient cohort assessed. In patients with GS=6, the significant predictors of GSU included the body mass index (BMI), prostate-specific antigen density(PSAD) and percentage of positive cores. The area under the curve (AUC) of the prediction models was 0.753 for the entire patient population and 0.727 for the patients with GS=6. Both nomograms were well calibrated, and decision curve analysis demonstrated a high net benefit across a wide range of threshold probabilities. This study may be relevant for improved risk assessment and clinical decision-making in PCa patients.

Relationship of phosphodiesterase type 5 inhibitor to biochemical recurrence after definitive therapy for prostate cancer.

119 Background: Phosphodiesterase type 5 inhibitors (PDE5i) are commonly utilized among men receiving definitive treatment for prostate cancer (PCa). Recently, contradictory clinical evidence regarding the association between biochemical recurrence (BCR) and receipt of PDE5i has been reported. We aimed to clarify this question among a multi-center, cohort of men with PCa. Methods: Participants enrolled in Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) at diagnosis and received radical prostatectomy, RP, or radiation therapy, RT (external beam radiation therapy or brachytherapy) without androgen deprivation therapy ≤ 6 months. We examined associations between clinical, Prostate Cancer Index Sexual Function score, SF (0-100 (best)), and pathological characteristics as well as baseline, time-dependent and ever-use of PDE5i (patient or physician reported) with risk of BCR using descriptive analyses, Kaplan-Meier method, and multivariate Cox proportional hazards models. Results: A total of 4,844 men were identified (3,847 RP, 997 RT.) Men received RP at median age 61 years (IQR 56-66), had a mean baseline SF score 62.4 (SD 26.7), were followed for a median of 77 months (IQR 36-117), and 3,089 (80%) were prescribed or reported use of PDE5i post-operatively. Patients treated with RT were older with a median age 69 years (IQR 63-74) and mean baseline SF score 46.6 (SD 29.5), were followed for a median of 91 months (IQR 53-125), and had lower rates of reported PDE5i usage (421 men, 42%). In Cox regression models baseline use (HR = 0.9 (95% CI 0.3-2.4) p = 0.83) and ever-usage (HR = 0.7 (0.5-1.1) p = 0.73) of PDE5i were not independently associated with BCR after RP. Time-dependent use (HR 1.3 (0.6, 2.7) p = 0.45) also was not associated with BCR after RP among men taking PDE5i medications. Baseline (HR = 4.6 (0.6-37.3) p = 0.14) and ever-usage (HR 0.6 (0.3-1.5) p = 0.30) also were not associated with BCR after RT. This study was limited by incomplete data on prescription compliance. Conclusions: PDE5i usage following RP or RT for PCa was not associated with BCR. PDE5i therapy should not be withheld due to concerns that it increases the risk of disease recurrence.

External validation of a prognostic Gleason grade classification system.

123 Background: We aimed to evaluate a recently proposed prognostic Gleason grading system among two distinct cohorts of men receiving treatment for localized PCa with extended clinical follow. Methods: We identified patients receiving treatment with radical prostatectomy (RP) in two settings: an academic referral center and the multi-center Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE) registry. We examined the independent prognostic ability of the proposed grade groups (3+3; 3+4; 4+3; 4+4; 9-10), adjusted for significant clinical and pathological characteristics, on disease recurrence, defined as two consecutive PSA values ≥ 0.2 ng/mL or receipt of salvage treatment, using Cox proportional hazards models. Adjusted pairwise comparisons were made between grade groups. Distant disease endpoints including metastatic progression and prostate cancer specific mortality (PCSM) were similarly evaluated within the CaPSURE cohort. Results: We identified 1,734 men receiving treatment at UCSF with immediate RP with pathologic assessment consistent with the 2005 ISUP modification, and 4,564 men within the CaPSURE database. Median follow up within the UCSF cohort was 33 months (interquartile range, IQR 16-58) and 91 months (IQR 50-135) within CaPSURE. Relative to Gleason grade 3+3, all prognostic Gleason grade groups were independently associated with risk of recurrence among the UCSF cohort (all p &lt; 0.01). Adjusted pairwise comparisons of biopsy and pathologic Gleason groups, except 4+3 versus 4+4, also were statistically significant. Among the CaPSURE cohort, biopsy and pathologic prognostic Gleason grade groups were independently associated with risk of recurrence, metastatic progression and PCSM, though pairwise distinctions between Gleason 4+3 and 4+4 and Gleason 4+4 versus 9-10 were not significant. This study was limited by the comparatively smaller proportion of men receiving radical prostatectomy for higher Gleason grade ( &gt; 4+4) disease. Conclusions: A proposed prognostic Gleason classification system stratifies men according to the risk of recurrence and downstream endpoints. However, the discrimination of outcomes among higher grade disease appeared less robust.

On the Association between Travel Distance and Treatment Choice for Low-Risk Prostate Cancer: Results from a Rural State

Background: Evidence suggests that cancer patients with increased travel burden to treatment centers may have limited treatment options. Purpose: To investigate the association between travel distance to a treatment facility and initial treatment choice among young men with low-risk prostate cancer in a rural state. Methods: A retrospective medical charts review was conducted of young men (65 years or younger) newly diagnosed with low-risk prostate cancer from January 1, 2005 through December 31, 2014 who were treated with either active surveillance, radical prostatectomy, or brachytherapy at either of the two major hospital systems in Bismarck, ND, USA. Results: Information on a random sample of 242 patients was studied. The majority of patients (66%) received radical prostatectomy. Patients who received radical prostatectomy were significantly younger (p-value 0.001). PSA at diagnosis, clinical stage, and Gleason score were not associated with treatment choice (p-value = 0.06; p-value = 0.1794; and p-value = 1.00; respectively). Adjusting for age at diagnosis, PSA at diagnosis, and treatment facility, treatment choice was not associated with travel distance (p-value = 0.309). Patients treated at St. Alexius facility were more likely to undergo radical prostatectomy than Sanford health patients (p-value Conclusions: We found no association between travel distance and treatment choice for low-risk prostate cancer. Treatment choice was associated with institution which may suggest institutional bias in patterns of care.

Preoperative predictive factors and further risk stratification of biochemical recurrence in clinically localized high-risk prostate cancer.

To identify preoperative predictive factors for biochemical recurrence (BCR) and to further stratify its risk in high-risk localized prostate cancer patients receiving radical prostatectomy (RP). Subjects included 195 high-risk prostate cancer patients undergoing RP from 2000 to 2012. RP consisted of retropubic radical prostatectomy and robot-assisted radical prostatectomy, involving 84 cases and 111 cases, respectively. BCR was defined as a prostate serum antigen (PSA) level ≥0.2ng/mL. BCR-free survival (BCRFS) was calculated using the Kaplan-Meier method. Preoperative predictors of BCR were assessed with Cox's proportional hazard regression analysis. Eighty-nine patients (45.6%) experienced recurrence. BCRFS rates 3 and 5years after RP were 58 and 50%, respectively. Prostate volume, transition zone volume, and Gleason score were not significantly associated with BCR. Patients with higher preoperative PSA, PSA density (PSAD), PSA density of the transition zone, percentage of positive cores (PPC), and PPC from the dominant side showed significantly lower BCRFS. The PPC from the dominant side and PSAD were significant independent prognostic factors for BCR. Using these variables, the hazard ratio of BCR could be calculated and patients stratified into three risk groups. The 5-year BCRFS rates for Groups 1, 2, and 3 were 64.9 %, 48.1 %, and 21.3%, respectively. Patients with high-risk localized prostate cancer as currently defined do not have uniformly poor prognosis after RP. PPC from the dominant side and PSAD are significant predictors of BCR. These factors can identify high-risk patients with very poor prognosis.

New Rates of Interventions to Manage Complications of Modern Prostate Cancer Treatment in Older Men

BackgroundInterventions to treat complications from prostate cancer (PCa) treatment are common and affect the course of a patient's life. ObjectiveTo examine rates of complications other than urinary incontinence and impotence for older patients treated for PCa. Design, setting, and participantsPopulation-based retrospective cohort study of patients aged 65–79 yr receiving radical prostatectomy or radiotherapy (RT) from 2001 to 2008 in the US Surveillance Epidemiology and End Results and Medicare linked databases. Outcome measures and statistical analysisComplications were organised in three categories: urologic procedures, rectal–anal procedures, and major surgeries. We analysed the role of primary treatment on the number of complications using negative binomial regression. Results and limitationsAmong 60476 men, 14492 underwent primary surgery and 45984 underwent primary RT; 33418 (55%) experienced at least one complication (mean: 2.6 complications per patient). For both groups, complications peaked within 2 yr of treatment but continued at a steady rate for 10 yr. Patients treated with radiation had higher rates of urologic procedures (adjusted relative rate [aRR]: 1.25; 95% confidence interval [CI], 1.2–1.3; p<0.0001) and rectal–anal procedures (aRR: 1.4; 95% CI, 1.4–1.5; p<0.0001) but a lower rate of major surgeries (aRR: 0.9; 95% CI, 0.8–0.9; p<0.0001) compared with those having surgery. Because patients treated with RT were older and more comorbid, selection bias limits the strength of conclusions that can be drawn from this data. ConclusionsComplications are common following PCa cancer treatment and occur many years after treatment. The primary treatment is an important predictor of complication rates that may inform treatment decisions and long-term survivorship plans. Patient summaryWe examined complications after prostate cancer treatment in a large American population. Patients treated with radiotherapy rather than surgery had higher rates of complications requiring urologic procedures and rectal–anal procedures but lower rates of open surgeries. However, we were only able to examine men aged >65 yr, and this, along with the observational study technique, means that these results may not apply to all patients and that factors beyond those that we could measure may have affected these results.

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.

Let-7a and its target, insulin-like growth factor 1 receptor, are differentially expressed in recurrent prostate cancer.

Prostate cancer (PCa) is the most common malignancy in males worldwide. Approximately 30% of those patients who received radical prostatectomy developed clinical recurrence accompanied by elevated serum prostate‑specific antigen levels. Although knowledge regarding the development of PCa has been significantly improved, the molecular mechanism underlying recurrence remains largely unknown. The objective of the present study was to identify the differentially expressed microRNAs (miRNAs) in recurrent PCa to explore the possible involvement of miRNAs in the relapse. The expression of 6 miRs that have been previously reported to be downregulated in PCa stem cells were examined in a total of 32 recurrent and 36 non‑recurrent PCa samples, and let‑7a was substantially decreased in the recurrent PCa. Using the online prediction tools, let‑7a was identified to virtually target insulin‑like growth factor 1 receptor (IGF1R). IGF1R as a target of let‑7a was subsequently validated using the luciferase assay. Exogenous expression of let‑7a suppressed the expression of IGF1R, and reduced the proliferation of PCa cells by introducing apoptosis to the cells. In conclusion, the present data demonstrated a possible involvement of let‑7a in the pathogenesis of recurrent PCa, and it may be a potential target of the disease.

Influence of clinical factors on Gleason score upgrade in patients undergoing radical prostatectomy

To evaluate clinical factors affecting Gleason score upgrade in patients receiving radical prostatectomy (RP). A total of 322 patients with prostate cancer who received RP from January 2012 to December 2013 at Department of Urology at Fudan University Shanghai Cancer Center were included, and their data of age, body mass index (BMI), prostate-specific antigen (PSA), prostate volume, percentage core, clinical staging, pathological characteristics, biopsy Gleason score and RP Gleason score were analyzed. Differences in categorical variables and continuous variables were compared using χ² tests and Student's t-test, respectively. Unconditional multiple logistic regression was used to estimate OR and 95% CI of the association of Gleason score upgrade with clinical factors. Gleason score upgrade occurred in 107 of 322 (33.3%) patients. There was no difference in age, BMI and clinical staging between the two groups. Compared with patients without Gleason score upgrade, higher levels of PSA (χ² =6.740, P=0.034), smaller prostate volume (t=3.481, P=0.002) and elevated percentage core (t=-2.097, P=0.037) were observed in patients with Gleason score upgrade. In addition, lymph node metastasis (χ² =4.193, P=0.041) and extracapsular extension (χ² =4.747, P=0.029) were more common in patients with Gleason score upgrade. After adjusting for potential confounders, PSA levels (OR=2.451, 95% CI: 1.290-4.660), prostate volume (OR=0.982, 95% CI: 0.969-0.995) and percentage core (OR=2.756, 95% CI: 1.033-7.357) were independent predictors for Gleason score upgrade. Gleason score upgrade happens at a relatively high rate. PSA levels, prostate volume and percentage core are important factors affecting Gleason score upgrade.

Clinical value of core length in contemporary multicore prostate biopsy.

ObjectivesThere is little data about the clinical value of core length for prostate biopsy (PBx). We investigated the clinical values of various clinicopathological biopsy-related parameters, including core length, in the contemporary multi-core PBx.Patients and MethodsMedical records of 5,243 consecutive patients who received PBx at our institution were reviewed. Among them, 3,479 patients with prostate-specific antigen (PSA) ≤10ng/ml level who received transrectal ultrasound (TRUS)-guided multi (≥12)-core PBx at our institution were analyzed for prostate cancer (PCa). Gleason score upgrading (GSU) was analyzed in 339 patients who were diagnosed with low-risk PCa and received radical prostatectomy. Multivariate logistic regression analyses for PCa detection and prediction of GSU were performed.ResultsThe mean age and PSA of the entire cohort were 63.5 years and 5.4ng/ml, respectively. The overall cancer detection rate was 28.5%. There was no statistical difference in core length between patients diagnosed with PCa and those without PCa (16.1 ± 1.8 vs 16.1 ± 1.9mm, P = 0.945). The core length was also not significantly different (16.4 ± 1.7 vs 16.4 ± 1.6mm, P = 0.889) between the GSU group and non-GSU group. Multivariate logistic regression analyses demonstrated that the core length of PBx did not affect PCa detection in TRUS-guided multi-core PBx (P = 0.923) and was not prognostic for GSU in patients with low-risk PCa (P = 0.356).ConclusionsIn patients undergoing contemporary multi-core PBx, core length may not have significant impact on PCa detection and also GSU following radical prostatectomy among low-risk PCa group.

MP78-02 RELATIONSHIP BETWEEN THE CONTINUITY AND DISCONTINUITY OF TWO POSITIVE CORES IN PROSTATE BIOPSY SPECIMENS FOR THE PREDICTION OF LOW-RISK PROSTATE CANCER AND IDENTIFICATION OF CANDIDATES FOR ACTIVE SURVEILLANCE

INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is increasingly recognized as the recommended treatment option in prostate cancer (PCa) patients with clinically localized, low-risk disease. However, previous studies suggest that its utilization is uncommon.Weset to evaluate the nationwide utilization rate of AS in the contemporary era, identifying predictors of local treatment of the prostate in AS candidates. METHODS: We relied on the 2010e2011 Surveillance Epidemiology and End Results (SEER) database using all 18 SEER-based registries. We identified 9,049 patients that fulfilled the University of California, San Francisco (UCSF) AS criteria: prostate-specific antigen (PSA) <10ng/ ml, biopsy Gleason score 6 with no pattern 4 or 5, clinical stage T1/T2a, and percentage of positive cores <33%. The main outcome was local treatment of PCa, defined as receiving radical prostatectomy, external beam radiation therapy, or brachytherapy. Logistic regression analysis tested the relationship between receiving local treatment and all available predictors, which consisted of age, race (White vs. African American vs. Hispanic vs. Other), marital status (not married vs. married), annual family income, insurance status (uninsured vs. Medicaid covered vs. insured), total PSA, clinical stage (T1 vs. T2a), and percentage of positive cores. RESULTS: Overall, 6,130 patients (68%) received local treatment of PCa. At multivariable analysis, married patients (odds ratio [OR]: 1.63; 95% confidence interval [CI]: 1.46, 1.82; p<0.0001), insured patients (OR: 1.71; 95% CI: 1.10, 2.66; p1⁄40.016), clinical stage cT2a (OR: 1.23; 95%CI: 1.01, 1.49; p1⁄40.037), and percentage of positive cores (OR per2%:1.09; 95%CI: 1.08, 1.11; p<0.0001)weresignificantly associated with higher probability of receiving local treatment of PCa. In contrast, patient age (OR: 0.90; 95% CI: 0.89, 0.91; p<0.0001) was inversely correlated with receiving local treatment of PCa. Differently, African American (OR: 0.91; 95% CI: 0.79, 1.05; p1⁄40.2) and Hispanic patients (OR: 0.90; 95% CI: 0.76, 1.06; p1⁄40.2) did not have significantly different probability of receiving local treatment when compared toWhite patients. CONCLUSIONS: In the United States, a considerable proportion of patients suitable for AS receive local treatment of the prostate. More extensive and palpable diseases, as well as having a medical insurance, are associated with increased probability of receiving local treatment. Conversely, racial disparities in the management of contemporary AS candidates were not observed.

MP73-09 TYPE OF ANDROGEN DEPRIVATION THERAPY AFFECTS METABOLIC CONDITION AND ADIPOSE TISSUE DISTRIBUTION

INTRODUCTION AND OBJECTIVES: The adverse events of androgen deprivation therapy (ADT) to prostate cancer patients are associated with metabolic condition and adipose tissue increasing. We evaluated whether type of androgen deprivation therapy affects metabolic condition and adipose tissue distribution. METHODS: From January 2003 to March 2011, we performed definitive therapy with 6 months neoadjuvant ADT to 445 prostate cancer patients in our hospital. Among them, we analyzed the data available 146 prostate cancer patients. We retrospectively evaluated the metabolic values (glycohemoglobin (HbA1c), total cholesterol (T-cho), triglyceride (TG) value and body mass index (BMI) and adipose distribution (subcutaneous and visceral) before and after ADT. One hundred nine patients received radical prostatectomy, 28 patients with extra beam radiotherapy and 9 patients with brachytherapy. We divided patients in two groups according to the regimen of ADT; combined androgen blockade (LH-RH analog with antiandrogen drug, CAB) and LH-RH analog with estramustine (EMP) groups. The difference of BMI and adipose volume were compared between CAB and EMP group. Adipose volumes (total, subcutaneous and visceral) and abdominal circumference before and after 6 months ADT were analyzed from computed tomography by Visceral Fat Analyzer, M2 ver2.3. RESULTS: There were no significant difference in age, BMI, clinical stage and initial PSA between CAB and EMP group. HbA1c and T-cho values were significantly deceased in EMP group (P < 0.001) but TG was not different between two group. BMI was significantly increased in CAB (P < 0.001) but not changed in EMP group. Total adipose volume was significantly increased in CAB (P <0.001) but decreased in EMP group (P 1⁄4 0.027) during the 6 months ADT. The Subcutaneous fat increased in both groups (P < 0.001), and the visceral fat was increased in CAB but decreased in EMP (P < 0.001). There were no changes in abdominal circumference. Adipose increasing rates were correlated with ADT duration. CONCLUSIONS: Although the present study is retrospective, the above data suggest that ADT regimen of LH-RH analog with estramustine has potential to suppress visceral fat increases and improve glucose-lipid metabolism in the prostate cancer patients. Source of Funding: none

Incidence and predictors of upgrading and upstaging among 10,000 contemporary patients with low-risk prostate cancer.

32 Background: To inform decisions about active surveillance, we determined the incidence of upgrading and upstaging for a contemporary cohort of low-risk prostate cancer patients who received radical prostatectomy and identified clinical predictors of advanced disease. Methods: We studied 10,273 patients in the Surveillance, Epidemiology, and End Result (SEER) database diagnosed with low-risk prostate cancer (cT1c-T2a, PSA&lt;10 ng/mL and Gleason 3+3=6) in 2010-2011. Upgrading was defined as pathologic Gleason score 7-10 and upstaging as pathologic T3-T4/N1 disease. Regression coefficients were used to evaluate the predictive value of clinical factors for upgrading or upstaging. Significant factors were used to develop a risk stratification table to evaluate individual patients. Results: At prostatectomy, 44% of patients were upgraded and 9.7% were upstaged. Multivariable analysis showed age, PSA, and percent total cores positive were associated with advanced disease (all p&lt;0.001). When these variables were dichotomized by the median, age &gt;60 (Adjusted Odds Ratio [AOR] 1.39), PSA&gt;5.0 (AOR 1.28), and &gt;25% total cores positive (AOR 1.76) were significantly associated with upgrading (all p&lt;0.001). Similarly, age&gt;60 (AOR 1.42), PSA&gt;5.0 (AOR 1.44), and &gt;25% total cores positive (AOR 2.26) were associated with upstaging (all p&lt;0.001). Sixty percent of low-risk patients with PSA 7.5-9.9 and &gt;25% total cores positive were upgraded. Conclusions: A significant proportion of low-risk patients eligible for active surveillance were harboring more aggressive or locally-advanced prostate cancer. Age, PSA and percent total cores positive should be used to assess risk of upgrading or upstaging and can guide decisions to pursue further evaluation or treatment. [Table: see text]

Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy

Although the likelihood of radiation-related adverse events influences treatment decisions regarding radiation therapy after prostatectomy for eligible patients, the data available to inform decisions are limited. This study was designed to evaluate the genitourinary, gastrointestinal, and sexual adverse events associated with postprostatectomy radiation therapy and to assess the influence of radiation timing on the risk of adverse events. The Regione Emilia-Romagna Italian Longitudinal Health Care Utilization Database was queried to identify a cohort of men who received radical prostatectomy for prostate cancer during 2003 to 2009, including patients who received postprostatectomy radiation therapy. Patients with prior radiation therapy were excluded. Outcome measures were genitourinary, gastrointestinal, and sexual adverse events after prostatectomy. Rates of adverse events were compared between the cohorts who did and did not receive postoperative radiation therapy. Multivariable Cox proportional hazards models were developed for each class of adverse events, including models with radiation therapy as a time-varying covariate. A total of 9876 men were included in the analyses: 2176 (22%) who received radiation therapy and 7700 (78%) treated with prostatectomy alone. In multivariable Cox proportional hazards models, the additional exposure to radiation therapy after prostatectomy was associated with increased rates of gastrointestinal (rate ratio [RR] 1.81; 95% confidence interval [CI] 1.44-2.27; P<.001) and urinary nonincontinence events (RR 1.83; 95% CI 1.83-2.80; P<.001) but not urinary incontinence events or erectile dysfunction. The addition of the time from prostatectomy to radiation therapy interaction term was not significant for any of the adverse event outcomes (P>.1 for all outcomes). Radiation therapy after prostatectomy is associated with an increase in gastrointestinal and genitourinary adverse events. However, the timing of radiation therapy did not influence the risk of radiation therapy-associated adverse events in this cohort, which contradicts the commonly held clinical tenet that delaying radiation therapy reduces the risk of adverse events.

The association between metabolic syndrome and advanced prostate cancer in Chinese patients receiving radical prostatectomy.

The global incidence of metabolic syndrome (MetS) is dramatically increasing. Considerable interest has been devoted to the relationship between MetS and prostate cancer (PCa) risk. However, few studies have examined the association between MetS and PCa progression. This retrospective study consisted of 1016 patients with PCa who received radical prostatectomy. The association between MetS and pathological features was evaluated using logistic regression analysis. Compared with patients without MetS, those with MetS indicated an increased risk of prostatectomy Gleason score (GS) ≥8 (odds ratio [OR] =1.670, 95% confidence interval (CI) 1.096–2.545, P= 0.017), and a 1.5-fold increased risk of pT3–4 disease (OR = 1.583, 95% CI 1.106–2.266, P= 0.012). The presence of MetS was an independent predictor of lymph node involvement (OR = 1.751, 95% CI 1.038–2.955, P= 0.036). Furthermore, as the number of MetS components accumulated, the risk of a GS ≥ 8 increased. The present study indicates a significant association between MetS and advanced PCa. The results need to be evaluated in large-scale prospective cohorts.

Serum lipid profiles: novel biomarkers predicting advanced prostate cancer in patients receiving radical prostatectomy.

This study aimed to evaluate the role of serum lipid profiles as novel biomarkers in predicting pathological characteristics of prostate cancer (PCa). We retrospectively analyzed 322 consecutive patients with clinically localized PCa receiving radical prostatectomy (RP) and extended pelvic lymphadenectomy. Unconditional logistic regression was used to estimate the prostatectomy Gleason score (pGS), pathological stage and lymph node involvement (LNI) in RP specimens. Preoperative prostate-specific antigen (PSA) levels, biopsy GS (bGS), and preoperative tumor, node, metastasis staging were used as basic variables to predict postoperative pathological characteristics. Preoperative serum lipid profiles were introduced as potential predictors. A receiver operating characteristic (ROC) curve was used to determine predictive efficacy. Significant differences in pathological characteristics were observed among patients with normal and abnormal total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) levels, with the exception of pGS in the TG group. Multivariable regression analysis revealed that the odds ratio for high levels of TC for LNI compared with normal TC levels was 6.386 (95% confidence interval [CI] 1.510–27.010), 3.270 (95% CI: 1.470–7.278) for high levels of TG for pT3–4 disease, and 2.670 (95% CI: 1.134–6.287) for high levels of LDL for pGS. The area under the ROC curve of the models with dyslipidemia was larger than that in models without dyslipidemia, in predicting pathological characteristics. Abnormal TC, TG, and LDL levels are significantly associated with postoperative pathological status in PCa patients. Together with preoperative PSA levels, bGS, and clinical stage, dyslipidemia is more accurate in predicting pathological characteristics.

Artificial neural network for predicting pathological stage of clinically localized prostate cancer in a Taiwanese population

BackgroundWe developed an artificial neural network (ANN) model to predict prostate cancer pathological staging in patients prior to when they received radical prostatectomy as this is more effective than logistic regression (LR), or combined use of age, prostate-specific antigen (PSA), body mass index (BMI), digital rectal examination (DRE), trans-rectal ultrasound (TRUS), biopsy Gleason sum, and primary biopsy Gleason grade. MethodsOur study evaluated 299 patients undergoing retro-pubic radical prostatectomy or robotic-assisted laparoscopic radical prostatectomy surgical procedures with pelvic lymph node dissection. The results were intended to predict the pathological stage of prostate cancer (T2 or T3) after radical surgery. The predictive ability of ANN was compared with LR and validation of the 2007 Partin Tables was estimated by the areas under the receiving operating characteristic curve (AUCs). ResultsOf the 299 patients we evaluated, 109 (36.45%) displayed prostate cancer with extra-capsular extension (ECE), and 190 (63.55%) displayed organ-confined disease (OCD). LR analysis showed that only PSA and BMI were statistically significant predictors of prostate cancer with capsule invasion. Overall, ANN outperformed LR significantly (0.795 ± 0.023 versus 0.746 ± 0.025, p = 0.016). Validation using the current Partin Tables for the participants of our study was assessed, and the predictive capacity of AUC for OCD was 0.695. ConclusionANN was superior to LR at predicting OCD in prostate cancer. Compared with the validation of current Partin Tables for the Taiwanese population, the ANN model resulted in larger AUCs and more accurate prediction of the pathologic stage of prostate cancer.

Impact of comorbidity on health‐related quality of life after prostate cancer treatment: combined analysis of two prospective cohort studies

To improve and individualise estimates of treatment outcomes for men diagnosed with prostate cancer, we examined the impact of baseline comorbidity on health-related quality of life (HRQL) outcomes in an analysis of two pooled, prospective cohort studies. We studied 697 patients from three academic hospitals who received radical prostatectomy (RP), external beam radiation therapy (EBRT), or brachytherapy (BT). Measures of patient-reported bowel, urinary, and sexual symptoms along with physical and mental health were prospectively collected before treatment and 3, 12, 24, and 36 months after treatment. We assessed baseline comorbidity by the validated Index of Co-Existent Disease (ICED), abstracted from medical records. Regression mixed-models were built for each treatment group and HRQL outcome controlling for baseline age, education, marital status, risk group and patient-reported general health. About 71% of patients had one or more comorbid conditions at baseline. After adjusting for covariates, we found baseline comorbidity was independently associated with poorer sexual function after BT (P = 0.04) and RP (P = 0.03) but not EBRT (P = 0.35). Physical health was significantly worse for men receiving BT with more comorbidities (P = 0.02). Baseline comorbid conditions were not associated with urinary incontinence or bowel functioning. Comorbidity at baseline is significantly associated with poorer sexual function after prostate BT or RP. This information may help patients and their physicians anticipate outcomes after surgical and radiation treatments.