Uro-oncology Group Research Articles

Efficacy of avelumab maintenance therapy for advanced urothelial carcinoma with histologic subtype and divergent differentiation: a multicenter retrospective study conducted by the Uro-Oncology Group in Kyushu.

The subtype of urothelial carcinoma (SUC) has been known to possess morphological diversity for histologic subtype or divergent differentiation. However, the efficacy of avelumab against SUC remains unclear. Therefore, the effect of the treatment as well as the survival results of avelumab monotherapy were evaluated as a first-line therapeutic maintenance in patients with advanced SUC. A retrospective analysis was conducted on consecutive patients from the Uro-Oncology Group in Kyushu study population with advanced lower and upper urinary tract cancer who underwent avelumab maintenance therapy without progression after first-line platinum-based chemotherapy. Patients with pure urothelial carcinoma (PUC) and SUC were comparatively analyzed based on objective response rate (ORR), disease control rate, progression-free survival (PFS), and overall survival (OS). Out of 49 recorded patients, 38 and 11 had PUC and SUC, respectively. The most common subtype element was glandular differentiation (n=5), followed by squamous differentiation (n=3), micropapillary (n=1), and plasmacytoid subtypes (n=1). The SUC and PUC groups had comparable ORR (0% vs. 2.6%, P>0.99) and disease control rates (54.5% vs. 44.7%, P=0.73). These patient groups also showed no significant difference in PFS (median 3.9 vs. 3.1 months, P=0.33) or OS (median 16.7 vs. 22.1 months, P=0.47). The response of SUC and PUC to avelumab was comparable in patients with advanced lower and upper urinary tract cancer, indicating that avelumab maintenance therapy is also effective for SUC.

Clinical Outcomes of Enfortumab Vedotin in Advanced Urothelial Carcinoma With Prior Avelumab Versus Pembrolizumab Therapy.

This study retrospectively evaluated whether enfortumab vedotin (EV) monotherapy is effective as a late-line treatment according to prior treatment type in patients with advanced urothelial carcinoma (UC). We assessed consecutive patients from the Uro-Oncology Group in the Kyushu study population with lower and upper urinary tract cancer treated with EV monotherapy after platinum-based chemotherapy and immune checkpoint inhibitor therapy failure between December 2021 and March 2024. In particular, patients receiving avelumab maintenance or pembrolizumab therapy before EV for advanced UC were analyzed and compared according to the response rate, progression-free survival (PFS), and overall survival (OS). Of the 80 enrolled patients, 31 and 49 received avelumab and pembrolizumab before EV therapy, respectively. The avelumab and pembrolizumab groups had comparable objective response rates (48.4% vs. 44.9%, p=0.820) and disease control rates (77.4% vs. 67.3%, p=0.448). These two groups showed no significant difference in PFS from the initiation of EV (median: 6.4 months vs. 4.2 months, p=0.184); meanwhile, the avelumab group had better OS from the initiation of EV than the pembrolizumab group (median: 16.0 months vs. 10.2 months, p=0.019). Moreover, the median OS after first-line chemotherapy initiation was longer in the avelumab group than in the pembrolizumab group (40.3 months vs. 24.7 months, p=0.054). On multivariate analysis, avelumab maintenance therapy before EV reduced the mortality risk by 47% (95% confidence interval=0.27-1.03; p=0.059). EV monotherapy after avelumab maintenance therapy provides favorable survival outcomes in patients with advanced UC.

2022 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) guideline: Management of castration-resistant prostate cancer (CRPC).

2022 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) guideline: Management of castration-resistant prostate cancer (CRPC).

Rectal spacers in patients with prostate cancer undergoing radiotherapy: A survey of UK uro-oncologists.

To understand the awareness and use of rectal spacers for prostate cancer patients undergoing radical radiotherapy in the United Kingdom. An expert-devised online questionnaire was completed by members of the British Uro-oncology Group (BUG). Sixty-three specialists completed the survey (50% of BUG members at that point in time). Only 37% had used rectal spacers, mostly for private patients or those with pre-existing bowel conditions. However, many (68%) would like to use these devices in future. More than 70% of the uro-oncologists felt that bowel toxicity was underreported, but 60% believed that the use of radiotherapy without bowel toxicity was achievable with the use of rectal spacers. The current use of rectal spacers by UK uro-oncologists for patients with localised or locally advanced prostate cancer receiving radiotherapy is low and largely restricted by resourcing issues.

Management of newly diagnosed metastatic hormone-sensitive prostate cancer: A survey of UK Uro-oncologists.

To explore the practice and views of uro-oncologists in the United Kingdom regarding their use of chemotherapy and androgen receptor-targeted agents (ARTAs) in patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC). An expert-devised paper or online questionnaire was completed by members of the British Uro-oncology Group. All respondents stated that they would offer patients with newly diagnosed mHSPC docetaxel and androgen deprivation therapy (ADT) if they were sufficiently fit to receive chemotherapy (this was the only option available at the time of the survey); 64% would strongly recommend docetaxel for those with high-volume metastatic disease and 31% for those with low-volume disease. Hypothetically, if both docetaxel and ARTAs were available in the United Kingdom for mHSPC, almost 65% of respondents would recommend an ARTA with ADT to these patients in at least one-half of all cases, with the strongest recommendations to patients with high-risk disease. Imaging for the response was conducted according to suspicion of disease progression, regardless of treatment, with the minority of clinicians recommending routine imaging. If a choice of therapy was available, docetaxel would be more likely to be offered to patients with liver or lung metastases, and ARTAs to patients with bone or lymph node only metastases. Almost all respondents would offer local radiotherapy to the primary tumour in patients with low-volume disease. All the UK uro-oncologists surveyed stated that they would offer docetaxel in combination with ADT to all newly diagnosed patients with mHSPC if fit enough for chemotherapy. ARTAs would be offered to many patients if available, especially those with high-risk disease or those unfit to receive chemotherapy. Scanning was typically conducted following treatment only at the suspicion of disease progression.

UPDATE - 2021 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) castration-resistant prostate cancer (CRPC) guideline: What has changed since 2019?

UPDATE - 2021 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) castration-resistant prostate cancer (CRPC) guideline: What has changed since 2019?

2021 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) guideline: Management of castration-resistant prostate cancer (CRPC).

2021 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) guideline: Management of castration-resistant prostate cancer (CRPC).

The management of sexual dysfunction resulting from radiotherapy and androgen deprivation therapy to treat prostate cancer: A comparison of uro-oncology practice according to disease stage.

To establish current uro-oncology practice in the management of sexual dysfunction (SD) following radiotherapy (RT) and/or androgen deprivation therapy (ADT) to treat prostate cancer. To identify differences in approach to the management of SD according to disease stage. A 14-question mixed methods survey was designed to assess the current UK practice. Closed- and open-ended questions were used to quantify results while allowing participants to expand on answers. The survey was distributed to members of the British Uro-Oncology Group at the 2019 annual meeting. Surveys were completed by 63 uro-oncologists attending the annual meeting of the British Uro-Oncology Group (response rate 66%). The major issue highlighted was a difference in approach to managing SD according to disease stage. More than half of the participants (56%) said 'advanced stage of disease' was a barrier to discussing SD. Clinicians were less likely to discuss SD, take baseline assessments, refer to a specialist clinic or offer rehabilitation when dealing with patients with advanced disease. Only a minority said that the management of SD was primarily their responsibility (11%). Nearly all clinicians (92%) had access to SD clinics; however, the majority of clinicians did not routinely refer patients. This study shows that men with advanced prostate cancer need better support in managing SD. Patients receiving long-term ADT are less likely to be offered any kind of help or intervention. Specific guidance on managing SD in this cohort may result in improvements in sexual function, emotional well-being, quality of life, mental health and confidence.

Use of bisphosphonates and other bone supportive agents in the management of prostate cancer-A UK perspective.

To explore the practice and views of uro-oncologists in the UK regarding their use of bone supportive agents in patients with prostate cancer. An expert-devised online questionnaire was completed by members of the British Uro-oncology Group (BUG). Of 160 uro-oncologists invited, 81 completed the questionnaire. Approximately 70% of respondents never use a bone supportive agent in patients with metastatic hormone-naïve prostate cancer on androgen deprivation therapy (ADT). However, use was more frequent in men with metastatic castration-resistant prostate cancer, from first-line treatment onwards. The majority of uro-oncologists do not use a bone supportive agent to prevent skeletal-related events in men with non-metastatic disease unless the individual patient is at an increased risk of osteoporosis. In men with more advanced disease, respondents would use an oral or intravenous (IV) bisphosphonate in 41% and 61% of patients, respectively. Zoledronic acid is the first-choice bone supportive treatment in 77% of cases, with the lack of clinical data cited as a barrier to use for other IV bisphosphonates. Local guidelines also have a significant influence on the use of bone supportive agents, especially with respect to denosumab. Bone mineral density measurement is conducted in approximately 40% of men with ADT exposure of 2 years or longer, or those with metastatic prostate cancer. Uro-oncologists in the UK generally do not use bone supportive agents for men with metastatic hormone-naïve prostate cancer or those with non-metastatic disease. However, increasing the duration of ADT and the presence of castration-resistant metastatic prostate cancer increases use.

MP18-10 CHRONIC INFLAMMATION-DERIVED IMMUNOSUPPRESSIVE STATUS INCLUDING MYELOID DERIVED SUPPRESSOR CELL, T CELL EXHAUSTION OR PD-L1 EXPRESSION IS COMMON IN NON-CLEAR CELL RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Basic Research & Pathophysiology II (MP18)1 Apr 2020MP18-10 CHRONIC INFLAMMATION-DERIVED IMMUNOSUPPRESSIVE STATUS INCLUDING MYELOID DERIVED SUPPRESSOR CELL, T CELL EXHAUSTION OR PD-L1 EXPRESSION IS COMMON IN NON-CLEAR CELL RENAL CELL CARCINOMA Hiroaki Matsumoto*, Kazuhiro Nagao, Jun-Ichi Mori, Sho Ozawa, Masahiro Samoto, Ryo Inoue, Yoshiaki Yamamoto, Seiji Yano, Hiroshi Hirata, Tomoyuki Shimabukuro, Yoji Nagashima, and Hideyasu Matsuyama Hiroaki Matsumoto*Hiroaki Matsumoto* More articles by this author , Kazuhiro NagaoKazuhiro Nagao More articles by this author , Jun-Ichi MoriJun-Ichi Mori More articles by this author , Sho OzawaSho Ozawa More articles by this author , Masahiro SamotoMasahiro Samoto More articles by this author , Ryo InoueRyo Inoue More articles by this author , Yoshiaki YamamotoYoshiaki Yamamoto More articles by this author , Seiji YanoSeiji Yano More articles by this author , Hiroshi HirataHiroshi Hirata More articles by this author , Tomoyuki ShimabukuroTomoyuki Shimabukuro More articles by this author , Yoji NagashimaYoji Nagashima More articles by this author , and Hideyasu MatsuyamaHideyasu Matsuyama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000843.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Non-clear cell renal cell carcinoma (ncRCC) is a rare entity with heterogeneous pathology, and few information about the effect of immune checkpoint inhibitor (ICI). We aimed to investigate the status of PD-L1, VEGFR, or chronic inflammation markers and to correlate with pathological and prognostic outcomes in ncRCC. METHODS: In January 2005 to December 2014, 139 cases of ncRCC had been treated by radical or partial nephrectomy and were retrospectively collected from multi-institutional database (Yamaguchi Uro-Oncology group), and analyzed the expression status of PD-1, PD-L1, VEGFR2, Arginase-1, and CD8 positivity by immunohistochemical staining (ICH). All pathological diagnosis was re-assessed by one central pathologist (YN). RESULTS: Mean age, and pathological stage (I/II/III/IV) was 65.6, and 87/22/23/4, respectively. Out of 127 cases with pathologically confirmed, papillary RCC, chromophobe, sarcomatoid, and other types were 51 (41%), 31 (24%), 21 (16.5%), respectively. PD-L1 expression and VEGFR2 expression was present in 11 (9%), and 54 (44%), respectively. VEGFR2 expression was significantly associated with durable response (CR/PR/SD) of VEGF-TKI (p=0.0195). Higher PD-1 expression was statistically correlated with neutrophil-lymphocyte ratio (NLR, p=0.0002), leucocyte count (p=0.0189), Glasgow prognostic score (p=0.0038), tumor-infiltrating CD8 positivity (p= 0.0219). Higher Arginase expression was present in 25 (21%) and significantly associated with PS (p=0.0003), leucocyte count (p=0.0007), neutrophil count (p<0.0001), NLR (p<0.0001), VEGFR2 expression (p=0.0161). Concerning patient outcome, sarcomatoid subtype, CRP, NLR, PD-L1 expression was significantly associated with OS in the univariate analysis. Multivariate analysis proved PD-L1 to the sole independent prognostic factor (P-0.005, HR:6.72, 95% CI: 1.55-21.14). CONCLUSIONS: These data suggest that tumor-infiltrated T cell exhaustion and activation of MDSC is present, presumably induced by chronic inflammation in ncRCC. NLR may become surrogate for T cell exhaustion. Modest VEGFR2 and PD-L1 expression indicate combination therapy with ipilimumab/nivolumab, or axitinib/pembrolizumab seems to be reasonable strategy for the treatment of ncRCC. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e239-e239 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroaki Matsumoto* More articles by this author Kazuhiro Nagao More articles by this author Jun-Ichi Mori More articles by this author Sho Ozawa More articles by this author Masahiro Samoto More articles by this author Ryo Inoue More articles by this author Yoshiaki Yamamoto More articles by this author Seiji Yano More articles by this author Hiroshi Hirata More articles by this author Tomoyuki Shimabukuro More articles by this author Yoji Nagashima More articles by this author Hideyasu Matsuyama More articles by this author Expand All Advertisement PDF downloadLoading ...

886P - Efficacy of enzalutamide in hormone-sensitive metastatic prostate cancer: Clinical utility of 18F-choline PET and whole body MRI

BackgroundAR-inhibition with Enzalutamide may be an attractive alternative for 1L treatment of men with hormone-sensitive prostate cancer compared to androgen deprivation therapy (ADT). There is an unmet need for robust, reproducible imaging technology allowing accurate quantification and qualification of bone plus soft tissue metastases and assessment of early tumour responses to novel agents. PET/CT or WB MRI imaging offer advantage over traditional bone and CT scans. MethodsSixty patients with metastatic hormone-sensitive PC were included in this prospective cohort study. Patients received Enzalutamide 160mg once daily until progression of disease. Imaging tests were performed at baseline and bone scintigraphy and CT repeated at 3 month intervals, 18F-choline PET/CT at 2 weeks, 2, 6, 9 and 12 months and WB-MRI at 6 and 12 months. Enumeration of circulating tumor cells and quality of life assessments were secondary outcomes. ResultsSixty patients with a median age of 72 yrs (range 57−85) and a median PSA of 62.8μg/L (range 3-622) were enrolled. This study is ongoing; all of the first 50 patients experienced a≥50% PSA decline and 49 a≥90% PSA decline. Choline-PET imaging and WB MRI were more frequently able to detect metastases and measure favorable responses than bone scan or CT thorax and abdomen. Investigator and central review of all imaging results are ongoing. Treatment was well tolerated. Conclusions18F-choline PET/CT and WB-MRI were superior in detection of bone and lymph node metastases and 18F-choline PET/CT was useful for early response detection already at 2 weeks. Based on results both 18F-choline-PET and WB MRI imaging have great clinical utility in aiding clinicians treating men with hormone-sensitive metastatic prostate cancer. Clinical trial identificationNCT02815033. Legal entity responsible for the studyEuropean Uro-Oncology Group (EUOG). FundingAstellas Pharma. DisclosureAll authors have declared no conflicts of interest.

2019 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) guideline: Management of castration-resistant prostate cancer (CRPC).

Castration-resistant prostate cancer (CRPC) is defined by disease progression despite castrate levels of testosterone and may present as either a continuous rise in serum prostate-specific antigen (PSA) levels, the progression of pre-existing disease, and/or the appearance of new metastases. Advanced prostate cancer has been known under a few names over the years, including hormone-resistant prostate cancer (HRPC) and androgen-insensitive prostate cancer (AIPC). Most recently, the terms castration-resistant prostate cancer or castration-recurrent prostate cancer were introduced with the realization that extra-testicular androgen production plays a significant role in the resistance of prostate cancer cells to medical or surgical castration therapy.1 In their second publication, the Prostate Cancer Working Group defined CRPC as a continuum on the basis of whether metastases are detectable (clinically or by imaging) and whether the serum testosterone is in the castrate range by surgical orchidectomy or medical therapy.2 This definition creates a clinical-states model, where patients can be classified. The rising PSA states (castrate and non-castrate) signify that no detectable (measurable or non-measurable) disease has ever been found. The clinical metastases states (castrate and non-castrate) signify that disease was detectable at some point in the past, regardless of whether it is detectable now.3 Prognosis is associated with several factors that go beyond PSA levels. These include performance status, presence of visceral metastases, presence of bone pain, extent of disease on bone scan, and serum lactate dehydrogenase and alkaline phosphatase levels. Bone metastases will occur in 90% of men with CRPC and can produce significant morbidity, including pain, pathological fractures, spinal cord compression, and bone marrow failure. Paraneoplastic effects, including anemia, weight loss, fatigue, hypercoagulability, and increased susceptibility to infection, are also common. CRPC includes patients without metastases or symptoms with rising PSA levels despite androgen-deprivation therapy (ADT) to patients with metastases and significant debilitation due to cancer symptoms.

Measuring testosterone and testosterone replacement therapy in men receiving androgen deprivation therapy for prostate cancer: A survey of UK uro-oncologists' opinions and practice.

To explore the practice and attitudes of uro-oncologists in the UK regarding monitoring testosterone levels and the use of testosterone replacement therapy (TRT) in their prostate cancer patients treated with androgen deprivation therapy (ADT). An expert-devised online questionnaire was completed by the members of the British Uro-oncology Group (BUG). Of 160 uro-oncologists invited, 84 completed the questionnaire. Before initiating ADT in patients with non-metastatic prostate cancer, only 45% of respondents measured testosterone levels and 61% did not measure testosterone at all during ADT in the adjuvant or neoadjuvant setting. However, in men with metastatic prostate cancer, 71% of the uro-oncologists measured testosterone before starting ADT and the majority continued testing during treatment. Approximately two-thirds of respondents did not prescribe TRT for their patients who were in remission following neo(adjuvant) ADT and who had castration levels of testosterone. Among UK uro-oncologists, the measurement of testosterone levels before and during ADT was not typically part of routine practice in the management of patients with prostate cancer. However, testosterone levels were checked more frequently for patients with metastatic disease than disease at an earlier stage. Testing could be conducted in parallel with PSA measurement as testosterone levels are linked to biochemical failure. The majority of specialists participating in the survey did not prescribe TRT for their patients in remission following ADT. Uro-oncologists in the UK do not generally measure testosterone as part of their patient management and they remain cautious about the possible benefits of TRT in men with prostate cancer.

National survey of fiducial marker insertion for prostate image guided radiotherapy

IntroductionIn the United Kingdom fiducial marker IGRT is the second most common verification method employed in radical prostate radiotherapy yet little evidence exists to support centres introducing or developing this practice. We developed a survey to elicit current fiducial marker practices adopted in the UK, to recommend standardisation of practice. MethodsA 16 question survey was distributed across UK Radiotherapy centres via promotion at the British Uro-Oncology Group Conference, 2016. Included were questions relating to workforce planning, patient preparation, insertion procedure and verification methods. The survey was open from September 2016 to January 2017. ResultsResults from 15 centres routinely inserting fiducial markers for prostate IGRT are presented. Eleven professional groups insert fiducial markers across the UK. Fourteen centres insert fiducial markers trans-rectally; one trans-perineally. Centres adopting a trans-rectal approach administer prophylactic ciprofloxacin as a single agent or combined with gentamicin or metronidazole; poor agreement between regimes presented. One centre has introduced targeted antibiotic prophylaxis.Five brands of fiducial markers are utilised nationally. Fourteen centres standardly insert three single fiducial markers, two common configurations emerged. Coupled fiducial markers are routinely implanted by one centre.All centres delay at least one week between fiducial marker insertion and planning CT; seven centres wait two weeks. The most common fiducial verification method is two-dimensional, paired kilo Voltage imaging. ConclusionVariation in fiducial marker practice across the UK is considerable. Standardisation is required to support centres and healthcare professionals developing this service. Seven recommendations, to unify practice, have been proposed based on survey results and literature.

MP05-17 IDENTIFICATION OF TREATABLE HIGH RISK PROSTATE CANCER ONLY BY RADICAL PROSTATECTOMY-WHO ARE GOOD CANDIDATES FOR RADICAL PROSTATECTOMY IN HIGH RISK PROSTATE CANCER-

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I1 Apr 2018MP05-17 IDENTIFICATION OF TREATABLE HIGH RISK PROSTATE CANCER ONLY BY RADICAL PROSTATECTOMY-WHO ARE GOOD CANDIDATES FOR RADICAL PROSTATECTOMY IN HIGH RISK PROSTATE CANCER- Kazuhiro Nagao, Junichi Mori, Kosuke Shimizu, Yoshihisa Kawai, Ryo Inoue, Yoshiaki Yamamoto, Hiroaki Matsumoto, and Hideyasu Matsuyama Kazuhiro NagaoKazuhiro Nagao More articles by this author , Junichi MoriJunichi Mori More articles by this author , Kosuke ShimizuKosuke Shimizu More articles by this author , Yoshihisa KawaiYoshihisa Kawai More articles by this author , Ryo InoueRyo Inoue More articles by this author , Yoshiaki YamamotoYoshiaki Yamamoto More articles by this author , Hiroaki MatsumotoHiroaki Matsumoto More articles by this author , and Hideyasu MatsuyamaHideyasu Matsuyama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.188AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES According to the EAU guideline, not all patients with high risk prostate cancer (PCa) have a uniformly poor prognosis after radical prostatectomy (RP), but there is no consensus regarding who could get most benefit by RP in the patients with high-risk PCa. We aimed to identify the treatable high-risk PCa only by RP. METHODS We retrospectively reviewed 315 patients with D′Amico high-risk PCa treated by RP without neoadjuvant or adjuvant therapy in the institutions belonging to Yamaguchi Uro-Oncology Group between 2009 and 2013. Primary end-point was biochemical progression free survival (bPFS) after RP. Risk factors for biochemical progression were extracted using the Cox proportional hazard model. We stratified the high risk PCa into 3 subgroups in bPFS after RP by using the risk factors. RESULTS At a median follow-up of 49.9 months (1.9-1335), biochemical progression was observed in 63 cases (20.5%). bPFS at 2 and 5 years after RP were 89.4% and 70.0%, respectively. Univariate analysis showed prostate specific antigen (PSA) at diagnosis (≥15ng/ml), PSA density (≥0.5), Gleason score (GS) at biopsy (≥8) and % positive core (≥30%) could be risk factors for biochemical progression. On multivariate analysis, GS at biopsy (HR: 1.92, p<0.05) and % positive core (HR: 2.85, p<0.005) could be independent predictors of biochemical progression. Patients were stratified into favorable- (0 risk factor; 117 patients), intermediate- (1 risk factor; 127 patients), and poor-risk (2 risk factors; 57 patients) groups based on the number of predictive factors. On Cox proportional hazard model, this risk classification model could significantly predict biochemical progression after RP (low-risk; HR: 1.0, intermediate-risk; HR: 2.26, high-risk; HR: 5.03, p<0.0001). CONCLUSIONS Risk of biochemical progression of high risk PCa after RP could be stratified by GS at biopsy (≥8) and % positive core (≥30%). Our stratification model may aid in selecting treatment modality for D′Amico high risk PCa. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e49-e50 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kazuhiro Nagao More articles by this author Junichi Mori More articles by this author Kosuke Shimizu More articles by this author Yoshihisa Kawai More articles by this author Ryo Inoue More articles by this author Yoshiaki Yamamoto More articles by this author Hiroaki Matsumoto More articles by this author Hideyasu Matsuyama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Identification of curable high-risk prostate cancer using radical prostatectomy alone: who are the good candidates for undergoing radical prostatectomy among patients with high-risk prostate cancer?

BackgroundCurrently, there is no consensus regarding which patients with high-risk prostate cancer (PCa) would benefit the most by radical prostatectomy (RP). We aimed to identify patients with high-risk PCa who are treatable by RP alone.MethodsWe retrospectively reviewed data on 315 patients with D’Amico high-risk PCa who were treated using RP without neoadjuvant or adjuvant therapy at the institutions of the Yamaguchi Uro-Oncology Group between 2009 and 2013. The primary endpoint was biochemical progression-free survival (bPFS) after RP. Risk factors for biochemical progression were extracted using the Cox proportional hazard model. We stratified the patients with high-risk PCa into 3 subgroups based on bPFS after RP using the risk factors.ResultsAt a median follow-up of 49.9 months, biochemical progression was observed in 20.5% of the patients. The 2- and 5-year bPFS after RP were 89.4 and 70.0%, respectively. On multivariate analysis, Gleason score (GS) at biopsy (≥ 8, HR 1.92, p < 0.05) and % positive core (≥ 30%, HR 2.85, p < 0.005) were independent predictors of biochemical progression. Patients were stratified into favorable- (0 risk factor; 117 patients), intermediate- (1 risk factor; 127 patients), and poor- (2 risk factors; 57 patients) risk groups, based on the number of predictive factors. On the Cox proportional hazard model, this risk classification model could significantly predict biochemical progression after RP (favorable-risk, HR 1.0; intermediate-risk, HR 2.26; high-risk, HR 5.03; p < 0.0001).ConclusionThe risk of biochemical progression of high-risk PCa after RP could be stratified by GS at biopsy (≥ 8) and % positive core (≥ 30%).

The systemic inflammation-based Glasgow Prognostic Score as a powerful prognostic factor in patients with upper tract urothelial carcinoma.

Introduction and ObjectiveThe combination of C-reactive protein and albumin, the Glasgow Prognostic Score (GPS), had independent prognostic value in patients with varying cancers, except for upper tract urothelial carcinoma (UTUC). The aim of this study was to describe the relationship between GPS and survival in patients with UTUC after adjustment for other prognostic factors.Materials and MethodsWe queried 2 UTUC databases. Retrospective clinical series on patients with localized UTUC managed by nephroureterectomy with bladder cuff, for whom data from the Yamaguchi Uro-Oncology Group and Osaka Medical College registry, including age, presence of bladder cancer, pT stage, lymphovascular invasion, C-reactive protein (CRP) and albumin, were analyzed. The GPS was constructed by combining CRP and albumin. Cancer specific survival (CSS) and overall survival (OS) and relative excess risk of death were estimated by GPS categories after adjusting for gender, age, ECOG performance status (PS), grade, and lymphovascular invasion (LVI).ResultsSeven hundred and twenty four UTUC patients were identified. Our final cohort included 574 patients; of these, 29.2% died during a maximum follow up of 16.7 years. The estimated mean 10-year CSS of patients with GPS of scre-0, -1, and -2 was 99.5, 95.1, and 75.9 months, respectively. Patients with GPS of score-2 had poorest 10-year estimated mean OS of 67.6 months (57.2–77.9). Raised GPS also had a significant association with excess risk of cancer death at 10 years (GPS 2: Relative Excess Risk = 1.74, 95% CI 1.20–2.54) after adjusting for gender, patients’ age, ECOG PS, and tumor focality. C-index of GPS both for CSS and OS were superior to patients’ age and tumor focality, and comparable to grade.ConclusionsThe GPS is an independent prognostic factor for CSS and OS after surgery with curative intent for localized UTUC. It significantly increases the accuracy of established prognostic factors. The GPS may provide a meaningful adjunct for patient counseling and clinical trial design.

Biological Behavior and Long-Term Outcomes of Carcinoma In Situ in Upper Urinary Tract Managed by Radical Nephroureterectomy

In patients with urothelial carcinoma CIS (carcinoma in situ) generally has a poor prognosis. However, to our knowledge the outcomes of pure/primary CIS and the behavior of CIS concomitant with pTa-pT4 upper tract urothelial carcinoma managed by nephroureterectomy have not been previously specified. We explored the biological and prognostic features of concomitant CIS compared with those of pure/primary CIS. We queried a multicenter upper tract urothelial carcinoma database. Data from NUOG (Nishinihon Uro-Oncology Group) were analyzed, including patient gender, age, presence of bladder cancer and pT stage. Clinicopathological features were compared between the different subtypes. Cancer specific and overall survival, and the relative excess risk of death were estimated by CIS subtype. We identified 163 patients with CIS in the upper urinary tract, of whom pure/primary CIS was noted in 24.5%. In the concomitant CIS cohort the pathological diagnosis of the nonCIS region was pTa, pT1, pT2, pT3 and pT4 in 4.9%, 22.8%, 25.2%, 44.7% and 1.6% of patients, respectively. The sensitivity of a selective urine cytology test was higher in the pure/primary CIS group than in the concomitant CIS group (60.0% vs 37.4%). At a median followup of 32 months 10-year estimated mean cancer specific survival was 92.4 months (range 83.7 to 101.0) in the overall CIS cohort. Ten-year estimated mean cancer specific survival in patients with pure/primary CIS was significantly longer than in patients with concomitant carcinoma in situ (111.8 months, range 101.0 to 122.6 vs 85.89, range 75.3 to 96.5, log rank p = 0.007). Patients presenting with concomitant CIS have a worse outcome than those who present with pure/primary CIS, suggesting a need to differentiate these 2 entities in the treatment decision process.

Heterogeneity of advanced prostate cancer: clinical implications of genomics

This report is based on a session held during the 13th Annual Meeting of the British Uro-oncology Group (BUG) in London in September 2016. The session discussed the clinical implications of genomics in the management of advanced prostate cancer, in the context of the potential use of biomarkers to predict outcomes to treatment and the future of biomarker-driven trials.

MP27-14 LOCATION OF THE TUMOR IN UPPER TRACT UROTHELIAL CARCINOMA (UTUC) IMPACTS ON THE PRESENCE OF CONCOMITANT UROTHELIAL CARCINOMA OF THE BLADDER: A MULTI-INSTITUTIONAL DATABASE STUDY

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II1 Apr 2016MP27-14 LOCATION OF THE TUMOR IN UPPER TRACT UROTHELIAL CARCINOMA (UTUC) IMPACTS ON THE PRESENCE OF CONCOMITANT UROTHELIAL CARCINOMA OF THE BLADDER: A MULTI-INSTITUTIONAL DATABASE STUDY Teruo Inamoto, Kiyoshi Takahara, Hideyasu Matsuyama, Kiyohide Fujimoto, Hiroaki Shiina, Shigeru Sakano, Kazuhiro Nagao, Makito Miyake, Yoshihiro Tatsumi, Hiroaki Yasumoto, and Haruhito Azuma Teruo InamotoTeruo Inamoto More articles by this author , Kiyoshi TakaharaKiyoshi Takahara More articles by this author , Hideyasu MatsuyamaHideyasu Matsuyama More articles by this author , Kiyohide FujimotoKiyohide Fujimoto More articles by this author , Hiroaki ShiinaHiroaki Shiina More articles by this author , Shigeru SakanoShigeru Sakano More articles by this author , Kazuhiro NagaoKazuhiro Nagao More articles by this author , Makito MiyakeMakito Miyake More articles by this author , Yoshihiro TatsumiYoshihiro Tatsumi More articles by this author , Hiroaki YasumotoHiroaki Yasumoto More articles by this author , and Haruhito AzumaHaruhito Azuma More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1045AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The predictive impact of primary tumor location for patients with upper-tract urothelial carcinoma (UTUC) on the presence of concomitant urothelial carcinoma of the bladder is still contentious. We precisely evaluated the association between tumor location and concomitant presence of urothelial carcinoma of the bladder, along with urothelial recurrence free survival (URFS) in patients with UTUC. METHODS A total of 1349 patients with localized UTUC (Ta-4N0M0) from a retrospective multi-institutional cohort were studied. We queried 4 UTUC databases. Retrospective clinical series on patients with localized UTUC managed by nephroureterectomy (NU) with bladder cuff, for whom data from the Yamaguchi Uro-Oncology Group and 4 tertiary medical centers registries. Patients with a history of chemotherapy were excluded from the study. Associations between the location of the tumor and subsequent outcome following NU were assessed using COX multivariate analysis. Location of the tumor was verified by pathological samples. Urothelial recurrence was defined as tumor relapse in any local urothelium, and coded apart from distant metastasis. The median follow-up was 34 months. RESULTS Six hundred and three patients had pelvic tumors (45.1%), 123 had ureteral tumors in U1 segment (9.2%), 109 in U2 segment (8.1%), and 263 in U3 segment (19.7%). 240 had multifocal tumors (17.80%) as follows; 14 (1.0%) in pelvis and ureter, 14 (1.0%) in U1+U2, 2(0.1%) in U1+U3, 28 (2.1%) in U2+U3, 9 (0.7%) in U1+U2+U3. 173 (12.9%) had solitary ureteral tumors where the distinct location was not described. Of all, 159 (17.5%) had concomitant bladder tumors. Logistic regression analysis which include gender, age, hydronephrosis, cytology, performance status, grade, lymphovascular invasion (LVI), pT, pN, tumor focality, tumor location was associated with the presence of concomitant bladder cancer (p=0.004, HR; 1.265). When the tumor location was stratified into 8 segments, including multifocal tumors, only U3 segment remained as predictive for the presence of concomitant bladder cancer (p=0.002, HR= 2.872). Kaplan-meier analysis for unifocal disease showed that lower ureter tumors (combinatnion of U2 U3) had the worse prognosis for urothelial recurrence than pelvic tumors or upper ureteral tumors (U1) (p=0.019 for lower ureteral tumors vs. pelvic tumors, p=0.132 for upper ureteral tumor vs. pelvic tumor by log rank). Multivariate analysis showed that lower ureter location remained as a prognostic factor for urothelial recurrence after adjusting for gender, age, hydronephrosis, urine cytology, LVI, pT, and pN (p=0.006, HR=1.761), and similar tendency was found when the analysis was run for patients without concomitant bladder tumors (p=0.002, HR=2.244). Lower ureteral tumors had a higher prevalence of disease specific deaths (HR=2.224) with reference to upper ureter tumors and pelvic tumors. CONCLUSIONS This multi-institutional study showed the primary tumor locations were independently associated with the presence of concomitant bladder tumors and subsequent urothelial recurrence. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e368 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Teruo Inamoto More articles by this author Kiyoshi Takahara More articles by this author Hideyasu Matsuyama More articles by this author Kiyohide Fujimoto More articles by this author Hiroaki Shiina More articles by this author Shigeru Sakano More articles by this author Kazuhiro Nagao More articles by this author Makito Miyake More articles by this author Yoshihiro Tatsumi More articles by this author Hiroaki Yasumoto More articles by this author Haruhito Azuma More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...