1212 PREDICTORS OF BIOCHEMICAL RECURRENCE (BCR) POST ...

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Vol. 189, No. 4S, Supplement, Monday, May 6, 2013

1211 SMALLER PROSTATE SIZE IS INDEPENDENTLY ASSOCIATED WITH BIOCHEMICAL RECURRENCE IN GLEASON 7 PROSTATE CANCER Boris Gershman*, Francis McGovern, Niall Heney, W. Scott McDougal, Chin-Lee Wu, Boston, MA

Source of Funding: None

1210 SMALLER PROSTATE SIZE IS ASSOCIATED WITH GREATER VOLUME OF DISEASE AT PROSTATECTOMY Boris Gershman*, Douglas Dahl, Francis McGovern, Niall Heney, W. Scott McDougal, Chin-Lee Wu, Boston, MA INTRODUCTION AND OBJECTIVES: Smaller prostate size is associated with a number of negative prognostic indicators including higher Gleason score and positive surgical margins. We hypothesized that this may be related to a longer time to diagnosis and increased volume of disease for patients with smaller glands. METHODS: A retrospective review was performed of patients with Gleason 6-10 prostate cancer who underwent radical prostatectomy from 2001 through 2010. Patients were identified from a prostatectomy tumor bank database. Univariate and multiple logistic regression were performed to determine association between prostate weight and volume of disease at prostatectomy. Number of quadrants with prostate cancer on surgical pathology was used as a surrogate for volume of disease. RESULTS: A total of 2054 patients underwent radical prostatectomy. Mean age, PSA, and prostate weight were 59.6 ⫾ 6.6 years, 6.0 ⫾ 4.7 ng/ml, and 45.5 ⫾ 17.5 grams, respectively. Gleason score was 6 in 1055 patients (51.4%), 7 in 858 patients (41.8%), and 8-10 in 141 patients (6.9%). Number of quadrants with prostate cancer was distributed as follows: 1 quadrant in 274 patients (13.3%), 2 quadrants in 557 patients (27.1%), 3 quadrants in 464 patients (22.6%), and 4 quadrants in 759 (37.0%). On one-way analysis of variance, increasing number of quadrants with cancer was associated with decreasing prostate weight (p ⬍ 0.001). On univariate and multiple logistic regression (Table), smaller prostate weight, higher PSA, and higher Gleason score were associated with increasing volume of disease. CONCLUSIONS: Smaller prostate gland size is independently associated with increased volume of disease at prostatectomy. Small gland size is a clinical indicator of disease volume. Multiple logistic regression of number of quadrants with prostate cancer. One quadrant with cancer is reference category for pairwise comparisons. OR for 4 OR for 3 OR for 2 vs 1 vs 1 vs 1 Quadrants p-value Quadrants p-value Quadrants p-value Variable Age (years) 1.02 0.220 1.03 0.066 1.02 0.199 PSA (ng/ml)

1.08

0.001

1.09

Prostate weight (grams)

0.988

0.003

0.975

0.003 ⬍ 0.001

1.16

⬍ 0.001

0.967

⬍ 0.001

Gleason score 6

ref

-

ref

-

ref

-

7

1.27

0.184

1.93

⬍ 0.001

2.64

⬍ 0.001

8-10

1.77

0.150

2.53

0.019

3.87

⬍ 0.001

Source of Funding: None

INTRODUCTION AND OBJECTIVES: Prostate size is associated with a number of negative prognostic indicators. We evaluated the effect of prostate size on biochemical recurrence following radical prostatectomy. METHODS: We conducted a retrospective review of patients with Gleason 6-10 prostate cancer who underwent radical retropubic prostatectomy at the Massachusetts General Hospital from 1993 – 1999. Patients were excluded if they received neoadjuvant therapy, had less than 8 weeks of follow-up, or PSA did not fall below 0.2 ng/ml post-operatively. Biochemical recurrence was defined as a PSA rise to 0.2 ng/ml or greater with a confirmatory value if available. Cox proportional hazards models were used to evaluate for association between variables and biochemical recurrence. RESULTS: A total of 877 patients underwent surgery with a mean follow-up of 7.5 ⫾ 4.5 years (range 0.2 – 16.3). Mean age, PSA, and prostate weight were 61.0 ⫾ 6.9 years, 7.3 ⫾ 5.5 ng/ml, and 46.7 ⫾ 19.1 grams, respectively. Gleason score was distributed as follows: 6 in 422 patients (48.1%), 7 in 372 patients (42.4%), and 8-10 in 83 patients (9.5%). Using univariate Cox proportional hazards models, older age, higher PSA, higher Gleason score, presence of pT3 or pT4 disease, positive margins, and smaller prostate weight were associated with biochemical recurrence (p ⬍ 0.05 for each). After stepwise addition of each variable in a multivariate Cox model, prostate weight lost significance only when Gleason score was included in the model. However, when multivariate Cox models were stratified by Gleason score, prostate weight was associated with biochemical recurrence for Gleason 7 disease (Table). CONCLUSIONS: Smaller prostate size is independently associated with biochemical recurrence for Gleason 7 disease. These results suggest that more aggressive therapy would be indicated for patients with small glands and Gleason 7 disease. Multivariate Cox proportional hazards model stratified by Gleason score Gleason Gleason Gleason 8-10 7 pGleason 6 pGleason Gleason value 8-10 HR p-value value 7 HR Variable 6 HR Age (years) 1.01 0.657 1.02 0.091 0.993 0.778 ⬍ 0.001

1.02

0.485

0.986

0.023

1.01

0.355

1.42

0.076

1.39

0.302

1.43

0.054

0.779

0.406

PSA (ng/mL)

1.04

0.312

1.05

Prostate weight (grams)

0.985

0.147

pT3⫹ vs pT2

0.675

0.410

Positive margin

3.98

⬍ 0.001

Source of Funding: None

1212 PREDICTORS OF BIOCHEMICAL RECURRENCE (BCR) POST ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY (RALP): ANALYSIS OF 916 PATIENTS WITH 5 AND 7 YEAR FOLLOW UP Nithin Theckumparampil*, Adnan Ali, Sheela Metgud, Abhishek Srivastava, George Ghareeb, Wesley Ludwig, Alexandra Peyser, Steve Kaplan, Siobhan Gruschow, Matthieu Durand, Niyati Harneja, Robert Leung, Richard Lee, Michael Herman, Brian Robinson, Maria Shevchuck, Ashutosh Tewari, New York, NY INTRODUCTION AND OBJECTIVES: The objective of the study was to determine the predictors of BCR in patients with localized prostate cancer (PCa) treated with RALP, with focus on 5 and 7 year follow up. METHODS: We collected data on all patients who underwent RALP between January 2005 and October 2007 by a single surgeon (AKT). Data was gathered on Age, Pre-Operative Prostate specific

Vol. 189, No. 4S, Supplement, Monday, May 6, 2013

antigen level (PSA), biopsy Gleason score, total positive cores, clinical stage, nerve sparing grade. Pathological variables such as prostate volume, Gleason, TNM staging and margin status were also gathered along with BCR data. BCR was denoted as 1) Adjuvant therapy or 2) PSA ⱖ0.2ng/ml with a confirmatory value. Univariable and Multivariable regression models were used to determine the predictive variables of BCR. RESULTS: A total of 916 patients had 5 to 7 years follow up and 2 (⬍1%) were lost to follow-up. 60% had a pathological Gleason 7-10 disease, 12.5% had ⱖT3 disease on final pathology and 10.7% had a positive surgical margin. BCR was noted in 66(7.2%) patients with a median time to recurrence of 10 months (range 4 to 34 months). The overall BCR rates at 5 and 7 years were 7.2% and 7.7% respectively. BCR for T2 and T3 disease were 5.6% and 18.2% respectively. Patients with PSM had a BCR of 20.2% compared to 5.6% in those with negative surgical margins. After Multivariate analysis we found that Gleason score ⱖ7 (4⫹3), Nerve sparing Grade, pathology Gleason and presence of positive surgical margin were found to be significant predictors of BCR (p value ⬍0.05). CONCLUSIONS: To the authors’ knowledge, this is one among the first few ?Long term (7 year) oncological outcomes post RALP’ studies, demonstrating a 7 year BCR of 7.7%. However, it is to be noted that BCR was denoted as 1) Adjuvant therapy or 2) 2 consecutive PSA values ⱖ0.2ng/ml and yet the results are comparable with that of PSA recurrence alone. Such studies will soon help determine the need and timing of adjuvant treatment post RALP. Further studies need to be done due to a paucity of data on long term oncological outcomes for patients undergoing RALP for prostate cancer. Source of Funding: None

1213 CONTEMPORARY ANALYSIS OF POST-PROSTATECTOMY SPECIMENS IN A LARGE VOLUME ROBOTIC PROSTATECTOMY PROGRAM: A PARADOXICAL STAGE MIGRATION TOWARD MORE AGGRESSIVE DISEASE Michael Maddox*, Gyan Pareek, Simone Thavaseelan, Anthony Mega, Joseph Renzulli, Providence, RI INTRODUCTION AND OBJECTIVES: As a result PSA screening, there is concern for over diagnosis and treatment of low risk prostate cancer. With the widespread use of robot-assisted radical prostatectomy (RARP), a stage migration to less aggressive prostate cancer may be expected in pathological specimens. As our robotic experience has matured, we sought to analyze if the institution of robotics leads to more surgical treatment of indolent cancers. METHODS: A total of 262 patients who underwent open prostatectomy (OP) from 2004 to 2006 and 757 patients who underwent RARP from 2007 to 2011 were identified from an IRB approved prospective database accrued by an independent third party committee. Demographic data, pathology, positive margin rates along with standard prostate cancer reporting data were recorded. The two groups were compared with regards to percentage of cases performed stratified by Gleason grade and pathologic stage. RESULTS: The number of prostate cancer cases managed at our institution increased considerably after the introduction of robotics in 2007. The distributions of pathologic gleason grade and stage for OP versus RARP are shown in table 1. Overall, there was a significant decrease in the patients with Gleason 6 prostate cancer undergoing RARP as compared to open prostatectomy (p⬍0.0001). Additionally, RARP was performed on a significantly greater percentage of Gleason 7 disease (p⬍0.0001). Comparing pathological stage between the two groups, there was a significant increase in the incidence of pT3 disease following robotic prostatectomy (p⬍0.0001). CONCLUSIONS: Recent studies suggest there is an increase in treatment of indolent prostate cancer. In our experience the introduction of minimally invasive radical prostatectomy did not result in an increased application of surgery for the treatment of low risk prostate cancer. Conversely, our data suggests that RARP has led to an increase in surgery for higher risk cancers.

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Gleason 6

Open Prostatectomy(%) 52.3

Robotic Prostatectomy(%) 32.6

Statistical Significance p ⬍ 0.0001

Gleason 7

61.2

40.9

Gleason 8

4.6

2.5

p⫽0.138

pT2

86.8

75.6

p⫽0.0001

pT3

10.7

24.4

p ⬍ 0.0001

p ⬍ 0.0001

Source of Funding: None

1214 ONCOLOGICAL OUTCOMES IN LOW, INTERMEDIATE AND HIGH D’AMICO RISK PATIENTS UNDERGOING LAPAROSCOPIC RADICAL PROSTATECTOMY AT A SINGLE UK CENTRE Andrew Moon, Nikhil Vasdev*, Rajan veeratterapillay, Mark Johnson, Anna O’Riordan, Naeem Soomro, Newcastle upon Tyne, United Kingdom INTRODUCTION AND OBJECTIVES: Laparoscopic radical prostatectomy (LRP) is an established treatment option for patients with prostate cancer in selected centres with appropriate expertise. The goal of LRP is to achieve excellent cancer control whilst attempting to preserve normal urinary continence and erectile function. We studied our single centre experience evaluating the oncological outcomes in patients undergoing LRP. METHODS: Three hundred and six patient underwent LRP between 2005 and 2011. Patients were divided into D’Amico low, intermediate and high risk groups. RESULTS: The mean age was 61.9 years (range 46 – 74 y). The two most important factors predictive of positive surgical margins at LRP were the initial PSA level and tumour stage at diagnosis. The overall PSM rate was 26.7%. For low D’Amico risk patients, the PSM was 24.5%, intermediate risk patients had a PSM of 32.4%, while high risk patients had a PSM of 13.6%. 6.4% of patients sampled had evidence of lymph node positive disease. 5 year PSA progression free survival rates were 83% in low risk patients, 57% in intermediate risk and 41% in high risk. CONCLUSIONS: LRP offers good oncological outcomes in the low and intermediate risk groups with low incidence of biochemical recurrence for patients with localised disease. Our high risk group has a low incidence of PSM and a 5 year PSA progression free survival rate of 41%. Patients with high risk, but non-metastatic, prostate cancer can be offered a minimally invasive prostatectomy in an experienced centre. Source of Funding: None

1215 IMPACT OF THE PRIMARY GLEASON PATTERN ON BIOCHEMICAL RECURRENCE-FREE SURVIVAL IN JAPANESE PATIENTS WITH GLEASON 7 PROSTATE CANCER WHO UNDERWENT RADICAL PROSTATECTOMY Hideaki Miyake*, Mototsugu Muramaki, Masato Fujisawa, Kobe, Japan INTRODUCTION AND OBJECTIVES: Gleason score has been shown to be a powerful predictor of disease progression and mortality in patients with prostate cancer undergoing radical prostatectomy. Recent studies, however, have shown the heterogeneity of Gleason 7 tumors consisting of those with a predominant Gleason 4 pattern (Gleason 4 ⫹ 3) and a predominant Gleason 3 pattern (Gleason 3 ⫹ 4). Furthermore, there have been limited data on the significance of primary Gleason pattern in Japanese patients with Gleason 7 tumor. The objectives of this study were to retrospectively review our experience with radical prostatectomy for Japanese patients with Gleason 7 prostate cancer and to identify factors associated with biochemical outcome in this category of patients. METHODS: This study included 959 consecutive patients who underwent radical prostatectomy and pelvic lymphadenectomy without