Post AUA Cancer de la Prostate

1
Post AUACancer de la Prostate

• Fred Saad

2
Late Breaking Abstracts

• PCPT
• RP from PCPT are insignificant cancers in 25
• RR reduction 30 if consider bias and if all men
  had a BX
• IN RP specimens the RR cancers
• 32 for Gleason 6 (p.0001)
• 28 for gleason gt6 (p.02)
• 3 Papers conclude no added risk of HG cancer from
  finasteride
• SWOG 8794 update
• pT3 randomised to adj vs no adj rads
• Metastasis free survival improved 26 (plt.031)

3
CONVERTING FROM OPEN TO ROBOTIC PROSTATECTOMY
INSTITUTIONAL IMPACT ON NUMBER OF PELVIC
LYMPHNODES RETRIEVED DURING ROBOTIC-ASSISTED
LAPAROSCOPIC RADICAL PROSTATECTOMY
(RALRP)Jennifer Yates , Joseph Renzulli MD ,
Harry Iannotti MD , George E Haleblian MD and
Gyan Pareek MD .

• RESULTS
• The mean number of lymph nodes obtained during
  robotic PLND was 3.2 and the mean number obtained
  by open PLND was 6.9 (plt 0.001).
• CONCLUSIONS
• Robot-assisted laparoscopic PLND yielded fewer
  lymph nodes compared to open PLND at the time of
  radical prostatectomy for organ confined disease.
  
• In patients presenting with a high risk of lymph
  node involvement based on preoperative staging,
  open PLND yields a higher number of lymph nodes
  compared to robotic PLND and should be considered
  the gold standard.

4
PATHOLOGIC UPGRADING AND UPSTAGING WITH IMMEDIATE
REPEAT BIOPSY FOR PATIENTS ELIGIBLE FORACTIVE
SURVEILLANCERyan K Berglund MD , Timothy A
Masterson MD , Kinjal C Vora MD , Scott E Eggener
MD , James A Eastham MD and Bertrand D
Guillonneau MD .

• METHODS
• A retrospective review of consecutive patients
  undergoing repeat biopsy within 3 months of a
  first positive biopsy
• from March 2002 until June 2007 was analyzed.
  Patients were considered eligible if they had a
  PSA lt 10 ng/ml, clinical stage lt
• T2b, Gleason pattern lt4, lt4 cores positive, and
  no single core with gt 50 cancer involvement.
• RESULTS
• 104 patients
• Of the repeat biopsies performed, 27/104 (26)
  were negative,
• 58/104 (56) had Gleason score 6,
• 17/104 (16) had Gleason score 7,
• one patient had Gleason score 9,
• 10/104 (10) of patients had gt 3 cores involved
  on repeat biopsy,
• 12/104 (12) had gt 50 involvement of at least
  one core.
• A total of 27/104 (26) patients were upgraded or
  upstaged.
• CONCLUSIONS
• Immediate repeat biopsy in patients with prostate
  cancer being considered for AS resulted in more
  than one
• quarter being upgraded or upstaged

5
PATHOLOGIC DISEASE PROGRESSION ON REPEAT
TRANSRECTAL BIOPSY IN A CONTEMPORARY
WATCHFULWAITING PROSTATE CANCER COHORTAndrew
Feifer MD , Mohammed F Al-Otaibi MD , Kanishka
Sircar MD , Louis R Begin MD , Armen G Aprikian
MD , Wassim Kassouf and Simon Tanguay .

• METHODS
• In a prospective study, 186 men with prostate
  cancer were conservatively managed by active
  surveillance (AS).
• Of these, 92 men had at least one 12-core
  re-biopsy.
• followed every 3-6 months and were offered
  re-biopsy annually or if there were any changes
  on physical exam or PSA.
• Progression while on AS was defined as having one
  or more of the following gtcT2b, gt2 positive
  cores, gt50 of cancer in at least
• one core, or predominant Gleason 4 in
  re-biopsies.
• RESULTS
• 92 patients underwent re-biopsy
• 24/92 patients (26) had pathologic progression,
• 32/92 (34.78) had no change,
• 36/92 (39.12) had improved pathology.
• Of the 36 patients with improved pathological
  findings, 72.3 had no cancer on re-biopsy.
• Patients demonstrated histological progression at
  1st, 2nd, 3rd, 4th, and 5th repeat biopsy in 46,
  25, 17, 8 and 4 of the
• time respectively.

6
IMPROVED PREDICTION OF DISEASE RELAPSE AFTER
RADICAL PROSTATECTOMY USING A PANEL
OFPREOPERATIVE BLOOD-BASED BIOMARKERSShahrokh F
Shariat MD , Jochen Walz , Claus G Roehrborn ,
Francesco Montorsi , Claudio Jeldres , Fred Saad
, Kevin M Slawin and Pierre I Karakiewicz .

• METHODS
• 421 consecutive patients treated with radical
  prostatectomy and bilateral PLND
• Preoperative plasma levels of transforming growth
  factor-b1 (TGF-b1), interleukin-6 (IL-6),
  interleukin-6 soluble
• receptor (IL-6sR), vascular endothelial growth
  factor (VEGF), vascular cell adhesion molecule-1
  (VCAM1), Endoglin, urokinase
• plasminogen activator (uPA) urokinase plasminogen
  inhibitor-1 (PAI-1), and urokinase plasminogen
  receptor (uPAR) were
• measured using commercially available enzyme
  immunoassays in Multivariable models were used to
  explore the gain in the
• predictive accuracy of the models. The accuracy
  was quantified by the c-index statistic and was
  validated with 200 bootstrap
• resamples.
• RESULTS
• In standard multivariable analyses that adjusted
  for the effects PSA, biopsy Gleason sum, and
  clinical stage,
• TGF-b1 (plt0.001), IL-6sR (plt0.001), IL-6
  (plt0.001), VCAM-1 (plt0.001), VEGF (p0.008),
  Endoglin (p0.002), and uPA (plt0.001)
• were associated with biochemical recurrence.
• The multivariable model containing standard
  clinical variables alone had an accuracy of
  71.6.
• The addition of TGF-b1, IL-6sR, IL-6, VCAM1,
  VEGF, Endoglin, and uPA increased the predictive
  accuracy by 15 to
• 86.6 (plt0.001) and demonstrated virtually
  perfect calibration.

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LONG-TERM SURVIVAL PROBABILITY IN A COHORT OF
OVER 20,000 IN MEN WITH PROSTATE CANCER TREATED
CONSERVATIVELY OR WITH DEFINITIVE TREATMENT
(RADIOTHERAPY OR RADICAL PROSTATECTOMY)Robert A
Leung , Jay K Jhaveri , Rajiv Yadav , Sandhya
Rao , Terry Field , Edward H Wagner , Mani Menon
, E Darracott Vaughanand Ashutosh K Tewari MD .

• The goal report the long-term survival in men
  diagnosed with prostate cancer in a cohort of
  23,811 men.
• METHODS
• The HMO Cancer Research Network (CRN) consists of
  data systems of 12 health maintenance
  organizations
• nationwide. included tumor characteristics,
  neo-adjuvant hormone therapy, age, mean follow-up
  time,
• treatment modality, co-morbidity score.
• RESULTS
• 23,811 men diagnosed with prostate cancer between
  1990 and 1998. mean follow-up time is 6.6 years
• (median 10.9 years). Overall death rate was
  26.82 (n 6,385) with a prostate
• cancer specific death rate of 6.06 (n 1,442)
• CONCLUSIONS
• The results of this study have shown that
  compared with conservative management, both
  radiotherapy and
• Radical prostatectomy increase survival for men
  with localized prostate cancer.

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IS DIABETES MELLITUS ASSOCIATED WITH POORLY
DIFFERENTIATED PROSTATE CANCER (PCa)?Firas
Abdollah , Andrea Salonia , Andrea Gallina ,
Vincenzo Scattoni , Rayan Matloob , Patrizio
Rigatti and Francesco Montorsi .

• METHODS
• 1874 consecutive radical prostatectomy between
  February 1997 and July 2007.
• Six and a half percent (120/1874) of them were
  diabetic at the moment of PCa diagnosis.
• RESULTS
• No significant differences between diabetic and
  non diabetic men were observed regarding age
  (666 vs 657 years
• p0.7), PSA level at diagnosis (9.59 vs 9.810
  ng/ml p0.1), and pathological stage (pT2 67,
  pT3 33, pT4 0 vs pT2 71,
• pT3 28, pT4 1).
• Significantly higher percentage of poorly
  differentiated PCa were found in diabetic
  patients
• (pGS lt6 12, pGS 6 21, pGS 7 55, pGS gt7
  12 vs pGS lt6 16, pGS 6 26, pGS 7 52, pGS
  gt7 6 p0.02).
• Multivariate significantly higher risk of having
  a poorly differentiated PCa in diabetic patients
  (OR 2.4 P0.05).
• the other parameters included in the multivariate
  analysis (age, total PSA, and pathological stage)
  were
• not significantly correlated to the presence or
  not of DM.
• CONCLUSIONS
• Diabetic patients have a higher risk of having a
  poorly differentiated PCa at final pathology
  following radical
• prostatectomy than patients who are euglycemic.

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HIGHER CHOLESTEROL INCREASES THE RISK OF
BIOCHEMICAL FAILURE AFTER RADICAL
PROSTATECTOMYRESULTS FROM THE SEARCH DATABASE
GROUPLionel L Banez MD , Robert J Hamilton MD,
MPH , William J Aronson MD , Martha K Terris MD ,
Joseph C Presti MD , Christopher J Kane ,
Christopher L Amling MD and Stephen J Freedland
MD ..

• METHODS
• 471 men from the Shared Equal Access Regional
  Cancer Hospital (SEARCH) database who
• underwent radical prostatectomy from 1998 to 2007
  and had available cholesterol, low-density
  lipoprotein
• (LDL) and high-density lipoprotein (HDL) levels
  and known statin medication use status prior to
  surgery.
• RESULTS
• increased serum cholesterol (p0.001) and
  increased serum LDL (p0.007) increased the risk
  for biochemical recurrence after surgery.
• HDL was not associated with biochemical relapse
  (p0.79).
• Men in the highest quartile of serum cholesterol
  (³ 217 mg/dl) had 2.5 times higher risk for
  biochemical relapse
• (HR 2.49, 95 CI 1.28 - 4.86, p0.007) compared
  to men in the lowest quartile (lt167 mg/dl).
• CONCLUSIONS
• Suggest that hypercholesterolemia may promote
  prostate cancer progression.

10
EXTERNAL-BEAM RADIATION THERAPY INCREASES THE
RATE OF SECONDARY MALIGNANCIES RELATIVE
TORADICAL PROSTATECTOMY IN MEN WITH PROSTATE
CANCERNaeem Bhojani MD , Claudio Jeldres MD ,
Luigi F Da Pozzo MD , Monica Morgan MD , Shahrokh
F Shariat MD , Paul Perrotte MD , Nazareno Suardi
MD , Fred Saad MD , Francesco Montorsi MD and
Pierre I Karakiewicz

• METHODS
• The study population consisted of 10,333 men
  treated with radical prostatectomy (RP) (n6196)
  or EBRT (n 4137)
• between 1983 and 2004 without neo- or adjuvant
  hormonal therapy.
• The diagnosis of bladder, lung and colo-rectal
  cancer were established with the ICD-9 and
  surgery codes,
• (cystectomy, lobectomy or pneumectomy and
  colectomy with or without rectal resection).
• RESULTS
• Overall, 92 (0.9) cystectomies, 82 (0.8) lung
  cancer surgeries and 228 (2.2) surgeries for
  colo-rectal cancers
• were performed.
• In univariable analyses, the rate of cystectomies
  (log-rank p0.002), of treatments for lung cancer
  (log-rank
• plt0.001) and for colo-rectal cancers (log-rank
  plt0.001) were higher in patients treated with
  EBRT relative to patients treated
• with RP.
• At multivariable analyses, after adjusting for
  age, baseline comorbidities and year of treatment
  EBRT predisposed to a
• 3.0-fold higher rate of cystectomy for bladder
  cancer (p0.04),
• 1.8-fold higher rate of lung cancer resections
  (p0.02)
• 1.7-fold higher rate of rectal cancer (p0.02).

11
DIETARY LONG-CHAIN OMEGA-3 FATTY ACIDS, COX2 GENE
POLYMORPHISM, AND AGGRESSIVE PROSTATE
CANCERVincent Fradet MD , Iona Cheng PhD ,
Graham Casey PhD and John S Witte PhD .

• METHODS
• case-control study of aggressive prostate cancer
  of 1012 subjects
• prostate cancer presenting with one or more of
  the following clinical criteria
• clinical T stage gtT2b, initial PSA gt10 ng/mL or
  biopsy Gleason score gt6.
• Controls had no diagnosis of prostate cancer, a
  serum PSA lt4 ng/mL, and were frequency matched to
  cases for age, institution
• and ethnicity.
• Assessed food intake by a validated questionnaire
  and calculated nutrient intake.
• RESULTS
• Both EPA and DHA were associated with a
  dose-response reduction in prostate cancer risk
  (ps for trend 0.0001).
• The Odds Ratios (95 Confidence Intervals)
  comparing the highest quartile of fatty acid
  intake to the lowest equaled 0.44 (0.30 -
• 0.65) and 0.37 (0.25 - 0.55) for DHA and EPA,
  respectively.
• CONCLUSIONS
• Intake of food containing the long-chain omega-3
  fatty acids EPA and DHA is inversely associated
  with
• aggressive, clinically significant, prostate
  cancer.

12
SERUM TESTOSTERONE IS ASSOCIATED WITH AGGRESSIVE
PROSTATE CANCER RESULTS FROM THE BALTIMORE
LONGITUDINAL STUDY OF AGINGPhillip M Pierorazio
MD , Luigi Ferrucci , Anna E Kettermann , E
Jeffrey Metter and H Ballentine Carter MD .

• INTRODUCTION AND OBJECTIVE
• Evaluated the relationship between testosterone
  and the development of high-risk prostate cancer.
  
• Prospectively evaluated serum androgen
  concentrations and the development of high risk
  prostate cancer.
• METHODS
• Cohort was 729 male participants in the Baltimore
  Longitudinal Study of Aging who had sex steroid
• measurements prior to a diagnosis of prostate
  cancer, or last visit for those without prostate
  cancer (no cancer,
• n 611 prostate cancer not high risk, n83
  prostate cancer high risk, n35).
• High risk cancer was defined as death from
  prostate cancer, or gt20 at diagnosis, or Gleason
  score gt8.
• RESULTS
• After adjusting for age and date of diagnosis,
  calculated free testosterone was significantly
  associated with high
• risk prostate cancer (RR1.25 95 CI1.03
  to1.51, p0.022).
• CONCLUSIONS
• Higher levels of calculated serum free
  testosterone are associated with an increased
  risk of aggressive prostate
• cancer.

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OBESE MEN HAVE LARGER AND HIGHER-GRADE TUMORS
AN ANALYSIS OF THE DUKE PROSTATE CENTER
DATABASENicholas J Fitzsimons MD , Leon Sun MD,
PhD , Judd W Moul MD , John F Madden MD and
Stephen J Freedland

• METHODS
• Retrospective analysis of 2,171 patients treated
  with radical prostatectomy
• Association between BMI and tumor volume and
  high-grade disease (Gleason 43 or
• greater) was assessed
• RESULTS
• Increased BMI was significantly associated with
  younger age (plt0.001), black race (plt0.001), more
  recent year
• of surgery (plt0.001), positive surgical margins
  (plt0.001), higher-grade disease in the surgical
  specimen
• (p0.03), and larger tumor volumes (p0.003).
• Higher BMI was associated with increased tumor
  volume (plt0.001) and high-grade
• disease (p0.001).
• Men with a BMI of 35 kg/m2 or greater had nearly
  40 larger mean tumor volumes than normal weight
  men
• (5.1 vs. 3.7 cc).
• CONCLUSIONS
• first study to show obese men have larger cancers
  and higher grade tumors at the time of RP

14
TESTOSTERONE (T) LEVEL CORRELATES WITH SURVIVAL
IN PTS WITH ADVANCED PROSTATE CANCER (APC) THE
LOWER IS REALLY THE BETTERMassimo Perachino MD
and Valerio Cavalli MD .

• METHODS
• 162 consecutive pts with diagnosis of PC treated
  with ADT
• T and PSA were measured every 3 months
• age, stage, Gleason Score (GS), basal PSA, basal
  T, PSA nadir, time to PSA nadir, T after 6 m, T
  nadir and time to T nadir. Multivariate analysis
  was performed
• With a mean follow up of 52.3 33.2 months, 97
  pts are dead (59.9) and 65 pts are alive
  (50.1).
• Statistical analysis using Cox's model shows that
  serum T at 6 m correlates with pts survival
  (HR1.92, plt.05).
• Death risk is directly correlated not only to GS
  (plt.01) and to basal PSA (plt.01), but also to 6 m
  serum T level (p.0286).
• The lower the T level after 6 m, the longer the
  survival.
• pt with GS 7 and pretreatment PSA 50 ng/ml has
  60 5-yr probability of survival if 6m T is 10
  ng/ml. 5-yr
• probability of survival decreases to 54.3 if 6m
  T is 40 ng/ml.
• CONCLUSIONS
• correlation between T levels and survival.
• suggest to choose an LHRH analogue that allows to
  reach the lowest possible T value in the shortest
  time, and to strictly monitor

15
CORRELATIONS BETWEEN N-TELOPEPTIDE OF TYPE I
COLLAGEN RESPONSE AND ZOLEDRONIC ACID ONCLINICAL
OUTCOMES IN PATIENTS WITH BONE METASTASES FROM
PROSTATE CANCERFred Saad MD , Richard Cook ,
Allan Lipton and Robert Coleman .

• METHODS
• Data were obtained from patients with bone
  metastases secondary to HRPC who had urinary NTX
  assessments at
• baseline and month 3 (n 314)
• Patients were stratified by baseline NTX
• (normal N group, lt 64 nmol/mmol creatinine
  elevated E group, ³ 64 nmol/mmol creatinine).
• All patients received standard anticancer
  therapies in addition to zoledronic acid.
• RESULTS
• Baseline NTX was elevated in 193 (62) patients
  (E group).
• NTX levels normalized within 3 months of
  zoledronic acid therapy in 70 of the E group.
• NTX normalization was associated with a
  significant 59 decrease in relative risk
• of death (relative risk 0.410 P lt .0001)
  compared with patients whose NTX levels remained
  elevated.
• percentage decrease in NTX at 3 months correlated
  with a continuum of benefit, with the longest
  survival in patients whose NTX
• levels decreased ³ 75 (P lt .0001 for comparison
  between percentage-reduction quartiles).
• CONCLUSIONS
• NTX normalization correlated with survival
  benefits.

16
RESULTS OF A PROSPECTIVE PILOT CLINICAL TRIAL
ADMINISTERING ACUPUNCTURE FOR HOT FLASHES
INPATIENTS UNDERGOING HORMONAL THERAPY FOR
PROSTATE CANCERJillian L Capodice , Zhezhen Jin
PhD , Brian A Stone MD , James M McKiernan MD ,
Carl A Olsson MD and Aaron E Katz MD .

• First prospective clinical trial testing the
  safety and efficacy of acupuncture in reducing
  hot flashes in advanced CaP patients
• undergoing hormonal therapy.
• METHODS reporting gt4 flashes/day (a standardized
  value on the Expanded Prostate Cancer Index
  (EPIC)-hormone
• questionnaire).
• patients received standardized full body
  acupuncture 1x/week (wk) for 14 wks.
• Patients were evaluated at 0, 7, 14 and a 14-wk
  follow-up (F/U) (28-wks).
• At 0 and 14 wks serum testosterone was measured.
  At the 0, 7, 14 and 28-wk evaluations EPIC and
  patient reported
• hot flash frequency were administered. Endpoints
  are number of flashes as determined by the EPIC
  and patient report, and
• testosterone levels.
• RESULTS
• all patients were enrolled (n16) and 14
  completed the trial.
• no change in testosterone at baseline 11(ng/mL)
  (range 0-32) vs endpoint 18 (range 0-28)
  (p0.237).
• No serious adverse events
• Analysis of patient reported frequency shows a
  significant reduction in the number of
• flashes at 7 (plt0.01), 14 (plt0.01) and 28 wk F/U
  (plt0.01) as compared to baseline

17
IMPACT OF PELVIC LYMPHADENECTOMY ON DISEASE-FREE
SURVIVAL AFTER RADICAL PROSTATECTOMY
AMULTICENTER STUDYMichele Lodde MD , Helene
Hovington , Francois Harel MD , Michael J Harris
MD , David P Wood MD , Michel Hugues Lebel MD ,
Louis Lacombe MD and Yves Fradet MD .

• METHODS
• The databases of (RP) from three different
  Urological Departments were retrospectively
  analyzed.
• Center A performed only perineal prostatectomies
  (PP) with no PNLD in patients with PSA lt 10.
• Center B performed a standard PNLD
• center C performed an extended PLND including
  internal and common iliac LN.
• RESULTS
• The median of LN removed was 0, 6 and 14 and LN
  0, 1.2 and 6 respectively.
• the risk of PSAF was increased in patients with
  PP and no PLND (Group A) vs extended PLND (Group
  C) (HR1.49 p0.017) but not
• vs standard PLND (Group B).
• standard vs no PLND did not reduce the risk of
  PSAF
• extended PLND was associated with a risk
  reduction of 64 (HR0.36 plt.0001).
• Standard PLND was associated with 2 times more
  risk of PSAF (HR 2.11 plt.0001) compared to
  extended PLND.
• Type of PLND was a stronger independent predictor
  than pStage, Gleason gt7 and positive margin.

18
EXTENDED PELVIC LYMPH NODE DISSECTION DOES NOT
AFFECT RISK OF BIOCHEMICAL FAILURE AFTER
RADICALPROSTATECTOMY A 20-YEAR,
SINGLE-INSTITUTION ANALYSISStefan T Samuelson ,
Manisha Desai , Mitchell C Benson MD , James M
McKiernan MD and Ketan K Badani MD .

• METHODS
• 1052 men with negative LN on final pathology and
  complete data on the following parameters 12
  months of
• follow-up, a known number of nodes removed,
  preoperative prostate-specific antigen (PSA),
  biopsy Gleason
• score, clinical stage, pathological stage, and
  surgical margin status. met these criteria.
• The primary endpoint of the study was biochemical
  failure, defined as PSA gt0.2 ng/mL.
• The number of LN removed was assessed as both a
  continuous and categorical variable (0-2, 3-5,
  6-8, and 9).
• RESULTS
• The categorical LN breakdown was as follows
• 0-2 nodes, n69 3-5 nodes, n280 6-8 nodes,
  n255 9 or more nodes, n448.
• On univariate analysis, BCFR was significantly
  influenced by preoperative PSA (Plt0.001), Gleason
  grade
• (plt0.001), and pathologic tumor stage (p0.001).
• There was no significant difference found in BCFR
  among all lymph node categories.
• On multivariate analysis controlling for stage,
  grade, and preoperative PSA, there was no
  significant difference found
• CONCLUSIONS

19
CHARACTERISTICS OF PROSTATE CANCERS DETECTED AT
LOW PSA VALUESJoshua J Meeks MD, PhD , Stacy
Loeb MD , Donghui Kan , Brian T Helfand MD, PhD ,
Norm D Smith MD , Christopher R Griffin and
William J Catalona MD .

• METHODS
• 934 radical retropubic prosatectomy (RRP) by one
  surgeon between 2003 and 2007.
• 78 had a preoperative PSA level lt2.5 ng/ml.
• We evaluated the clinicopathological features of
  these men after stratification for DRE findings.
• RESULTS
• Of the 78 men with a PSA lt2.5 ng/ml, the digital
  rectal exam was abnormal in 51 men (65) and
  normal in 27 men (35).
• Prostate cancer was detected in the (TURP)
  specimen in 15 of the men with a normal DRE.
• In the subgroup with a normal DRE, 8.0 had
  biopsy Gleason score of gt6, while 15.4 had
  final pathology grade of gt6 on RP
• overall rate of upgrading was 8 in these men.
• mean tumor volume at the time of RRP was
  significantly higher in men with an abnormal DRE
  (p0.017).
• trend toward a higher prostatectomy Gleason score
  in men with palpable disease (p0.09)
• CONCLUSIONS
• Despite low PSA, a significant proportion of men
  with PSA lt2.5 ng/ml have aggressive pathology on
  biopsy and
• ultimately in the radical prostatectomy specimen.

20
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21
LONG TERM OUTCOME OF PATIENTS WITH POSITIVE LYMPH
NODES DURING RADICAL PROSTATECTOMYSURVIVAL
BENEFIT OF PATIENTS WITH COMPLETED VS. ABANDONED
SURGERYThomas P Steuber MD , Frederike Beyer ,
Felix K H Chun , Sascha A Ahyai , Alexander Haese
, Andreas Erbersdobler , Hartwig Huland and
Markus Graefen .

• METHODS
• Between 1992 and 2000, 158 of 2591 patients
  treated with rP for clinically localized PCa were
  pNpos (6).
• Follow-up information was available for 140 men.
  All patients received adjuvant or salvage
  hormonal therapy.
• RESULTS Five and 7-year cpfs for pNpos patients
  was 71 and 65, respectively 5- and 7-year css
  was 86
• and 76, respectively.

22
HYPOFRACTIONATED EXTERNAL BEAM RADIATION THERAPY
AND SINGLE FRACTION HDR-BRACHYTHERAPYIMPROVING
THE RESULTS IN THE TREATMENT OF INTERMEDIATE-RISK
PROSTATE CANCERMarie Duclos MD , Armen G
Aprikian MD , Favio Cury MD , Marc David MD ,
George Shenouda MD , Jordan Steinberg MD , Sergio
Faria MD , Boris Bahoric MD , Horacio Patrocino
PhD and Luis Souhami MD .

• METHODS
• Since 2001, 111 patients with intermediate risk
  PC were treated with HDR-B plus H-EBRT, without
  ADT.
• The median age was 69 years.
• Radiotherapy consisted of a single HDR-B fraction
  of 10 Gy to the prostate surface followed by
  H-EBRT to a dose of 50 Gy in 20 fractions.
• The first 73 consecutive patients with minimum
  follow-up of 2 years were assessed for toxicity
  and disease control.
• Repeat prostate biopsies and PSA control (Phoenix
  definition), were used to assess local control.
• RESULTS
• Median follow-up was 50.6 months. No patient
  presented acute grade III or higher
  gastro-intestinal or genito-urinary
• toxicities. Late rectal toxicity grade II was
  seen in 5 patients and grade III in one. Five
  patients presented intermittent gross
• hematuria, and one patient developed urinary
  incontinence.
• After a minimum follow-up of 2 years, 42 patients
  (57.5) underwent
• a repeat prostate biopsy the remaining either
  refused or were never offered the procedure.
• Negative biopsies were found in 39/42 patients
  (92.9) among the 3 positive biopsies, only one
  patient has true biochemical failure, while
• the other two have stable serum PSA levels below
  0.1 ng/dL.
• Overall, eight patients (10.9) failed the
  treatment, 6 with metastatic disease and 2

23
WHAT IS THE BEST TREATMENT FOR CLINICALLY
LOCALIZED PROSTATE CANCER RADICAL
PROSTATECTOMY,BRACHYTHERAPY, OR EXTERNAL BEAM
RADIATION THERAPY?Kimberly A Roehl , Jessica M
Duerscheidt , William J Catalona MD , Stacy Loeb
and Brian K Suarez PhD .

• METHODS
• evaluated 3565 patients diagnosed with prostate
  cancer until 2003 who were treated by radical
• prostatectomy, brachytherapy, or external beam
  radiation therapy.
• Kaplan-Meier 10-year PFS, OS and CSS rates.

24
TREATMENT OF LOCALIZED PROSTATE CANCER BY HIGH
INTENSITY FOCUSED ULTRASOUND (HIFU) RESULTS
OFTHE FIRST FRENCH PROSPECTIVE STUDY ON PATIENTS
NOT PREVIOUSLY TREATED MINIMUM OF FIVE YEARS OF
FOLLOW-UPPierre Conort MD , Pascal Rischmann
MD, PhD , Henri Bensadoun MD, PhD , Daniel
Chevallier MD , Christian Pfister MD, PhD,
Christian Saussine MD, PhD , Guy Vallancien MD
and Albert Gelet MD, PhD .

• METHODS
• Ablatherm (EDAP S.A., CE mark on 2000), from
  25/01/01 to 25/01/02, 8 urological centers
• PSAlt15 ng/mL, Score de Gleason (GS) lt8, lt50 of
  positive biopsies, volume prostate volume (PV) lt
  50 cc, stageT1b- c T2.
• Data management and analysis were done by an
  independent institution (ITEC).
• RESULTS
• 117 patients (68 T1, 49 T2) were included mean
  age 69 ans (47-79),
• PSA 8,4 3,4 ng/mL (1-15), 2 1 positive
  biopsies from 8 3, GS 6 1 (2-7), PV 31 10
  cc (12-50).
• Sessions of HIFU 179. Retreatment 52
• With a mean FU of 62 months, 73 patients were
  treated by HIFU alone (retreatment 39) with a
  mean PSA 1,9
• 2,0 ng/mL (31lt 1,0 et 63 lt 4,0).
• With more than 5 years of FU, 55 patients (75 of
  those without adjuvant treatment) were considered
  as success.
• Initial PSA is not a pronostic factor, but PSA
  nadir after the first session seems to be related
  to success
• 38 success from 42 patients with PSA nadir lt 1,0
  ng/mL.
• CONCLUSIONS
• this first prospective study, gt 5years of FU, has
  shown that HIFU (Ablatherm)
• a retreatment rate of 39, can successfully treat
  more than 50 of patient without any major
  side-effects
• adjuvant treatment was required for 22

25
LONG-TERM SURVIVAL AFTER RADICAL PROSTATECTOMY
FOR PATIENTS WITH HIGH RISK PROSTATE CANCER IN
THE PSA ERAStephen A Boorjian MD , R Jeffrey
Karnes MD , Laureano J Rangel MS , Eric J
Bergstralh PhD and Michael L Blute MD .

• METHODS
• 7,591 consecutive patients who underwent RP
  without prior therapy at the Mayo Clinic between
  1987-2003
• to identify patients with high risk disease (PSA
  gt 20 ng/mL, biopsy Gleason score 8-10, or
  clinical stage T2c).
• RESULTS
• total of 1513 men underwent RP for high risk
  disease, with a median follow-up of 8.7 years.
• 858/1513 (56.7) men were found to have
  organ-confined tumors at RP.
• Ten year cancer-specific survival (CSS) was 95,
  with 90 of patients without local recurrence
  (LR)
• 55 free from biochemical recurrence (BCR,
  defined as a PSA gt 0.4 ng/mL) (figure).
• On multivariate analysis, Gleason score on biopsy
  (HR 1.3, p0.006) and at RP (HR1.4, p0.006),
• pathological tumor stage (HR 1.8, p0.04),
  positive lymph nodes (HR 2.3, p0.02), and
  positive surgical margins (HR 2.1,
• p0.008) predicted death from prostate cancer.
• Age, year of surgery, preoperative PSA, clinical
  stage, and the number of high
• risk features did not affect survival.

26
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27
PROSTATE SPECIFIC ANTIGEN TESTING AMONG THE
ELDERLY WHEN TO STOP?H Ballentine Carter MD ,
Anna E Kettermann , Luigi Ferrucci MD, PhD ,
Patricia Landis BS , Bruce J Trock and E Jeffrey
Metter MD.

• INTRODUCTION AND OBJECTIVE
• We determined the proportion of men who developed
  aggressive prostate cancer by PSA and age to
  evaluate
• the safety of discontinuing PSA testing among
  older men.
• METHODS The probability of aggressive prostate
  cancer (death from prostate cancer) by PSA and
  age was determined from a
• Cohort participating in the Baltimore
  Longitudinal Study of Aging (National Institute
  on Aging).
• RESULTS
• PSA of 3.0ng/ml and above at the age of 75-80
  years had a probability of death from prostate
  cancer
• afterwards that continued to increase
• no subject at the age of 75-80 years with a PSA
  below 3.0ng/ml died of prostate cancer afterwards
  (Plt.001, Fisher's exact test).
• aggressive prostate cancer was defined as death
  from prostate cancer, or Gleason score 8 or above
  at diagnosis, or PSA 20ng/ml or above at
  diagnosis.
• CONCLUSIONS
• Men who have a PSA level below 3ng/ml at age
  75-80 years are unlikely to develop aggressive
  prostate
• cancer during their remaining life and for these
  men PSA testing might be safely discontinued.

28
IS PROSTATE CANCER AT YOUNG AGE BIOLOGICALLY MORE
AGGRESSIVE THAN IN ELDERLY MEN?David Pfister ,
Dina Sahi , David Thuer , Carsten Ohlmann , Udo
Engelmann and Axel Heidenreich .

• INTRODUCTION AND OBJECTIVE
• study to compare the clinical and oncological
  characteristics of PCA at young age lt 55 years
  with a cohort of
• patients gt 55 years.
• METHODS 550 consecutive patients with PCA were
  retrospectively evaluated
• 108 (19.6) patients were lt 55 years (Group 1),
• 442 (80.4) patients were gt 55 years (Group 2).
• RESULTS
• There were no significant differences between
  both groups with regard to clinical stage, number
  of positive
• Biopsies and preoperative PSA serum
  concentration.
• RP specimens revealed more locally advanced PCA
  in group 1 as compared to group 2 pT3b/4 PCA
  (p0.05)
• positive lymph nodes were significantly more
  often diagnosed in men lt 55 years (27.3 vs.
  12.7, p0.005).
• Gleason Score 8-10 (30 vs. 19, plt0.05) and
  positive urethral surgical margins (42 vs. 26,
  plt0.05).
• The 5-year biochemical progression-free survival
  was significantly lower in the low age group (62
  vs. 82,
• plt0.007), the PCA - specific mortality was
  significantly higher in the low age group (18
  vs. 6, plt0.003).

29
DETECTION OF TMPRSS2-ERG FUSION TRANSCRIPTS AND
PCA3 IN URINARY SEDIMENTS MAY IMPROVEDIAGNOSIS
OF PROSTATE CANCERDaphne Hessels , Frank P Smit
, Gerald W Verhaegh , J Alfred Witjes , Erik B
Cornel and Jack A Schalken .

• METHODS
• 78 men with prostate cancer-positive biopsies and
  30 men with prostate cancer-negative biopsies
  were included in
• this study.
• After DRE, the first voided urine was collected
  and urinary sediments were obtained. We used
  semi-quantitative
• RT-PCR analysis followed by Southern-blot
  hybridization with a radiolabeled probe for the
  detection TMPRSS2-ERG fusion
• transcripts in these urinary sediments.
• A quantitative RT-PCR assay for PCA3 was used to
  determine the PCA3 score in the same sediments.
• RESULTS
• TMPRSS2-ERG fusion transcripts were detected in
  the urine after DRE with a sensitivity of 37. In
  this cohort of
• patients the PCA3-based assay had a sensitivity
  of 62. When both markers were combined the
  sensitivity increased to 73.
• In men with persistently elevated serum PSA
  levels and history of negative biopsies the
  positive predictive value of
• TMPRSS2-ERG fusion transcripts was 94,
  suggesting that detection of TMPRSS2-ERG fusion
  transcripts could give a better
• indication which patients require repeat
  biopsies.
• CONCLUSIONS
• combination of TMPRSS2-ERG and PCA3, improve the
  sensitivity for prostate cancer diagnosis.