Best Papers. F. Fusco

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1 Best Papers UROLOGY F. Fusco

2 Best papers RP/RT Oncological outcomes RP/RT IN ct3 Utilization trends RP/RT Complications Evolving role of elnd /Salvage LND

3 This cohort reflects the current clinical situation of EBRT in the era of IMRT Aims To compare outcomes, including mortality, of RP and EBRT for localized PC. Methods We retrospectively analyzed 891 patients with ct1-4n0m0 PC who underwent either RP (n = 569) or EBRT (n = 322) with curative intent at our single institution between 2005 and Of the EBRT patients, 302 (93.8%) underwent intensity-modulated radiotherapy. Primary endpoints were overall survival (OS) and cancer-specific survival (CSS). Related to these, other-cause mortality (OCM) was also calculated. Biochemical recurrence-free survival was assessed as a secondary endpoint. Median follow-up durations were 53 and 45 months, in the RP and EBRT groups, respectively.

4 Overall survival ALL RISKS

5 Overall survival LOW RISK

6 Overall survival INTERMEDIATE RISK

7 Overall survival HIGH RISK

8 Cancer specific survival ALL GROUPS

9 Cancer specific survival LOW RISK There was no death from PCa in men with low D Amico risk

10 Cancer specific survival INTERMEDIATE RISK There was one death in men with intermediate D Amico risks in the EBRT group

11 Cancer specific survival HIGH RISK In high-risk patients, significantly more patients died from PCa in the EBRT group than the RP group

12 Predictors of cancer specific survival RP might be the better choice, especially for high-risk patients

13 Aims to describe changes in treatment patterns for clinical T3 prostate cancer (PCa) from 1998 to 2012, specifically investigating what factors influence receipt of prostatectomy or radiation Methods Using the Surveillance, Epidemiology, and End Results database, we studied 11,604 men with clinical T3N0M0 PCa from 1998 to 2012, with treatment categorized as radiation, radical prostatectomy (RP), or no curative therapy. Michelle D. Nezolosky., et al., Urologic Oncology, 2015

14 Treatment trends for overall cohort 55.8% 44.4% 31.7% 12.5% 38.4% 17.2%, Significant increase in the use of RP for clinical T3 PCa and a significant decrease in the use of radiation such that Rates of prostatectomy increased significantly from 1998 to 2012, radiation decreased significantly,and receipt of no treatment also decreased ( all P < 0.001). In 2012, the use of prostatectomy exceeded the use of radiation. Michelle D. Nezolosky., et al., Urologic Oncology, 2015

15 Treatment trends for ct3a and ct3b These trends were similar for clinical T3a and T3b. Rates of prostatectomy surpassed radiation by 2008 in clinical T3a,reaching 49.8%vs.37.1%,respectively,in 2012(P=0.002), and were statistically similar to radiation in 2012 for clinical T3b,reaching 41.6%vs.42.1%. Michelle D. Nezolosky., et al., Urologic Oncology, 2015

16 Predictors of RP use Multivariable logistic regression analysis demonstrated that patients were more likely to receive RP if: Younger, Lower initial PSA, Biopsy Gleason scores of 5 to 7 vs. Gleason scores of 8 to 10 disease, Lower country-education level (all P < 0.04) Michelle D. Nezolosky., et al., Urologic Oncology, 2015

17 Aims The relationship between the number of removed lymph nodes (RLNs) and cancer-specific mortality (CSM) was tested in patients with LNI. Methods We examined data of 315 pn1 PCa patients treated with radical prostatectomy (RP) and anatomically eplnd between 2000 and 2012 at one tertiary care centre. All patients received adjuvant hormonal therapy with or without adjuvant radiotherapy (art).

18 Cancer specific survival Kaplan-Meier survival estimates based on multivariable analysis, depicting cancerspecific survival rate in 315 pn1 prostate cancer patients treated with surgery and adjuvant treatment. Patients were stratified according to (a) the total number of lymph nodes removed

19 Cancer specific survival Kaplan-Meier survival estimates based on multivariable analysis, depicting cancer-specific survival rate in 315 pn1 prostate cancer patients treated with surgery and adjuvant treatment. Patients were stratified according to (b) the most informative cut-off for the association between the number of nodes removed and cancer-specific survival.

20 Cancer specific mortality - predictors An eplnd should be considered in all patients with a significant preoperative risk of harbouring an LNI (INTERMEDIATE/HIGH RISK PATIENTS)

21 Objective: To examine long-term outcomes of salvage LND in patients with nodal recurrent PCa documented by 11C-choline positron emission tomography/computed tomography (PET/CT) scan. Design, setting, and participants: Overall, 59 patients affected by biochemical recurrence (BCR) with 11C-choline PET/CT scan with pathologic activity treated between 2002 and 2008 were included. Intervention: Pelvic and/or retroperitoneal salvage LND.

22 Outcome measurements Biochemical response (BR) was defined as prostate-specific antigen (PSA) <0.2 ng/ml at 40 d after surgery. biochemical recurrence (BCR) for those who achieved BR was defined as a PSA >0.2 ng/ml. Clinical recurrence (CR) was defined as a positive PET/CT scan after salvage LND in the presence of a rising PSA. Kaplan-Meier curves assessed time to BCR, CR, and cancerspecific mortality (CSM).

23 Results Median follow-up after salvage LND was 81.1 mo. Overall, 35 patients (59.3%) achieved BR The 8-yr BCR-free survival rate in patients with complete BR was 23%. Overall, the 8-yr CR- and CSM-free survival rates were 38% and 81%, respectively.

24 Models predicting clinical recurrence after salvage lymph node dissection In multivariable analyses evaluating preoperative variables, PSA at salvage LND represented the only predictor of CR ( p = 0.03).

25 Models predicting clinical recurrence after salvage lymph node dissection When postoperative variables were considered, BR and the presence of retroperitoneal lymph node metastases were significantly associated with the risk of CR (all p 0.04).

26 Conclusions: Salvage LND may represent a therapeutic option for patients with BCR after RP and nodal pathologic uptake at 11C-choline PET/CT scan. Although most patients progressed to BCR after salvage LND, roughly 40% of them experienced CR-free survival. Ideal candidates for such an approach are patients with a small volume of nodal recurrence limited to the pelvic area.

27 Aims To assess rates of treatment-related complications after radical prostatectomy or radiotherapy monotherapy Methods On the basis of a population-based study of men undergoing surgery or radiotherapy for prostate cancer in Ontario between 2002 and 2009, we undertook a propensity score matched analysis including age, comorbidity, and year of treatment to assess treatment-related complication end points. These included: hospital admission; urologic, rectal, or anal procedures; open surgeries; and secondary malignancies. Wallis C.J.D., et al., UROLOGY, 2015

28

29 From the original cohort of 32,465 patients, 15,870 (48.9%) had surgery and 16,595 (51.1%) had radiation. Propensity score matching produced 8797 pairs (17,594 patients). Using propensity score analysis and direct matching techniques, we showed that patients who underwent radiotherapy for prostate cancer had an increased risk of long-term complications across all 5 measures compared with patients who had surgery when accounting for age, comorbidity, and year of treatment. When the analysis was restricted to only patients receiving full 3D treatment preparation for radiotherapy, the results were similar Wallis C.J.D., et al., UROLOGY, 2015

30 Conclusions 1.Better oncological outcomes with RP in high risk patients 2.Increasing use of RP over RT 3.Potential therapeutic role of elnd 4.Lower long term complications rate with RP

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