A.R. Zlotta

Diagnostic prostate biopsy performed in a non-academic center increases the risk of re-classification at confirmatory biopsy for men considering active surveillance for prostate cancer

Background:To examine whether diagnostic biopsy (B1), for patients on active surveillance (AS) for prostate cancer, performed at an outside referral centre (external) compared with our in-house tertiary center (internal), increased the risk of re-classification on the second (confirmatory) biopsy (B2).Methods:Patients on AS were identified from our tertiary center database (1997–2012) with PSA<10, Gleason sum (GS) ⩽6, clinical stage ⩽cT2, ⩽3 positive cores, <50% of single core involved, age ⩽75 years and having a B2. Patients who had <10 cores at B1 and delay in B2 >24u2009mo were excluded. Depending on center where B1 was performed, men were dichotomized to internal or external groups. All B2 were performed internally. Multivariate logistic regression examined if external B1 was a predictor of re-classification at B2.Results:A total of 375 patients were divided into external (n=71, 18.9%) and internal groups (n=304, 81.1%). At B2, more men in the external group re-classified (26.8%) compared with the internal group (13.8%)(P=0.008). On multivariate analysis, external B1 predicted grade-related re-classification (odds ratio (OR) 4.14, confidence interval (CI) 2.01–8.54, P<0.001) and volume-related re-classification (OR 3.43, CI 1.87–6.25, P<0.001). Other significant predictors for grade-related re-classification were age (OR 2.13 per decade, CI 1.32–3.57, P<0.001), PSA density (OR 2.56 per unit, CI 1.44–4.73, P<0.001), maximum % core involvement (OR 1.04 per percentage point, CI 1.01–1.09, P=0.02) and time between B1 and B2 (OR 1.43 per 6 months, CI 1.21–1.71, P<0.001).Conclusion:At our institution, patients on AS who had their initial B1 performed externally were more likely to have adverse pathological features and re-classify on internal B2.

Hypoxia Marker GLUT-1 (Glucose Transporter 1) is an Independent Prognostic Factor for Survival in Bladder Cancer Patients Treated with Radical Cystectomy

Background: Tumour hypoxia, which is frequent in many cancer types, is associated with treatment resistance and poor prognosis. The role of hypoxia in surgically treated bladder cancer (BC) is not well described. We studied the role of hypoxia in two independent series of urothelial bladder cancers treated with radical cystectomy. Methods: 279 patients from the University Hospital Network (UHN), Toronto, Canada, and Turku University, Finland were studied. Hypoxia biomarkers (HIF1-α, CAIX, GLUT-1) and proliferation marker Ki-67 were analyzed with immunohistochemistry using defined tissue microarrays. Kaplan-Meier methods and Cox proportional hazards regression models were used to investigate prognostic role of the factors. Results: In univariate analyses, strong GLUT-1 positivity and a high Ki-67 index were associated with poor survival. In multivariate model containing clinical prognostic variables, GLUT-1 was an independent prognostic factor associated with worse disease-specific survival (HR 2.9, 95% CI 0.7–12.6, Wald pu200a=u200a0.15 in the Toronto cohort and HR 3.2, 95% CI 1.3–7.5, Wald pu200a=u200a0.0085 in the Turku cohort). Conclusion: GLUT-1 is frequently upregulated and is an independent prognostic factor in surgically treated bladder cancer. Further studies are needed to evaluate the potential role of hypoxia-based and targeted therapies in hypoxic bladder tumours.

Improving patient journey and quality of care: Summary from the 2nd Bladder Cancer Canada-Canadian Urological Association-Canadian Urologic Oncology Group (BCC-CUA-CUOG) bladder cancer quality of care consensus meeting.

In the January-February 2016 issue of the Canadian Urological Association Journal, a multidisciplinary committee published a white paper entitled, “Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015.”1 The paper was produced in response to concerns regarding the variability in management and outcomes of patients with bladder cancer throughout centres and geographical areas in Canada. The final paper contents were the result of consensus deliberations during a two-day meeting that took place in late 2014. In November 2016, another multidisciplinary committee consisting largely of the same members convened the second “BCC-CUA-CUOG Bladder Cancer Quality of Care Meeting 2016.” The focus was on patient journey and optimizing management. The following document is a summary of the proceedings of this meeting. The objectives for the meeting were as follows: 1. Patient journey To discuss unmet needs in bladder cancer care from the patient perspective. 2. Optimizing management To select the top 10–15 indicators of bladder cancer quality of care and establish benchmarks; To develop a score card for measurement of bladder cancer quality of care; To address complex bladder cancer management from a training perspective; To identify bladder cancer centres of expertise across Canada using refined criteria; To discuss the establishment of a bladder cancer research network of excellence.

625 A non-invasive urine-based epigenetic urinary biomarker panel for the detection of bladder cancer and the discrimination of high-grade and low-grade disease

1Princess Margaret Cancer Centre, Dept. of Surgical Oncology, Division of Urology, University of Toronto, Toronto, Canada, 2Mount Sinai Hospital, Samuel Lunenfeld Research Institute, Toronto, Canada, 3University Health Network, Dept. of Surgery, Division of Urology, University of Toronto, Toronto, Canada, 4Mount Sinai Hospital, Dept. of Surgery, Division of Urology, Toronto, Canada, 5Dalhousie University, Dept. of Urology, Halifax, Canada, 6University of Liege, Dept. of Urology, Liege, Belgium, 7University Health Network, Dept. of Pathology, University of Toronto, Toronto, Canada

De FGFR3-mutatie identificeert patiënten met een relatief gunstige prognose na radicale cystectomie voor blaascarcinoom

Introductie De selectie van patiënten met een laagrisicoprostaatcarcinoom (PCa) voor active surveillance (AS) is gebaseerd op klinisch stadium, PSA en TRUS-geleide biopsiecriteria. Grootste beperking van een dergelijke benadering is de potentiële onderschatting van de werkelijke gecombineerde gleasonscore en het pathologisch stadium. Doel van onze serie is te evalueren in hoeverre de pathologie bij radicale prostatectomie (RP) bij kandidaten voor AS overeenkomt met de preoperatieve klinische en pathologische stadiëring.

1092 5-alpha reductase inhibitors diminish the rate of progression in men with low risk prostate cancer on active surveillance

INTRODUCTION AND OBJECTIVES: 5-alpha reductase inhibitors (5ARIs) have been shown to prevent prostate cancer in two large randomized controlled trials. No prior work has shown the effect of 5ARIs on those already diagnosed with low risk prostate cancer. Our goal was to determine the effect of 5ARIs on pathologic progression in men on active surveillance for prostate cancer. METHODS: This was a single institution retrospective cohort study comparing men taking a 5ARI versus no 5ARI while on active surveillance for prostate cancer. All men had at least two biopsies. Inclusion criteria for active surveillance were PSA 10 ng/ml, clinical stage T1c/T2a, Gleason score 6, and 3 cores positive with no more than 50% of a core involved at initial diagnostic biopsy. Pathologic progression was evaluated and defined as Gleason score 6, or maximum core involvement 50% or 3 cores positive on a follow-up prostate biopsy. Univariate, multivariate and Kaplan-Meir analyses were conducted. RESULTS: A total of 288 men on active surveillance met the inclusion criteria. The median follow-up was 38.5 months (IQR 23.6– 59.4) with 93 men (32%) experiencing pathologic progression and 96 men (33%) abandoning active surveillance. Men taking a 5ARI experienced a lower rate of pathologic progression (18.6% vs 36.7%, p 0.004) and were less likely to abandon active surveillance (20% vs 37.6%, p 0.006). The median time to progression was longer in the 5ARI group (42.5 months) compared to the non-5ARI group (31.5 months; p 0.026). On multivariate analysis, lack of 5ARI use was most strongly associated with pathologic progression (OR 2.98, 95% CI 1.5–5.9) followed by age and baseline maximum percentage involvement of any biopsy core. CONCLUSIONS: 5ARIs were associated with a significantly lower rate of pathologic progression and abandonment of active surveillance.

299 ANDROGEN RECEPTOR (AR) AND BLADDER CANCER: A LARGE BI-INSTITUTIONAL STUDY ON 473 PATIENTS

S143 only in the Triton-insoluble fraction. Under non-reducing conditions, PRDX 1 and 6 were found as bands of high molecular weight (>170 kDa) in spermatozoa incubated with 0.35-5 mM H2O2 (strong oxidative stress). PRDX 6 became a strong single band due to a mild oxidative stress (0.05 mM H2O2, a condition that promotes sperm capacitation). H2O2 (0.35-5 mM) caused a decrease of the signal for PRDX 4 and 5 compared to non-treated cells. Conclusion: PRDXs are present in human spermatozoa and differentially modified by oxidative stress. These results suggest a role of PRDXs as antioxidants and as potential modulators of H2O2 action in human spermatozoa.