Daniel Porres-Knoblauch

Risk and timing of biochemical recurrence in pT3aN0/Nx prostate cancer with positive surgical margin – A multicenter study

BACKGROUND AND PURPOSE Positive surgical margins (PSM) after radical prostatectomy have been shown to be associated with impaired outcome. In pT3pN0 patients with PSM either immediate radiotherapy or clinical and biological monitoring followed by salvage radiotherapy is recommended by the latest guidelines of the European Association of Urology. MATERIALS AND METHODS A retrospective, multicenter study of eight urological centers was conducted on 536 prostatectomy patients with pT3aN0/NxR1 tumors and no neoadjuvant/adjuvant therapy. A pathological re-review of all prostate specimens was performed. Association of clinical and pathological features with biochemical recurrence (BCR) was analyzed using univariate and multivariate analysis. RESULTS With 48months median follow-up, BCR occurred in 39.7%. Preoperative PSA value, performance of pelvic lymph node dissection and Gleason score were significantly associated with BCR. In multivariate analysis, Gleason score was the only independent prognostic factor (p<0.001) for BCR. Five-year BCR-free survival rates were 74%, 70%, 38%, and 51% with Gleason score 6, 3+4=7a, 4+3=7b, and 8-10, respectively. CONCLUSIONS In pT3aN0/NxR1 patients with no adjuvant/neoadjuvant treatment, Gleason Score permits independent prediction of the risk for BCR. These findings could help to estimate and discuss the individual risk for BCR with our patients on an individual basis.

Radical salvage prostatectomy for locally recurrent prostate cancer after radiation therapy.

47 Background: Radical salvage prostatectomy (SRP) is one local treatment option with curative intent in patients failing radiation therapy (RT) for localized prostate cancer (PCA). We compared the surgical, histological and functional outcome of a large cohort of patients who underwent SRP for locally recurrent PCA following LDR - brachytherapy (BRT). METHODS 66 consecutive patients with locally recurrent PCA after BRT underwent retropubic SRP and pelvic lymphadenectomy. Preoperative PSA, PSA doubling time, PSA prior to initial RT, biopsy Gleason score, number of positive biopsies, cT stage, neoadjuvant androgen deprivation were correlated with pathohistological stage, complications and functional outcome by uni- and multivariate analysis. RESULTS Mean preop. PSA was 5.6 (2-13.5) ng/ml; mean preoperative biopsy Gleason score was y5.6 (4-9). 1 patient (1.5%) experienced a rectal lesion, mean blood loss was 430 (200-900) ml, none of the patients received blood transfusions. Pathohistology demonstrated organ confined prostate cancer pT2a-2c in 38 (57.5%) patients, stage pT3a and stage pT3b was identified in 14 (21.1%) patients and in 14 (21.1%) patients, respectively. Positive surgical margins were diagnosed in 9 (13.6%) patients and 12 (15.1%) patients harboured lymph node metastases. Functional outcome was good with a continence rate of 82%; the mean time until recovery of continence was 8.4 (6-14) months. After a mean follow-up of 22.5 (1-72) months, 28% of the patients experienced a PSA relapse defined as any PSA increase > 0.2 ng/ml validated by 2 consecutive measures. CONCLUSIONS SRP can be performed safely and with a low morbidity in biopsy proven locally recurrent PCA following BRT. However, our data demonstrate an unfavourable histology with locally advanced disease in about 40% of the patients who all were diagnosed with low risk prostate cancer. These data question the quality of the selection process for patients being counselled for BRT and the data raise the possibility of both intrinsic radioresistance of prostate cancer or poorly performed BRT.

The role of reference pathology to assess MRI-TRUS fusion prostate biopsies in a tertiary referral center.

32Background: Risk stratification for patients diagnosed with prostate cancer (PCa) through MR-TRUS fusion biopsy still relies on Gleason (GL) grading of the biopsy specimens. GL grading of the same sample can differ between pathologists. In our tertiary high-volume center GL grading of the biopsy specimens is crucial for further therapy planning. Methods: Reference pathology of 42 patients after transperineal MR-TURS fusion plus saturation biopsy was assessed by one specialized genitourinary pathologist. GL grading of the original pathology and the reference pathology for the saturation and targeted biopsy cores were compared. Risk groups for this study were set as GL 6 for low, GL 7a and GL 7b for intermediate and GL 8, GL 9 and GL 10 for high-risk. Results: In 42 patients 49 lesions were identified by mpMRI (PI-RADS 3-5) in which 150 biopsy cores were taken. In addition, 709 cores were taken as saturation biopsies. The highest GL grading per patient differed in 18 (43 %) of the cases. In 16 cases, ther...

MP51-17 IS EVERY PT3A-PROSTATE CANCER (PCA) WITH POSITIVE SURGICAL MARGIN A CANDIDATE FOR ADJUVANT RADIATION (ARTX)? INDIVIDUAL RISK ASSESSMENT BASED ON A PATHOLOGICAL GLEASON SCORE PREDICTIVE MODEL – A MULTICENTRE STUDY

Alexander Karl*, Alexander Buchner, Christian Stief, Christiane Tympner, Thomas Kirchner, Ute Ganswindt, Claus Belka, Munich, Germany; Roman Ganzer, Wolf Wieland, Fabian Eder, Ferdinand Hofst€ adter, Regensburg, Germany; David Schilling, Karl-Dietrich Sievert, Arnulf Stenzl, Marcus Scharpf, Falko Fend, T€ ubingen, Germany; Frank vom Dorp, Jochen Hess, Herbert R€ ubben, Kurt Werner Schmid, Essen, Germany; Daniel Porres-Knoblauch, Axel Heidenreich, Birgit Hangarter, Ruth Kn€ uchel-Clarke, Aachen, Germany; Michael Rogenhofer, Bernd Wullich, Arndt Hartmann, Erlangen, Germany; Evi Comploj, Armin Pycha, Esther Hanspeter, Bozen, Italy; Dirk Pehrke, Guido Sauter, Markus Greafen, Alexander Haese, Hamburg, Germany