E. Pérez-Fernández

Long-term oncological outcomes of an active surveillance program in recurrent low grade Ta bladder cancer.

INTRODUCTION Over the last 2 decades, there has been a major increase in active surveillance (AS) as a therapeutic alternative in urological tumors regarded to be of low risk. Owing to the findings of significant clinical outcomes in our series, this report presents an update of our AS program in patients with recurrent non-muscle-invasive bladder tumor. The objective was to confirm the oncological long-term safety of this protocol and to determine possible variables associated with progression. MATERIALS AND METHODS Cohort of patients included in AS between 1999 and 2014. INCLUSION CRITERIA recurrent papillary tumors, previous pTa-pT1, G1-G2, shorter than 1cm, and fewer than 5 tumour sites. EXCLUSION CRITERIA prior G3, CIS (carcinoma in situ), or positive-result cytology. All patients underwent close monitoring with flexible cystoscopy every 3 to 4 months for the first 2 years. After this time, follow-ups were conducted every 6 months, alternating between cystoscopy and ultrasound. Urinary cytology test was performed at all visits. RESULTS In all, 252 AS periods in 186 patients were studied, with a median follow-up of 6 years. Out of all periods, 203 (80.6%) underwent active treatment. After remaining under observation, 86.4% had not progressed in stage, and 79.3% in grade. Of these patients, 4 experienced progression to T2; all of them were previously T1G2. CONCLUSIONS AS in a high-selectivity group of patients with recurrent non-muscle-invasive bladder tumor is feasible and oncologically safe in the long term. Patients with previous history of T1 should not be included in AS protocols even when very small recurrences are diagnosed.

Vigilancia activa en cáncer de próstata de bajo riesgo. Aceptación por el paciente y resultados

OBJECTIVES To evaluate the acceptance of active monitoring by patients treated in our healthcare community and to report the clinical results of an active surveillance program in patients with low-risk prostate cancer. MATERIAL AND METHODS Prospective study of patients enrolled in an active surveillance programme at our centre between 2004 and 2012. The inclusion criteria were PSA <10 ng/ml, Gleason score ≤6, clinical stage T1c/T2a, ≤2 positive cores, and no more than 50% of the core being affected. Curative treatment was proposed when faced with pathological progression over the course of the monitoring. RESULTS In 2011, only 17% of the total number of potential candidate patients rejected their inclusion in a surveillance programme and were treated actively. We analysed a series of 144 patients included in our active surveillance protocol. The mean follow-up time was 3.22 years (SD 2.08). A total of 110 patients (76.3%) remained under active monitoring, with an estimated median treatment-free survival after diagnosis of 6.9 years (95% CI: 6.2-7.6). The percentage of patients who remained free of treatment at 2 and 5 years was 96.3% (95% CI: 92.8%-99.8%) and 70.9% (95% CI: 59.3%-85.5%), respectively. Thirty four patients (23.6%) required curative treatment. The mean time to treatment was 4.6 years (SD 2.3). CONCLUSIONS Active surveillance of highly selected patients with low-risk prostate cancer is a valid alternative therapy that is accepted by patients in our community.

Cambios en el grado de Gleason en las biopsias de seguimiento de pacientes con cáncer de próstata en programa de vigilancia activa

INTRODUCTION Active surveillance for prostate cancer has grown systematically in the recent years with more robust mid-term outcomes. However, changes in Gleason score during serial biopsies are not detailed in many of these reports. OBJECTIVES To evaluate changes in Gleason score on follow-up biopsies in low-risk prostate cancer in patients undergoing AS program in our center. MATERIAL AND METHODS Series of patients diagnosed of prostate cancer between 2004 and 2013 have been analyzed. The inclusion criteria were: PSA ≤ 10 ng/ml + Gleason ≤ 6 + T1c/T2a + ≤ 2 positive cores, and no more than 50% of affected core. The pathology of each of the biopsies was analyzed. RESULTS We studied a series of 175 patients undergoing AS. Mean follow-up was 3.96 years (SD 2.4). Follow-up biopsies with Gleason scores ≥ 7 were: 5.72% in the first biopsy, 7.39% and 7.41% in subsequent biopsies. By contrast, in 42.03% of cases did not show evident tumor involvement in the first biopsy, 40.74% and 51.85% in the second and third biopsies respectively. Median stay in the AS program was: 90.99 months (95% CI: 53.53-128.46) in patients with first positive biopsy vs. 96.66 months (95% CI: 63.19-130.13) in those without evidence of tumor. CONCLUSIONS In our series the pathological data of the first 3 biopsies remain stable in terms of the positive biopsy rate, Gleason score, or indication of active treatment proportions. Those patients who do not show evidence of malignancy in the first follow-up biopsy are less likely to need active treatment than the other patients in the series.

Influencia de la localización y del número de metástasis en la supervivencia de los pacientes con cáncer de próstata metastásico

INTRODUCTION The prognosis of patients diagnosed with metastatic prostate cancer seems to be modulated by factors such as the number and site of metastases. Our objective is to evaluate survival outcomes according to the number and site of metastases in our series of metastatic patients over the last 15 years. MATERIALS AND METHODS A retrospective analysis was performed on patients diagnosed between 1998 and 2014. We analyzed overall survival and progression-free survival, depending on the number and location of metastases on patients with newly diagnosed metastatic prostate cancer. Other potential prognostic factors were also evaluated: age, clinical stage, PSA at diagnosis, Gleason, PSA nadir, time till PSA nadir and first-line or second-line treatment after progression. RESULTS We analyzed a series of 162 patients. The mean age was 72.7yr (SD: 8.5). The estimated median overall survival was 3.9 yr (95% CI 2.6-5.2). The overall survival in patients with only lymph node metastases was 7 yr (95% CI 4.1-9.7), 3.9 (95%CI 2.3-5.5) in patients with only bone metastases, 2.5 yr (95% CI 2-2.3) in lymph nodes and bone metastases, and 2.2 yr (95% CI 1.4-3) in patients with visceral metastases (P<.001). In multivariate analysis, the location of metastasesis significantly associated with overall survival and progression-free survival. The number of metastases showed no association with survival. CONCLUSIONS The site of metastases has a clear impact on both overall survival and progression-free survival. Patients with only lymph node involvement had a better prognosis. The number of metastases showed no significant impact on survival in our series.

MP58-17 CASE-LOAD IS NOT ASSOCIATED WITH SURGICAL OUTCOMES OF RADICAL CYSTECTOMY. A NATION-WIDE STUDY OF CURRENT PRACTICE

INTRODUCTION AND OBJECTIVES: Surgeonand hospitalcase volume are identified as factors related with outcomes of surgical procedures. Radical cystectomy (RC), due to its major impact on the patient, might substantially benefit from centralization if this assumption were true. We aim to test this hypothesis in Spain, a country in which no lower limit nor centralization for radical cystectomy exists. METHODS: We performed a retrospective cohort review of patients undergoing RC in Spain during 2011 and 2012, accessing data from inpatient discharge forms (CMBD) of every patient operated on of radical cystectomy. CMBD is a mandatory file that is submitted to the Ministry of Health and provides information on patient’s demographics as well as morbidity and cause of discharge including death. Hospitals were stratified into volume quartiles depending on their 2-year cumulative cystectomy volume (very lowvolume 58). Hospitals were also categorized according to their size in beds and teaching facilities. A comparison with data in the literature was made. RESULTS: We analyzed 5,594 RCs in 266 centers of Spain during 2011 and 2012 (2,701 RCs in 2011 and 2,893 RCs in 2012). Mean age was 66.5 9.8 years and 84.7% were males. Mean hospital stay was 20.7 16.6 days. Mortality rate at 30, 60 and 90 days was 2.8%, 4.7% and 5.9%, respectively. 90-day mortality rate for very-low, low, medium and high-volume centers was 5.9%, 5.9%, 7% and 5.1%, respectively (p1⁄40.2). Hospital size and teaching facilities were not associated with mortality. A statistically significant difference was noted in the complications and readmission rate. These results compare favorably with reported multicenter series in the literature with 90-day mortality rate ranging from 4.2 to 7.9%. CONCLUSIONS: Our data do not support an urgent need for regionalization of radical cystectomy in our country. However, initiatives to improve surgical outcomes of radical cystectomy within individual national setting should be explored.