Laureano Rangel

MP53-16 LONG-TERM ONCOLOGIC OUTCOMES OF ADDING RADICAL PROSTATECTOMY TO CASTRATION FOR PATHOLOGICAL NODE-POSITIVE PROSTATE CANCER

any urinary leak) after RP and post IMRT was achieved in 29 (69%) and 27 (64.3%), respectively. After a median follow up of 3.4 years, a PSA recurrence and clinical recurrence were observed in 7 (16.7%) and 4 (9.5%) patients. A 5-year biochemical and clinical recurrencefree survival rate were 70.7% and 84.0%, respectively. 5-year overall free survival was 93.6%. None of patients died for prostate cancer during follow up. CONCLUSIONS: This phase II trial test a novel multimodal treatment paradigm for high-risk prostate cancer. Toxicity was acceptably low and long term oncological outcomes were good. Further studies are needed to compare this novel treatment paradigm to the standard of care.

MP46-05 PREDICTING URETHRAL ATROPHY IN PATIENTS UNDERGOING PRIMARY PLACEMENT OF ARTIFICIAL URINARY SPHINCTER

INTRODUCTION AND OBJECTIVES: Long-term data on effects of testosterone therapy (TTh) on urinary function in hypogonadal men published so far are from observational studies without a control group. We present registry data including an untreated hypogonadal control group. METHODS: Registry study in 656 men with testosterone 350 ng/dL and hypogonadal symptoms. 360 received TU 1000 mg/12 weeks following an initial 6-week interval (T-group). 296 men opted against TTh and served as controls (CTRL). 8-year data are presented. Changes over time between groups were compared by a mixed effects model for repeated measures with a random effect for intercept and fixed effects for time, group and their interaction. Changes were adjusted for age, weight, waist circumference, blood pressure, fasting glucose, lipids and quality of life to account for baseline differences between groups. In order to further validate results, propensity matching was performed for baseline age, BMI, and waist circumference. 82 men in each group fulfilled criteria. RESULTS: Total group: mean age was 57.4 7.3 years in the T-group and 64.8 4.3 in CTRL, median follow-up time 7 years for both. In the T-group, IPSS decreased from 6.4 4.0 to 2.1 1.0 with a change from baseline of 5.0 points. In CTRL, IPSS increased from 4.5 2.0 to 6.5 2.6 after 8 years by 1.8 points (p<0.0001 for both). Residual urine volume decreased from 47.3 22.8 to 13.7 4.6 mL in the T-group and increased from 48.3 16.3 to 64.5 22.2 in CTRL. Prostate volume increased from 29.2 10.4 to 31.1 11.5 mL in the T-group (p<0.0001) and fell from 34.5 5.9 to 33.5 12.0 in CTRL (NS). Propensity-matched group: mean age was 61.7 5.1 years in the T-group and 61.6 2.9 in CTRL, median follow-up time 8 years in the T-group and 7 in CTRL. In the T-group, IPSS decreased from 7.4 4.2 to 2.0 0.9 with a change from baseline of 5.4 points. In CTRL, IPSS increased from 4.3 2.3 to 7.0 2.6 after 8 years by 1.9 points (p<0.0001 for both). Residual urine volume decreased from 50.6 23.6 to 14.0 4.7 mL in the T-group and increased from 45.7 16.4 to 64.6 16.7 in CTRL. Prostate volume increased from 31.4 12.0 to 33.2 12.7 mL in the T-group (p<0.0001) and from 33.4 6.2 to 33.6 11.0 in CTRL (NS). CONCLUSIONS: Urinary function is improved and preserved for a prolonged period of time by TTh in hypogonadal men and deteriorates in untreated hypogonadal men. The observed changes seem independent of prostate volume.

MP20-01 VALIDATION OF THE AMERICAN JOIN COMMITTEE ON CANCER (AJCC) 8TH EDITION PROSTATE CANCER STAGING SYSTEM

INTRODUCTION AND OBJECTIVES: In the recently published 8 edition update of the AJCC staging system for prostate cancer (PCa), pT2a/b/c sub-classifications were consolidated as pT2. Also, serum prostate-specific antigen (PSA) 20ng/ml or Grade Group (GG) 5 now classify patients as Stage III disease. We sought to validate these changes in a large institutional registry with long-term follow-up. METHODS: Men who underwent radical prostatectomy without prior therapy at Mayo Clinic between 1987-2011 were identified. The prognostic significance of a single pT2 designation was compared to previous stratification as unilateral (pT2a-b) versus bilateral (pT2c). Further, 7 edition Stage II patients were then re-categorized based on the presence or absence of PSA 20ng/ml and GG 5. Biochemical recurrence-free (BCR) survival, systemic progression-free survival (sPFS), and cancer-specific survival (CSS) were evaluated using Kaplan Meier analyses and multivariable Cox regression models, adjusting for age, Gleason score, preoperative PSA, and surgical margin status. RESULTS: The overall cohort included 17,846 men with a median follow-up of 11 years (IQR 7,16), during which time 5021 experienced BCR, 1246 progressed systemically, and 641 died from PCa. Among pT2 patients, sub-stratification was not independently associated with BCR-free survival (HR1⁄41.0; 95%CI 0.9-1.1; p1⁄40.69), sPFS (HR1⁄41.0; 95%CI 0.8-1.3; p1⁄40.68), or CSS (HR1⁄40.9; 95%CI 0.61.2; p1⁄40.41). Meanwhile, patients previously classified with Stage II disease who had a preoperative PSA 20ng/ml (now Stage III) had a 15-year CSS that was significantly worse than Stage group II patients with PSA < 20ng/ml (88% vs 94%; p<0.001), but similar to 7 edition Stage III patients (88% vs 86%; p1⁄40.12). On the other hand, Stage II patients now classified as Stage III based on GG 5 had a 15 year CSS that was significantly worse than both 7 edition Stage II patients with GG 1-4 (48% vs 68%; p<0.001) and 7 edition Stage III patients (48% vs 60%; p<0.001). Results for BCR-free survival and sPFS were similar. CONCLUSIONS: We validate the new AJCC pT2 staging classification. Moreover, our data support the designation of patients with a PSA 20ng/ml as Stage III disease. Interestingly, while upstaging GG5 patients from Stage II to III is an improvement, these patients have even worse outcomes than 7 edition Stage III patients, emphasizing the particular prognostic significance of the new GG and the importance of including GG in staging classification.