Matthew Coward

OUTCOMES AND IMPLICATIONS OF FOLLOW-UP BIOPSIES OF MEN ON ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is an important strategy for many men with low-risk prostate cancer. As part of the AS program, many chave advocated the use of follow-up biopsies (bx) to help monitor the disease. We evaluated the outcomes and implications of follow-up prostate bx in men in an AS program. METHODS: The AS program at our institution includes followup PSA, DRE, and a 12-core prostate needle bx at 6-12 months after diagnosis and every 1-2 years thereafter. The selected interval chosen was dependent on a variety of factors including patient age, health status, PSA level and dynamic, DRE, and qualitative elements of patient or physician concern. Demographic and clinical characteristics, biopsy outcomes, and clinical follow-up of these men are described. Biochemical, pathological, and clinical follow-up are described in this cohort. RESULTS: 71 men underwent initial bx and at least 1 follow-up bx as part of their AS program. Entry characteristics were as follows: mean age 63.5 years (53-82 yrs), mean PSA = 6.1 (1.3 23). 65/71 (92%) had Gleason 3+3 disease, 4 (6%) men had 3+4, 2 (3%) men had 4+3. 67 men were cT1c and 4 were cT2. On repeat (2nd) bx, negative bx rate was 41% (29/71) and the positive bx rate was 59% (42/71). No differences were observed with regard to pre-treatment PSA, original grade, stage, age, or race between those with negative vs. positive 2nd bx. Cancer core length appears to be associated with a positive 2nd bx: Of patients with negative 2nd bx, 27/29 (93%) had 1 mm and 2/29 (7%) had 2mm with no pt with 3mm or more on their original bx. Of those with positive 2nd bx, 12/42 (29%) had 1mm, 15/42 (36%) had 2 mm, and 15 (36%) had >=3mm on cores on original biopsies. Of those with a positive 2nd bx, 28 had no upgrading and 14 were upgraded. Of the 14 who had upgrading at 2nd bx, 10 had definitive treatment (6 RP, 4 XRT) and 4 were lost to FU. Of the 29 who had negative 2nd bx, none have undergone treatment. Of the 28 who had positive repeat (but no upgrading), 2 underwent treatment (1 RP and 1 brachy). Four patients with 2nd negative bx had a 3rd bx, and all were negative. 10 patients with positive 2nd bx had 3rd bx and all were positive. The PSAV trended higher in patients with negative vs. positive (no upgrade) vs. positive (upgrade) (-0.753 vs. 0.011 vs. 0.555 ng/ml/yr) CONCLUSIONS: The study helps characterize the outcomes and implications of repeat prostate bx in patients on AS. These results suggest that repeat biopsies are important in characterizing the volume, grade, and eventually decisions for treatment in men on active surveillance.

ANALGESIC USE IN MEN UNDERGOING ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY: A DETAILED ANALYSIS OF DEMOGRAPHIC, CLINICAL, AND OPERATIVE, INFLUENCES

INTRODUCTION AND OBJECTIVES: A variety of factors may potentially influence post-operative pain and narcotic use after surgery including patient factors (e.g. cultural influences, age, obesity), clinical factors (PSA, stage), and operative outcomes (EBL, OR time). We analyzed the potential influence of demographic, clinical, and operative factors on the use of post-operative analgesics in patients undergoing robotic-assisted radical prostatectomy. METHODS: 200 consecutive men undergoing robotic-assisted radical prostatectomy were evaluated as to their inpatient analgesic use. This included both narcotic and non-narcotic (e.g. ketorolac) usage. Narcotic use was converted to morphine(MSO4-) equivalents, and ketorolac use reported as mg delivered and also converted to MSO4equivalents by a 3:1 (keteroloac:MSO4) conversion an often used conversion rate in the anesthesia literature. Analysis and comparisons were made to several demographic (race, age, BMI), clinical (PSA, stage), and operative factors (OR time, EBL) to evaluate the potential influences of these factors on post-operative analgesic usage. RESULTS: Characteristics of this cohort were as follows: mean age = 59.2 years; mean BMI = 29.2; mean PSA 6.4 ng/ml. Mean analgesic usage (MSO4 equiv) was significantly higher in men 65 years (n=37) (50.2 vs. 37.3 vs. 30.8; p =30) (44.8 vs. 41.0 vs. 35.5), this did not achieve significance (p=0.130). Analgesic usage was also not different based on race, PSA, stage, OR time, or EBL. In addition, post-op analgesic usage did not correlate with longterm functional outcomes of continence (pad use) or potency. CONCLUSIONS: In patients undergoing robotic prostatectomy, analgesic usage is higher in younger men and trends higher in patients with lower BMI. No other differences were observed based on demographic, operative, pathologic, or functional outcomes.