Stefania Munegato

Cell-cycle Progression-score Might Improve the Current Risk Assessment in Newly Diagnosed Prostate Cancer Patients

OBJECTIVE To assess whether cell-cycle progression (CCP)-score (Prolaris) can improve the current risk assessment in newly diagnosed prostate cancer (PCa) patients. CCP-score is a well-validated prognostic assay predictive of PCa death, biochemical recurrence, and progression. METHODS We evaluated CCP-score at biopsy in 52 patients newly diagnosed with PCa who underwent radical prostatectomy. CCP-score was calculated as average RNA expression of 31 CCP genes, normalized to 15 housekeeping genes. The predictive ability of CCP-score was assessed in univariate and multivariate analyses, and compared to that of Ki-67 levels and traditional clinical variables including prostate-specific antigen, Gleason score, stage, and percentage of positive cores at biopsy. RESULTS In spite of an overall good accuracy in attributing the correct risk class, 7 high-risk and 13 intermediate-risk patients were misclassified by the Prolaris test. On analysis of variance, mean CCP-score significantly differed across different risk classes based on pathologic results (-1.2 in low risk, -0.444 in intermediate risk, 0.208 in high risk). CCP-score was a significant predictor of high-risk PCa both on univariate and multivariate analyses, after adjusting for clinical variables. Combining CCP-score and the European Association of Urology clinical risk assessment improved the accuracy of risk attribution by around 10%, up to 87.8%. CCP-score was a significant predictor of biochemical recurrence, but only on univariate analysis. CONCLUSION The CCP-score might provide important new information to risk assessment of newly diagnosed PCa in addition to traditional clinical variables. A correct risk attribution is essential to tailor the best treatment for each patient.

Prostate Cancer Treatment in Renal Transplant Recipients: A Systematic Review

The aim of this review was to summarize the current evidence and to highlight the main issues future research needs to address regarding prostate cancer (PCa) treatment in renal transpant recipients (RTRs). We conducted a search of AMED, Medline and Embase up to 17 November 2016 to investigate oncological and functional outcomes of PCa treatment in RTR. Type and use/protocols of immunosuppression and peri‐operative antibiotic drugs were also assessed. The search was implemented manually. Exclusion criteria were absence of full text or absence of information that allowed us to differentiate oncological and/or functional outcomes of each therapeutic approach used. We included 241 patients from 27 retrospective studies published between 1991 and 2016; seven of the studies were case–control and 20 were case series. We also considered nine case reports published between 1999 and 2016. Follow‐up ranged from 1 to 120 months. PCa was organ‐confined, with Gleason score ≤6 in 75.2% and 60.4% of patients. Surgery was the most frequent treatment used (n = 186), for which cancer‐specific (CSS) and overall survival (OS) rates were both 96.8%. Functional outcomes, including continence and erectile function, and complications were less frequently reported and were generally similar to those reported for radical prostatectomy (RP) in non‐RTRs. Other treatment methods in the patients included in the review were radiotherapy (RT) ± androgen deprivation therapy (ADT; n = 34; OS 88.2%; CSS 88.2%), ADT alone (n = 14; OS 42.9%; CSS 64.3%), brachytherapy (BT; n = 11; OS and CSS 100%), watchful waiting (n = 4) and active surveillance (n = 1). Overall no treatment‐related graft loss occurred. Immunosuppression and antibiotic schemes were poorly reported and inconsistent. Outcomes of PCa treatment in RTRs are encouraging and do not appear to be inferior to those of non‐RTR. RP was the most commonly assessed approach, whilst RT, BT and ADT were less frequent. Immunosuppression and antibiotic use were poorly reported and highly variable. High‐quality studies are needed because the current level of evidence is low, and our results should therefore be interpreted with caution.

Predicting survival in node-positive prostate cancer after open, laparoscopic or robotic radical prostatectomy: A competing risk analysis of a multi-institutional database.

To investigate cancer‐specific mortality and other‐cause mortality in prostate cancer patients with nodal metastases.

PD51-08 ASSESSING THE 20-YEAR OUTCOMES OF RADICAL PROSTATECTOMY FOR HIGH RISK PROSTATE CANCER: RESULTS FROM A LARGE, MULTI-INSTITUTIONAL SERIES

RESULTS: On IVA adjusting for socio-demographic, facilityand tumor-specific covariates, RP was associated with lower overall mortality compared to RT+ADT (hazard ratio (HR) 0.52; 95% CI, 0.470.57; p<0.001) in the overall analysis, in patients with age 1⁄465 years with CCI 0 (HR 0.48; p<0.001), in patients >65 years with CCI 0 (0.53; p<0.001), those receiving RT with neoadjuvant (HR 0.52; p<0.001) or adjuvant ADT (HR 0.47; p<0.001), or treated with high dose (1⁄475.6 Gy) RT (HR 0.54; p<0.001). While the survival outcomes for patients treated with RT (+/-ADT) in the RCTs were not statistically different from similarly treated and appropriately selected patients within the NCDB, RP was associated with greater overall mortality-free survival than any of the arms represented in the RCTs. CONCLUSIONS: Our results suggest that in patients with clinically high-risk PCa, primary RP is associated with greater overall mortality-free survival than primary RT+ADT in patients with clinically high-risk PCa, regardless of baseline characteristics. These findings, in lieu of a randomized trial, can guide the clinicians to carefully choose the primary modality of treatment for patients with high-risk PCa.

MP93-02 COMPARISON OF ONCOLOGICAL OUTCOMES BETWEEN OPEN VERSUS ROBOT-ASSISTED SALVAGE RADICAL PROSTATECTOMY: A RETROSPECTIVE MULTICENTRE SERIES

INTRODUCTION AND OBJECTIVES: To report our new vesicourethral anastomosis technique during robot assisted radical prostatectomy and test its impact on the immediate and early continence rates. METHODS: Between January-June 2016, 60 patients were enrolled in the study and data collected prospectively. Modified vesicourethral anastomosis was performed by a single surgeon. The new technique was based on stabilizing the posterior urethra with anastomosis sutures before transecting the prostatic urethra. Two 3/ 0 barbed sutures were passed from the urethra at 5 o clock and 7 o clock positions and then used for vesicourethral anastomosis. This cohort of patients (Group I, 60 pts) was compared with the most recent consecutive patients in whom standard continuous running anastomosis technique was used prior to initiating the new technique (Group II, 60 pts). Post catheter removal 1st week and 1st month continence status were compared with the standard technique using ICIQ-SF form and 1st month overactive bladder questionnaire form. Preoperative ICIQ-SF scores were aslo obtained for both groups but there were no statistical significant distance between groups. RESULTS: Groups were compared in terms of Prostate specific antigen (EBL), age, body mass index (BMI), American society of anesthesiology score (ASA), prostate volume, final gleason score, operation and anastomosis time, and estimated blood loss (EBL). Also surgical margin positivity, bladder neck reconstruction rate, lymph node invasion rate were compared. Only statistically significant difference was encountered in modified anastomosis group in terms of age; group II was younger compared to group I. (61+7.5 vs. 64+7.6, p<0.05). For the 1st week of post catheter removal, mean ICIQ-SF scores for group I and -group II were 4.1+5.7 vs. 12.1+4.1 respectively (p<0.001). Recatheterization was needed in ;4 of 60 patients in Group 1 and 1 of 60 patients in Group 2; (p>0.05). Similarly; 1st month ICIQ-SF scores for group II and group I were 10.8+4.4 vs. 2.6 +4.3, respectively (p<0.001). Overactive bladder questionnaire scores were also compared. There was a statistically significant difference between two groups in favor of group I (18+7.7 vs. 5.3+6.2) (p<0.001). CONCLUSIONS: Modified anastomosis technique seems to have better early continence rates compared to the standard technique. Moreover, overactive bladder symptoms were significantly less common with the novel anastomosis technique. Further randomized studies are needed to better evaluate the effect and reproducibility of this new technique.

MP64-02 ONCOLOGICAL OUTCOMES OF SALVAGE RADICAL PROSTATECTOMY: A MULTICENTRE SERIES OF 243 PATIENTS

INTRODUCTION AND OBJECTIVES: The CAPRA-S score uses pathologic data from radical prostatectomy to predict biochemical recurrence and mortality. Recently, external validation was performed using the American and European cohorts, however, it has not previously been validated in a large, multi-institutional Asian cohort. Thus, we independently validated CAPRA-S score in an independent multiinstitutional Korean (K-CaP) database. METHODS: The study cohort comprised 3,274 patients treated with radical prostatectomy between March 2005 and December 2014. Prediction of biochemical recurrence was assessed by Kaplan-Meier analysis and the concordance index (c-index). Performance of CAPRAS in predicting biochemical recurrence was assessed by calibration plots, and decision curve analysis. RESULTS: During the median follow-up duration of 43.0 months, biochemical recurrence developed in 697 patients (21.3%). When stratifying patients with a CAPRA-S of 0-2, 3-5, and 6-12 (defining low, intermediate and high risk group), 39.4%, 35.9%, and 24.7% of patients were in a CAPRA-S low, intermediate and high risk group, respectively. Also, estimated 5-year biochemical recurrence-free survival was 91.2%, 71.3% and 30.7%, respectively. The c-index of the CAPRA-S to predict biochemical recurrence was 0.782 (Fig. 1). The calibration plot at 5-year generally showed a good fit. Decision curve analysis revealed a greater net benefit (net increase in the proportion of patients appropriately identified for adjuvant treatment) of the CAPRA-S score for the threshold probabilities of treating all men or no men with adjuvant therapy (Fig. 2). CONCLUSIONS: The CAPRA-S score was accurate when applied in a multi-institutional Korean database. It predicted biochemical recurrence after radical prostatectomy with a c-index of 0.782. The CAPRA-S score can be valuable that may aid in determining the need for adjuvant therapy. Source of Funding: None

MP50-03 SALVAGE RADICAL PROSTATECTOMY COMPLICATIONS AND FUNCTIONAL OUTCOMES: OPEN VERSUS ROBOTIC PROCEDURES.

Paolo Gontero*, Giancarlo Marra, Paolo Alessio, Marco Oderda, Anna Palazzetti, Francesca Pisano, Antonino Battaglia, Stefania Munegato, Claudia Filippini, Bruno Frea, Turin, Italy; Fernando Munoz, Aosta, Italy; Estefania Linares, Raphael Sanchez Salas, Paris, France; Sanchia Goonewardene, Prokar Dasgupta, Declan Cahill, Ben Challacombe, London, United Kingdom; David Gillatt, Raj Persad, Bristol, United Kingdom; Juan Palou, Barcelona, Spain; Steven Joniau, Leuven, Belgium; Salvatore Smelzo, Thierry Piechaud, Bordeaux, France; Alexandre De La Taille, Cr eteil, France; Morgan Roupret, Paris, France; Derya Tilki, Hamburg, Germany; Rick Popert, London, United Kingdom