1. health and fitness
2. disease
3. cancer

Abstract
book
for congress participants only
12-14 JUNE 2013
le Palais du Pharo
Marseille, France
I
For appropriate referencing to the abstracts, please use:
Printed version: Mirrors of medicine Congress proceedings ISSN 2034-8398 Online version: Mirrors of medicine Congress proceedings ISSN 2034-8401
12-14 JUNE 2013 le Palais du Pharo
Marseille, France
ABSTRACTS REVIEWED BY:
GUEST EDITORS
LOCAL ORGANISING COMMITTEE OF THE CONGRESS
Alberto Bossi, Gustave Roussy Institute, Villejuif, France
Karim Fizazi, Gustave Roussy Institute, Villejuif, France
Nicolas Mottet, University Hospital, Saint Etienne, France
Arnauld Villers, Hospital Claude Huriez, Regional University Hospital Centre of Lille, Lille, France
SCIENTIFIC COMMITTEE OF THE CONGRESS
Gert De Meerleer, Department of Radiation Oncology, University of Ghent, Ghent, Belgium
Nandita deSouza, Department of Radiotherapy and Imaging, Royal Marsden Hospital, London, UK
Steven Joniau, Department of Urology, University Hospitals Leuven, Leuven, Belgium
Francesco Montorsi, Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
Alex Mottrie, Department of Urology, OLV Clinic, Aalst, Belgium
Peter Wiklund, Department of Urology, Karolinska Hospital, Stockholm, Sweden
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ABSTRACTS OF THE GLOBAL CONGRESS ON
PROSTATE CANCER, 2ND EDITION
MARSEILLE, FRANCE, 12-14 JUNE 2013
TABLE OF CONTENTS
Abstracts accepted for oral presentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3 Abstracts accepted for poster presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-57
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Abstracts accepted
for oral presentation
1
Choice between prostatectomy and
radiotherapy: RCT with a patient decision aid for
localized prostate cancer
The 3 winning abstracts are presented during the main session
in Auditorium 1.
van Tol-Geerdink Julia, Radiation Oncology, Radboud UMC, Nijmegen, Netherlands
Leer Jan Willem, Radiation Oncology, Radboud UMC, Nijmegen, Netherlands
van Oort Inge, Urology, Radboud UMC, Nijmegen, Netherlands
Wijburg Carl, Urology, Rijnstate Hospital, Arnhem, Netherlands
Vergunst Henk, Urology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
van Lin Emile, Radiation Oncology, Radboud UMC, Nijmegen, Netherlands
Witjes Fred, Urology, Radboud UMC, Nijmegen, Netherlands
Stalmeier Peep, Health Evidence, Radboud UMC, Nijmegen, Netherlands
Introduction & Objectives: For prostate cancer different
treatment options are available, of which the most common
are prostatectomy and radiotherapy (either external beam or
brachytherapy). These treatments yield a comparable likelihood
of cure. Guidelines indicate that patients’ preferences should
be taken into account in the treatment choice. Some clinicians
may fear that the advantages of increased patient participation
could be counteracted by e.g. increased anxiety and treatmentrelated regret. This study examined the effect of increased patient
involvement, by means of a patient decision aid.
Methods: Based on a literature study, a decision aid for prostate
cancer treatment was developed, in collaboration with urologists
and radiation oncologists. The decision aid provided evidence
based information on the pros and cons of different treatment
options.
From 2008 to 2011, 240 patients with localized prostate cancer
(T1-3aN0NxM0) were enrolled from three hospitals. Only
patients who were eligible for both prostatectomy and external
beam radiotherapy were included. Brachytherapy was offered
as a third option for eligible patients only, i.e. about half of the
patients. Patients were randomized to 1) a usual care group,
that discussed the treatment choice with their urologist and 2)
a decision aid group, that, in addition, was offered a decision aid
by a researcher. All patients were asked to fill out questionnaires
before and shortly after the treatment choice and at 6 and
12 months after treatment.
Results: The treatment choice was affected by the use of the
decision aid (p=0.03) and by the hospital (p<0.001). The decision
aid left fewer people undecided (p<0.05) and led to more people
choosing brachytherapy (p=0.02). Prostatectomy was the most
preferred treatment in both arms.
The decision aid caused patients to feel better informed (p=0.006)
and to participate more actively in decision making (p=0.002). It
did not increase anxiety or regret. If anything, for patients with
serious side effects at 12 months, a trend towards less regret was
found (p=0.06) when a decision aid was used.
Conclusions: The decision aid, with evidence based information
on the pros and cons of different treatments, was effective in
increasing patient participation in the treatment choice for
prostate cancer without causing anxiety or regret later on. It
even appeared to lower the risk of regret in an important patient
group, i.e. the patients faced with serious treatment-related side
effects.
1
2
3
Extended pelvic lymph node dissection can
increase survival in prostate cancer patients
with positive lymph nodes
Subgroup analyses of efficacy and safety of
radium-223 dichloride (Ra-223) in patients (Pts)
who did or did not receive prior docetaxel (pD)
in the phase 3 ALSYMPCA trial
Andrianov Andrey, Oncourology, Moscow Hertzen Oncology Institute, Moscow,
Russian Federation
Alekseev Boris, Oncourology, Moscow Hertzen Oncology Institute, Moscow, Russian
Federation
Nyushko Kirill, Oncourology, Moscow Hertzen Oncology Institute, Moscow, Russian
Federation
Vorobyev Nikolay, Oncourology, Moscow Hertzen Oncology Institute, Moscow,
Russian Federation
Krasheninnikov Alexey, Oncourology, Moscow Hertzen Oncology Institute, Moscow,
Russian Federation
Kaprin Andrey, Oncourology, Moscow Hertzen Oncology Institute, Moscow, Russian
Federation
Hoskin Peter, Clinical Oncology, Mount Vernon Hospital Cancer Centre, Middlesex,
United Kingdom
Logue John, Clinical Oncology, Christie Hospital, Manchester, United Kingdom
Bottomley David, Clinical Oncology, St. James Hospital, Leeds, United Kingdom
Nilsson Sten, Oncology-Pathology, Karolinska University Hospital, Stockholm,
Sweden
Fang Fang, Global Clinical Statistics, Bayer HealthCare, Montville, NJ, United States
Garcia-Vargas Jose, Global Clinical Development Oncology, Bayer HealthCare,
Montville, NJ, United States
Staudacher Karin, Clinical Research, Algeta ASA, Oslo, Norway
Pawar Vivek, Global HEOR, Bayer HealthCare, Montville, NJ, United States
Reuning-Scherer Jonathan, Statistics, Yale University, New Haven, CT, United States
Parker Christopher, Clinical Oncology, The Royal Marsden NHS Foundation Trust and
Institute of Cancer Research, Sutton, United Kingdom
Introduction & Objectives: The aim of the study was to assess
biochemical progression-free survival (b-PFS) in lymph node
(LN) positive PC pts after radical prostatectomy (RPE) in subject
to anatomical boundaries of pelvic lymph node dissection (PLND)
performed and number of LN metastases (MTS) revealed.
Introduction & Objectives: In the ALSYMPCA trial in
castration-resistant prostate cancer (CRPC) pts with bone
metastases (mets), Ra-223, a first-in-class alpha-emitting
pharmaceutical, significantly prolonged overall survival (OS)
(median: 14.9 vs 11.3 mo; HR=0.695; P=0.00007), significantly
delayed time to first skeletal-related event (SRE) (median: 15.6 vs
9.8 mo; HR=0.658; P<0.001), and was associated with better
preservation of quality of life (QOL), compared with placebo
(Pbo) (Parker et al. IPCU 2013. Abstr). Data from predefined
subgroup analyses assessing efficacy and safety of Ra-223 in pts
who did or did not receive pD are presented.
Material & Methods: Retrospective analysis of database
from 1148 pts after RPE and PLND was performed. 680 pts
with exactly established anatomical extent of PLND and
known follow-up survival status were included. According to
anatomical regions of PLND performed, pts were divided in
to 2 groups: standard (S-PLND) was performed in 289 (42.5%)
patients; extended (E-PLND) – in 391 (57.5%). Mean PSA level
was 13.6±11.7 ng/‌m l in S-PLND group and 16.1±15.6 ng/‌m l in
E-PLND group (p<0.001); mean percentage of positive biopsy
cores was 47.8±31.1% and 53.9±30.7% respectively (p=0.02).
Clinical stage (p<0.001) and biopsy Gleason score (p<0.001)
were significantly more favorable in S-PLND group of patients.
Biochemical recurrence (BR) was assessed as elevation of
PSA>0.2 ng/‌m l on 3 consecutive measurements.
Methods: Eligible pts had progressive, symptomatic CRPC
with ≥2 bone mets; had no known visceral mets; were receiving
best standard of care; and had received pD, or were unfit for or
declined D (npD). Pts were randomized 2:1 to 6 injections of
Ra-223 (50 kBq/‌kg IV) q4wk or matching Pbo and stratified by
prior D use, baseline alkaline phosphatase level, and current
bisphosphonate use. The primary endpoint was OS. Secondary
endpoints included SRE and QOL. Subgroup efficacy data were
compared using a log-rank test. Interaction of prior D use with
treatment effect on QOL was compared using a mixed-effects
linear regression model.
Results: Mean number of LN removed was 14±6 (4-37) in
S-PLND and 26±8 (8-61) in E-PLND group (p<0.001). LN
metastases were verified in 34 (11.7%) and in 80 (20.5%),
p=0.003. ADT was administered in 22 (19.3%) pts. Median follow
up time was 30.5±28 months (3-156 months). During this period
BR were observed in 22 (78.6%) pts in S-PLND group and in
21 (32.8%) pts in E-PLND group (p<0.001). Cumulative 3-year
b-PFS rate was 20.1±8.3% for pts with LN MTS in S-PLND group
and 49.6±8.7% in E-PLND group (p=0.005). Cumulative 3-year
b-PFS in pts with 1 positive LN and with ≥2 positive LN was
36.6±13.3% and 10.3±9.4% in S-PLND group and 75.8±9.7% and
29.8±10.8% in E-PLND group (p<0.05).
Results: 395/‌921 (43%) randomized pts had npD (Ra-223,
n=262; Pbo, n=133); 526/‌921 (57%) had received pD (Ra-223,
n=352; Pbo, n=174). Irrespective of prior D use, median OS
was prolonged in the Ra-223 vs Pbo group (npD, HR=0.75; pD,
HR=0.71). There was a trend toward risk reduction in time to
first SRE with Ra-223 vs Pbo, regardless of prior D use (npD,
HR=0.74; pD, HR=0.62). Similarly, the treatment effect on QOL
with Ra-223 was generally not influenced by prior D use. Overall,
there was a low incidence of myelosuppression in both subgroups.
Incidences of grade 3/‌4 neutropenia and thrombocytopenia were
higher in pD vs npD pts.
Conclusions: E-PLND could be associated with better b-PFS even
in PC pts with LN MTS. Probably better results could be achieved
by more extensive PLND in pts with minimal LN invasion.
S-PLND is associated with worse survival and should not be
performed especially in pts with intermediate and high risk PC.
2
Conclusions: Regardless of prior D use, Ra-223 prolonged OS
and, in general, showed QOL benefit. The safety profile of Ra223 was highly favorable; pD pts had a higher incidence of grade
3/‌4 hematologic AEs than npD pts.
npD
pD
No. (%) Pts With
Ra-223 Pbo
Ra-223 Pbo
Grade 3/‌4 AEs*
n=253
n=130
n=347
n=171
Anemia
27(11)
15(12)
50(14)
24(14)
Neutropenia
2(1)
1(1)
11(3)
1(1)
Thrombocytopenia
7(3)
1(1)
31(9)
5(3)
Hematologic
*Safety population
3
Abstracts accepted
for poster presentation
4
Laparoscopic radical prostatectomy in prostate
cancer of low-risk tumors D’Amico. Evolution
Saez Felipe, Urology, Virgen de la Victoria, Málaga, Spain
Castillo Elisabeth, Urology, Hospital Virgen de la Victoria, Málaga, Spain
Yañez Ana, Urology, Hospital Virgen de la Victoria, Málaga, Spain
Herrera Bernardo, Urology, Hospital Virgen de la Victoria, Málaga, Spain
Machuca Francisco Javier, Urology, Hospital Virgen de la Victoria, Málaga, Spain
Introduction & Objectives: Localized prostate cancer at low
risk includes in its management options (observation, active
surveillance, radiotherapy and radical surgery). However, a
subgroup of these patients did not present the expected cancer
evolution. With this review we try to quantify this subgroup.
Material & Methods: Retrospective, descriptive and
inferential of 191 low-risk tumors D’Amico for a total of
354 cancer PRL analyzing the behavior of the same in terms
of organoconfination, variability between the Gleason score of
biopsy and surgical specimens, and surgical margins biochemical
progression (PBQ).
Results:
Frequency of descriptive: Mean age was 61 years (46-73). Mean
PSA 6.33 ng/‌d l.
Inferential Analysis:
• Organoconfination: 86% of low risk tumors corresponded to
organ confined tumors in the surgical specimen (pT2a, T2b and
pT2c). 11% has fallen to pT3a and 3% for pT3b (p 0.006).
• Variability of biopsy Gleason score versus Gleason score of
the piece: In the low risk group by 23.5% and 1.8% have been
shown as a Gleason score 7 and 8 respectively as in the surgical
specimen (p 0.7)
• PBQ: The group of low-risk tumors has shown a 5% PBQ
(7 cases). 42% (3 cases) criteria has recurred with distant
disease and 58% (4 cases) with local recurrence criteria.
• Surgical margins: 19%.
Considering any of the above criteria, 25% of tumors initially
classified as low risk have not been.
Conclusions: LRP offers a high rate of cancer control in low-risk
tumors. However, up to 25% of these tumors may not behave
as such to follow up more by the variability between the biopsy
Gleason score and specimen.
4
5
6
Are peri-urethral prostate core biopsies
necessary when performing transperineal
template biopsies?
HIFU: the challenge in individualized prostate
cancer treatment for the next decade.
Less=more. Review of over 1000 single center
patients treated in the past decade with HIFU
Hussain Muddassar, Urology, Frimley Park Hospital, Surrey, United Kingdom
Pereira Nicola, Urology, Frimley Park Hospital, Surrey, United Kingdom
Bott Simon, Urology, Frimley Park Hospital, Surrey, United Kingdom
D’Hont Christiaan, Urology - Urologic Oncology, ZNA Middelheim, Antwerp, Belgium
Van Erps Peter, Urology, ZNA Middelheim, Antwerp, Belgium
Sorber Marc, Urology, ZNA Middelheim, Antwerp, Belgium
Cortvriend Jim, Urology, ZNA Middelheim, Antwerp, Belgium
Debacker Tibaut, Urology, ZNA Middelheim, Antwerp, Belgium
Toussaint Nele, Urology, ZNA Middelheim, Antwerp, Belgium
Introduction & Objectives: To investigate whether periurethral
biopsies (PUB) taken at the time of transperineal template biopsy
(TTB) contribute to the diagnosis and management of patients
with prostate cancer.
Patients & Methods: 270 patients underwent transperineal
TTB by a single surgeon between November 2010 and November
2012. Criteria for inclusion included an elevated PSA, an
abnormal DRE of the prostate, a diagnosis of ASAP or high-grade
PIN on a previous biopsy, and/‌or as part of an active surveillance
protocol. The prostate gland was divided into 10 regions,
including a separate periurethral region defined as within 1cm of
the urethra: right (R), left (L), medial (m), lateral (l), posterior (p),
anterior (a), and peri-urethral (pu).
Introduction & Objectives: To report biochemical and
biopsy outcomes + Quality of Life of 1000 fully evaluable
patients treated with HIFU as a primary treatment for T1T3aNxM0 prostate cancer. Full and individualized nerve
sparing/‌focal treatments will be reported.
Methods: Patients treated by Ablatherm (EDAP-TMS, Lyon,
France) with single HIFU treatment strategy for localized
prostate cancer. Salvage treatments were excluded. Patients were
stratified according to D’Amico’s 2003 risk group definitions.
Kaplan-Meier analysis was performed to determine biochemical
survival with failure defined according to the 2006 Phoenix
definition (nadir+2).
Results: The median patient age was 65 years (range 40-78)
with a median PSA of 7.1 ng/‌mL (range 0.5-36) and a median
prostate volume of 41.0cm3 (range 8-140). Patients had
undergone a median of 1 (range 0-3) prior negative TRUS and
prostate biopsies and/‌or TTB. Prostate cancer was diagnosed in
123 patients (45.6%). The prostate cancer core distribution rates
are as follows: Rmp 18.0%, Rma 28.7%, Rlp 50.8%, Rla 37.7%,
Lmp 30.3%, Lma 34.4%, Llp 47.5%, Lla 30.3%, Rpu 21.3%, Lpu
24.6%. 46.7% patients had unilateral disease (left 23.0%, right
23.8%). 13.9% of prostate cancer was found exclusively in the
anterior regions. Prostate cancer was diagnosed in 123 patients
(45.6%). PUB were positive in 34.4% of patients diagnosed with
prostate cancer. In three patients the Gleason grade was higher in
PUB vs. other positive regions, potentially altering management.
One patient had Gleason 3+3 tumour exclusively in PUB
involving 2mm of a single core and went onto active surveillance.
In one further case, 4 out of 6 positive cores were from PUB
(maximum core length 4mm, Gleason grade 3+3) influencing the
patient’s decision to pursue radical treatment. 10.0% of patients
went into urinary retention following TTB.
Results: A total of 695 consecutive fully evaluable patients
met the inclusion criteria for full treatment/‌295 had a more
individualized nerve sparing treatment. The average age
was 63.0/‌60.2 ± 7.6 years. Pretreatment PSA was 10,8/‌9,3 ±
7,8 ng/‌m l, the median Gleason sum was 7 (6:56.8%, 7:30.7%,
8 and up:11%) and 9,8/‌17,7%, 37,7/‌49,4% and 52,7/‌32,9% of
patients were in the low, moderate and high+T3a risk groups,
respectively. 8% T1, 68,2%T2 and 23,3%T3a. Patients were
followed for 4.3 ± 2.2 years (range: 1 to 11 years). The median
PSA nadir was 0.11 which was reached 14.6 ± 14.2 weeks after
HIFU (67,4% < 0,2 ng/‌m l; 32,6% 0,2-1ng/‌m l). Biochemical
failure free survival rates at 5,6 and 7 years are 78%, 75% and
73% respectively. 5YBFSR is 88%,86% and 63% for the low,
intermediate and high+T3a risk groups (p=0,012). No significant
difference between Full and Individualized treatments. A 2nd
HIFU treatment is offered in case of bx proven local recurrence
(9.2 %). Side effects are extremely low (3,8/‌1,3% SI gr 1, 5.4/‌5,1%
UTI, 6/‌3,8%TUR/‌BNI, 0,6%AUR). Potency preservation (IFFE5>20) is 85%, 55%, 8% in unilateral nerve sparing, full and
T3a treatment (outside capsula) groups resp. The comorbidity
difference is significant: Less treatment = More QuOL for Same
QuOTreatment.
Conclusions: Considerable anatomic variability in the prostate
cancer distribution was documented. Prostate cancer was found
in the periurethral zone in a third of cases, however it was
only found exclusively in this region in one case. The volume of
disease in the PUB affected management choice in one patient.
By avoiding the periurethral area when performing TTB fewer
biopsies may be taken without significantly effecting diagnostic
power but potentially reducing morbidity including urinary
retention.
Conclusions: HIFU provides good biochemical control through
> 7 years of follow-up combined with a relatively low rate of side
effects and meets the results of classical treatments as primary
PCA treatment. Equal results on cancer control can be obtained
with more individualized nerve sparing/‌focal procedures in
carefully selected patients. Extremely low comorbidity and
repeatability of the procedure make HIFU a first choice safe
treatment for prostate cancer both in primary as in salvage
curative settings for any Gleasonscore or age.
5
7
Reached Conti-
Miss-
Reached Conti-
3mo FU,
nent
ing
1y FU,
nent 1y, ing
Parameters influencing continence recovery
after endoscopic extraperitoneal radical
prostatectomy
n
3mo,
3mo,
n
n(%)
n(%)
n(%)
Hermans Tom, Urology, Maastricht University Medical Center, Maastricht,
Netherlands
Jacobs Rens, Urology, Maastricht University Medical Center, Maastricht, Netherlands
Fossion Laurent, Urology, Maxima Medical Center, Veldhoven, Netherlands
52(28.7)
2(1.1)
154
78(52.7)
6(3.9)
PMPR+
83
30(36.0)
0(0.0)
54
34(67.3)
2(3.7)
PMPR-
100
22(22.4)
2(2.0)
100
43(44.8)
4(4.0)
5.1)
35(29.4)
2(1.7)
103
52(53.1)
5(4.9)
pT3 Pca
62
17(27.4)
0(0.0)
53
26(52.0)
1(2.0)
0.9(0.5-
1.0(0.5-
1.8)
1.9)
PV < 50cc
124
38(31.1)
2(1.6)
106
54(53.5)
5(4.7)
PV > 50cc
49
10(20.4)
0(0.0)
38
18(47.4)
0(0.0)
PV X
10
4(40.0)
0(0.0)
10
6(66.7)
1(10.0)
0.6(0.3-
0.8(0.4-
1.3)
1.7)
BPNVB+
35
12(34.4)
0(0.0)
29
19(65.5)
0(0.0)
BPNVB-
148
40(27.4)
2(1.4)
125
59(49.6)
6(4.8)
1.4(0.6-
1.9(0.8-
3.0)
4.5)
Age < 65y
88
26(30.2)
2(2.3)
75
33(47.1)
5(6.7)
Age ≥ 65y
95
26(27.4)
0(0.0)
79
45(57.7)
1(1.3)
OR(95%-CI)
Conclusions: In this series patients undergoing EERPE+PMPR
acquire better short- and long- term continence recovery rates.
More randomized controlled trails are needed to confirm the
value of PMPR in radical prostatectomy.
2.5(1.3-
3.8)
121
OR(95%-CI)
Results: Continence recovery rates after EERPE
2.0(1.0-
pT1-2 Pca
OR(95%-CI)
All patients followed the same continence rehabilitation
program. Patients were considered continent using 0-1 pad
daily. Data on continence recovery after 3 and 12 months were
gathered prospectively and analyzed in a retrospective manner.
Univariate logistic regression analysis was performed to evaluate
the relationship between variables and continence recovery.
n(%)
183
OR(95%-CI)
Methods: From May 2008 until October 2012, 183 consecutive
patients underwent EERPE performed by a single surgeon,
having previous experience with 81 EERPE procedures. Median
age, BMI, PSA, and PV were 65.0y, 26.1kg/‌m2, 9.0µg/‌l and
38.0cc, respectively. Clinical tumor stages were: cT1c 62 (33.9%)
patients, cT2c 92 (50.3%), cT3 29 (15.8%). The last 83 patients
underwent PMPR as described by Rocco.
1yr,
Overall
OR(95%-CI)
Introduction & Objectives: To assess the influences of age,
body mass index (BMI), prostate volume (PV), tumor stage (pT),
bilateral preservation of the neurovascular bundle (BPNVB) and
posterior musculofascial plate reconstruction (PMPR) on shortand long-term continence recovery in endoscopic extraperitoneal
radical prostatectomy (EERPE).
Miss-
BMI 18.5–
0.9(0.5-
1.5(0.8-
1.7)
2.9)
56
17(30.4)
0(0.0)
49
27(57.4)
2(4.1)
110
29(26.9)
2(1.8)
91
43(48.9)
3(3.3)
25kg/‌m2
BMI 25–
30 kg/‌m2
OR(95%-CI)
BMI ≥
17
0.8(0.3-
0.8(0.2-
2.5)
3.0)
6(35.3)
0(0.0)
14
1(7.1)
30kg/‌m2
OR(95%-CI)
0.7(0.2-
0.6(0.2-
2.0)
2.0)
CI=Confidence interval, OR=Odds ratio, Pca=Prostate cancer, X=Unknown.
6
8
9
Choline PET/‌CT in staging and restaging at
biochemical recurrence for prostate cancer: a
systematic review and meta-analysis of cohort
studies
The effectiveness of salvage stereotactic body
radiation therapy for recurrent prostate cancer
Favretto Maria Silvia, Radiotherapy, San Bortolo, Vicenza, Italy
Bolzicco Giampaolo, Radiotherapy, San Bortolo, Vicenza, Italy
Satariano Ninfa, Medical Physics, San Bortolo, Vivenza, Italy
Scremin Enrico, Urology, San Bortolo, Vicenza, Italy
Baiocchi Cristina, Radiotherapy, San Bortolo, Vucenza, Italy
Tasca Andrea, Urology, San Bortolo, Vicenza, Italy
Center Finn, Office, Center of Tobacco Control Research, Odense, Denmark
Kairemo Kalevi, Department of Molecular Radiotherapy and Nuclear Medicine,
International Comprehensive Center Docrates, Helsinki, Finland
Introduction & Objectives: The clinical value of choline
PET/‌‌C T for staging and restaging of patients with prostate cancer
is not well established. In the present meta-analysis, we aimed to
evaluate benefits and harms from choline PET/‌C T scans.
Introduction & Objectives: Radiation therapy is a common
practice in cases of biochemical recurrence of prostate cancer
after surgery. We evaluated the safety and efficacy of CyberKnifeStereotactic Body Radiation Therapy (CK-SBRT) in a series of
22 patients with measurable local recurrence of prostate cancer.
Methods: The search by 1 author extracted records from PubMed
and Embase databases and from a hand search. We selected
cohort studies from 1998 to January 2013 for patients with
prostate cancer at staging or restaging at biochemical recurrence.
The meta-analysis pooled positive findings of the individual
articles.
Methods: Twenty-two patients with a mean age of 71 years
(range 61-81) have been treated with Cyberknife robotic
radiosurgery (Accuray Inc., Sunnyvale, CA, USA). Evidence
of recurrence was performed with biopsy in 8 patients and
with PET and MRI in 14. Ten patients had had a relapse
after prostatectomy, 9 after radical radiotherapy and 3 after
prostatectomy plus adjuvant radiotherapy. In all patients three or
four gold fiducial seeds were implanted in the prostate gland or
in the prostatic bed under transrectal ultrasound guidance; a CT
and PET/‌R MN images fusion was performed for clinical target
volume delineation. Half of the patients (11pts) had a Foley
catheter placed for better identification of the urethra. The mean
volume of disease recurrence was 7.8 cc. The planning treatment
volume (PTV) ranged from 4 to 35.8 cc. (median 18.23 cc).
Prescription dose ranged from 24 to 30 Gy in 3-5 fractions,
depending on whether the lesion was in surgical bed following
radical prostatectomyor intraglandular.
Results: Across 89 articles, 3,364 (58%) of 5,757 patients had
lesions by PET/‌C T scans. Of the patients, 1,248 (22%) had lesions
in the prostatic bed, 910 (16%) had lesions in pelvic lymph
nodes, 676 (12%) had lesions in distant organs, and 530 (9%) had
lesions in two or more regions. Sensitivity of choline PET/‌C T for
pelvic lymph node metastases was 0.58 (95% CI 0.51 to 0.65)
using 176 patients. Specificity was 0.91 (95% CI 0.88 to 0.94).
Choline PET/‌C T detected lesions better than bone scan, present
for 124 (46%) versus 56 (21%) of 272 patients, and detected
lesions better than 18F-FDG PET/‌C T, present for 187 (63%)
versus 99 (33%) of 298 patients. The scans changed treatment
for 323 (38%, 95% CI 35% to 41%) of 854 patients, and improved
outcome for 103 (27%, 95% CI 22% to 32%) of 380 patients.
Results: The median follow up was 24 months (range
3-102 months). Seven patients had Grade 1-2 acute genitourinary
(GU) toxicity and 1 Grade 3; one patient developed Grade 2 acute
rectal toxicity, no patients experienced Grade 3 acute rectal
toxicity. Late GU toxicity occurred in 5 patients (22.7%): GU
Grade 1 in 4 patient (18%) and GU Grade 2 in 1 (4.5%); only
1 patient had Grade 1 late rectal toxicity. After salvage-CK-SBRT,
local recurrences occurred in 3 patients (13,6%): one had had
surgery, one radiotherapy and one surgery plus radiotherapy.
Four patients (18% developed distant metastases (1 bone,
1 lymph nodes and 2 bone plus lymph node metastases) (Table 1).
One patient with bone and lymph-node metastasis died of related
disease, the other patients with clinical progression are alive in
androgen deprivation therapy (ADT) or chemotherapy.
Conclusions: Choline PET/‌C T had appropriate clinical efficacy
for patients with prostate cancer and biochemical recurrence.
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10
Conclusions: CyberKnife-Stereotactic Body Radiation Therapy
is a feasible approach for local measurable recurrence of prostate
cancer with good control and low acute or late toxicity. A longer
follow-up and a larger number of patients are necessary to
evaluate its effectiveness.
Patients’ decision making after the diagnosis of
prostate cancer
Bellardita Lara, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Villa Silvia, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Magnani Tiziana, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Villa Sergio, Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori,
Milan, Italy
Bedini Nice, Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori,
Milan, Italy
Biasoni Davide, Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Stagni Silvia, Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Valdagni Riccardo, Prostate Cancer Program, Radiation Oncology 1, Fondazione
IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Introduction & Objectives: According to international
guidelines, patients receiving a diagnosis of prostate cancer
(PCa) should be informed of the different appropriate
therapeutic/‌observational options. To date, it is not completely
clear how concerns about side effects influence patients’ choice
and what the core landmarks of patients’ decision making (DM)
process are. The aim of our study was to explore the experience of
DM in patients diagnosed with PCa.
Patients & Methods: Between February and May 2012,
10 patients (mean age 64.8) were recruited for an observational,
qualitative study. Patients had low or intermediate risk PCa.
A decision aid (DA, Ottawa Personal Decision Guide) was used
to increase the patients’ awareness of the DM process after a
multidisciplinary visit. The DA focused on three main areas:
a) clarify the decision; b) identify patients’ decision making
needs and c) explore these needs. A further set of questions was
added in order to explore patients’ emotions. Interviews were
audio-recorded and verbatim transcriptions were made. Content
analysis was performed by using a text analysis software (T-LAB).
Results: Text analysis showed the following results: a) all
patients reported to be informed of the available options; 3 of
them reported not to be prone toward a particular treatment
option; b) 8 out of 10 patients stated they did not clearly
understand benefits and risk of each option; all of them reported
to know what mattered the most to them in terms of personal
priorities; 9 out of 10 patients reported to have enough support
and advice from their family; c) 9 out 10 patients felt to be
supported mainly by their partners even if their partners wanted
them to make the final choice; all patients considered physician’s
point of view as a crucial factor for the choice; 8 out 10 patients
mentioned their need to clarify some doubts and expand their
knowledge as a necessary step to finalize their choice. All the
patients mentioned fear and concern about the issue of recovery
and/‌or about the potential threats of quality of life.
Conclusions: The use of a decision aid helped to highlight
that patients experienced the choice of treatment for PCa as a
complex process, involving the evaluation of medical information
as well as of psycho-social factors. A better knowledge and
understanding of patients’ subjective experience may help to
reach an informed and aware choice and to promote a patientcentred approach to PCa care.
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Results: The mean age of study population at T0 was 66.2 years
(median 66, range 42-79). ANOVAs showed the following
significant changes over time: social wellbeing decreased from
T0 to T3 (p = 0.001); PCS decreased between T0 and T3 (p =
0.014); emotional wellbeing increased between both T0 and T2 (p
= 0.016) as well as T0 and T3 (p = 0.001). Anxious preoccupation
and avoidance significantly decreased from T0 and T2 (p =
0.0001 and p = 0.035, respectively).
The quality of life of patients on active
surveillance: two years follow-up
Bellardita Lara, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Alvisi Maria Francesca, Prostate Cancer Program, Fondazione IRCCS Istituto
Nazionale dei Tumori, Milan, Italy
Rancati Tiziana, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Villa Silvia, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei
Tumori,,
Marenghi Cristina, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale
dei Tumori, Milan, Italy
Nicolai Nicola, Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Avuzzi Barbara, Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Villa Sergio, Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori,
Milan, Italy
Salvioni Roberto, Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan,
Italy
Magnani Tiziana, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Valdagni Riccardo, Prostate Cancer Program, Radiation Oncology 1, Fondazione
IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Conclusions: Patients on AS reported high levels of physical and
psychological wellbeing throughout the first two years. QoL was
not impaired by the idea of living with an untreated cancer. It is
particularly interesting that anxious preoccupation, i.e.worry
about disease progression, decreased over the first year on AS
and then remained stable. The decrease in the perception of
social wellbeing could be related to the fact that support from
family/‌f riends is likely to be higher in the period immediately
following the diagnosis. The increase of PCa-related symptoms is
unexpected and needs to be further detailed. Acknowledgements
to Foundations I. Monzino and ProADAMO.
Introduction & Objectives: The distress that men may
experience due to living with untreated prostate cancer (PCa)
when choosing Active Surveillance (AS) is still an open issue.
Research showed that most patients did not report psychological
burden; nonetheless, longer term follow-up is still needed. The
aim of this study was to investigate the changes in quality of life
(QoL) over the first two years on AS.
Patients & Methods: Between Nov 2007 and Jan 2013,
208 patients completed questionnaires at enrolment in the AS
protocol (T0). Evaluations after 10 months (T1) from diagnostic
biopsy, 12 months (after the first re-biopsy- T2) and 24 months
(T3) were completed by 156, 109 and 62 patients, respectively.
Validated self-report questionnaires were administered,
including: a) Functional Assessment of Cancer Therapy – Prostate
Version (FACT-P), measuring physical wellbeing, social wellbeing,
emotional wellbeing, functional wellbeing, and wellbeing related
to prostate cancer symptoms (PCS); b) Mini Mental Adjustment
to Cancer (Mini-MAC), evaluating the strategies of coping with
cancer: fighting spirit, helplessness/‌hopelessness, fatalism,
anxious preoccupation and avoidance. Descriptive analyses were
performed. Repeated measure analyses of variance (ANOVA)
were performed to test changes over time and Bonferroni
correction was used for pair time comparisons.
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Prostate cancer screening in men 50 to
70 years old in Fasa in 2012 EphB4 as a new prognostic marker in prostate
cancer
Abbasfard Adnan, Anesthetist in Shiraz Hospital, Mir Shiraz Hospital, Shiraz, Iran,
Islamic Republic of
Biegmohamadlo Hossein, Specialist in Kidney and Urinary Tract in Fasa University of
Medical Science, Shariati Hospital, Tehran, Iran, Islamic Republic of
Shabbooie Zohre, Student of Research Committee in Fasa University of Medical
Science, Fasa, Iran, Islamic Republic of
Naghizade Mohammad, Expert Stats in Fasa University of Medical Science, Fasa
University of Medical Science, Fasa, Iran, Islamic Republic of
Stonier Thomas, Medicine, Bristol Royal Infirmary, Bristol, United Kingdom
Wall Joshua, Medicine and Dentistry, University of Bristol, Bristol, United Kingdom
Nobes Kate, Biochemistry, University of Bristol, Bristol, United Kingdom
Introduction: The Gleason scoring method currently used
to diagnose prostate cancer is poor at determining cancer
aggressiveness and thus prognosis. With over 40% of men over
the age of 50 having a well-differentiated form of prostate cancer,
this is a major issue. The Eph receptors are the largest family of
tyrosine kinase receptors and have been shown to have increased
expression in association with prostate cancer, in particular
EphB4.
Introduction & Objectives: Cancer is one of the leading
causes of deaths worldwide. Prostate cancer occurs in older men.
Screening clinical trials are conducted in many parts of the
world. According to the importance of men’s health and the lack
of comprehensive researches we decided to do prostate cancer
screening for men aged 50 to 70years in Fasa to improve health
and reduce mortality of men.
Methods & Results: Using immunohistochemistry we have
shown that the EphB3 receptor has a similar increase in
expression in prostate cancer when compared with benign
prostate gland (p<0.0001), and thus is a potential diagnostic
biomarker. We also investigate a possible correlation between
increase in the expression of these receptors and cancer grade, as
determined by the current Gleason scoring method. We find that
increasing EphB4 expression directly correlates with increasing
cancer grade (Gleason 6-7) (p<0.05). We also observe a trend for a
similar correlation with the EphB3 receptor.
Methods: This cross-sectional study (descriptive -analytical)
was done in order to screen men for prostate cancer. At first the
comments were explained to the volunteers and each patient was
taken to interview after reading the informed consent. The data
collected were analyzed by SPSS software, version17.
Results: Of the 921 men who participated, mean age was
58.9±7.9. From 760 people took a rectal examination, prostate
size in 558 patients (73.4%) was normal, in 198 men (26.1%)
was bigger than normal and in 4 men (0.5%) was so bigger than
normal. The mean of prostate-specific antigen (PSA) in men
was 1.55±3.28. This factor in 697 men (91.7%) was lower than
3.5 ng/‌m l and normal, in 12 men (1.6%) was edgy 3.5-4.5ng/‌m l
and in 51 men (6.7%) was increased.
Conclusions: Our results pave the way for a follow-up study,
with a larger sample size and clinical outcome data, to determine
whether the level of EphB3 and EphB4 expression could give an
indication of prostate cancer aggressiveness and thus become a
prognostic marker.
Conclusions: The study showed that men with PSA above 4
and formidability of hard or semi-hard in rectal examination,
are suspected for prostate cancer that need to have a biopsy to
confirm the diagnosis. It is recommended for men over 50 to visit
for prostate exam every year and if they have abnormal rectal
examination and PSA above 4 apply for biopsy and treatment.
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Strontium-89 for prostate cancer with bone
metastases: the potential of cancer control and
improvement of overall survival
The occurrence of high-grade prostatic
intraepithelial neoplasia in transition zone of
prostate
Kuroda Isao, Urology, Ibaraki Medical Center, Tokyo Medical University,
Ami,Inashiki,Ibaraki, Japan
Aoyagi Teiichiro, Urology, Ibaraki Medical Center, Tokyo Medical University,
Ami,Inashiki,Ibaraki, Japan
Shimodaira Kenji, Urology, Ibaraki Medical Center, Tokyo Medical University,
Ami,Inashiki,Ibaraki, Japan
Gordeev Vasily, Department of Urology, Railroad clinical hospital at
Khabarovsk-1 station, Khabarovsk, Russian Federation
Antonov Alexander, Department of Urology, Far Easern state medical university,
Khabarovsk, Russian Federation
Evseev Alexey, Department of Pathology, Far Easern state medical university,
Khabarovsk, Russian Federation
Masaltseva Natalia, Department of Urology, Railroad clinical hospital at
Khabarovsk-1 station, Khabarovsk, Russian Federation
Introduction & Objectives: Strontium-89 (Sr89) has been
thought to have a tumoricidal effect with minimal adverse
events. However, there have not been many reports on it. In this
study, we examined the tumoricidal and pain-relief effects of
Sr89 on prostate cancer with bone metastasis and also survivals.
Introduction: It is generally accepted that high-grade prostatic
intraepithelial neoplasia (HG PIN) is mainly localized in
the peripheral zone of the prostate, which corresponds to
the characteristics of the zonal location of prostate cancer.
Considered that incidence of HG PIN in transition zone
significantly lower. These conclusions were based mainly on
the results obtained during the prostate needle biopsy and
monopolar transurethral resection of the prostate (TURP). But,
during prostate needle biopsy ordinarily less specimens takes
from transition zone then from peripheral zone. The analysis of
benign prostate hyperplasia (BPH) surgery specimens can give
more correct data about HG PIN incidence in transition zone of
prostate.
Methods: A retrospective study was performed involving
31 prostate cancer patients with bone metastasis treated with
Sr89. Using PSA as an evaluation criterion of cancer control,
patients were divided into PSA responder and non-responder
groups, and the survival rates were compared. In addition, using
the total amount of pain killers as an evaluation criterion of
pain relief, patients were divided into pain responder and nonresponder groups, and the survival rates were compared. As
secondary investigation items, age, PSA (ng/‌m l), pain site, extent
of the disease (EOD), the presence or absence of castrationresistant prostatic cancer (CRPC), the presence or absence of a
past medical history of treatment with docetaxel (DTX) in CRPC
cases, Gleason Score (GS), hemoglobin (Hb) (g/‌dL), platelet (Plt)
(/‌μl), serum carboxyterminal telopeptide of type I collagen(ICTP)
(ng/‌m l), and bone-alkaline phosphatase (BAP) (U/‌L) were
investigated.
Objective: To evaluate the occurrence of HG PIN in transition
zone of prostate.
Material & Methods: The incidence of HG PIN was studied
among patients who had prostate needle biopsy or BPH
surgery. A bipolar TURP were performed at 57 cases (group
1), monopolar TURP were performed at 130 patients (grour
2), simple prostatectomy were performed at 128 man (group
3), and 617 patients had prostate needle biopsy (group 4). The
comparison of groups was performed by Chi-square test using.
Results: The occurrence of HG PIN in group 1 was 22,8% in
group 2 – 6,9% in group 3 – 14,8% in group 4 – 16%. Statistically
significant differences in the detection of HG PIN between simple
prostatectomy, prostate needle biopsy groups and bipolar TURP
group were absent (chi-square = 1.9; p=0.37). At the same time,
the frequency of HG PIN with bipolar TURP was higher than in
the monopolar TUR (chi-square = 8.16; p=0.004).
Results: Longer survival was expected for the PSA responder
than the PSA non-responder group,and, as predictors of this,
whether the spine was the pain site or not and the presence or
absence of CRPC were useful. Plt, ICTP, and BAP were suggested
to be useful indicators; however, no significant difference was
noted. Furthermore, the survival time was significantly longer
in the pain responder than in the pain non-responder group, and
whether the pain site was present in the spine was considered to
be a predictor, but no significant difference was noted in any of
the items assumed to be biomarkers.
Conclusions: Sr89 has a potency to control PSA and prolong the
survival. A large-scale prospective study of the therapeutic effect
of Sr89 is expected.
Conclusions: These results show the same prevalence of the
HG PIN in peripheral and transition zones of the prostate.
The conclusion of a preferential occurrence of HG PIN in
the peripheral zone of the prostate, based on the worst
representation of the material obtained by biopsy or by
monopolar TURP.
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Risk of hernia complications after minimally
invasive and open radical prostatectomy
Verification of a protocol for 3D IMRT quality
assurance of prostate radiotherapy
Eastham James, Urology, Memorial Sloan-Kettering Cancer Center, New York, United
States
Carlsson Sigrid, Urology, Memorial Sloan-Kettering Cancer Center, New York, New
York, United States
Ehdaie Behfar, Urology, Memorial Sloan-Kettering Cancer Center, New York, New York,
United States
Elkin Elena, Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center,
New York, New York, United States
Atoria Coral, Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer
Center, New York, New York, United States
Gueorguiev Gueorgui, Radiation Oncology, Massachusetts General Hospital, Boston,
United States
Mah’d Mufeed, Electrical and Computer Engineering, University Of Massachusetts,
Lowell, Massachusetts, United States
Sharp Gregory, Radiation Oncology, Massachusetts General Hospital, Boston,
Massachusetts, United States
Turcotte Julie, Radiation Oncology, Massachusetts General Hospital, Boston,
Massachusetts, United States
Crawford Bruce, Radiation Oncology, Massachusetts General Hospital, Boston,
Massachusetts, United States
Introduction: Increased incidence of prostate cancer, largely as
a result of widespread prostate cancer screening, has led to a rise
in the number of radical prostatectomies. Many urologists have
shifted from an open surgical approach to minimally invasive
techniques. It is not clear whether the risk of incisional hernia
varies by surgical approach.
Introduction & Objectives: To test the detectability of
systematic errors of previously designed 3D prostate pretreatment IMRT quality assurance protocol.
Methods: Previously designed 3D prostate pre-treatment IMRT
quality assurance protocol is tested for detectability of systematic
errors. For the protocol, measurements were performed on
thirteen IMRT prostate patients. All plans were for an initial
treatment course to the prostate and the seminal vesicles with
prescription dose of 45Gy, and planned with step-and-shoot
IMRT. A total of 75 3D IMRT QA measurements were performed
on all patients, on different days and on different beam matched
linear accelerators. IBA COMPASS system was used for 3D QA
measurements. For each patient, nine structures of interest were
selected: femoral heads, two planning target volumes (PTV1,
PTV2), prostate, seminal vesicles, anterior and posterior rectal
wall and bladder. For each structure the following statistical
parameters were evaluated: average dose, 3D gamma test, volume
at 4% and 6% difference, and volume that receives between 5%105% of the prescription dose. Two QA protocols are proposed, a
conservative with pass/‌fail QA thresholds the maximum of these
75 passing measurements; standard protocol with pass/‌fail QA
threshold value at the maximum of the 75 measurements +50%
increase. The proposed protocols are tested for their detectability
to systematic errors: for each beam the monitor units we
increased and decreased by 2,5 and 10%; linear accelerator jaws
were removed; in COMPASS QA software initial plan computed
dose was compared with boost plan measured dose or computed
dose for one patient was compared with the measured for
another; all beams were not collimated; plans were run with one
extra or less field; one, two and three central collimator leaves
were in parked position.
Objective: To estimate the impact of surgical approach on the
incidence of post-prostatectomy incisional hernia.
Design, Setting, Participants: We used the linked
Surveillance, Epidemiology, and End Results (SEER)-Medicare
dataset to identify men age 66 and older who had minimally
invasive (MIRP) or open radical prostatectomy (ORP) for prostate
cancer diagnosed 2003-2007.
Main Outcome Measures: Incisional hernia repair identified in
Medicare claims following prostatectomy. We also examined the
frequency of umbilical, inguinal and other hernia repairs.
Results: We identified 3,199 patients who had MIRP and
6,795 who had open radical prostatectomy ORP. The frequency
of incisional hernia repair was 5.3% (median follow-up 3.1 years)
in the MIRP group and 1.9% (median follow-up 4.4 years) in the
ORP group, corresponding to incidence rates of 16.1 and 4.5 per
1000 person-years for MIRP and ORP, respectively. Compared
with ORP, MIRP was associated with a more than 3-fold
increased risk of incisional hernia repair, controlling for patient
and disease characteristics (adjusted hazard ratio 3.39, 95% CI,
2.63–4.38, p <0.0001). MIRP was associated with an attenuated
but increased risk of any hernia repair compared with ORP
(adjusted hazard ratio 1.48, 95% CI 1.29–1.70, p <0.0001).
Conclusions: In this population-based cohort of older men
treated surgically fro prostate cancer, MIRP was associated with
a significantly increased risk of incisional hernia compared with
ORP. This is a potentially remediable complication of prostate
cancer surgery that warrants increased vigilance with respect to
surgical technique.
Results: It was found that both protocols can detect most
systematic errors, excluding when few collimator leaves are in
parked position. Further assessment of the validity of the two
protocols, as well as their sensitivity to systematic errors is
ongoing.
Conclusions: 3D IMRT QA is a powerful and versatile tool for
pre-treatment prostate IMRT QA, with ability to perform variety
of statistical tests and overlay dose and anatomy. It also has
the ability to detect systematic errors. However, because of its
complexity QA protocol containing pass/‌fail thresholds needs
to be established and systematic error detectability needs to be
tested.
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19
Infective complications following TRUS-Bx - a
tale of two cities
Complications following prostate biopsy –
a retrospective audit
Venugopal Suresh, Department of Urology, Royal Hallamshire Hospital, Sheffield,
United Kingdom
James Nicola, Department of Urology, Chesterfield Royal District Hospital,
Chesterfield, United Kingdom
Boucher Nigel, Department of Urology, Chesterfield Royal District Hospital,
Chesterfield, United Kingdom
Rosario Derek, Academic Unit of Urology, Royal Hallamshire Hospital, Sheffield,
United Kingdom
Iyer Subrmanian, Urology, Nobles (IOM), Douglas, Isle of Man, United Kingdom
Upsdell Stephen, Urology, Nobles(IOM), Douglas, Isle of man, United Kingdom
Rai Hem, Urology, Nobles Hospital, Douglas, Isle of Man, United Kingdom
Introduction: Prostate cancer is the no 1 cancer in man(1)
and no 2 cause of mortality in all male cancers(2). Trans
rectal ultrasound guided biopsy (TRUSB) of the prostate is
the gold standard for localising, volume measurement and
tissue acquisition for prostate cancer. Infective sequel, form a
significant part of the complications, sometimes serious or even
fatal (rare).
Introduction & Objectives: There is a recognised but variable
rate of infective complications reported following TRUS-Biopsy.
There remain concerns regarding antibiotic resistance with no
level I evidence as to best antibiotic prophylaxis. The aim of
this study was to compare prospectively the infective morbidity
within 30 days of TRUS-Bx across two neighbouring cities with
different antibiotic protocols, using data from the prospective
PROBE study as the reference population.
Methods: We present a retrospective audit on 100 consecutive
TRUSB patients and analyse their infective complication rate.
Results: We are pleased to announce that our complication rates
are well within the accepted (7%) as per world wide guidelines.
Conclusions: In our study, TRUSB of prostate is a safe procedure.
Material & Methods: Group 1 (reference population, IV Coamoxiclav pre-biopsy and 5 doses of ciprofloxacin 500 mg postbiopsy) consisted of 282 men undergoing first-time biopsy within
the PROBE study. Group 2 consisted of 172 consecutive men from
a neighbouring centre (single dose 500mg Ciprofloxacin and
Metronidazole 1mg pre-biopsy and 5 doses ciprofloxacin 500 mg
post-biopsy). All men had standard 10-12 core biopsies.
References:
1.Cancer Research UK.http:/‌/‌w ww.cancerresearchuk.org/‌cancerinfo/‌cancerstats/‌t ypes/‌prostate/‌incidence/‌
2.Cancer Research UKhttp:/‌/‌w ww.cancerresearchuk.org/‌cancerinfo/‌cancerstats/‌t ypes/‌prostate/‌mortality/‌
3.The British Association of Urological Surgeonshttp:/‌/‌w ww.
baus.org.uk/‌Resources/‌BAUS/‌Documents/‌PDF%20
Documents/‌Patient%20information/‌TRUSP.pdf
Results: There were no deaths in either group. Hospital
admission for sepsis was required for 1 man (0.4%) and 5 men
(2.9%) in groups 1 and 2 respectively (95% CI for difference
0.2 to 6.3% favouring centre 1), (χ2 p = 0.059). Group 2 had 1 man
with a positive blood culture demonstrating an organism with
quinolone resistance.
4.European Association of Urology Nurseshttp:/‌/‌w ww.uroweb.
org/‌fi leadmin/‌E AUN/‌g uidelines/‌E AUN_TRUS_Guidelines_
EN_2011_LR.pdf
Conclusions: Serious sepsis rates between protocols are more
indicative of pharmacokinetic differences than sensitivities per
se. Parenteral administration improves reliability of cover and
may contribute to reduction of serious infectious complications
following TRUS-Bx.
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21
RANKL pathway proteins as risk parameters
for biochemical recurrence in prostate cancer
patients
Quantification of multiparametric prostate MR
data to predict adverse pathologic features:
preliminary findings
Todenhöfer Tilman, Urology, University Hospital Tübingen, Tübingen, Germany
Hennenlotter Jörg, Urology, University Hospital Tübingen, Tübingen, Germany
Aufderklamm Stefan, Urology, University Hospital Tübingen, Tübingen,
Blumenstock Gunnar, Biometry and Statistics, University Hospital Tübingen,
Tübingen, Germany
Stenzl Arnulf, Urology, University Hospital Tübingen, Tübingen, Germany
Schwentner Christian, Urology, University Hospital Tübingen, Tübingen, Germany
Acar Ömer, Urology, VKF American Hospital, Istanbul, Turkey
Vural Metin, Radiology, VKF American Hospital, Istanbul, Turkey
Akpek Sergin, Radiology, VKF American Hospital, Istanbul, Turkey
Cezayirli Fatin, Urology, VKF American Hospital, Istanbul, Turkey
Esen Tarık, Urology, VKF American Hospital, Istanbul, Turkey
Introduction & Objectives: PI-RADS (prostate imaging,
reporting, and data system) scoring system quantifies
multiparametric prostate MRI (Mp-MRI) data and it is being
used to estimate the probability of a lesion to be malignant.
In this preliminary study, we aimed to analyze the correlation
between the total score of radiologically detected index lesions
and pathologic outcome in those patients who were operated due
to clinically localized prostate cancer.
Introduction & Objectives: The development of bone
metastases from prostate cancer is closely linked to the activity
of the receptor activator of the NF-kB Ligand (RANKL) pathway.
Recent evidence exists that this pathway might play a role for
tumor biology before metastatic disease becomes manifest.
We aimed to assess the prognostic impact of proteins of the
RANKL pathway in serum samples of patients undergoing radical
prostatectomy (RP).
Material & Methods: Between November 2011 and March
2013, a total of seventeen patients have undergone Mp-MRI of
the prostate before radical prostatectomy. Anatomic T2-weighted
sequences, diffusion weighted and dynamic contrast-enhanced
images were available for all of the patients. Twelve patients had
additional spectroscopic evaluation. Two radiologists assessed all
images to identify the lesion most suspicious of being the index
lesion. Total score of each index lesion was calculated by adding
the individual scores of the studied parameters. Histopathologic
evaluation was conducted by the whole-mount step-section
technique. The relationship between PI-RADS score and
pathologic outcome was investigated.
Patients & Methods: 178 patients undergoing RP between
2004 and 2006 were included. Serum concentrations of soluble
RANKL (sRANKL) and osteoprotegerin (OPG) were determined
retrospectively using Enzyme Linked Immunosorbent Assay
(ELISA). Results of serum measurements were correlated to
clinical and patient follow-up data using the Wilcoxon-MannWhitney test, the Kaplan-Maier method, and single variable or
multifactorial Cox proportional hazards analysis.
Results: Increased sRANKL (p=0.01), decreased OPG (p=0.01)
and an increased sRANKL/‌OPG Ratio (p=0.004) were significant
risk factors for biochemical recurrence (BCR). In multifactorial
analysis adjusted for classical risk factors for BCR, sRANKL and
sRANKL/‌OPG ratio were confirmed as independent prognostic
factors. Neither sRANKL nor OPG showed a clear association
with classical histopathologic factors such as pT, pN, PSA,
Gleason score or R status.
Results: Mean age and mean PSA value of the study population
were 63.5 ± 4,8 years and 11.3 ± 15.8 ng/‌m l, respectively.
Gleason score in the prostatectomy specimen was 6 in 3, 7 in 9,
8 in 2 and 9 in 3 patients. Disease was confined to the prostate in
12 patients while 4 patients had extracapsular extension (pT3a).
Mean tumor volume was 2.5 ± 1.9 cm3. Surgical margins were
clear.
Conclusions: Increased activity of the RANKL pathway in serum
of patients with prostate cancer undergoing RP is a risk factor for
biochemical recurrence. The RANKL pathway seems to contribute
to the biologic behavior of prostate cancer already in an organconfined stage of the disease. Whether serum proteins of this
pathway are also able to predict response to RANKL-inhibition in
patients without bone metastases remains to be elucidated.
Since spectroscopy score was absent in 5 patients, we did not use
it while making comparisons. Index lesions were represented
as the most voluminous tumor focus in the prostatectomy
specimens. Tumor volume in the prostatectomy specimens and
PI-RADS score exhibited a weak but insignificant correlation
(r: 0.292). Patients with a primary Gleason grade of ≥ 4 had
a significantly higher mean total score than those with a
primary Gleason grade of 3 (15.7 ± 2.2 vs. 12.5 ± 1.6, p= 0.003).
Mean total score was insignificantly higher for those with
pathologically confirmed extracapsular extension than those who
had organ-confined disease (13.8 ± 0.4 vs. 12.5 ± 1.7, p= 0.148).
Conclusions: Quantification of Mp-MRI data by PI-RADS
scoring system may provide discriminative information
regarding histopathologic variables. Higher scores might be
associated with adverse pathologic outcomes and may be utilized
while counseling patients.
14
22
Conclusions: We have found a statistically significant difference
in the glycosylation patterns of patients with BPH versus PCa
patients. These changes in N-glycosylation could lead to the
discovery of a new biomarker for PCa. A larger sample size and
subsequent validation will show us if this glycosylation marker
can be used as a clinically usable assay in the future.
Prostate protein glycosylation profile may serve
as a diagnostic biomarker for prostate cancer
Vermassen Tijl, Department of Medical Oncology, University Hospital Ghent, Ghent,
Belgium
Lumen Nicolaas, Department of Urology, University Hospital Ghent, Ghent, Belgium
Van Praet Charles, Department of Urology, University Hospital Ghent, Ghent, Belgium
Vanderschaeghe Dieter, Unit for Medical Biotechnology, Department for Molecular
Biomedical Research, Flemish Institute for Biotechnology, Ghent University, Ghent,
Belgium
Callewaert Nico, Unit for Medical Biotechnology, Department for Molecular
Biomedical Research, Flemish Institute for Biotechnology, Ghent University, Ghent,
Belgium
Hoebeke Piet, Department of Urology, University Hospital Ghent, Ghent, Belgium
Van Belle Simon, Department of Medical Oncology, University Hospital Ghent, Ghent,
Belgium
Rottey Sylvie, Department of Medical Oncology, University Hospital Ghent, Ghent,
Belgium
Delanghe Joris, Department of Clinical Chemistry, University Hospital Ghent, Ghent,
Belgium
Introduction: Prostate cancer (PCa) is the most common
malignancy in men. Prostate specific antigen (PSA) assays are
widely used for early detection of PCa. However, those analyses
are associated with considerable sensitivity and specificity
problems complicating the distinction between various forms
of prostate disease. Moreover, there is a risk of over-diagnosing
indolent PCa and missing potentially aggressive PCa’s.
Material & Methods: We determined the N-glycan profile of
prostatic proteins in the urine after digital rectal examination
of healthy volunteers (n = 21), patients with benign prostate
hyperplasia (BPH; n = 61), PCa patients (n = 42) and patients
with prostatitis (n = 17) by means of DNA sequencer-assisted
Fluorophore-assisted carbohydrate electrophoresis. Statistical
analyses were performed to examine whether differences in
N-glycan profile were statistically significant between the
4 subject groups.
Results: N-glycan profile analyses have pointed out differences
between patients with BPH and PCa patients, associated
with a decrease in triantennary structures and a decrease in
fucosylation of biantennary structures. The isolated test was
not statistically better than sPSA measurement (AUC after ROC
curve analyses are 0.795 ± 0.047 and 0.710 ± 0.053 for sPSA
screening and the glycosylation marker respectively). It gives
however an added value to sPSA screening. Combination of these
assays reached a diagnostic performance of 0.863 ± 0.040 for
all patients. In the diagnostic gray zone of sPSA between 4 and
10 ng/‌mL sPSA was not retained in the logistic regression model.
15
23
Conclusions: RARP showed acceptable oncologic outcomes.
Three years after surgery 73% of pts is free of biochemical
recurrence, despite the first 150 pts concerned the oncologic
learning curve of the surgeon (demonstrated at GCPC 2012). The
largest predictors for BCR were pGleason score 8-10 and pT3abstadium. More accurate imaging concerning local staging and
evaluating metastases is needed to prevent local treatment in
the metastatic setting and to perform a wide excision in locally
advanced tumors in combination with an eLND.
Predictors of biochemical progression after
RARP: oncological outcome and salvage
therapy three years after robot assisted radical
prostatectomy
Collette Eelco, Department of Urology, Maasstad Hospital, Rotterdam, Zuid-Holland,
Netherlands
Van den Ouden Dies, Department of Urology, Maasstad Hospital, Rotterdam, ZuidHolland, Netherlands
Klaver Sjoerd, Department of Urology, Maasstad Hospital, Rotterdam, Zuid-Holland,
Netherlands
Table: Proportion of patients with BCR three years after
RARP stratified to pT and surgical margin
BCR in
Margin-
BCR in
Margin+
Total
subgroup
Introduction & Objectives: Goal of this analysis is to analyse
the oncological outcome three years after RARP (robot assisted
radical prostatectomy) and to evaluate predictors of biochemical
progression (BCR) after RARP.
pT2ab, n= 33 3/‌29 (10%)
0/‌4 (0%)
3/‌33 (9%)
pT2c, n=121
13/‌97 (13%)
7/‌24 (29%)
20/‌121 (17)
pT3a, n=22
5/‌16 (31%)
4/‌6 (67%)
9/‌22 (41%)
Material & Methods: Prospective registration and retrospective
analysis. Between January 2009 and April 2010, 207 patients
(pts) underwent RARP in our hospital for clinically localized
prostate cancer, performed by one single surgeon. At time of
analysis all pts were minimal 36 months in follow-up. pTumorstadium, pGleason score, surgical margin status, BCR and salvage
therapy were evaluated. Time between RARP and onset of salvage
therapy was listed, as well as type of salvage therapy; external
radiotherapy (EBRT), androgen deprivation therapy (ADT) or a
combination. BCR is defined as PSA >0.2 ng/‌m l. None of the pts
received adjuvant therapy (<3 months) after RARP.
pT3b, n=31
13/‌20 (65%)
10/‌11 (91%)
23/‌31 (74%)
Total group,
n=207
34/‌162 (21%)
21/‌45 (47%)
55/‌207 (27%)
Results: Of the total group of 207 pts, 55 (27%) revealed
BCR within three years after initial treatment. All pts with
BCR received salvage therapy. Within this group 35/‌55 (64%)
pts received EBRT, 8/‌55 (14%) pts ADT and 12/‌55 (22%) pts
initially EBRT and later ADT. The peri-operative and three years
oncological outcomes are listed in the table. In multivariate
logistic regression analysis adjusted for initial PSA, prostate
volume and nerve sparing surgery, pGleason score 8-10 (OR
5,760; p<0.001) and pT3ab-stadium (OR 4,924; p<0.001)
appeared as strong significant predictors for BCR. Positive
surgical margin (p=0.53) was not significantly associated.
Mean time between RARP and salvage therapy was 15,4 (n=55)
months.
16
24
Conclusions: The SCP-classification differentiates outcome
between patient categories. RARP reached favourable oncological
and functional outcome at a follow-up of three years. Explanation
for the results may be due to the first 150 pts concerning the
oncologic learning curve of the surgeon (demonstrated at GCPC
2012), no adjuvant pts, no psa screening cohort and large portion
of pT3 tumors. Higher numbers and longer oncological follow-up
is needed.
Survival, continence and potency (SCP)
outcomes three years after robot assisted
radical prostatectomy
Collette Eelco, Department of Urology, Maasstad Hospital, Rotterdam, Zuid-Holland,
Netherlands
Van den Ouden Dies, Department of Urology, Maasstad Hospital, Rotterdam, ZuidHolland, Netherlands
Klaver Sjoerd, Department of Urology, Maasstad Hospital, Rotterdam, Zuid-Holland,
Netherlands
Table: SCP outcomes of entire cohort three years after
RARP
Outcome
Introduction & Objectives: Objective is to evaluate oncological
and functional outcomes three years after RARP (robot assisted
radical prostatectomy) and to identify different patient groups
by means of the survival, continence and potency (SCP)
classification.
Survival
Continence
Material & Methods: Prospective registration and retrospective
analysis by means of validated questionnaires. Between January
2009 and April 2010, 207 patients (pts) underwent RARP in
our hospital for clinically localized prostate cancer, performed
by one single surgeon. At time of analysis all pts were minimal
36 months in follow-up. Biochemical recurrence, continence
and potency were evaluated accordant to the SCP-classification.
S(urvival): Sx = adjuvant therapy <3 months after RARP, S0 = PSA
≤0.2, S1 = PSA >0,2 or salvage therapy. C(ontinence): Cx = pre-op
incontinent, C0 = no pad use, C1 = 1 (security) pad per day, C2 =
>1 pad per day. P(otency): P0 = SHIM ≥17 without medication,
P1 = SHIM ≥17 with medication, P2 = SHIM <17, Px = pre-op
impotent, no nerve-sparing surgery, no sexual activity or no
partner. Group A concerned pre-op continent and potent pts who
underwent nerve-sparing surgery. Group B concerned all the
other pts.
Potency
Oncologic success,
Entire cohort;
Group A:
Group B:
(n=207; 100%)
(n=81; 39%)
(n=126; 61%)
S0= 152 (73%)
S0= 64 (79%)
S0= 88 (70%)
S1= 55 (27%)
S1= 17 (21%)
S1= 38 (30%)
Sx= 0 (0%)
Cx = 5 (2%)
Cx = 5 (4%)
C0 = 157 (76%)
C0= 67 (83%)
C0= 90 (72%)
C1 = 40 (20%)
C1= 12 (15%)
C1= 28 (22%)
C2 = 5 (2%)
C2= 2 (2%)
C2= 3 (2%)
Px= 126 (61%)
Px= 126 (100%)
P0= 39 (19%)
P0= 39 (48%)
P1= 7 (3%)
P1= 7 (9%)
P2= 35 (17%)
P2= 35 (43%)
-
37/‌81 (46%)
88/‌126 (70%)
-
27/‌81 (33%)
0/‌126 (0%)
-
7/‌81 (9%)
35/‌126 (28%)
-
10/‌81 (12%)
3/‌126 (2%)
functional success
Oncologic success,
functional failure
Oncologic failure,
Results: The SCP outcomes are listed in the table. Within the
entire cohort a pT2-tumor was found in 154 pts (74%) and pT3tumor in 53 pts (26%).
functional success
Oncologic failure,
functional failure
17
25
Results: The cell cycle progression signature was a highly
significant predictor of outcome in all five studies. In
conservatively managed patients, the CCP score was the
dominant variable for predicting death from prostate cancer
in univariate analysis (p = 6.1 x 10-22 after diagnosis by TURP
and p = 8.6 x 10-10 after diagnosis by needle biopsy). In both
studies, the CCP score remained highly significant in multivariate
analysis, and in fact, was a stronger predictor of diseasespecific mortality than other prognostic variables. After radical
prostatectomy, the CCP score predicted biochemical recurrence
(BCR) in univariate analysis (p = 5.6 x 10-9 and p= 2.23 x 10-6)
and provided additional prognostic information in multivariate
analysis (p = 3.3 x10-6 and p = 9.5 x10-5). After external beam
radiation therapy, the CCP score predicted BCR (Phoenix) in
univariate (p=0.0017) and multivariate analysis (p=0.034). In
all five studies the HR per unit change in the CCP score was
remarkably similar, ranging from 1.89 to 2.92, indicating that
the effect size for the CCP score is robust to clinical setting and
patient composition.
A novel genetic test for prostate cancer
prognosis
Brawer Michael, Urology, Myriad Genetic Laboratories, Inc., Salt Lake City, UT, United
States
Cuzick Jack, Centre for Cancer Prevention, Queen Mary, University of London,
London, United Kingdom
Cooperberg Matthew, Urology, UCSF Helen Diller Family Comprehensive Cancer
Center, San Francisco, CA, United States
Swanson Greg, Radiation Oncology and Urology/‌Radiology, University of Texas
Health Science Center San Antonio, San Antonio, TX, United States
Freedland Stephen, Surgery, Durham VA Medical Center and Duke University School
of Medicine, Durham, NC, United States
Reid Julia, Informatics, Myriad Genetics, Inc., Salt Lake City, UT, United States
Fisher, Centre for Cancer Prevention, Queen Mary, University of London, London,
United Kingdom
Lanchbury Jerry, Administration, Myriad Genetics, Inc., Salt Lake City, UT, United
States
Gutin Alexander, Informatics, Myriad Genetics, Inc., Salt Lake City, UT, United States
King Gary, MGI International, Myriad Genetics, Inc., Salt Lake City, UT, United States
Stone Steven, Research, Myriad Genetics, Inc., Salt Lake City, UT, United States
Carroll Peter, Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San
Francisco, CA, United States
Conclusions: This CCP score test predicts prostate cancer
outcome in multiple patient cohorts and diverse clinical settings.
In all cases, it provides information beyond clinicopathologic
variables to help differentiate aggressive from indolent disease.
Introduction & Objectives: The natural history of prostate
cancer is highly variable and difficult to predict accurately.
Improved tools are needed to match treatment more
appropriately to a patient’s risk of progression. Therefore, we
developed an expression signature composed of genes involved
in cell cycle progression (CCP) and tested its utility in prostate
cancer.
Methods: We’ve developed an expression signature composed
of 31 cell cycle progression and 15 housekeeper genes. An
expression score (CCP score) was derived as the mean of all cell
cycle progression genes. The signature was tested at disease
diagnosis in two conservatively managed cohorts (N=337 and
349), after radical prostatectomy in an additional two cohorts
(N=366 and 413), and after external beam radiation therapy
(N=141) in a final cohort. All studies were retrospective.
18
26
27
Diagnostic accuracy of MRI and MRI targeted
biopsies for patient’s selection for active
surveillance for low risk prostate cancer
Preliminary experience with a novel method of
three-dimensional co-registration of prostate
cancer digital histology and in vivo multiparametric MRI
Marliere François, Urology, Claude Huriez, Université Lille 2, Lille, France
Ouzzane Adil, Urology, Claude Huriez, Université Lille 2, Lille, France
Villers Arnauld, Urology, Claude Huriez, Université Lille 2, Lille, France
Orczyk Clement, Urology and Renal Transplantation, University Hospital of Caen,
Caen, France
Rusinek Henry, Radiology, NYU Medical Center, New York City, New York, United
States
Rosenkrantz Andrew, Radiology, NYU Medical Center, New York City,
Mikheev Artem, Radiology, NYU Medical Center, New York City, New York, United
States
Deng Feng-Ming, Pathology, NYU Medical Center, New York City, New York, United
States
Melamed Jonathan, Pathology, NYU Medical Center, New York City, New York, United
States
Taneja Samir, Division of Urologic Oncology, Department of Urology, NYU Medical
Center, New York City, New York, United States
Introduction & Objectives: Although the rationale for active
surveillance (AS) in patient with low risk prostate cancer is well
established, there are limits in the ability of AS criteria to predict
the correct pathologic stage of insignificant prostate cancer at
radical prostatectomy. A strategy of targeted biopsies based
on pre-biopsy multiparametric resonance imaging (mp-MRI)
is associated with a high sensitivity, specificity and negative
predictive value for prostate cancer identification and staging. We
retrospectively measured the role of mpMRI-targeted biopsies for
reclassification to higher risk in patients eligible for AS based on
12 systematic biopsies in our center.
Material & Methods: From 1763 patients biopsied in one center
in the period 2008 to 2012, 1103 were diagnosed for prostate
cancer. Out of them, 922 underwent pre-biopsy mp-MRI and
12 transrectal ultrasound-guided systematic biopsies plus two
targeted biopsies at any mp-MRI area suspicious for malignancy.
The criteria for AS, based on 12 systematic biopsies, were
clinical stage T1-2 tumor, PSA ≤10ng/‌m l, biopsy Gleason sum
≤6 with no pattern of grade 4 or 5, < 3 biopsies, with maximum
cancer core length of 5mm. mp-MRI comprised T2 weighted,
diffusion weighted and dynamic contrast enhanced imaging
with either 1.5 or 3 Tesla magnetic field strengths. Suspicious
areas were ranked on a 5 point scale. Criteria for the likelihood of
maligancy were classified as either non suspicious (score of 1 or
2) or suspicious (score of 3, 4 or 5). Two targeted biopsies at any
mp-MRI lesion (score of 3, 4 or 5) were performed using fusion
software or by visual targeting. Both systematic and targeted
biopsies were performed during the same biopsy session in that
order. Patients were reclassified if targeted prostate biopsies
showed cancer core length > 5mm or Gleason score >6.
Introduction & Objectives: To assess a novel method of
three-dimensional (3D) co-registration of prostate cancer
digital histology and in vivo Multi-parametric MRI for clinical
usefulness.
Material & Methods: We developed a software platform to
achieve 3D co-registration. We prospectively applied this method
to three patients who underwent radical prostatectomy. Data
were comprised of in vivo MpMRI (T2WI, ADC, DCE), ex vivo
T2WI, 3D-rebuilt pathologic specimen, and digital histology.
Internal landmarks from zonal anatomy served as reference for
assessing co-registration accuracy and precision.
Results: Applying a method of deformable transformation based
upon 22 internal landmarks, we reached a 1.6mm accuracy to
align T2-weighted images and 3D-rebuilt pathologic specimen,
improving over the rigid approach by 32% (p=0.003). The
22 zonal anatomy landmarks were more accurately mapped using
the deformable transformation than the rigid one (p=0.0008). An
automatic method based on Mutual Information, permitted us
to automate the process and include perfusion and diffusion MR
images. Evaluation of coregistration accuracy by volume overlap
index (Dice index) met clinically relevant requirements, ranging
from 0.81 to 0.96 for sequences tested. Ex vivo images of the
specimen did not significantly improve co-registration accuracy
in our specific workflow.
Results: Of the 922 patients, 220 (24%) fulfilled all
clinicobiological criteria and biopsy criteria based on
12 systematic biopsies for AS. The median (range) age was 63 (6068) years ; median PSA level was 6 (4.8-7.2)ng/‌m l ; median PSA
density was 0.12 (0.08-0.16) ng/‌m l/‌cc. Out of the 220 patients
eligible for AS, 10 %(22/‌220) were reclassified to higher risk by
mp-MRI with targeted biopsy.
Conclusions: The risk of misclassification of patients eligible for
AS from the currents criteria can be reduced by 10% with prebiopsy mp-MRI and targeted biopsies at any MRI area suspicious
for malignancy.
19
28
Conclusions: This preliminary analysis suggests that deformable
transformation based on zonal anatomy landmarks is accurate in
co-registration of mpMRI and histology. Including diffusion and
perfusion sequences in the same 3 dimensional space as histology
is essential further clinical implication. The ability to localize
the cancer in 3D space may improve targeting for image-guided
biopsy, focal therapy and disease quantification in surveillance
protocols.
Long-term quality of life after open and robot
assisted laparoscopic radical prostatectomy
De Bruyne Peter, Urology, UZ Gent, Gent, Belgium
Van Praet Charles, Urology, UZ Gent, Gent, Belgium
De Smet Jens, Urology, UZ Gent, Gent, Belgium
Aspeslagh Barbel, Urology, UZ Gent, Gent, Belgium
Oosterlinck Willem, Urology, UZ Gent, Gent, Belgium
Verbaeys Anthony, Urology, UZ Gent, Gent, Belgium
Lumen Nicolaas, Urology, UZ Gent, Gent, Belgium
Introduction & Objectives: We examined and compared
quality of life (QoL) and continence after open radical
prostatectomy (ORP) versus a robot assisted laparoscopic
procedure (RALP) for clinically located prostate cancer (cT1-T2).
Material & Methods: We invited 244 persons who underwent
ORP between 1997 and 2011 to fill in EORTC QLQ-C30, EORTC
QLQ-PR25, and ICIQ-mLUTS questionnaires. We retrieved
108 (44%). Starting in 2009 the same questionnaires were
prospectively offered to RALP patients (n=78) after 1, 3 and
12 months. The ORP group was compared to the RALP group
and to a literature-reported reference population of healthy
males. Univariate linear regression was performed to identify
determinants of QoL and symptoms.
Results: Patient characteristics are listed in the table below.
ORP
(n = 108)
RALP
(n = 78)
P<x
Age
61,4 (±6,7)
63,4 (±6,6)
0,08
Follow-up
55,6 (±37,4)
18,5 (±10,6)
0,001
PSA (ng/‌ml)
10,9 (±8,5)
12,1 (±18,9)
0,97
Gleason
≤6: 37 (34%)
≤6: 21 (31%)
0,74
7: 50 (46%)
7: 35 (52%)
≥8: 21 (19%)
≥8: 11 (16%)
T2: 69 (64%)
T2: 51 (66%)
T3: 39 (36%)
T3: 23 (29%)
63/‌108:
75/‌78:
None:
30(48%)
None:
15(20%)
Unilateral:
16(25%)
Unilateral:
39(52%)
Bilateral:
17(27%)
Bilateral:
21(28%)
pT
Nerve sparing
20
0,5
0,001
Adjuvant or salvage 54/‌107 (51%)
radiotherapy
15/‌65 (23%)
0,001
Hormonal therapy
33/‌107 (31%)
8/‌64 (13%)
0,007
BMI
25,9 (±3,1)
27,6 (±4,1)
0,07
29
Age-stratification and comparison of the open group to a healthy
Dutch reference population illustrated that only patients
between 60-69 (n=47) and ≥70 years old (n=37) had a significant
lower QoL (P<0,001). There were no significant differences
in QoL and continence of the robot versus the open group.
Univariate analysis in the latter demonstrated an advantage of
nerve sparing but disadvantage of radiotherapy in terms of QoL
(P<0,035 and P<0,041 respectively). Hormonal therapy increases
incontinence (P<0,005). Bilateral nerve sparing in the robot
group was associated with better continence on the 3rd and 12th
month of follow up (P<0,013 and P<0,05). The BMI however is
detrimental to overall continence on the 12th month of follow up
(P<0,008).
Can we localize the prostate cancer index
lesion at our office? Performances of TRUS
saturation biopsies confronted to radical
prostatectomy specimen
Orczyk Clement, Urology and Renal Transplantation, University Hospital of Caen,
Caen, France
Doerfler Arnaud, Urology and Renal Transplantation, University Hospital of Caen,
Caen, France
Comoz François, Pathology, University Hospital of Caen, Caen,
Le Gal Sophie, Urology and Renal Transplantation, University Hospital of Caen, Caen,
France
Desmonts Alexis, Urology and Renal Transplantation, University Hospital of Caen,
Caen, France
Bazille Celine, Pathology, University Hospital of Caen, Caen,
Secco Michael, Urology and Renal Transplantation, University Hospital of Caen,
Caen, France
Tillou Xavier, Urology and Renal Transplantation, University Hospital of Caen, Caen,
France
Bensadoun Henri, Urology and Renal Transplantation, University Hospital of Caen,
Caen, France
Conclusions: Overall QoL several years after radical
prostatectomy is excellent and shows only a minor decrease
in comparison to a Dutch elderly reference population.
Radiotherapy was associated with worse QoL. Hormonal therapy
and BMI contribute to incontinence. As opposed to other
published literature there were no significant differences between
open and robotic surgery. However, longer follow-up is needed.
Introduction & Objectives: Index lesion should be defined
as the one within the gland that leads cancer prognosis. With
perspective of active surveillance (AS) and focal therapy (FT),
localize and identify this index lesion is critical. While TRUS
saturation biopsy (TRUS SB) is controversial for raw detection,
increased sample of tissue may improve qualitative information
about cancer foci. Objective is to assess the ability of TRUS SB, as
an office based procedure, to detect and localize the index lesion
confronted to radical prostatectomy specimen.
Material & Methods: We retrospectively reviewed the charts
of patients who underwent radical prostatectomy after TRUS
SB at our institution in 2010 and 2011. TRUS SB with 22 cores
is offered for baseline biopsy at our center (scheme figure1).
Each core was sent to pathology in separate jar. Biopsy analysis
included core-by-core analysis and a report using a scheme
with tissue length and cancer extension. Grouping contiguous
positive cores made up lesions. Specimens underwent step
section analysis and were reviewed by senior uropathologists
with reporting on a standardized scheme of the sliced gland
(figure 1). Specimen index lesion was the one with extra prostatic
extension, if not the largest. Correlation was done on a sextant
basis as described in figure 1.
Results: We included 50 patients, median age 62 years old (5172), median PSA 6.64 ng/‌m l (2.69-18.73), mean Gleason score
6.1(5-7). Median number of cores was 22, with median cancer
involvement of 9 mm by patient. 88% of patient presented
an index lesion at biopsy. Sensitivity (Se) for detection and
localization of index lesion as such was 87% and positive
predictive value (PPV) of 61%.
21
30
Conclusions: Intrinsic performance was high with sensitivity
of 87% for detection and localization of the index lesion. Results
are temperated by moderate PPV. TRUS SB is useful for detection
and localization of the index lesion in this population of patient
treated by radical prostatectomy. Clinical value of this technique
depends of the treatment option offered to patient such as AS and
FT. Our results need further controlled studies for validation.
Improvement will rise with 3D US core registration in space and
conjunction with modern imaging like Multiparametric MRI.
Stratification of prostate cancer: the benefit
of TRUS saturation biopsy for predicting final
Gleason score
Orczyk Clement, Urology and Renal Transplantation, University Hospital of Caen,
Caen, France
Doerfler Arnaud, Urology and Renal Transplantation, University Hospital of Caen,
Caen, France
Comoz François, Pathology, University Hospital of Caen, Caen, France
Le Gal Sophie, Urology and Renal Transplantation, University Hospital of Caen, Caen,
France
Bazille Celine, Pathology, University Hospital of Caen, Caen, France
Desmonts Alexis, Urology and Renal Transplantation, University Hospital of Caen,
Caen, France
Secco Michael, Urology and Renal Transplantation, University Hospital of Caen,
Cane, France
Tillou Xavier, Urology and Renal Transplantation, University Hospital of Caen, Caen,
France
Bensadoun Henri, Urology and Renal Transplantation, University Hospital of Caen,
Caen, France
Introduction & Objectives: Risk stratification of prostate
cancer needs accurate determination of Gleason score (GS).
TRUS extended biopsy are known to under evaluate GS in
25% up to 35% of cases. TRUS SB may identify aggressiveness
by maximizing tissue sampling.The objective is to assess
performance of TRUS SB, as an office base method, to predict the
Gleason score at radical prostatectomy analysis.
Material & Methods: We retrospectively reviewed the charts
of patients who underwent radical prostatectomies after TRUS
SB at our institution in 2010 and 2011 and for which biopsy
and specimen pathology were assessed by one identified senior
uropathologist. TRUS SB with 22 cores is offered for baseline
biopsy in our center and performed under local anesthesia.
Each core was sent to pathology in separate jar. Biopsy analysis
included core-by-core analysis and a report using a scheme with
tissue length, cancer extension and GS. Specimen underwent
a step section analysis and final GS was recorded. We used
Wilcoxon signed rank test for paired data with p significance at
0.05 to compare GS between biopsy and specimen.
Results: We included 41 patients median age 61.5 years old,
median PSA 6.58ng/‌m l, normal DRE rate of in 61%, median
Gleason score 6, median prostate weight 50.5 gr. Median number
of cores was 22, with median tissue length of 289 mm, median
cancer involvement of 10.5 mm by patient and median rate of
involvement of 3.2%. There was no significant difference (p=0.03)
between TRUS SB and final GS. Exact match for GS was observed
in 87% of cases. Performance for GS 6 and 7 are reported in
table 1.
22
31
Conclusions: We report high performance for TRUS SB, office
based procedure, for stratification of prostate cancer. High NPV
at 92% for GS 7 is critical for patient enrolled in AS. By increasing
number of cores, this technique may samples more tissue from
cancer foci than TRUS extended biopsy. TRUS SB has to be
evaluated with other techniques that aim to optimize sampling
the gland like MRI guided biopsy.
Correlation between prostate volume measured
by transrectal and suprapubic ultrasound: can
we do without TRUS ?
Van Praet Charles, Urology, Ghent University Hospital, Ghent, Belgium
Decaestecker Karel, Urology, Ghent University Hospital, Ghent, Belgium
Mortier Margarete, Radiology, Ghent University Hospital, Ghent, Belgium
Hoebeke Piet, Urology, Ghent University Hospital, Ghent, Belgium
Lumen Nicolaas, Urology, Ghent University Hospital, Ghent, Belgium
Table 1. TRUS SB performance
TRUS SB with GS of 6
Sensitivity (Se) %
93
Specificity (Sp) %
79
Positive predictive value (PPV) %
89
Negative Predictive Value (NPV) %
85
Introduction & Objectives: Transrectal ultrasound (TRUS) is
established as the gold standard prostate imaging tool in daily
clinical practice to determine prostate volume (Pvol). Pvol is
important for decision-making in prostate cancer to determine
prostate-specific antigen density (PSAD, with a suspicious
threshold of >15%) as well as in benign prostate hyperplasia
(BPH), with a threshold of >80 mL not to perform transurethral
resection of the prostate (TURP). TRUS however is not as widely
available as suprapubic ultrasound (SPUS), more expensive and
rather unpleasant for the patient. We investigate whether Pvol
measurement with TRUS or SPUS differ significantly.
TRUS SB with GS of 7
Sensitivity (Se) %
62
Specificity (Sp) %
100
Positive predictive value (PPV) %
100
Negative Predictive Value (NPV) %
92
Material & Methods: We included 55 patients who underwent
TRUS at Ghent University Hospital from March until May 2012.
All SPUS measurements were performed by a urology resident,
who also performed 18 (33%) of TRUS measurements. In 37 cases
(67%) TRUS was performed by another urologist blinded to
results from SPUS. In both examinations Pvol was calculated
with the ellipse formula after measurement of all three prostate
diameters (anteroposterior, transversal and craniocaudal).
Correlation between Pvol by TRUS and SPUS was determined
with Pearson correlation coefficient. Univariate and multivariate
linear regression was performed to account for influence of body
mass index (BMI), bladder volume and blinding on the ratio
Pvol(TRUS)/‌P vol(SPUS).
Results: Median Pvol was 32,1 mL (range 8,4-154,0) with SPUS
and 35,5 mL (range 10,1-117,0) with TRUS. Overall Pearson
correlation coefficient was 0,919 (P<0.001). All three prostate
diameters showed good correlation (range 0,739-0,875, all
P<0.001). However, in 31% of patients there was a difference
of >30% between SPUS and TRUS Pvol (range 0,5%-58,1%).
SPUS and TRUS were inconclusive in 5 patients (9%) for a PSAD
threshold of 15% and in 2 patients (4%) for a TURP threshold of
80mL. Both on uni- and multivariate linear regression lower BMI
(univariate P=0.006) and blinding between observers (univariate
P=0.008) predicted for lower ratio Pvol(TRUS)/‌P vol(SPUS).
Conclusions: Although there is a strong correlation between
Pvol measurement by SPUS and TRUS, in almost one in three
patients both measurements will differ >30%. Lower BMI
predicted for more accurate SPUS measurement.
23
32
Conclusions: Postoperative high-dose pelvic RT plus ADT comes
at the cost of a temporary increase in grade 2 GI toxicity.
Toxicity of postoperative high-dose pelvic
radiotherapy and androgen deprivation for N+
prostate cancer compared to postoperative
prostate bed-only radiotherapy: a matched
case analysis
Acute toxicity
GI
Late toxicity
Pelvic RT
Prostate- P
Pelvic RT
Prostate- P
(n=48)
only RT
(n=28)
only RT
value
(n=48)
Van Praet Charles, Urology, Ghent University Hospital, Ghent, Belgium
Ost Piet, Radiation therapy and oncology, Ghent University Hospital, Ghent, Belgium
Lumen Nicolaas, Urology, Ghent University Hospital, Ghent, Belgium
De Meerleer Gert, Radiation therapy and oncology, Ghent University Hospital, Ghent,
Belgium
Vandecasteele Katrien, Radiation therapy and oncology, Ghent University Hospital,
Ghent, Belgium
Villeirs Geert, Radiology, Ghent University Hospital, Ghent, Belgium
Decaestecker Karel, Urology, Ghent University Hospital, Ghent, Belgium
Fonteyne Valérie, Radiation therapy and oncology, Ghent University Hospital, Ghent,
Belgium
Grade 1 20 (42%)
24 (50%)
Grade 2 20 (42%)
7 (15%)
GU
Pelvic RT
(n=48)
value
(n=38)
0.007
16 (57%)
14 (37%)
7 (25%)
3 (8%)
Prostate- P
Pelvic RT
Prostate- P
only RT
(n=28)
only RT
value
(n=48)
Grade 1 20 (42%)
23 (48%)
Grade 2 17 (35%)
0.006
value
(n=38)
0.558
11 (39%)
14 (37%)
12 (25%)
10 (36%)
9 (24%)
Grade 3 2 (4%)
2 (4%)
2 (7%)
1 (3%)
Grade 4 0
0
1 (4%)
2 (5%)
0.229
Introduction & Objectives: Lymph node metastasized (N1)
prostate cancer (PC) patients may benefit from trimodality
therapy i.e. radical prostatectomy (RP) with pelvic lymph node
dissection (PLND) plus high-dose whole-pelvis radiotherapy (RT)
and androgen deprivation therapy (ADT). We assess acute and
early late RT-induced toxicity compared to patients receiving
postoperative prostate-only RT.
Material & Methods: Forty-eight N1-PC patients were treated
with adjuvant (n=19) or salvage (n=29) intensity-modulated arc
therapy and 2-3 years of ADT (median follow-up 12 months).
Mean dose to the prostate bed and lymph node regions (including
common, internal and external iliac vessels, obturator fossa
and presacral nodes) was 76 Gy and 54 Gy respectively in 3637 fractions. Patients were matched with 48 N0-PC patients
receiving prostate-only RT following RP-PLND from 239 eligible
patients. RT doses to the prostate bed were equivalent.
Prospective end points are acute and late genito-urinary (GU)
and gastro-intestinal (GI) toxicity. Late toxicity was restricted
to patients with ≥12 months follow-up. An in-house developed
toxicity scale was used based on RTOG/‌C TCAE/‌SOMA-LENT
scales for GU and a modified RTOG scale for GI toxicity.
Results: Patient and tumor characteristics did not differ
significantly in both groups, except for follow-up (pelvic RT
17 ± 16,1 vs. prostate-only RT 43 ± 30,2 months; p<0.001) and
ADT use (pelvic RT 98% vs. prostate-only RT 71%; p<0.001).
Toxicity outcomes are presented in the table. While GU toxicity
did not differ significantly, acute and late GI toxicity was higher
in patients receiving pelvic RT compared to prostate-only RT
(p≤0.007). In the pelvic RT group 59% of ≥grade 2 GU toxicity
recuperated and 100% of ≥grade 2 GI toxicity. Two patients
developed lymphedema.
24
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ASTELLAS, Leading Light for Life, the Star logo, Changing tomorrow and the Ribbon logos are trade marks
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© September 2011 Astellas Pharma Europe Ltd. CSC0461
ASTELLAS, Leading Light for Life, the Star logo, Changing tomorrow and the Ribbon logos are trade marks
of Astellas Pharma Inc. and/or its related entities.
019050_P_ASTELLAS_ONCOLOGY GENERAL AD CSC0461.indd 1
24/10/2011 18:14
Thursday 13 June 2013
11:30–12:30
Auditorium 1
12–14 June 2013
Le Palais du Pharo, Marseille, France
ENZ/13/0041/EUd
Date of preparation: May 2013
Join us for the Astellas Symposium
Over the past decade, the treatment of castration-resistant prostate cancer
(CRPC) has evolved considerably. In particular, a deeper understanding of the
continued importance of the androgen receptor signalling pathway during the
progression from hormone-sensitive to castration-resistant disease has led to
the development of a number of new therapies for CRPC that either indirectly
or directly target this pathway. Our esteemed faculty will explore recent
developments and discuss how the development of new agents will impact
future treatment decisions.
11:30 Introduction to symposium
The evolving mCRPC landscape
Prof. Nicolas Mottet, Clinique Mutualiste – Saint-Etienne, France
11:40 Androgen receptor signalling: A key driver in CRPC
Prof. John Fitzpatrick, MaterMisericordiae Hospital and University
College Dublin, Ireland
12:00 Directly targeting the androgen receptor signalling pathway in mCRPC
Dr Rob Jones, University of Glasgow, UK
12:20 Discussion and future perspectives
Prof. Nicolas Mottet, Clinique Mutualiste – Saint-Etienne, France
This symposium is funded by Astellas Pharma Europe Ltd.
The firsT 6 monthly formulation, now with
over 5 years’ experience across europe
Eligard® gets testosterone low
and keeps it low1,2,3
Abbreviated Prescribing Information
Eligard® (leuprorelin acetate) 7.5 mg, 22.5 mg and 45 mg, powder and
solvent for injection. Composition: After reconstitution of the powder with
the solvent the deliverable amount is 7.5 mg, 22.5 mg and 45 mg of leuprorelin
acetate. Indication: Treatment of hormone dependent advanced prostate
cancer. Posology: Eligard® 7.5 mg, administered every month subcutaneously.
Eligard® 22.5 mg, administered every three months subcutaneously. Eligard® 45 mg,
administered every six months subcutaneously. Contraindications: Hypersensitivity
to leuprorelin acetate, other GnRH agonists or to any of the excipients. Patients who
previously underwent orchiectomy (Eligard® does not result in further decrease of
serum testosterone in case of surgical castration). As sole treatment in prostate cancer
patients with spinal cord compression or evidence of spinal metastases (also refer to
the section “Special warning and special precautions for use”). Women and paediatric
patients. Special warnings and special precautions for use: Leuprorelin acetate causes
a transient increase in serum concentrations of testosterone, dihydrotestosterone and acid
phosphatase during the first week of treatment. This can lead to a transient worsening of
symptoms (additional administration of an antiandrogen beginning 3 days prior to Eligard® therapy
and continuing for the first two to three weeks of treatment should be considered). Patients with vertebral and/
or brain metastases as well as patients with urinary tract obstruction should be closely monitored during the first few weeks of treatment. If spinal cord compression or renal impairment develops,
standard treatment of these conditions should be instituted. Patients with tumours not hormone sensitive will not benefit from further therapy with Eligard®. Decreased bone density has been
reported in men who have had orchiectomy or who have been treated with a GnRH agonist. As in some patients changes in glucose tolerance have been reported, diabetic patients
should be monitored more frequently. During post-marketing surveillance, rare cases of pituitary apoplexy (a clinical syndrome secondary to infarction of the pituitary gland) have been
reported after the administration of GnRH-agonists, with a majority occurring within two weeks of the first dose, and some within the first hour. In these cases, pituitary apoplexy was
presented as sudden headache, vomiting, visual changes, ophthalmoplegia, altered mental status, and sometimes cardiovascular collapse. Immediate medical attention is required.
Undesirable effects: Adverse reactions seen with Eligard® are mainly subject to the specific pharmacological actions of leuprorelin acetate, namely increase and decrease in certain
hormone levels. The most commonly reported undesirable effects are hot flushes, malaise and fatigue and transient local irritation. Please consult SPC for full list of undesirable effects.
Pack and Prices: Country specific. Legal Category: Prescription only medicine. Product Authorisation numbers: Country specific. Date of revision: July 2012. Further information available
from: Astellas Pharma Europe Ltd, Lovett House, Lovett Road, Staines, TW18 3AZ. Eligard® is a registered trademark. For full prescribing information please refer to the Summary of Product
Characteristics.
Adverse events should be reported to Astellas Pharma Europe by using the following e-mail address: [email protected] or facsimile to +31 71545 5208.
References
1. Perez-Marreno R, Chu FM, Gleason D, Loizides E, Wachs B, Tyler RC. A six-month, open-label study assessing a new formulation of leuprolide 7.5 mg for suppression of testosterone
in patients with prostate cancer. Clin Ther 24(11):1902–14 (2002).
2. Chu FM, Jayson M, Dineen MK, Perez R, Harkaway R, Tyler RC. A clinical study of 22.5 mg. La-2550: A new subcutaneous depot delivery system for leuprolide acetate for the treatment
of prostate cancer. J Urol 168(3):1199–203 (2002).
3. Crawford ED, Sartor O, Chu F, Perez R, Karlin G, Garrett JS. A 12-month clinical study of LA-2585 (45.0 mg): a new 6-month subcutaneous delivery system for leuprolide acetate for the
treatment of prostate cancer. J Urol 175(2):533–6 (2006).
leuprorelin
EGD/13/0013/EU. Date of preparation: May 2013
acetate
33
Conclusions: Presence of >1 HR factor predicts for less
favourable BCR-free survival. HR-PC should be further stratified
according to number of HR factors.
Increased number of high-risk factors following
radical prostatectomy is associated with
decreased biochemical recurrence-free survival
in high-risk prostate cancer
Van Praet Charles, Urology, Ghent University Hospital, Ghent, Belgium
Decaestecker Karel, Urology, Ghent University Hospital, Ghent, Belgium
Fonteyne Valérie, Radiation therapy and oncology, Ghent University Hospital, Ghent,
Belgium
Oosterlinck Willem, Urology, Ghent University Hospital, Ghent, Belgium
Verbaeys Antony, Urology, Ghent University Hospital, Ghent, Belgium
Lumen Nicolaas, Urology, Ghent University Hospital, Ghent, Belgium
Introduction & Objectives: High-risk (HR) prostate cancer
(PC) is associated with less favourable biochemical recurrence
(BCR) rates and cancer control outcomes following radical
prostatectomy. However, HR-PC represents quite a heterogeneous
patient group. We evaluate whether number and type of HR
factors predicts for BCR-free survival.
Materials & Methods: We identified 143 patients with HR-PC
who underwent radical prostatectomy (116 open, 27 robotassisted) at Ghent University Hospital from 1997 until 2012. HRPC was defined by at least one of 3 HR factors: prostate-specific
antigen (PSA) >20 ng/‌mL, Gleason score ≥8 or stage pT3-4.
Mean age was 62,6 (± 5,92) years, mean follow-up was 57 (±43,2)
months. Mean PSA was 16,2 (±18,54) ng/‌mL. Pathological
Gleason score was ≤6 in 29 patients (20%), 7 in 62 (43%) and
≥8 in 52 patients (36%). Twenty-one patients (15%) had pT2 PC,
91 (64%) had pT3a, 28 (20%) pT3b and 3 patients (2%) pT4.
Adjuvant RT was delivered in 64 patients (45%) because of PSM
(n=51), stage pT3b (n=19) or pN1 (n=8). Kaplan-Meier analyses
were performed with multivariate Cox regression to correct for
delivery of adjuvant RT.
Results: Five-year BCR-free survival was 59,4% for the total
group and 64,0%, 48,6% and 53,3% for patients with 1, 2 and
3 HR factors respectively. On multivariate Cox regression (figure
1), presence of ≥2 HR factors was associated with worse BCRfree survival (hazards ratio 2,13 [1,12-4,06]; p=0.021). When all
HR factors were put in the multivariate regression model, only
PSA≥20 ng/‌mL was independently associated with worse BCRfree survival (hazards ratio 2,11 [1,03-4,31]; p=0.041).
29
34
35
Quality of life (QoL) in patients with metastatic
castration resistant prostate cancer (mCRPC)
treated with cabazitaxel: interim analysis of a
prospective non-interventional trial (QoLiTime)
Cancer volume is an independent predictor
for biochemical recurrence in high-risk
prostate cancer patients following radical
prostatectomy: a validation of Leuven’s cohort
Hofheinz Ralf, Hematology/‌Oncology, University Hospital Mannheim, Mannheim,
Germany
Al-Batran Salah-Eddin, Hematology/‌Oncology, Krankenhaus Nordwest, Frankfurt,
Germany
Hammerer Peter, Urology, Academic Hospital Braunschweig, Braunschweig, Germany
Kienitz Carsten, Oncology, Sanofi-Aventis Germany, Berlin, Germany
Kloß Susanne, Urology, DRK Hospital Luckenwalde, Luckenwalde, Germany
Lange Carsten, Urology/‌Oncology, Medical Practice for Urology and Oncology,
Bernburg, Germany
Hakim Lukman, Urology, University Hospitals Leuven, Leuven, Belgium
Tosco Lorenzo, Urology, University Hospitals Leuven, Leuven, Belgium
Chun Felix K.H., Urology, University Hospital Hamburg - Eppendorf, Hamburg,
Germany
Spahn Martin, Urology, Inselspital, Bern, Switzerland
Gontero Paolo, Urology, Vita-Salute San Raffaele Hospital, Milan, Italy
Alberts Arnout, Urology, University Hospitals Leuven, Leuven, Belgium
Briganti Alberto, Urology, Vita-Salute San Raffaele Hospital, Milan, Italy
Hsu Chao Yu, Medical and Research Education, Puli Christian Hospital, Puli, Taiwan,
Province of China
Karnes R Jeffrey, Urology, Mayo Clinic, Rochester, MN, United States
Graefen Markus, Urology, Martini Klinik, Hamburg, Germany
Van Poppel Hein, Urology, University Hospitals Leuven, Leuven, Belgium
Joniau Steven, Urology, University Hospitals Leuven, Leuven, Belgium
Introduction: Cabazitaxel (Caba) combined with Prednisone or
Prednisolone is approved for second-line treatment of mCRPC
after Docetaxel. Potential toxicity of chemotherapy may impact
on patient´s QoL and counterbalance treatment benefits. Thus
QoL data are becoming more important from patients and
regulatory perspective.
Introduction & Objectives: We have previously shown that CV
is an independent predictor for biochemical recurrence in a single
center at the University Hospitals of Leuven – Belgium (UZL).
This study aimed to validate the UZL observations using the
Martini Clinic Hamburg-Germany (MCH) data.
Methods: Patients with mCRPC receiving Caba are asked to fill
in EORTC QLQ C30 QoL questionnaires every three weeks. Here
we describe QoL results of the first 131 patients of 480 planned
in total.
Material & Methods: We retrospectively collected the
370 high-risk PCa patients treated with RRP and bilateral
lymphadenectomy at UZL and validated them towards 492 data
from MCH between 1987-2010. Patients were diagnosed either
cT 3-4, or PSA > 20 ng/‌m l, or biopsy Gleason score (bGS) 8-10.
Staging was based on TNM 2002. Biochemical recurrence
(BCR) was considered as a confirmed increase PSA>0.2 ng/‌m l,
while adjuvant treatment was defined as either hormonal and
or radiotherapy treatment given within 90 days following
RRP. Kaplan-Meier survival analysis was used to calculate the
biochemical progression-free survival (BPFS), cancer-specific
survival (CSS), and overall survival (OS), meanwhile log-rank test
was used to compare between survival curves. Univariate and
multivariate cox-proportional hazard were used to determine
the predictive ability of cancer volume models, corrected for
prostate specific antigen (PSA), pathological staging (pT), surgical
Gleason score (fGS), lymph node invasion (LNI), surgical margin
status (SM), adjuvant hormonal therapy (AHT) and adjuvant
radiotherapy (ART). Cancer volume were stratified into nonfixed intervals (quartiles) and fixed intervals (≤ 2.5, 2.5-5, >
5-7.5, > 7.5-10, > 10 ml) in both cohorts, to identify the strongest
predictor and critical cancer volume.
Results: 131 patients who had finished 4 cycles of Caba
treatment are evaluated. Median age was 72 years with generally
good performance status (ECOG 0, n=51; ECOG 1, n=70).
Bone metastases (n=106 (82%)) and lymph node metastases
(n=66 patients (51%)) are most common. 114 patients have
been pretreated with Docetaxel (6 cycles mean). Mean baseline
functioning scales were (n=119 patients): cognitive 80, emotional
65, physical 64, social 63, role 53. QoL questionnaire compliance
was excellent: 114 patients (96%) reporting QoL data in cycle
4. Mean functioning values and global health status remained
unchanged during the first 12 weeks of treatment. Mean
baseline values for symptom scales are: fatigue 50, pain 42,
sleep disturbance 39, appetite loss 32, dyspnea 31, constipation
24, financial difficulties 15, diarrhea 13, nausea/‌vomiting 9.
A significant improvement of pain between baseline and cycle
4 (mean 35) (p=0.03) and a trend regarding improvement of
sleeping disturbance (cycle 4 mean 33) (p=0.15) were noticed,
while diarrhea significantly increased (cycle 4 mean 21; p<0.01).
Other parameters remained unchanged.
Conclusions: This interim analysis is the largest prospective
non-interventional analysis of QoL in patients receiving
Cabazitaxel for mCRPC. QoL questionnaire compliance was
excellent. A significant improvement of pain and a trend for
improved sleep quality were shown, for the price of increased
diarrhea. Importantly, mean global health status was maintained
during the 12-week observation period. Results need to be
confirmed by final analysis.
This research is funded by Sanofi-Aventis.
30
36
Results: Biochemical progression-free survival at 5 years were
61.3% and 46.3% at UZL and MCH respectively, while at 10 years
it was 49.6% and 35%. Cancer-specific survival at 5 years were
97.7% and 97.3% respectively, while at 10 years it was 97.3% and
95.7%. The overall survival were 92.9% and 93.7% respectively,
meanwhile at 10 years it were 76.3% and 87.6%.
Cancer and precancerous lesions risk in
patients with probably precancerous processes
of the prostate
Cancer volume was proven to be an independent predictor
for BCR at UZL cohort (HR 1.86; 95% CI 1.26-2.76; p=0.002)
and MCH cohort (HR 2.15; 95% CI 1.4-3.29; p=0.0004). The
highest quartile of CV at UZL (> 8.2 ml) and MHC (> 17 ml)
were shown to be the only independent predictor among other
quartiles, yielding 1.61-fold (p=0.01) and 1.69-fold increased
(p=0.009) respectively, compared to the lowest quartile. Further
stratification into fixed intervals showed critical cancer volume of
10 ml in UZL cohort and 7.5-10 ml in MCH cohort.
log
Zakharava Viktoryia, Pathology, Belarusian State Medical University, Minsk, Belarus
Liatkouskaya Tatsiana, Pathology, Belarusian State Medical University, Minsk,
Belarus
Cherstvoy Eugeniy, Pathology, Belarusian State Medical University, Minsk, Belarus
Masansky Igar, Oncosurgery, Minsk City Clinical Oncologic Health Center, Minsk,
Belarus
Nitkin Dmitry, Urology, Belarusian Medical Academy of Postgraduate Education,
Minsk, Belarus
Dosta Nikolay, Urology, Belarusian Medical Academy of Postgraduate Education,
Minsk, Belarus
In this series, fGS 8-10 was shown to be the strongest
independent predictor for BCR in UZL (HR 2.67; 95% CI
1.58-4.51; p=0.0003) and MCH (HR 7.99; 95% CI 3.61-17.69;
p<0.0001) cohorts.
Introduction: According to the results of recent studies,
postatrophic hyperplasia (PAH), proliferative inflammatory
atrophy (PIA) and adenosis of the prostate demonstrate
overlapping histological and biological features with prostatic
intraepithelial neoplasia (PIN) and prostatic adenocarcinoma
(PCa).
Conclusions: This validation study consistently showed CV as
an independent predictor for BCR. Critical cancer volume in
this series is about 10 ml in both cohorts. This emphasize the
importance of CV measurement in a routine histopathology of
high-risk PCa specimens following RRP.
Methods: PCa risk in patients with probably precancerous
lesions (PAH/‌PIA and adenosis) has been assessed in biopsies
material from 172 patients having clinically suspicious
PCa. Suspicious foci were estimated with use of cocktail
AMACR+HWC+p63.
Results: According to our results, within the first 6 years the
overall incidence of precancerous lesions and PCa on re-biopsy in
the PAH/‌PIA and adenosis group makes 4% and 6% respectively.
Median lifetime in this group without precancerous lesions
and PCa made 5.8-years with no reliable difference between
groups (P=0,06). Thus, the cumulative share of patients without
precancerous lesions/‌PCa in the probably precancerous group
made 98/‌99%-96/‌95%-94/‌93%-90/‌91%-88/‌89%-85/‌8 4% at
the end of the first-second-third-fourth-fifth-sixth year of
supervision respectively with no reliable difference between
groups PAH, PIA and adenosis of the prostate.
Conclusions: Within the 6 years precancerous lesions and
PCa risk in the PAH/‌PIA and adenosis group makes 4% and
6% respectively. Cumulative share of patients in the group
of probably precancerous lesions of the prostate without
precancerous lesions and PCa in re-biopsy specimens decreased
from 98-99% to 85-84% during these six years respectively.
31
37
38
6-month hormonotherapy in advanced prostate
cancer: what is new about anxiety?
Was information provided by urologists when
patients started androgen blockade for
advanced prostate cancer, well-understood,
sufficient, appreciated?
De La Taille Alexandre, Urology Department, Henri Mondor Hospital, Creteil, France
Mardoyan Séta, Urology Department, Henri Mondor Hospital, Creteil, France
Duclos-Morlaes Bénédicte, Medical Department, Laboratory Astellas, LevalloisPerret, France
Lafaye Anaïs, Laboratory Epsilon EA 4556, Dynamics of Human Abilities and Health
Behaviors, University de Monpellier, Montpellier, France
Lebret Thierry, Department of Urology, Foch Hospital, Suresnes, France
Duclos-Morlaes Bénédicte, Medical Department, Laboratory Astellas, LevalloisPerret, France
Comet Denis, Medical Department, Axonal, Nanterre, France
Droupy Stéphane, Department of Urology, University Hospital, Nimes, France
Introduction & Objectives: Significant levels of anxiety were
found in patients suffering from prostate cancer (PCa), due to
the diagnosis and their treatment. The primary objective of this
study was to describe the level of anxiety associated with disease
in patients receiving leuprorelin acetate 45mg for the treatment
of advanced PCa, taking into account the exclusive or combined
nature of hormonotherapy.
Introduction & Objectives: Communication and information
have increasingly been considered important in helping people
to cope with cancer. The primary objective of this study was
to compare information given by the physician when starting
androgen deprivation therapy [adT] for prostate cancer (PCa)
with that perceived by the pt overall, and according to the main
circumstances of care (metastatic [M] stage, recurrence [R],
adjuvant therapy [AT]).
Methods: This was an observational, non-interventional,
multicenter study conducted among 172 specialists practicing in
France (may 2010-april 2011). Patients completed questionnaires
at inclusion and 6 months after starting their treatment.
PCaspecific anxiety was assessed with the Memorial Anxiety
Scale for Prostate Cancer (MAX-PC) and quality of life (QoL) with
SF-12.
Material & Methods: An observational, non-interventional,
multicenter study was conducted among French urologists
between September 2011 and June 2012. Physicians completed
questionnaires about the information they gave to the patients
(pts) concerning their PCa, prognosis and treatment the day
they intiate adT. Patients filled in self-questionnaires one
day after the consultation about messages they understood.
Concordance between physician and pt answers was assessed
using pourcentage of condordance, overestimed, underestimated
by pts and kappa indexes (k).
High MAX-PC (range 0-54) scores indicate greater anxiety while
high SF-12 scores (range 0-100) represent a better QoL.
Results: A total of 145 physicians (urologists 91%) included
813 patients, of whom 575 and 315 were evaluable at inclusion
and 6 months, respectively. Median age of patients was 77 years,
and median time to PCa diagnosis was 5.3 months. In half of
cases, PCa was at intermediate risk (Gleason score 7, PSA ≤
15 mg/‌mL).
Results: A total of 165 physicians included 915 pts. 770 pts
had evaluable questionnaires (M: 40%, AT: 27%, R: 33%). Mean
age of pts was 75 years. At inclusion, the majority of pts had an
advanced PCa T3N0M0, Gleason≥ 7. A total of 55% of pts went
accompanied to the consultation, mainly by their wife.
Initially, the 575 analyzed patients were little anxious, as 75%
of them had a MAX-PC score <27, limit of clinically significant
anxiety.
When physicians informed patients of the nature of the prostate
disease, respectively 77% of pts understood the information
related to disease extension, 82% the palliative nature of
treatment and duration of treatement and 92% information on
adverse event (AE).
Anxious patients were likely to be younger (with lymphatic
invasion/‌nodal metastasis (OR=2.2, p=0.002), and metabolic
disorders (OR=1.7, p=0.049). However, PCa had an impact on
QoL, especially on physical and mental (SF-12 scores ≤ 49).
At 6 months, the 315 patients were less anxious than at baseline
with a significant decrease in the MAX-PC total score of -2.0 ±
10.4 (95% CI [-3.2, -0.8], p<0.001), mainly due to improved
anxiety related to PCa diagnosis. Similarly, the vitality SF12 subscore significantly increased (1.2 ± 9.8 ; p=0.014). An
improving trend was also found with regard to generic anxiety
and mental health.
The best concordance between responses from physicians and
pts was found for treatment (nature, duration, AE; k 0.54-0.68).
Concordance was not significantly changed according to the
presence/‌absence of an accompagnist unlike the pts’s status:
More M pts overestimated the response regarding the nature
(severity) of the disease than pts with AT (respectively 17% vs
7%, k= 0.37 vs 0.17). In contrast, pts with AT underestimated the
duration of treatment compared with M pts (respectively 8% vs
14%, k= 0.56 vs 0.55).
Conversely, physical condition was significantly deteriorated
after 6 months of treatment (p<0.001) as well as pain (p=0.003)
and social functioning (p<0.001).
Conclusions: Key information delivered to pts at consultation is
not always well grasped and may be improved. Especially in the
domain of the disease (stage, severity) while for domains linked
to treatments, patients’ understanding is better.
Regarding the modalities of LHRH intake, there was no
significant difference between both groups (alone or combined),
except for a greater improvement in generic anxiety when
associated (p=0.013).
Conclusions: PCa-related anxiety estimated at 25% at baseline
improved after 6 months of hormonotherapy.
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39
40
Our way for treatment of locally advanced
prostate cancer
Prostate carcinoma in solid organ transplant
recipients
Haxhiu Isa, Urology, University Clinical Center of Kosovo, Prishtina, Albania
Quni Xhevdet, Urology, University Clinical Center of Kosovo, Prishtina, Kosovo,
Albania
Hyseni Sabri, Urology, University Clinical Center of Kosovo, Prishtina, Kosovo, Albania
Haxhiu Anduena, Consultant Department, Family Medical Center, Shtime, Kosovo,
Albania
Haxhiu Emirjon, Medical Faculty, University of Prishtina, Prishtina, Kosovo, Albania
Tillou Xavier, Urology and Transplantation, CHU de Caen, Caen, France
Guleryuz Kerem, Urology, CHU de Caen, Caen, France
Orczyk Clement, Urology, CHU de Caen, Caen, France
Hurault de Ligny Bruno, Nephrology, CHU de Caen, Caen, France
Chiche Laurence, Abdominal Surgery, CHU de Bordeaux, Bordeaux, France
Bensadoun Henri, Urology, CHU de Caen, Caen, France
Doerfler Arnaud, Urology and Transplantation, CHU de Caen, Caen, France
Introduction & Objectives: Prostate cancer develops primarily
in men over fifty. Our purpose was to give a full information
about the incidence of prostate cancer in Kosova, the methods of
treatment, especially those for locally advanced prostate cancer,
focusing more on the radical prostatectomy as a favorable choice.
Introduction & Objectives: Improvements in
immunosuppression and anti-infection drugs in solid organ
transplantation have led to a significant survival increase
for patients and grafts. Prostate cancer (PC), being the most
common tumor in men and given the increasing number of old
male recipients, should show an increasing incidence in solid
organ transplant recipients (SOTR). The aim of this study was to
analyze retrospectively our Liver (LTR) and Kidney transplant
recipients (KTR) treated for a PC.
Material & Methods: This is a perspective - retrospective study.
The material gives information about the incidence and the type
of surgical intervention applied to the patients diagnosed with
prostate cancer which were admitted to our Urological Center
(the only tertiary center in Kosova). 157 cases with prostate
cancer are processed, considering their age, the Gleason score
and the type of intervention. We have been more focused on
monitoring and the course of disease to the patients with locally
advanced prostate cancer.
Material & Methods: Between 1993 and 2012, we found
33 PC in SOTR. 12 PC in LTR and 21 in KTR. Age at diagnosis
was 64,4±5,9 (51,7-76,7) years old and the interval from
transplantation to diagnosis was 79,4±59,5 (9,1-241,5) months.
Mean PSA level was 12±12.7 (0.5-53) ng/‌m l. Clinical stages were
T1, T2 and T3 in respectively 11, 19 and 3 patients. Diagnosis
was suspected during screening, because of prostatitis or bone
pain in respectively 29, 1 and 1 patients. Two PC were discovered
after prostate transurethral resection.
Results: We have applied radical prostatectomy in 47 patients.
Before these interventions the sextant biopsy was performed and
the Gleason score resulted from 1-10. In seven of them Gleason
score was 10, with the infiltration of the seminal vesicles, and in
four of them this score was 9 respectively. The course of disease
was followed for two, respectively five years and it is seen that the
five cases had the levels of PSA normal inside two months and
there was no tendency for these values to increase. In two cases,
after surgery, the PSA level were jet high and we decided to treat
with Androcuror, for three months. After that we see that PSA
level was normalized.
Results: 24 patients (15 KTR and 9 LTR) with a localized disease
underwent radical prostatectomy (RP). Histological findings
were 16 pT2 and 8 pT3 tumors, with 5 positive surgical margins.
Gleason score (GS) was 5 in 1 case, 6 in 17 cases, 7 in 5 cases and
9 in 1 case. One patient with positive pelvic lymph nodes was
given hormonotherapy. Another had a biochemical recurrence
at 10 months and was treated with salvage radiotherapy. With a
mean follow-up of 51,7 ±38,2 (0,6-151,6) months, two KTR died
3 and 11 years after Hormonotherapy and RP respectively.
Conclusions: Their course of disease was followed by performing
the CT and measuring the PSA levels every four months, which
showed us that there was no relapse, and their condition was
good, so we came to the conclusion that radical prostatectomy
can be considered as a favorable choice even for the patients with
highly advanced prostate cancer, and even when the Gleason
score is 10.
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41
Conclusions: Prevalence of PC in SOTR remains controversial,
even though a significant increase can be expected in the coming
decades. It is therefore recommended to systematically screen
male transplant recipients after 50 years of age because outcome
is much better if PC is diagnosed and treated early. Radical
prostatectomy is feasible in KTR as well as in LTR. HIFU should
be an alternative curative treatment for small-localized PC in
older patients. Despite a poor prognosis for metastatic disease,
hormonotherapy is still indicated.
Stage III prostate cancer surgical treatment
after neoadjuvant androgen deprivation therapy
Zakharava Viktoriya, Pathology, Belarusian State Medical University, Minsk, Belarus
Puchinskaya Marina, Pathology, Belarusian State Medical University, Minsk, Belarus
Liatkouskaya Tatsiana, Pathology, Belarusian State Medical University, Minsk,
Belarus
Masansky Ihar, Oncosurgery #3, Minsk City Clinical Oncologic Health Center, Minsk,
Belarus
Introduction & Objectives: Prostate cancer (PCa) is one of
the most widespread cancers in men throughout the world and
affects mostly elderly people. Surgical treatment, i. e. radical
prostatectomy (RPE) is used for treatment of localized disease,
but nowadays patients with locally advanced PCa are also treated
surgically in some cases. Before operation neoadjuvant (NA)
androgen deprivation therapy (ADT) is often used to lessen the
size of the tumor. Such treatment gives the opportunity of radical
operation even in stage III PCa patients.
In our country surgical treatment of PCa with NA ADT is used for
a relatively low period of time, but gives good results. So, the aim
of the study is to analyze the current experience of PCa surgical
treatment after NA ADT.
Methods: We retrospectively analyzed the medical data of
23 patients, operated between 2009 and 2013. All of them had
stage III PCa and NA ADT was used in all cases.
Results: The mean age at diagnosis was 63 (from 55 to 75) years.
Different types of NA ADT were used, including orchidectomy
in 7 (30,43%) cases, antiandrogens (mostly cyprotherone
acetate) in 4 (17,39%), both orchidectomy and antiandrogens
in 8 (34,78%), LHRH agonists in 1 (4,35%) and LHRH agonists
with antiandrogens in 2 (8,70%) patients. In 1 (4,35%)
patient antiandrogen therapy for 22 months was followed by
radiotherapy (RT) (40 Hy) and then by RPE.
RPE was performed after a median of 4 months after the
beginning of ADT (mostly after 2 – 5 months (69,57%), less
than 2 months in 1 (4,35%), from 6 to 12 months in 3 (13,04%)
patients). In 3 (13,04%) cases NA ADT lasted for more than a year
(up to 29 months) for different reasons.
No other treatment after RPE was used in 15 (65,22%) cases, in
3 (13,04%) patients ADT continued postoperatively and external
beam RT was used in 2 (8,70%) cases. Both ADT and RT were used
in 1 (4,35%) case.
The mean follow-up was 26 months. During this time most
patients (n=19, 82,61%) stayed disease-free, progression was
diagnosed in 4 (17,39%) cases. 3 (13,04%) patients died because
of the PCa progression.
Conclusions: So, NA ADT is beginning to be used before RPE for
stage III PCa patients in our country, and it helps to obtain rather
good results for the treatment of this category of patients.
34
42
The mean PSA level of the patients with tumor is 5.43ng/‌m l
(3.7 to 7.41). Except one all patients with tumor had no DRE
abnormality. 4 patients with prostate cancer has chosen active
surveillance. They are followed for an average of three years.
On the control biopsies, except for one patient had no tumor.
The biopsy results of the patient who has detected tumor
on the control biopsy was similar to his first biopsy. Radical
prostatectomy is applied to 1 patient and his pathologic result
was pT2, Gleason score 3 +3, tumor volume was less than 1%
of the of prostate. We proposed radical prostatectomy to the
patient whose biopsy result was reported as gleason 4+3 prostate
adenocarsinoma
Early rebiopsy is not necessary for patients
with prior detected atypical small acinar
proliferation (ASAP) at 12 core TRUS guided
prostate biopsy and candidate for active
surveillance
Soydan Hasan, Urology, Gulhane Military Medical Academy Haydarpasa Teaching
Hospital, Istanbul, Turkey
Yesildal Cumhur, Urology, Gulhane Military Medical Academy Haydarpasa Teaching
Hospital, Istanbul, Turkey
Okcelik Sezgin, Urology, Gulhane Military Medical Academy Haydarpasa Teaching
Hospital, Istanbul, Turkey
Dursun Furkan, Urology, Gulhane Military Medical Academy Haydarpasa Teaching
Hospital, Istanbul, Turkey
Yilmaz Omer, Urology, Gulhane Military Medical Academy Haydarpasa Teaching
Hospital, Istanbul, Turkey
Ates Ferhat, Urology, Gulhane Military Medical Academy Haydarpasa Teaching
Hospital, Istanbul, Turkey
Senkul Temucin, Urology, Gulhane Military Medical Academy Haydarpasa Teaching
Hospital, Istanbul, Turkey
Karademir Kenan, Urology, Gulhane Military Medical Academy Haydarpasa Teaching
Hospital, Istanbul, Turkey
Conclusions: Although we have limited number of patients,
applying late biopsy instead of early does not effect the oncologic
outcomes adversly in patients detected ASAP in their first
biopsies appropriate for active surveillance.
Introduction & Objectives: To review rebiopsy and long-term
follow-up results of patients prior detected atypical small acinar
proliferation (ASAP) and investigate whether these patients are
candidate for active surveillance.
Material & Methods: We retrospectively reviewed the TRUS
guided at least 12 core prostate biopsy results. We examined age,
serum PSA level, digital rectal examination (DRE), rebiopsy and
follow up results and treatments of patients who detected ASAP
and investigated whether there is any difference between the
patients with tumor and no tumor at rebiopsy.
Results: Between 2007-2012 926 patiens underwent prostate
biopsy in our clinic. ASAP was detected in 20 (%2,2) of these
patients. The average age of patients was 62 (67-79) years. The
mean PSA level is 6.67 ng/‌m l (1.5 to 23). 3 patients had DRE
abnormality, while 17 patients had no abnormality. 18 patients
were detected with ASAP at their first biopsies. In one patient
ASAP was detected after one benign biopsy. In another patient
ASAP was detected after two benign biopsies. The following
18 core control biopsy results were reported benign for these two
patients. Considering the patients with ASAP detected at their
first biopsy, 15 of them underwent second biopsy. Among the
15 patients, 9 of them reported as benign, 6 of them reported as
prostate adenocarcinoma: 4 one core Gleason score 3+3, 1 two
core positive Gleason score 3+3, 1one core positive Gleason score
4+3.
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43
44
Age stratified outcomes after primary HIFU for
organ localized prostate cancer in a series of
5206 patients
Anticipating metabolic changes: magnetic
resonance spectroscopy as a diagnostic tool
for early detection of prostate cancer
Baco Eduard, Urology, Oslo University Hospital, Aker, Oslo, Norway
Blana Andreas, Urology, Fuerth Hospital, Fuerth, Germany
Berge Viktor, Urology, Oslo Univeristy Hospital, Aker, Oslo, Norway
Chaussy Christian, Urology, University of Regensburg, Krankenhaus St Josef,
Regensburg, Germany
Ganzer Roman, University of Regensburg, Krankenhaus St Josef, Krankenhaus St
Josef, Regensburg, Germany
Crouzet Sèbastian, Urology, Edouard Herriot Hospital, Lyon, France
Pasticier Gilles, Urology, Pellegrin Hospital, Bordeaux, France
Paulesu Antonello, Urology, Ospedale S.Anna, Como, Italy
Robertson Carry, Urology, Duke University, Durham, United States
Thueroff Stefan, Urology, Harlaching Hospital, Munich, Germany
Ward John, Urology, MD Anderson Center, Huston, United States
Sanchez-Salas Raul, Urology, Institut Mutualist Montsouris, Paris, France
Gelet Albert, Urology, Edouard Herriot Hospital, Lyon, France
Voskanyan Georgy, Urology, I.M. Sechenov First Moscow Medical Unviversity
Urological Clinic, Moscow, Russian Federation
Glybochko Pyotr, Urology, I.M. Sechenov First Moscow Medical Unviversity; Research
Institute for Uronephrology and Reproductive Health, Moscow, Moscow, Russian
Federation
Vinarov Andrey, Urology, I.M. Sechenov First Moscow Medical Unviversity; Research
Institute for Uronephrology and Reproductive Health, Moscow, Russian Federation
Korobkin Artem, Radiology, Cardiology Research Center, Moscow, Russian Federation
Shariya Merab, Radiology, Cardiology Research Center, Moscow, Russian Federation
Ternovoy Sergey, Radiology, Cardiology Research Center, Moscow, Russian
Federation
Introduction & Objectives: The objective of our study was
to evaluate the diagnostic capabilities of magnetic resonance
spectroscopy (MRS) as a novel imaging technique for early
detection and localization of organ-confined prostate cancer
(PCa).
Introduction & Objectives: High intensity focused ultrasound
(HIFU) performed by Ablatherm® has been used as primary
treatment of localized prostate cancer since 1993. In the last
years, HIFU has been recognized as a therapeutic option in
patients over 70 years old with 10 years life expectancy. The
objective of this study is to report the biochemical and biopsy
outcomes, stratified by age, in patients who have undergone
HIFU.
Material & Methods: The study enrolled 36 males aged between
49 and 81 years with suspected PCa based on solely elevated
PSA levels (4.52 to 53.4 ng/‌m l, mean 7.82±9.01 ng/‌m l) and no
signs of disease on DRE, TRUS, and negative bone scan when
PSA>20 ng/‌m l. MRS was a part of multiparametric MRI protocol,
the procedure being performed with “Philips Achieva 3T TX”
MR scanner. The spectroscopic scanning was carried out after
the native stage of MRI and was followed by diffusion MRI
and DCE imaging. MRS was carried out in multiple fixed size
7x7x7 mm voxels with water/‌fat noise suppression. The spectrum
interpretation was based on the single parameter--ratio of
choline, creatine and citrate peaks: (Cho+Cr)/‌Cit ≥.48±.11,
considered cancer-positive if exceeded the median norm by
more than 2 standard deviatioins. All patients subsequently
underwent transrectal 12-core needle prostate biopsy for
pathologic examination of prostate tissue. We estimated the
correlation between T2 MRI vs. MRS sings of PCa and pathologic
reports, MRS sensivity, specificity and diagnostic accuracy as well
as capacity to differentially diagnose between high grade PIN and
PCa, and MRS precision in localizing organ-confined prostatic
lesions.
Material & Methods: 5206 consecutive patients with
cT1-T3 prostate cancer treated by HIFU Ablatherm® (EDAPTMS, Lyon, France), 16 European HIFU centers were included.
Treatment results, and post treatment morbidity as the
bladder outlet obstruction (BOO) or urethra stenosis have been
registered in the online Ablatherm® HIFU database, @-Registry.
This is a secured on-line database collecting relevant de-identified
clinical and technical information for patients treated by HIFU.
Patients were stratified by age into two groups: below 70 years
(n=2291) and above 70 years (n=2915) and according to D’Amico’s
2003 risk group classification. Kaplan-Meier analyses were
performed to determine biochemical survival with failure defined
according to the 2006 Phoenix definition (nadir+2). Univariable
and multivariable Cox analyses were performed to adjust for
possible confounding variables (clinical stage, Gleason score,
PSA, prostate volume).
Results: Follow-up time was 3.4 ± 2.9 years. The median PSA
nadir: 0.15 ng/‌m l was reached 14.0 ± 11.5 weeks after HIFU. The
negative biopsy rates (<70 yrs/‌>70yrs) were 70%/‌73%, actuarial
biochemical disease free survival (BDFS) at 5 years: 84%/‌73% low
risk, 74%/‌65% intermediate risk, 69%/‌63% high risk patients.
Urinary incontinence rates (GII and GIII) were 4%/‌7%. BOO or
urethra stenosis rates were 18%/‌19 %.
Conclusions: HIFU presents positive oncological and functional
outcome in patients both below and above 70 years. HIFU
treatment appears therefore as a valuable therapeutic option for
prostate cancer control independent of age.
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45
Results: 13 (36%) and 23 (63%) of 36 enrolled patients
demonstrated symptoms of PCa on native MRI T2 images
and MRS respectively. PCa was verified by pathology in 20 of
36 patients (56%), Gleason score ranging from 4 to 9 pts. The
concordance of MRS data and pathologic report was observed in
17 (85%) of 20 verified patients. False positive and false negative
results accounted for 6 of 23 MRS-positive patients and 3 of
20 histologically proven cancers respectively. High grade PIN
was reported in all false positive cases which may reaffirm that
metabolic changes anticipated by MRS are early signs of PCa.
The precise localization of lesion was observed in 14 (82%) of
17 MRS positive histologically proved tumors; the rest of which
demonstrated a high-grade PIN in pathologic spectrum voxels.
The assessed spectroscopic ratio significantly (p<.01) differed
between groups of patients with histologically verified PCa vs.
patients without any tumorous lesion, whilst a less evident
difference could be observed among patients with histologically
verified high-grade PIN vs. without any tumor lesion and within
cancers with different Gleason patterns.
Development of a sheath for an ultrasound
probe used to monitor coagulation during
prostate cancer treatment
Alam Adeel, Institute of Biomaterials and Biomedical Engineering, University Health
Network, Toronto, Canada
Wilson Brian, Medical Biophysics, University Health Network, Toronto, Ontario,
Canada
Weersink Robert, Medical Biophysics, University Health Network, Toronto, Ontario,
Canada
Prostate cancer is one of the leading causes of death by cancer
for men. Several methods are available to treat low risk prostate
cancer; however each method causes a significant reduction in
the quality of life. Focal therapy is being tested to target only
the cancer portion in the prostate. However, due to the need
to ensure that the laser is targeting only the cancer and not
surrounding tissues, a real-time treatment monitoring system is
required.
Conclusions: Our current results suggest MRS as a diagnostic
tool for PCa to be 85% sensitive and 63% specific; diagnostic
accuracy of the technique was limited to 75%. We were unable
to discover reliable capability of MRS to distinctively diagnose
between high grade PIN and PCa. The sensitivity of MRS was
higher than that of native T2 MRI. The MRS specificity was lower
as compared to native MRI which may have been due to masking
effect of high-grade PIN and usage of a single spectroscopic
parameter. This also may confirm that metabolic changes in
prostate tumors precede structural ones detected by MRI. We are
looking forward to further investigation of the potential role of
MRS in early diagnosis of PCa, optimization of its protocol and
increasing the reliability of the results.
A combined optical-ultrasound monitoring system is in
development at Princess Margaret Hospital based on different
optical properties for coagulated versus normal tissue. Using this
property light will scatter and adsorb differently with coagulated
tissue.
In this project, we are developing the sheath, housing the fiberoptic cables used for light delivery to and from the prostate that
will be placed on top of the existing ultrasound probe. Computeraided design was used to design and visualize the prototype.
Specific consideration was given towards placement and holding
of the optical fibers, conformation of its shape to the ultrasound
probe and biocompatibility with the rectum. After a material is
chosen, based on toxicity and sterilization considerations, the
prototype will be fabricated. Simulated, controlled testing will
take place to observe the feasibility of the prototype. Once that
is complete, clinical testing will take place. Once approved, we
believe it the device will aid in making laser thermal therapy
a successful treatment for localized low risk prostate cancer
patients.
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Efficacy of early duloxetine therapy in
urinary incontinence occurred after radical
prostatectomy
Efficacy outcomes by baseline prostatespecific antigen (PSA): results from the
phase 3 AFFIRM trial
Eren Ali Erhan, Department of Urology, Canakkale Onsekiz Mart University Medical
Faculty, Canakkale, Turkey
Baştürk Gökhan, Department of Urology, Canakkale Onsekiz Mart University Medical
Faculty, Canakkale, Turkey
Alan Cabir, Department of Urology, Canakkale Onsekiz Mart University Medical
Faculty, Çanakkale, Turkey
Saad Fred, Department of Surgery, University of Montreal Hospital Center, Montreal,
Canada
de Bono Johann S., Drug Development Unit, Institute of Cancer Research, London,
United Kingdom
Shore Neal D., Urology, Carolina Urologic Research Center, Myrtle Beach, South
Carolina, United States
Fizazi Karim, Department of Cancer Medicine, University of Paris Sud, Villejuif, France
Hirmand Mohammad, Clinical Development, Medivation, Inc, San Francisco,
California, United States
Forer David, Clinical Development, Medivation, Inc, San Francisco, California, United
States
Scher Howard I., Department of Medicine, Memorial Sloan-Kettering Cancer Center,
New York, New York, United States
Introduction & Objectives: To evaluate the efficacy of early
duloxetine therapy in stress urinary incontinence occurred after
radical prostatectomy.
Material & Methods: Fifty-eight patients with an age range 5565, who had body mass index range 28-30, were selected between
112 patients operated due to prostate cancer between 2010 and
2013. The patients had radical prostatectomy were randomized
into 2 groups following the removeling of urinary catheter;
group1(n:28): in which the patients had pelvic outlet exercise
(POE) and duloksetin therapy, group 2 (n:30): in which the
patients had POE alone. ICIQ-IU-SF and IEF questionnaires were
used to evaluate the continence of the patients at the beginning
and during the follow-up. Number of pad used and 1-hour pad
test were used in determining the degree of urinary incontinence.
The treatment lasted for 10 months and called for the control
in the first month with 3-month intervals. The treatment was
assessed with the tests mentioned above in each controls.
Introduction: Enzalutamide (ENZA) inhibits multiple steps in
the androgen receptor signaling pathway. The Phase 3 AFFIRM
trial demonstrated that ENZA vs placebo (PBO) increased
median overall survival (OS) by 4.8 months (P <0.001, HR 0.63),
radiographic progression-free survival (rPFS) by 5.4 months
(P <0.001, HR 0.40), and time to PSA progression (TTPP) by
5.3 months (P <0.001, HR 0.25) in post-docetaxel metastatic
castration-resistant prostate cancer (mCRPC) patients (Scher et
al, NEJM 2012; 367:1187).
Methods: The AFFIRM trial was a Phase 3 multinational,
randomized, double-blind, PBO-controlled study in 1,199 postdocetaxel mCRPC patients. Randomization was stratified by
baseline ECOG performance status and mean pain score. Results
are presented by baseline PSA quartile for efficacy outcomes of
OS, rPFS, and TTPP.
Results: Mean age of the patients mean follow-up were 60.2 (5562) and 7.8 months (2-13), respectively. 27 of the patients (96.4%)
in group 1 were completely dry at the end of first year. 5 of them
were dry in first 3 months. On the other hand 17and 3 of rest
of the patients in group 1 had dryness in 6th and 10th months
and gave up pad usage, respectively. Only 1 patient in group
1 could not get dryness and had urethral stricture at the end of
first year. 26 of the patients (86.7%) in group 2 were completely
dry at the and of first year. None of these patients had dryness
in the first 3 months. 12 patients of group 2 were dry in 6th
months, hovewer, 6 and 8 patients in this group had dryness
in 9th and 12th months in follow-up and gave up pad usage.
4 patient in group 2 could not get dryness and 1 of them had
urethral stricture at the end of first year. There was a significant
difference for the time to reach continence in group 1 (p:0.008).
There were significant differences in number of pad usage and
weight of pad in 7th months between 2 groups. However, there
was no significant difference in IEF questionnaire. None of the
patients did give up the drug due to side effects and medication
was ended with dose reduction after 1 month of the obtainment
of continence.
Results: Consistent benefit in outcomes with ENZA treatment
were observed in all subsets (Table).
Conclusions: A consistent relative benefit in time to event
outcomes was observed with ENZA treatment in patients
enrolled in the Phase 3 AFFIRM trial regardless of baseline PSA.
Conclusions: According to our results, early duloxetine
therapy in stress urinary incontinence occurred after radical
prostatectomy has efficacy to provide continence.
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48
Baseline PSA (ng/‌mL)
<40.2
(n=299)
40.2 to
<111.2
(n=300)
111.2 to
<406.2
(n=300)
Outcomes in patients with liver or lung
metastatic castration-resistant prostate cancer
(mCRPC) treated with the androgen receptor
inhibitor enzalutamide: results from the
phase 3 AFFIRM trial
≥406.2
(n=300)
Median OS, months (95% CI)
ENZA
NM*
(NM, NM)
18.8 (17.0, NM)
PBO
19.2 (15.8, NM)
16.2 10.9 (10.4, NM) (9.5, 14.4)
0.55 (0.36, 0.85)
0.69 0.73 0.53 (0.47, 1.02) (0.53, 1.01) (0.39, 0.73)
HR**
(95% CI)
15.4 14.7 (13.0, NM) (12.3, 17.4)
9.5 (6.8, 11.3)
Loriot Yohann, Medical Oncology, Institute Gustave Roussy, Villejuif, France
Fizazi Karim, Department of Cancer Medicine, University of Paris Sud, Villejuif, France
de Bono Johann S., Drug Development Unit, Institute of Cancer Research, London,
United Kingdom
Forer David, Clinical Development, Medivation, Inc, San Francisco, California, United
States
Hirmand Mohammad, Clinical Development, Medivation, Inc, San Francisco,
California, United States
Scher Howard I., Department of Medicine, Memorial Sloan-Kettering Cancer Center,
New York, New York, United States
Median rPFS, months (95% CI)
ENZA
10.9 (8.3, 13.5)
8.3 (8.0, 10.1)
8.2 (5.6, 9.0)
8.1 (5.9, 10.6)
PBO
3.8 (2.8, 5.5)
3.2 (2.8, 5.5)
2.8 (2.8, 3.0)
2.8 (2.8, 4.0)
HR
(95% CI)
0.38 (0.28, 0.52)
0.39 0.40 (0.30, 0.41 (0.28, 0.52) 0.53)
(0.31, 0.55)
Introduction & Objectives: Enzalutamide (ENZA) inhibits
multiple steps in the androgen receptor signaling pathway
(Tran et al, Science. 2009;324:787). The Phase 3 AFFIRM trial
demonstrated that ENZA increased median overall survival
(OS) by 4.8 months (P <0.001, HR 0.63) vs placebo (PBO) in
post-docetaxel mCRPC patients (pts) (Scher et al, NEJM 2012;
367:1187). Here we assess the effect of ENZA on outcomes in pts
with liver or lung metastases in the AFFIRM trial.
Median TTPP, months (95% CI)
ENZA
11.1 (8.3, 14.0)
8.3 (5.6, 8.4)
8.2 (5.6, 8.3)
5.8 (5.6, 8.2)
PBO
2.9 (2.8, 3.0)
3.1 (2.8, 3.7)
2.9 (2.8, 3.7)
3.7 (3.0, 4.6)
HR
(95% CI)
0.20 (0.14, 0.30)
0.25 0.23 0.31 (0.17, 0.38) (0.15, 0.34) (0.20, 0.48)
Methods: The AFFIRM trial was a Phase 3 multinational,
randomized, double-blind study in post-docetaxel mCRPC pts.
Randomization was 2:1 to ENZA 160 mg/‌day or PBO, stratified
by baseline ECOG and mean pain score. The primary endpoint
was overall survival (OS). Radiographic progression-free survival
(rPFS) was a key secondary endpoint. PSA response defined as a
decline of ≥50% compared to baseline, and soft tissue objective
response per RECIST 1.1 were also assessed and reported here.
*NM = not met
**HR = hazard ratio as assessed by Cox regression with treatment
as covariate. HR <1 favors ENZA over PBO
Results: Pts with liver mCRPC comprised 11.5% (92/‌800) of
ENZA pts and 8.5% (34/‌399) of PBO pts. Pts with lung mCRPC
comprised 15.3% (122/‌800) of ENZA pts and 14.8% (59/‌399)
of PBO pts. The median OS for patients with liver and/‌or
lung mCRPC in the AFFIRM trial was 11.4 months (ENZA:
13.4 months; PBO: 9.5 months). Improved outcomes with ENZA
treatment were observed in both liver and lung mCRPC pts.
39
49
Conclusions: In the Phase 3 AFFIRM trial, pts with lung mCRPC
had higher median OS than pts with liver mCRPC. Consistent
with the overall results from AFFIRM, in these post-hoc analyses,
OS and rPFS were generally improved in both pt groups treated
with ENZA. ENZA also resulted in higher response rates in both
liver and lung mCRPC pts.
Liver mCRPC
Correlation between basal PCA3 level and
biopsy-driven disease reclassification in active
surveillance
Lung mCRPC
ENZA
PBO
ENZA
PBO
(n=92)
(n=34)
(n=122)
(n=59)
OS (months)
9.0
5.7 16.5 10.4 (95% CI)
(6.4‒10.7)
(4.2‒9.5)
(12.5‒NM)
(8.1‒NM)
HR=0.697 HR=0.760 (0.436‒1.114) (0.493‒1.172) rPFS (months)
2.9 2.8 5.6 2.8 (95% CI)
(2.8‒4.9)
(2.7‒3.2)
(5.3‒8.2)
(2.7‒2.9)
HR=0.645 HR=0.427 (0.413‒1.008)
(0.298‒0.612)
Confirmed PSA
35.1
4.8
52.8
4.3
response (%)
(24.4‒47.1)
(0.1‒23.8)
(42.9‒62.5)
(0.5‒14.5)
Objective
14.9
3.3
29.3
4.9
response (%)
(8.2‒24.2)
(0.1‒17.2)
(20.6‒39.3)
(0.6‒16.5)
Marenghi Cristina, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale
dei Tumori, Milan, Italy
Rancati Tiziana, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Ravagnani Fernando, Experimental Oncology, Fondazione IRCCS Istituto Nazionale
dei Tumori, Milan, Italy
Lombardo Claudia, Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Taverna Francesca, Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Magnani Tiziana, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Alviisi Maria Francesca, Prostate Cancer Program, Fondazione IRCCS Istituto
Nazionale dei Tumori, Milan, Italy
Colecchia Maurizio, Anatomopathology, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milan, Italy
Villa Sergio, Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori,
Milan, Italy
Nicolai Nicola, Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Salvioni Roberto, Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan,
Italy
Valdagni Riccardo, Prostate Cancer Program and Radiation Oncoloty 1, Fondazione
IRCCS Istituto Nazionale dei Tumori, Milan, Italy
(95% CI)
(95% CI)
CI=confidence interval; ENZA=enzalutamide; HR=hazard ratio; NM=not
met; OS=overall survival; PBO=placebo; rPFS=radiographic progression-free
survival; PSA=prostate-specific antigen
Introduction & Objectives: One of the open issues in Active
Surveillance (AS) for prostate cancer (PCa) is related to research
of new biomarkers that could more clearly discriminate PCa
aggressiveness. Urinary PCA3 levels has been significantly
associated with Gleason Score (GPS) and PCa volume in
prostatectomy series, suggesting that this marker may be useful
in the selection of pts for AS. The goal of the present study was
to evaluate the relationship between PCA3 and biopsy-driven
disease reclassification in an AS cohort.
Patients & Methods: Starting in 2005, we are proposing AS in
very low-risk Pca within an institutional protocol (SAINT). In
November 2007 we activated the international PRIAS protocol.
Until February 2013 a total of 454 pts were enrolled in AS.
Pts are monitored through PSA kinetics, with DRE and rebiopsy. Beginning in 2008, pts were proposed to provide urine
samples for PCA3 measurement at AS enrollment (no specific
selection criteria were applied). Biopsy-driven active treatment
free survival (ATFS) was assessed using Kaplan-Meier (KM)
survival analysis and the log-rank (LR) test was used to assess
correlation between PCA3 score and ATFS. 3 separate endpoints
were considered: reclassification due to upgrading OR upsizing,
reclassifications due to upgrading and upsizing separately.
Results: 78pts had PCA3 (75/‌78 had at least one re-biopsy).
A PCA3 score>80 was correlated with increased disease
reclassification rate due to upgrading+upsizing (LR p=0.005,
HR=3.7) and to upgrading (LR p=0.04, HR=4.4). KM curves are
presented in figure.
40
50
Conclusions: In this preliminary analysis, in a cohort of pts with
very-low risk PCa who were selected for AS, a PCA3 score>80 was
significantly associated with disease re-classification at re-biopsy.
Specifically, it was correlated to enhanced rates of upgrading.
Further analysis is necessary to assess the usefulness of PCA3 in
AS management.
The value of PSA testing in men presenting with
haematuria
Dhanasekaran Ananda Kumar, Urology, Wrightington Wigan & Leigh NHS Foundation
Trust, Wigan, United Kingdom
Hassouna Hussam, Urology, Wrightington Wigan & Leigh NHS Foundation Trust,
Wigan, United Kingdom
Manikandan Ramaswamy, Urology, Wrightington Wigan & Leigh NHS Foundation
Trust, Wigan, United Kingdom
Introduction & Objectives: To look at the clinical usefulness
of estimating PSA in patients presenting with both visible and
non-visible haematuria. No international guidelines available
regarding the usefulness of PSA screening in men presenting to
haematuria clinic.
Methods: We analysed the records of 1332 consecutive men
presenting to a protocol driven haematuria clinic. As part of
the work up all men were duly counselled about the implication
of PSA testing and had PSA estimation. We then analysed the
outcomes of these patients following PSA estimation.
Results: 1223 agreed to have their PSA estimated. The average
age was 69.9 years (Range is 52 to 74). Of these 68 (5.5%) had
a PSA above the age specific range. 62 underwent a transrectal
ultrasound guided biopsy of the prostate. Six patients did not
have a TRUS biopsy due to their advanced age. Nine had a positive
biopsy (0.73% of the total tested or 14.5% of those biopsied).
Conclusions: Incidence of CaP in our study population is only
0.73%. This is much lower than the incidence of CaP in screening
studies like ERSPC (8.2%) and PLCO (1.16%). Men presenting
with hematuria are not having higher incidence of CaP when
compared to the general population. Before offering PSA tests to
patients presenting for hematuria clinic, proper counselling is
necessary.
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51
52
Focal prostate cancer therapy - capabilities,
limitations, prospects
Intensity-modulated radiotherapy for prostate
cancer: 8-years follow-up at a single centre
Schostak Martin, Urology, Universitätsklinikum Magdeburg, Magdeburg, Germany
Baumunk Daniel, Urology, Universitätsklinikum Magdeburg, Magdeburg, SachsenAnhalt, Germany
Blana Andreas, Urology, Klinikum Fürth, Fürth, Bayern, Germany
Ganzer Roman, Urology, Uniklinikum Regensburg, Regensburg, Bayern, Germany
Henkel Thomas, Urology, Praxis, Berlin, Berlin, Germany
Köllermann Jens, Pathology, Dr. Horst Schmidt Kliniken, Wiesbaden, Hessen,
Germany
Roosen Alexander, Urology, Klinikum der Universität München, Campus Großhadern,
München, Bayern, Germany
Salomon Georg, Urology, Martini-Klinikum, Hamburg, Hamburg, Germany
Sentker Ludger, Urology, Praxis, Sinsheim, Baden-Württemberg, Germany
Witzsch Ulrich, Urology, Krankenhaus Nordwest, Frankfurt/‌Main, Hessen, Germany
Köhrmann Kai-Uwe, Urology, Theresienkrankenhaus, Mannheim, Baden-Württemberg,
Germany
De Meerleer Gert, Radiation Oncology, Gent University Hospital, Gent, Belgium
Ost Piet, Radiation Oncology, Gent University Hospital, Gent, Belgium
Villeirs Geert, Radiology, Gent University Hospital, Gent, Belgium
Lumen Nicolaas, Radiation Oncology, Gent University Hospital, Gent, Belgium
Sadeghi Simin, Radiation Oncology, Gent University Hospital, Gent, Belgium
Decaestecker Karel, Urology, Gent University Hospital, Gent, Belgium
Dhaenens Peter, Radiation Oncology, Gent University Hospital, Gent, Belgium
Fonteyne Valérie, Radiation Oncology, Gent University Hospital, Gent, Belgium
Objective: To report on long-term oncological results of IMRT
for prostate cancer.
Material & Methods: 140 patients were treated with IMRT to
2 dose levels: 74 Gy (n=55) and 76 Gy (n=85). Maximal rectal dose
was set at 72 Gy and 74 Gy respectively.
Patients were divided into 3 prognostic groups:
Introduction: Patients with low-risk prostate cancer (PCa) face
the difficult decision between a potential overtreatment by one
of the standard therapies and active surveillance (AS) with the
potential insecurities regarding cancer control. A ´focal therapy´
(FT) implies a treatment of the tumour within the prostate only.
• Good prognosis: no androgen deprivation therapy (ADT).
• Intermediate prognosis: ADT for 6 months.
• Poor prognosis: ADT for 36 months.
Biochemical relapse free-survival (bRFS), clinical relapse freesurvival (cRFS), cause specific survival (CSS) and overall survival
(OS) were calculated using Kaplan-Meier statistics.
Methods: This paper evaluates the current literature and expert
opinion of different therapies suited for FT as well as concepts for
prostate imaging, biopsy and the histopathological evaluation.
Results: Distribution in risk groups was as follows: low risk:
n=26; intermediate risk: n=75; high risk: n=39. Median followup was 96 months. The 8-year bRFS was 81%. The low- and
intermediate risk group had a significantly better 8-year bRFS
when compared to the high-risk group (94% vs. 84% vs. 68%;
p<0.01). The 8-year cRFS was 86%, with the best result observed
in the low risk group (100% vs. 88% vs. 75%; p=0.03). CSS and
OS at 8 years were 86% and 78% respectively. The actuarial
probability of being free of grade 3 GI and GU toxicity at 8 years
was 99 (± 1%) and 92 (± 3%), respectively.
Results: Currently there is a lack of multicenter, randomized,
prospective data on the effectiveness of FT. Nonetheless
the published data indicates a sufficient tumor control with
a favourable side effect profile. There are still flaws in the
diagnostics in regard to tumor detection and histological
evaluation. Multicenter studies are currently recruiting
worldwide. These studies will provide new data with a higher level
of evidence. This Paper presents the applied techniques.
Conclusions: At present, the effectiveness of FT should not be
compared directly to standard radical therapies. FT should only
be performed within studies. In case of cancer progression after
FT, a salvage treatment should stay executable.
Conclusions: IMRT for prostate cancer results in excellent
8-years bRFS, cRFS and CSS. Severe toxicity rates are low. This
study represents the longest follow-up of IMRT for prostate
cancer in Europe
42
53
38% low grade
62% high grade
The RADICALS trial, is adjuvant therapy needed
for the majority of cases?
Stage
n
T1
2
T2a
47
T2b
56
T2c
284
T3a
107
T3b
44
Criteria for adjuvant treatment
T4
9
• Post op PSA >0.2ng/‌m l
Stage
n
dxt
% dxt
• pT3/‌4 stage
T1
2
0
0
• Gleason score >6 (biopsy or surgery)
T2a
47
1
2
• Pre op PSA >10ng/‌m l
T2b
56
7
13
• Positive surgical margins
T2c
284
28
10
T3a
107
22
21
T3b
44
17
39
Results: see Kaplan Meier curve graphs enclosed.
T4
9
2
22
Conclusions: We see that biochemical relapse for all T3a
patients, whether they received adjuvant treatment or not fare
as well as T2 patients with over 90% free of PSA progression at
8 years.
T2 no adjuvant
87
T2 adjuvant
13
T3a no adjuvant
65
High grade disease includes a majority of Gleason 3+4 (82%)
which shows less BCR than 4+3.
T3a adjuvant
35
T3b/‌4 no adjuvant
49
T3b/‌4 adjuvant
51
Stage
n
Mean post op PSA
ng/‌ml
T2
258
0.08337
T3a
77
0.08878
T3b
33
0.24479
T4
9
0.1344
Robinson Simon, Urology, Wexham Park, Windsor And Slough, United Kingdom
Motiwala Hanif, Urology, Wexham Park, Windsor, United Kingdom
Karim Omar, Urology, Wexham Park, Windsor, United Kingdom
Laniado Marc, Urology, Wexham Park, Windsor, United Kingdom
Rao Amrith, Urology, Wexham Park, Windsor, United Kingdom
Radicals trial: Radiotherapy and androgen deprivation in
combination after local surgery.
Methods: 549 patients underwent radical prostatectomy and
were analysed for biochemical recurrence according to stage and
use of adjuvant treatment.
A total of 113 of 549 patients received adjuvant treatment.
37 T3a patients and 50 T2 patients, 87/‌113 (77%) do not appear
to need this additional treatment with its comorbidities.
43
54
Results: KRAS mutations were characterized in 30 prostate
carcinomas by enhanced multiplex PCR based StripAssay
reverse hybridisation method. The target proto-oncogene KRAS
genotyped for codon 12 and 13 in the current results. The
identified KRAS mutations were then analyzed with respect to
reoperative serum PSA levels, Gleason scores and tumour stages.
Twenty-nine (96.6%) were diagnosed as prostate adenocarcinoma
and one (3.33%) was diagnosed small cell prostate carcinoma.
Gleason scores (GS) of these patients were divided into two
groups as five (17.3%) low grade (GS ≤ 6), twenty- four (82.7%)
were high grade (GS ≥ 8–10) The point mutations in the KRAS
proto-oncogene were detected in 40% (12 of 30 patients) of
current PC patients. One patient with codon 12 Val (3.44%),
two patients with codon 13 Asp(6.8%) and nine patients with
combined mutations in both codons (31%) respectively. Prostate
carcinomas with a combined codon 12 and 13 mutations for
KRAS were tended to show higher pre- operative serum PSA
levels, Gleason scores and advance tumor stages. No mutation
was detected in 18 (60%) current PC patients with low grade
and PSA levels. Prostate adenocarcinomas with combined point
mutations showed clinicopathologic features that differed from
those of prostate adenocarcinoma without KRAS mutation.
Twelve mutated patients were detected (40%) in the second group
with a Gleason score ≥ 8 (high grade).
Combined point mutations in codon 12 and 13 of
KRAS oncogene in prostate carcinomas
Baştürk Gökhan, Urology, Canakkale Onsekiz Mart University, Çanakkale, Turkey
Alan Cabir, Urology, Canakkale Onsekiz Mart University, Çanakkale, Turkey
Eren Ali Erhan, Urology, Canakkale Onsekiz Mart University, Çanakkale, Turkey
Özdemir Öztürk, Medical Genetics, Canakkale Onsekiz Mart University, Çanakkale,
Turkey
Introduction & Objectives: To investigate the prevalence
and predictive significance of KRAS mutations in patients with
prostate carcinomas.
Material & Methods:Fresh tumoural prostate tissue samples
from 30 patients that underwent radical prostatectomy or
TUR(P) patients, who were diagnosed prostate cancer before,
no treatment given, not suitable for radical prostatectomy or
not accepted this operation, but had severe lower urinary tract
problem or urinary retension, in the Department of Urology were
used for KRAS mutation analysis in the current results. Fresh
tumoural tissue specimens that enriched in neoplastic cells were
used for total genomic DNA isolation and KRAS point mutation
analysis in the current descriptive study. Solid tumoural
tissues were also examined and diagnosed histopathologically.
Approximately, 5–10 mg of the fresh tumoural specimens were
used for genomic DNA isolation and in vitro gene amplification.
Total genomic DNA was isolated by the nucleospin kit extraction
technique (Invitrogene, Germany) with some modifications.
In vitro amplification of DNA fragments encompassing codons
12 and 13 of the KRAS oncogene was performed from blood
and tumoral tissue biopsy. Twelve common muation regions
of KRAS oncogene were simultaneously in vitro amplified and
biotin-labelled in a multiplex amplification reaction. PCR was
performed in a Perkin Elmer 9600 and the profile consisted of an
initial melting step of 2 min at 94_C; followed by 35 cycles of 30 s
at 94_C, 30 s at 61_C, and 30 s at 72_C; and a final elongation
step of 7 min at 72_C. The KRAS genotyping was performed
by StripAssay technique (Vienna Lab, StripAssay GmbH,
Austria) which is based on the reverse-hybridization principle
automatically.
Conclusions: Our results confirm the importance of combined
point mutations in KRAS codon 12 and 13 in the molecular
pathogenesis of high grade prostate adenocarcinomas in human.
The current findings also pointed out the tumoural tissue specific
idendification extremely need for the alter- native therapeutic
strategies and patient’s survival. The complexity of etiological
parameters in PC development showed us; case specific tumour
identification and treatment extremely need for each affected
subject in the future.
44
55
56
PCA3 and TMPRSS2:ERG urine tests stratify
prostate cancer risk in men recommended for
initial prostate biopsy
Predictive factors associated with biochemical
recurrence after radical prostatectomy with
negative surgical margins for organ-confined
disease
Groskopf Jack, Director, Oncology Research & Development, Hologic Gen-Probe, San
Diego, United States
Day John, Hologic Gen-Probe, San Diego, CA, United States
Kella Naveen, Urology & Prostate Institute, San Antonio, TX, United States
Jones LeRoy, Urology San Antonio Research, San Antonio, TX, United States
Meyer Sarah, Hologic Gen-Probe, San Diego, CA, United States
Hodge Petrea, Hologic Gen-Probe, San Diego, CA, United States
Aussie Jacqueline, Hologic Gen-Probe, San Diego, CA, United States
Saltzstein Daniel, Urology San Antonio Research, San Antonio, TX, United States
Henriet Benjamin, Urology, Erasme-ULB hospital, Brussels, Belgium
Tombal Bertrand, Urology, Cliniques Universitaires St Luc, Brussels, Belgium
Van Velthoven Roland, Urology, Bordet Institute, Brussels, Belgium
Roumeguère Thierry, Urology, Erasme-ULB Hospital, Brussels, Belgium
Introduction & Objectives: Despite excellent surgical cancer
control, some patients with organ-confined disease experience
biochemical recurrence. Positive surgical margins have been
clearly demonstrated to be one of the main predictive factors
for biochemical failure. The goal of this study was to identify
potential factors associated with biochemical recurrence in
patients with organ-confined prostate cancer and negative
surgical margins after radical prostatectomy.
Introduction & Objectives: There is an unmet need for new
tests that can be used in conjunction with current methods to
guide initial prostate biopsy decisions. PROGENSA®PCA3 and
TMPRSS2:ERG (T2:ERG) gene fusion urine tests can improve
accuracy for predicting prostate biopsy outcome, and may also
help discriminate between indolent and significant cancers. The
purpose of this study was to examine the utility of PCA3 and
T2:ERG in a large cohort of men undergoing initial prostate
biopsy.
Material & Methods: 910 patient’s data from 3 university
centres were evaluated after radical prostatectomy performed
between 1990 and 2006 for a localised prostate cancer with
negative surgical margins. Several parameters were evaluated:
age, body mass index, smoking status, testosterone values before
and after surgery, PSA, PSA density, pathological stage Gleason
score, perineural invasion, capsular invasion and apical invasion.
Material & Methods: Patients enrolled in the study were
referred for an initial prostate biopsy based on elevated
serum PSA, abnormal DRE, or other clinical suspicion. PostDRE first-catch urine was collected prior to 12-core prostate
biopsy. PCA3 and T2:ERG RNA copies were quantified using
transcription-mediated amplification assays and normalized to
PSA mRNA copies. PCA3 and T2:ERG results were used to divide
the subject population into risk groups. For each risk group,
the percent of subjects with cancer, significant cancer (Epstein
criteria) or high-grade cancer (Gleason Score >6) at biopsy was
determined.
Results: Median follow-up was 108 months. 11.76% of the
patients presented with a biochemical recurrence. Univariate
analysis showed that smoking status (p=0.003), PSA value
(IC95% 6.9-9.3, p=0.002), PSA density (p=0,009), Gleason score
≥7 (p<0.01) and perineural invasion (p=0,005) were associated
with biochemical recurrence. Multivariate analysis showed
that Gleason score (RR 2.48, IC95% 1.36-4.53, p=0.003) and
perineural invasion (RR 2.08 (IC95% 1.13-3.83, p=0.018) were
independent prognostic factors of recurrence, respectively.
Results: A total of 638 subjects were enrolled in the study:
66% white, 27% Hispanic, and 6% black. 99.8% (637/‌638) of
specimens yielded sufficient RNA for analysis and the proportion
of men who had a positive biopsy was 43% (272/‌637). For
predicting cancer at biopsy, areas under the receiver operating
characteristics curve for PCA3, T2:ERG and serum PSA were 0.73,
0.69, and 0.59, respectively. Positive biopsy rates in the lowest
and highest PCA3 + T2:ERG Score risk groups were 14% vs. 84%
(any cancer), 5% vs. 80% (significant cancer) and 2% vs. 44%
(high-grade cancer).
Conclusions: Gleason Score and perineural invasion status
are associated with worse prognosis in terms of recurrence free
survival after radical prostatectomy for organ-confined disease
with negative surgical margins. Smoking status could have a
potential impact on the recurrence risk. These data could help
physicians for a personalized patient counselling.
Conclusions: In men recommended for initial prostate biopsy,
urinary PCA3 and T2:ERG Scores can be combined into a simple
matrix to stratify risk of detecting cancer, significant cancer and
high-grade cancer at biopsy.
45
57
58
Urethrovesical anastomosis with single knot
running suture in open retropubic radical
prostatectomy. Experience with 536 cases
Active surveillance in prostate cancer: 8 year
experience
Marenghi Cristina, Prostate Cancer Program, Fondazione IRCCS istituto Nazionale
dei Tumori, Milan, Italy
Rancati Tiziana, Prostate Cancer Program, Fondazione IRCCS istituto Nazionale dei
Tumori, Milan, Italy
Avuzzi Barbara, Radiation Oncology 1, Fondazione IRCCS istituto Nazionale dei
Tumori, Milan, Italy
Nicolai Nicola, Surgery Department Urology Unit, Fondazione IRCCS istituto
Nazionale dei Tumori, Milan, Italy
Magnani Tiziana, Prostate Cancer Program, Fondazione IRCCS istituto Nazionale dei
Tumori, Milan, Italy
Alvisi Maria Francesca, Prostate Cancer Program, Fondazione IRCCS istituto
Nazionale dei Tumori, Milan, Italy
Bellardita Lara, Prostate Cancer Program, Fondazione IRCCS istituto Nazionale dei
Tumori, Milan, Italy
Salvioni Roberto, Surgery Department Urology Unit, Fondazione IRCCS istituto
Nazionale dei Tumori, Milan, Italy
Valdagni Riccardo, Radiation Oncology 1, Fondazione IRCCS istituto Nazionale dei
Tumori, Milan, Italy
Filipensky Petr, Urology, St.Ann´s University Hospital Brno, Brno, Czech Republic
Pacik Dalibor, Urology, University Hospital Brno, Brno, Czech Republic
Rehorek Petr, Urology, St.Ann´s University Hospital Brno, Brno, Czech Republic
Hrabec Roman, Urology, St.Ann´s University Hospital Brno, Brno, Czech Republic
Cermak Ales, Urology, University Hospital Brno, Brno, Czech Republic
Varga Gabriel, Urology, University Hospital Brno, Brno, Czech Republic
Introduction & Objectives: The authors describe results
of 536 consecutive nerve sparing open radical retropubic
prostatectomies (RRP) performed by 3 surgeons, where the
anastomosis was created with running suture. This technique
described by Van Velthoven is commonly used in laparoscopic
radical prostatectomy. In our center this method is performed
also for open retropubic radical prostatectomy since September
2005.
Methods: Between September 2005 and December 2012 536 RRP with „single knot running suture“ in urethrovesical
anastomosis were performed. Two polyglycolic acid 2-0 sutures
are used and tied together at their tail ends. A running suture
is completed from the 5:00-o`clock position to the 12:00-o’clock
position counter clockwise by first part and then clockwise to the
12:00-o’clock position by the second part of the suture, where
they are tied together. The catheter is placed before completing
the anterior row of sutures. Number of turns varies from 6 to
10 for one half of the suture. The water-tightness of anastomosis
is tested by irrigation of 300ml saline solution. With regards
to the evaluation of the benefits of this approach the following
factors were followed up: operative time (skin to skin), time
for anastomosis, water-tightness of anastomosis, duration of
permanent catheterization, acute urinary retention occurrence
after catheter removal, continence rate and development of
anastomotic stricture.
Introduction & Objectives: To avoid overtreatment, in March
2005 we started to offer Active Surveillance (AS) to selected low
risk prostate cancer (PCa) patients (pts), in a multidisciplinary
setting. Active Treatment-Free Survival (ATFS) was evaluated as
primary end-point.
Patients & Methods: The mono-institutional SAINT
protocol started in March 2005. In November 2007 we
joined the PRIAS study. Common inclusion criteria: initial
PSA≤10ng/‌m l, DRE≤T2 and GPS≤3+3. Differences: PSA density
(PSAd)<0.2 ng/‌m l/‌cc required by PRIAS and number of positive
cores ≤ 2 in PRIAS, ≤ 25% with ≤ 50% core involvement in SAINT.
First repeated biopsy was at 12 mos and subsequently every
2 yrs in SAINT, every 3 yrs in PRIAS. PSA doubling time (DT) in
the range 3-10 yrs advised extra biopsy. Patients are switched
to active treatment when PSADT turns < 3yrs, cT>2, number of
positive cores > 2 (or 25%) or GPS>3+3.
Results: The average time for surgery (skin to skin) was
77 minutes (range 42 to 153). The average time for the
anastomosis was 9 minutes (range 7 to 20). In 5 cases (<1%)
symptomatic postoperative urinary leaks have occurred, when
the anastomosis could not be performed precisely. The catheter
was left in place for 5 to 16 days, mean time 6,2 days. 12 weeks
after RRP with running suture 78% patients were continent
using 0 or 1 pad (security pad)/‌24hours. There were 3 clinically
evident bladder neck contractures observed in our set – follow
up time varies from 4-88 months. Bladder neck strictures were
solved by ureterotomy with TUR of bladder neck.
ATFS was assessed using Kaplan-Meier survival analysis and
correlations were analysed through log-rank test and Cox
analysis.
Results: 454 pts were enrolled in AS (Feb 2013): 167 in SAINT
and 287 in PRIAS. 266/‌454 (58.6%) pts are still on AS (median
f-up of 37.2 mos, range 2.3-107.7). 136 (29.9%) pts dropped out:
22 due to PSADT, 114 to upgrading and/‌or upsizing at re-biopsy
(64 at first re-biopsy). 10 pts dropped out due to comorbidities,
7 due to anxiety, 34 due to off-protocol reasons and 1 due to nonPCa death. Actuarial ATFS is 76% and 58% at 18 (after the first
rebiopsy) and 36 months, respectively (Fig. 1). To date only 1 pt
experienced a biochemical failure after radical prostatectomy.
Biopsy-related ATFS correlates with age <66 yrs (p=0.06,
HR=1.6), with PSAd<0.12 ng/‌m l/‌cc (p=0.03, HR=1.8) and prostate
volume <52cc (p=0.004, HR=2.2).
Conclusions: Single knot running suture during open retropubic
radical prostatectomy is considered a feasible alternative
technique for anastomosis creation associated with the following
major advantages: reduced time to catheter removal in open
technique (primarily), water-tightness of anastomosis and
elimination of urethrovesical strictures. These improvements can
have impact on satisfactory continence recovery.
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Conclusions: AS is feasible in selected men with low risk PCa.
Half drop out from AS occurred after 1yr re-biopsy, due to
histology re-classification. Age>66yrs, PSAd>0.12 ng/‌m l/‌cc and
prostate volume >52cc correlate with 1-year ATFS due to biopsy
reclassification.
Development of prostate cryoablation program
in Russia
Govorov Alexander, Urology, Moscow State University of Medicine and Dentistry,
Moscow, Russian Federation
Vasyliev Alexander, Urology, Moscow State University of Medicine and Dentistry,
Moscow, Russian Federation
Ivanov Vladimir, Urology, City Hospital 50, Moscow, Russian Federation
Pushkar Dmitry, Urology, Moscow State University of Medicine and Dentistry,
Moscow, Russian Federation
Introduction & Objectives: The first cryoablation for prostate
cancer (PCa) using the modern equipment was performed in
Russia in March 2010 at the Department of Urology of MSMSU.
The aim of our study was to prospectively collect and analyze the
results of prostate cryoablation in Russian patients.
Material & Methods: From March 2010 through March
2013 89 PCa patients were treated with third generation
cryotherapy device SeedNet (Galil Medical, Israel). Primary
treatment was performed in 81 (91%) men and salvage treatment
– in 8 (9%) patients (4 after EBRT, 2 after brachytherapy and
2 after primary cryoablation). According to D’Amico classification
33 (37.1%), 40 (44.9%) and 16 (18%) patients were from the low,
intermediate and high-risk groups respectively. Mean patient’s
age was 72.6 (60-81) years, median PSA 10.6 (1.3-65) ng/‌m l and
prostate volume 46.2 (14-110) cc. The cT1c, cT2 and cT3 stages
were diagnosed in 45 (50.6%), 30 (33.7%) and 14 (15.7%) patients
respectively. Gleason score (GS) of 6, 7(3+4), 7(4+3) and 8 (4+3)
was diagnosed in 38 (42.7%), 24 (27%), 21 (23.6%) and 6 (6.7%)
of cases. The median Qmax was 11.5 (4.2-36) ml/‌s and IPSS 9 (027). The median IIEF score was 2.4 (1-8) in patients scheduled for
total prostate cryoablation. In the past 3 men underwent TURP
and 5 – open prostatectomy due to BPH.
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Results: We have performed 85 total and 4 focal prostate
cryoablation procedures. General anesthesia was used in 1 case;
all other operations were performed under epidural/‌spinal
anesthesia. “IceRod” needles were used in 63 (70.8%) and
“IceSeed” needles – in 26 (29.2%) patients. Intra-op cystostomy
was done only in 1 case and Foley catheter was inserted in
88 men for a median of 7 (4-9) days. The median operation time
was 105 (72-168) min. The only 1 intraoperative complication
consisted of malfunction of urethral warming catheter which has
resulted later in urethral sloughing: subsequently transurethral
removal of necrotic tissue was performed. The follow-up
regimen included total PSA test every 3 months and transrectal
prostate biopsy in 1 year (independently of PSA level). At 3,
6 and 12 months IPSS and Qmax were also checked. The median
follow-up was 20 months. 55 patients had full evaluation data
at 1 year: the median total PSA was 0.28 (0.001-12.8) ng/‌m l,
IPSS score 12 (2-18) and Qmax 10.4 (4.4-32) ml/‌s. The 1-year
biopsy detected 4 adenocarcinomas out of 55 cases. One salvage
patient had severe urinary incontinence, 3 men suffered from
urgent incontinence 3-7 times per week. One patient underwent
bilateral orchidectomy due to orchoepididymitis 3 months after
cryo.
Applicability of radical radiotherapy for prostate
cancer after renal transplantation: a case
report
Alessandro Marina, Oncology Department, Ospedale Città di Castello, Città di
Castello, Italy
Corazzi Francesca, Oncology Department, Ospedale Città di Castello, Città di
Castello, Perugia, Italy
Ferranti Francesca, Oncology Department, Ospedale Città di Castello, Città di
Castello, Perugia, Italy
Minciarelli Marco, Oncology Department, Ospedale Città di Castello, Città di Castello,
Perugia, Italy
Pentiricci Andrea, Oncology Department, Ospedale Città di Castello, Città di Castello,
Perugia, Italy
Rossi Giampaolo, Oncology Department, Ospedale Città di Castello, Città di Castello,
Perugia, Italy
Angelini Massimo, Oncology Department, Ospedale Città di Castello, Città di Castello,
Perugia, Italy
Biagini Francesco, Oncology Department, Ospedale Città di Castello, Città di
Castello, Perugia, Italy
Checcaglini Franco, Oncology Department, Ospedale Città di Castello, Città di
Castello, Perugia, Italy
Conclusions: We consider the development of the first and
largest prostate cryoablation program in Russia successful. After
a short-term follow-up few patients have showed PSA progression
and even fewer had histologically proven adenocarcinoma of the
prostate at 1 year. The small number of serious complications (e.g.
no cases of urethra-rectal fistula) during the learning curve may
encourage other centers to adopt cryoablation of the prostate in
their PCa treatment armamentarium. We continue to evaluate
the oncological and functional results of both total and focal
prostate cryoablation.
Introduction & Objectives: In renal transplant recipients
(RTR), the incidence of malignances appears to be 3-4 times
higher than the general population. Over the past 30 years,
the survival of these patients has greatly improved, so the
incidence of prostate cancer, even if similar to that of the general
population, it is still important; because prostate cancer is one of
the most frequent cancers in males. Radiotherapy remains one
of the principle treatment option for patients with localized or
locally advanced prostate cancer but the anatomical position of
renal allograft in the pelvis can creates serious difficulties for the
treatment planning. We report the case of a 69-years-old man
with prostate cancer and renal allograft, who received radical
radiotherapy, at the Città di Castello Hospital.
Patients & Methods: In October 2012 we treated with radical
radiotherapy the patient with bilateral prostatic adenocarcinoma
Gleason score 3+3, cT2cN0M0, PSA of value 9.1 ng/‌m l, with
relevant co-morbidities morbidities that indicated against the
intervention.For the treatment planning, computer tomographic
images were obtained in supine position, the bladder full and the
rectum empty. Three dimensional radiotherapy planning was
used, the CTV included the prostate and the seminal vesicles for
a total dose of 60 Gy in 30 fractions, the prostate receiving 78 Gy.
The planning target volume (PTV) was obtained expanding
the CTV with 7 mm wide margin in all directions and 5 mm
posteriorly to reduce the dose to the rectal wall. Both to obtain an
optimal coverage of the PTV and to reduce the dose to the OAR,
in particular to the bladder, femoral heads and especially to the
graft some options have been evaluated and we used a 4 fields
technique for the first 30 fractions and a 6 fields technique for
the last 9. The mean dose delivered to the graft was 0.61 Gy, the
femoral heads received a mean dose of 22 Gy and 20 Gy and the
bladder of 33 Gy.
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Results: During radiotherapy, the patient evaluated each
week with a clinical visit did not complain of urinary and
gastrointestinal toxicity, except for mild cystitis (G1). Moreover,
he performed regular evaluations of the renal function with
monitoring of creatinine clearance. The patient was enrolled in
our protocol of follow-up, consisting of a clinical evaluation, PSA
dosage and renal function evaluation 1 month after the end of
the treatment and every 3 months thereafter. At the last follow–
up, the patient was well without signs of recurrence.
Stereotactic body radiation therapy with realtime tracking for localized prostate cancer
Beltramo Giancarlo, Cyberknife, Centro Diagnostico Italiano, Milan, Italy
Bergantin Achille, Cyberknife Unit, Centro Diagnostico Italiano, Milan, Italy
Martinotti Anna Stefania, Cyberknife Unit, Centro Diagnostico Italiano, Milan, Italy
Vite Cristina, Cyberknife Unit, Centro Diagnostico Italiano, Milan, Italy
Ria Francesco, Cyberknife Unit, Centro Diagnostico Italiano, Milan, Italy
Invernizzi Marta, Cyberknife Unit, Centro Diagnostico Italiano, Milan, Italy
Bianchi Livia Corinna, Cyberknife Unit, Centro Diagnostico Italiano, Milan, Italy
Conclusions: Radiotherapy is part of the standard treatment
for many cases of prostate cancer. In the literature few cases of
RTR treated with radiotherapy for prostate cancer are reported.
Improving techniques of radiotherapy, the 3D planning
techniques allow higher doses of radiation to be administered
safely reducing the risk of acute and cronic toxicities. According
to the few series reported in the literature and also to our
experience, radiation therapy is feasible also in RTR with
accurate treatment planning.
Introduction & Objectives: To evaluate the clinical outcome
of a cohort of localized prostate cancer patients treated with
Stereotactic Body Radiation Therapy
Material & Methods: A retrospective analysis was carried out
on 125 consecutive patients with a median age of 75 (range 60 –
86) years and clinically localized prostate cancer who underwent
Cyberknife stereotactic radiosurgery at our Institution. The
majority of patients 68 (54%) were low risk, 35 pts (28%) were
intermediate risk and 22 pts (18%) were high risk patients
using the NCCN criteria. Pre-treatment PSAs ranged from
1.75 to 23.88 ng.ml (median 7.4 ng.ml). Among the entire
study cohort 11 of 22 high risks patients received androgen
deprivation therapy (ADT), ADT was not administered to any
low – intermediate risk patients. A prescribed dose of 38 Gy in
four fraction was delivered to the PTV, which was defined as the
prostate (plus seminal vesicles in High risk patients). Real-time
intrafractional motion tracking was used.
Results: Acute urinary symptoms (frequency, disurya, urgency,
hesitancy and nicturia) were common with 53% of patients
experiencing grade I-II RTOG toxicity. Only 3 patients (2%)
experienced RTOG grade 3 acute and late urinary toxicity
following repeated urological instrumentation, including
cistoscopy and urethral dilatation. No RTOG grade 3 acute and
late rectal toxicity was observed. Four patients, one with prior
Turp, experienced incontinence, One 9 months after treatment,
two 12 months after treatment, one 27 months later. One patient
experienced rectal incontinence 12 months after treatment. The
actuarial median follow up is 34 months (range 12 – 66 months).
The Five years actuarial psa relapse free survival rate is 94%
(CI: 89.0%-99..2%) with 98.1% for low risk-patients, 93.2% for
intermediate –risk patients and 82.2% for high risk-patients. To
date 6 patients failed biochemically. One low risk patient revealed
local relapse 30 months after Cyberknife treatment. One high
and one intermediate risk patients developed bone metastases,
in 2 intermediate and in 1 high risk patient we observed nodal
metastases. All patients are alive except four died of unrelated
causes.
Conclusions: Cyberknife SBRT produces excellent biochemical
control rates at up to 4 years with mild toxicity and minimal
impact on quality of life. Median PSA levels compare favourably
with other radiation modalities and strongly suggest durability of
our results.
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Hydrodissection technique of neurovascular
bundles preservation during robotic radical
prostatectomy
Barbed bidirectional suture in robotassisted radical prostatectomy: first Russian
randomized trial
Kolontarev Konstantin, Urology, MSMSU, Moscow, Russian Federation
Pushkar Dmitry, Urology, MSMSU, Moscow, Russian Federation
Pushkar Dmitry, Urology, MSMSU, Mocow, Russian Federation
Kolontarev Konstantin, Urology, MSMSU, Moscow, Russian Federation
Dyakov Vladimir, Urology, MSMSU, Moscow, Russian Federation
Rasner Pavel, Urology, MSMSU, Moscow, Russian Federation
Introduction & Objectives: Preservation of the neurovascular
bundle during radical prostatectomy is extremely important
for postoperative erectile function. We determined whether
hydrodissection of the neurovascular bundle during da Vinci
radical prostatectomy would result in improved erectile function
postoperatively.
Introduction & Objectives: The urethrovesical anastomosis
(UVA) is one of the most challenging steps of robot-assisted
radical prostatectomy (RARP). Failure to achieve a watertight
anastomosis is associated with postoperative urinary leak and its
consequences. In a previous pilot study of 40 consecutive patients
who underwent this self-sinching anastomotic technique using
a Quill absorbable barbed suture during RARP for clinically
localized prostate cancer, barbed suture for UVA was associated
with shorter time for UVA compared to monofilament suture.
Material & Methods: Sixty-three patients (mean age
64.4 years) who underwent nerve sparing radical prostatectomy
were randomly assigned to a standard neurovascular bundles
dissection (n=30) or hydrodissection of the neurovascular
bundles using ErbeJet 2 equipment (n=33). All procedures were
done by a single high volume surgeon. In all men erectile function
was evaluated by the International Index of Erectile Function
(IIEF-6) score preoperatively, and 6 weeks and 3 months
postoperatively.
Material & Methods: This was a prospective randomized
controlled trial which was conducted in 100 consecutive RARP
cases by a single surgeon. All patients were randomized in
two groups according to UVA technique. Standard UVA was
performed using two 3-0 monofilament sutures (Monocryl;
Ethicon Endosurgery, Cincinnati, OH, USA) in one group
(50 cases). In the other group (40 pts) UVA was performed using
a Quill absorbable barbed suture. Time to complete anastomosis
and need to adjust suture tension were recorded. Suture-related
complications and validated-questionnaire continence were also
examined.
Results: There was no significant difference in IIEF6 score preoperatively in both groups. In men with bilateral
neurovascular bundle preservation mean International Index
of Erectile Function scores in the hydrodissection group were
higher than in the standard dissection group by 1.8 at 6 weeks
and by 2.8 at 3 months (p <0.05). In men with unilateral partial
neurovascular bundle resection there was also significant
improvement between the hydrodissection and standard
dissection groups at 6 weeks and 3 months (p <0.05).
Results: All cases were finished successfully without major
complications or conversion to open surgery. Compared with the
conventional reconstruction technique, there was a significant
reduction in mean reconstruction time (13.1 vs. 20.2 min; P
< 0.01) for the barbed suture technique. The need to readjust
suture tension for watertight closure was greater in the standard
monofilament group than in the barbed suture group (20% vs.
7%; P < 0.01). With a median follow-up of 9.1 months no delayed
anastomotic leak or bladder neck contracture was observed in
either group. Pad-free continence rates for the monofilament
suture vs. the barbed suture groups at 1, 3 and 6 months were
similar.
Conclusions: Hydrodissection of the neurovascular bundle
during da Vinci radical prostatectomy improves postoperative
International Index of Erectile Function scores. Longer follow-up
needed to evaluate direct impact of hydrodissection on erectile
function in patients after da Vinci prostatectomy.
Conclusions: Our experience with a barbed bidirectional Quill
suture has shown that this novel technique is feasible, shortens
anastomotic time, provides for a faster anastomotic recovery
and is as safe as monofilament suture. Use of the barbed suture
technique prevents slippage, precluding the need for assistance,
knot-tying and constant reassessment of anastomosis integrity.
Further follow-up will determine any benefits of this technique
on anastomotic urinary leak rates, continence, and catheter
removal times.
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Results: GSs in the 48 patients with prostatectomy were
GS6 n=17, GS7 n=27, and GS8 n=4. GS agreement on biopsy
versus prostatectomy was found in 43/‌48 (90%), (κ 0.81).
Anterior prostate cancer: Gleason score based
on MRI/‌TRUS elastic image fusion guided
prostate biopsy vs prostatectomy
GS over- and under-grading of biopsy were in 4/‌48 (8%) and
1/‌48 (2%). Upgrading to high risk cancer from biopsy GS 7b to
prostatectomy GS 8 was found only in one patient.
Conclusions: MRI/‌TRUS guided prostate biopsies of MRI
suspected APC offer a high agreement between Gleason score
biopsy and prostatectomy.
Baco Eduard, Division of Surgery and Cancer Medicine, Department of Urology, Oslo
University Hospital, Aker, Oslo, Norway
Rud Erik, Division of Diagnostic and Intervention, Department of Radiology and
Nuclear Medicine, Oslo University Hospital, Aker, Oslo, Norway
Vlatkovic Ljiljana, Division of Diagnostic and Intervention, Department of Pathology,
Oslo University Hospital, Radiumhospitalet, Oslo, Norway
Svindland Aud, Division of Diagnostic and Intervention, Department of Pathology,
Oslo University Hospital, Radiumhospitalet, Oslo, Norway
Eggesbø Heidi, Division of Diagnostic and Intervention, Department of Radiology and
Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
A few biopsy cores are needed to achieve the diagnosis.
Introduction & Objectives: Gleason score (GS) based on needle
prostate biopsy PBx is one of the most important factors in
decision making for appropriate treatment of prostate cancer
(PCa). The literature reports on 40-80% agreement of GS from
prostatectomy and PBx. Anterior prostate cancers (APC) are
commonly under-estimated by PBx.
Magnetic resonance imaging (MRI) can localize clinically
important PCa. Further, low apparent diffusion coefficient (ADC)
values) can indicate the aggressiveness of PCa.
The aim of this study was to evaluate the agreement of GS
performed using MRI/‌TRUS elastic image fusion guided prostate
biopsy versus GS after prostatectomy in patients with APC.
Material & Methods: Forty-eight patients with elevated
prostate specific antigen (PSA) and suspicious APC on MRI were
prospectively included in this quality control study conducted
from January 2010 to February 2013. All patients underwent
robot assisted laparoscopic prostatectomy (RALP) after
MRI/‌TRUS guided PBx that confirmed APC.
Mean (range) of age, PSA and MRI-prostate volume were:
63 years (45-73 years), 19 ng/‌m l (4-44 ng/‌m l) and 45 ml (2298 ml). MRI was performed using 1.5T Avanto (Siemens®,
Erlangen, Germany). The sequences were: axial 3D T2 weighted
(T2w), axial diffusion weighted imaging (DWI) with apparent
diffusion coefficient (ADC) map calculated from b50 and
b1000. In addition, an axial DWI using b2000 was obtained. A
suspicious APC were highlighted on axial T2 images as a circle
in the areas with the lowest ADC signal. Targeted biopsies (TBs)
were performed using 3D TRUS Accuvix V10 (Medison®, Korea)
and elastic MRI/‌TRUS fusion and navigation system Urostation
(Koelis®, La Tronche, France). Biopsy groups were: initial biopsy
in 3, and 1st -11th re-biopsies in 45 patients. Mean previous
negative biopsy procedures was 3.1 (range 2-11). Of these, rebiopsy due to active surveillance was performed in 9/‌48 (19%)
patients. Mean number of TB from each MRI target was
2.4 (range 1-5). Both prostate biopsy material and prostatectomy
specimen were evaluated by the same group of uropathologists.
Kappa (κ) statistics were used for measurement of agreement on
GS.
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A phase III randomised, open-label,
multicenter trial to evaluate the benefit of
leuprorelin acetate for 24 months after radical
prostatectomy in patients with high risk of
recurrence (AFU-GETUG 20/‌0310)
A pathology verified, innovative method to
predict nodal (N) status using an artificial
intelligence (AI) approach in prostate cancer
(PC) patients (pts): beyond the Roach formula?
De Bari Berardino, Istituto del Radio “O. Alberti”, AO Spedali Civili di Brescia - Brescia
University, Brescia, Italy
Vallati Mauro, University of Huddersfield, School of Computing and Engineering,
Huddersfield, United Kingdom
Gatta Roberto, Istituto del Radio “O. Alberti”, AO Spedali Civili di Brescia - Brescia
University, Brescia, Italy
Buglione Michela, Istituto del Radio “O. Alberti”, AO Spedali Civili di Brescia - Brescia
University, Brescia, Italy
Pasinetti Nadia, Istituto del Radio “O. Alberti”, AO Spedali Civili di Brescia - Brescia
University, Brescia, Italy
Girelli Giuseppe, Radiation Oncology, Ivrea Hospital, Ivrea, Italy
Munoz Fernando, Radiation Oncology, Turin University, Turin, Italy
Meattini Icro, Radiation Oncology, Florence University, Florence, Italy
Bellarita Rita, Radiation Oncology, Perugia Hospital, Perugia, Italy
Krengli Marco, Radiation Oncology, Piemonte Orientale University, Novara, Italy
Cagna Emanuela, Radiation Oncology, Como Hospital, Como, Italy
Guarnieri Alessia, Radiation Oncology, Turin University, Turin, Italy
Bunkheila Feisal, Radiation Oncology, Policlinico S.Orsola-Malpighi, Bologna, Italy
Ricardi Umberto, Radiation Oncology, Turin University, Turin, Italy
Signor Marco, Radiation Oncology, Udine Hospital, Udine, Italy
Mangoni Monica, Radiation Oncology, Florence University, Florence, Italy
Borghesi Simona, Radiation Oncology, Arezzo Hospital, Arezzo, Italy
Gabriele Pietro, Radiation Oncology, Fondazione Piemontese per la Ricerca sul
Cancro, Candiolo, Italy
Bonetta Alberto, Radiation Oncology, Cremona Hospital, Cremona, Italy
Stefanacci Marco, Radiation Oncology, Pistoia Hospital, Pistoia, Italy
Di Marco Adriano, Radiation Oncology, Mantova Hospital, Mantova, Italy
Bertoni Filippo, Radiation Oncology, Modena Hospital, Modena, Italy
Pegurri Ludovica, Istituto del Radio “O. Alberti”, AO Spedali Civili di Brescia - Brescia
University, Brescia, Italy
Caraffini Bruno, Istituto del Radio “O. Alberti”, AO Spedali Civili di Brescia - Brescia
University, Brescia, Italy
Ciccarelli Stefano, Istituto del Radio “O. Alberti”, AO Spedali Civili di Brescia - Brescia
University, Brescia, Italy
Magrini Stefano, Istituto del Radio “O. Alberti”, AO Spedali Civili di Brescia - Brescia
University, Brescia, Italy
Rozet Francois, Urology, IMM, Paris, France
Habibian Muriel, Unicancer, Paris, France
Salomon Laurent, Urology, CHU Mondor, Creteil, France
Soulié Michel, Urology, CHU Toulouse, Toulouse, France
Culine Stephane, Medical Oncology, Saint Louis, Paris, France
Introduction & Objectives: Post radical prostatectomy patients
(RP) with extra prostatic extension or high Gleason grade are
considered to have a high risk of treatment failure. Actual role of
LH-RH agonists after RP in patients with high risk of recurrence
remains unclear, except for the patients with positive lymph
nodes. For pN0 patients, randomized studies with flutamide
or bicalutamide showed no improvement in overall survival.
No randomized prospective study has been published with LHRH agonists in the PSA era. Recent SWOG 9921 study shows
a favorable disease-free and 5-year overall survival of 96% for
high-risk patients treated with 24 months of ADT after surgery.
However, this study does not define the optimal protocol of
adjuvant ADT, and does not demonstrate the superiority of
immediate vs delayed treatment. The objective of the AFUGETUG 20 study is to evaluate the benefit of leuprorelin acetate
for 24 months after RP in patients with high risk of recurrence.
Methods: Academic phase III randomised, open-label,
multicenter trial starting in late 2011. Inclusion criteria:
R0, N0-Nx M0 patients after RP in the 3 months preceding
inclusion and with postoperative Gleason score > 7, or ≥ 7 with
the presence of 5 grade Gleason patterns or, or pT3b tumor,
and with postoperative PSA < 0.1 ng/‌mL. Exclusion criteria:
previous/‌current therapy for PCa. Primary endpoint is the
evaluation of metastatic progression free survival. Secondary
endpoints include overall survival, disease-specific survival, PSA
evolution, evaluation of testosterone level, and quality of life.
Results: A total of 700 patients (350 in each arm) and 250 events
are required to have 80% ability to detect a difference with
a bilateral Logrank test with α= 0.05 and β= 0.20. Decision
rules will be determined by the O’ Brien-Fleming sequential
boundaries at the time of the analysis. Interim analysis is
planned at the 125th event (50% of events) for 6.5 years after the
start of the trial. Final analysis is planned for 12 years after the
inclusion of the first patient.
Introduction & Objectives: We present an innovative AIbased, pathologically verified method, to predict N status in PC,
integrating several pre-treatment variables (Gleason Score/‌sum,
age, initial PSA, neoadjuvant hormonal therapy vs no hormonal
therapy - HT).
Material & Methods: 1804 pts from a National Italian
multicentre database with a known cN0-1 status were analyzed.
Cases (N=55) with node-positive pelvic MRI and/‌or CT scan
and/‌or showing a nodal only relapse after RT (none received
pelvic RT), were considered N+. The performances of the Roach
formula (cut-offs: >15%, >10% and >5%) and of 3 AI methods,
based on decision trees (J48, Random Tree and Random Forest)
combined with 3 techniques of manipulation of imbalanced
samples (oversampling, undersampling and combined
under/‌oversampling) were tested on an independent population
of 204 operated Brescia patients classified as cN0 preoperatively,
with a known pN status (187 pN0 and 17 pN1 pts).
Conclusions: The AFU-GETUG 20 study is a pioneering French
multicenter trial aiming to evaluate the actual role and place of
ADT after RP for patients with high-risk prostate cancer.
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Results: The AI methods perform better than the Roach formula.
The classic approach showed an accuracy rate (i.e. true positives
+ true negatives/‌whole population) ranging, depending on the
cut-off, between 19% and 42% in the test sample of 204 pts
and between 34% and 52% in the whole series of 1804 pts. The
accuracy of the 3 AI methods ranged between 19% and 86% in the
test sample of 204 pts and between 56% and 98% in the whole
series of 1804 pts. Concerning the specificity, the Roach Formula
showed rates ranging, depending on the cut-off, between 12%
and 38% in the test sample of 204 pts and between 72% and
81% in the whole series of 1804 pts. The specificity of the 3 AI
methods ranged between 13% and 91% in the test sample of
204 pts and between 53% and 100% in the whole series of
1804 pts. Concerning the sensitivity, the Roach Formula showed
rates ranging, depending on the cut-off, between 88% and 94% in
the test sample of 204 pts and between 32% and 51% in the whole
series of 1804 pts. The sensitivity of the 3 AI methods ranged
between 17% and 88% in the test sample of 204 pts and between
57% and 96% in the whole series of 1804 pts. It should be noticed
that HT was always considered in the decisional trees obtained
with the AI-based methods (when considered amongst the input
variables). When the HT is not considered as input variable, the
performances of the AI-based methods worsened.
High AMACR expression in multifocal PIN
patients makes it possible to anticipate the
diagnosis of prostate cancer in consecutive
biopsy
Zakharava Viktoryia, Pathology, Belarusian State Medical University, Minsk, Belarus
Liatkouskaya Tatsiana, Pathology, Belarusian State Medical University, Minsk,
Belarus
Cherstvoy Eugeniy, Pathology, Belarusian State Medical University, Minsk, Belarus
Ivanovskaya Margarita, Belarusian Medical Academy of Postgraduate Education,
Minsk, Belarus
Masansky Igar, Oncosurgery, Minsk Municipal Center for Clinical Oncology, Minsk,
Belarus
Sagalchik Lidia, Oncosurgery, Minsk Municipal Center for Clinical Oncology, Minsk,
Belarus
Puchinskaya Marina, Pathology, Belarusian State Medical University, Minsk, Belarus
Dedik Sergey, Belarusian State Medical University, Minsk, Belarus
Introduction & Objectives: Multiple research data
demonstrate the importance of detecting high grade prostatic
intraepitelial neoplasia (HGPIN) in needle biopsy material as it
is associated with higher probability of finding prostate cancer
(PCa) in consecutive biopsies, however frequency of occurrence
of cancer differs depending whether the HGPIN process is
unifocal or multifocal and whether or not it is associated with
atypical small acinar proliferation (ASAP). The aim of the study
was assessment of the frequency of detection of PCa in patients
with multifocal HGPIN in relation to the degree of expression of
AMACR in the material of the initial prostate biopsy.
Conclusions: Non-linear relationships with more than
two variables influence the N status of the patients and the
Roach formula has suboptimal predictive performances. New
approaches considering more variables could possibly improve
these performances. Considering their intrinsic algorithms,
the AI techniques could be interestingly and usefully used to
perform analysis on large numbers of variables in order to find
relationships between the considered variables and to establish
the weight of each variable in the considered clinical context.
These results should be prospectively confirmed in larger
databases.
Material & Methods: A prospective study comprising
72 patients who were submitted to repeated prostate biopsy
during the period from 2005 to 2012 after they had been
diagnosed with multifocal HGPIN (not associated with ASAP or
small cancer foci) based on the material of their first prostate
biopsy with 6 to 18 random cores. All patients were re-biopsied
with the mean period of 11.8 months. All the cases were
examined using immunohistochemistry with triple-antibody
cocktail (34βE12+p63+AMACR) staining in single paraffin
sections. AMACR expression was scored semi-quantitatively
as 0 (no expression), 1+ (partial and/‌or weak expression), or 2+
(strong circumferential expression).
53
68
Results: In initial prostate biopsy 2+AMACR expressions was
observed in 48 cases (66.7%), 1+AMACR – in 18 cases (25%)
and 0+AMACR expression – in 6 cases (8.3%). The first rebiopsy revealed PCa in 45 cases (62.5%), at that in 40 cases
PCa were detected in patients with 2+AMACR expressions in
initial prostate biopsy, in 4 cases – in patients with 1+AMACR
expression and in 1 case – in a patient with 0+AMACR. Cancer
detection rate in repeated biopsy in patients with 2+AMACR
HGPIN in the initial biopsy was 88.9% which differed
significantly from that in patients with 1+AMACR HGPIN
(22.2%, p<0.01) and 0+AMACR HGPIN (16.7%, p=0.024) in
the initial biopsy. The difference between the 1+AMACR and
0+AMACR groups was not statistically significant (p=1.0).
Calculation of Kaplan-Meier survival probability showed
prognostic significance of strong AMACR expression in
multifocal HGPIN in the initial biopsy in relation to frequency of
PCa detection in consecutive biopsies.
Functional and early oncological results
of radical perineal prostatectomy for the
management of clinically locally advanced
prostate cancer. Experience of a single institute
Bolomitis Stefanos, Urology, 401 General Military Hospital of Athens, Athens, Greece
Andritsos Konstantinos, Urology, 401 General Military Hospital of Athens, Athens,
Greece
Tsavdaris Dimitrios, Urology, 401 General Military Hospital of Athens, Athens, Greece
Ioannidis Konstantinos, Urology, 401 General Military Hospital of Athens, Athens,
Greece
Tzelepis Vasileios, Urology, 401 General Military Hospital of Athens, Athens, Greece
Archontakis Athanasios, Urology, 401 General Military Hospital of Athens, Athens,
Greece
Conclusions: Patients with multifocal HGPIN with high AMACR
expression run high risk of PCa being found in their consecutive
biopsies even without ASAP-associated HGPIN in their initial
biopsy.
Introduction & Objectives: According to current literature,
radical prostatectomy is the best choice for the management of
organ confined prostate cancer. There is increased evidence that
surgical approach has an important role to play as a therapeutic
approach for clinically locally advanced prostate cancer. The aim
of our study is to evaluate the oncological and functional results
of radical perineal prostatectomy for the management of patients
with clinically advanced prostate cancer.
Patients & Methods: Between 1993 and 2012 627 patients
underwent radical perineal prostatectomy for histologically
confirmed prostate cancer. 83 out of 627 patients had clinically
advanced disease. Perioperative morbidity, functional results
and early oncological outcomes were examined and compared
between the organ confined and clinical advanced subgroups.
Results: The mean follow-up was 37 (8-62) months. There was
no statistically significant difference in the operative time, the
intraoperative blood loss, the hospital stay and the duration of
catheterization between the 2 groups. The rate of complications
was also similar, with the exception of two rectal injuries at the
locally advanced subgroup, which were repaired successfully at
the same time. 17.3% of the clinically advanced patients resulted
to be organ-confined (pT2). 99,8% were continent and 36,7%
were potent at the locally advanced subgroup compared to 100%
and 62,5% respectively at the organ confined subgroup. One
patient of the first subgroup, with infiltration of the apex, had
postoperative urinary incontinence, which was managed with the
placement of an artificial sphincter. The cancer-specific survival
rates were not significantly different between the 2 groups.
Conclusions: In cases of locally-advanced prostate cancer, the
removal of the tumor -combined with adjuvant therapy, when
necessary- may possibly change the natural course of the disease.
In addition, through the application of RPP it is possible that the
number of cases with positive surgical margins may be further
reduced. At the same time, there are good functional results
for the patients, without complications and local symptoms,
providing overall a satisfactory quality of life.
54
69
GS 7(3+4) pt who underwent RP who were SOCS3 (+) had an
organ confined disease (≤ pT2) in 8/‌9 (88,8%) and 1/‌9 (11,1%)
had a biochemical recurrence; otherwise GS 7(3+4) pt with
SOCS3 (+/‌-) had an organ confined disease in 13/‌23 (56,5%) and
10/‌23 (43,4%) had a biochemical recurrence. The last group of
GS 7(3+4) pt with the SOCS3 (-) had an organ confined disease
(≤ pT2) in just 2/‌7 (28,5%) and 5/‌7 (71%) had a biochemical
recurrence.
SOCS3-protein expression as marker of
prostate cancer aggressiveness
Calarco Alessandro, Urology, Catholic University School of Medicine “A. Gemelli”
Hospital, Roma, Italy
Pinto Francesco, Urology, Catholic University School of Medicine “A. Gemelli”
Hospital, Roma, Italy
Recupero Salvatore Marco, Urology, Catholic University School of Medicine “A.
Gemelli” Hospital, Roma, Italy
Totaro Angelo, Urology, Catholic University School of Medicine “A. Gemelli” Hospital,
Roma, Italy
Palermo Giuseppe, Urology, Catholic University School of Medicine “A. Gemelli”
Hospital, Roma, Italy
Miglioranza Eugenio, Urology, Catholic University School of Medicine “A. Gemelli”
Hospital, Roma, Italy
D’Agostino Daniele, Urology, Catholic University School of Medicine “A. Gemelli”
Hospital, Roma, Italy
Pierconti Francesco, Pathology, Catholic University School of Medicine “A. Gemelli”
Hospital, Roma, Italy
Bassi Pierfrancesco, Urology, Catholic University School of Medicine “A. Gemelli”
Hospital, Roma, Italy
Conclusions: The suppression of the SOCS3 protein seems to
identify PC with more aggressive behavior. SOCS3 (-) pts turned
out to have a more aggressive disease compared with SOCS3 (+)
ones. Also SOCS3 (+/‌-) tumors seemed to have an aggressive
behavior like the negative ones. This is more evident in the GS
7(3+4) pt who represent the most challenging category.
Introduction: Chronic inflammation might play a key role in
prostate carcinogenesis. Interleukin-6 (IL-6) by the interaction
with its specific receptor or the inhibitory effect of several
regulators, such as the suppressor cytokine signaling (SOCS18 and CIS) family proteins or the protein inhibitor of activated
STAT (PIAS) instaurates and maintains chronic inflammation.
SOCS3 was identified as a inhibitor of FGF-2 signalling and, in
prostate cancer cells, antagonises the effect of the growth factor
by interfering with the activation of the p44/‌p42 MAPK pathway.
Hypermethylation of SOCS-3 with downregulation of protein
expression identifies a subgroup of prostate cancer with a more
aggressive behavior.
Methods: We analyzed SOCS3 protein expression by
immunohistochemistry in 85 patients (pt) who underwent
prostate biopsy and radical prostatectomy (RP) from
January 2006 to March 2011. Both prostate biopsy and
surgical specimens were analized. Follow-up was on 69/‌85 pt
(median 4 years, max 7 min 2). Slides were incubated with
monoclonal antibody SOCS3 (1E4, 1.5 μg/‌m l; Abnova,Taiwan).
SOCS3 staining intensity was evaluated in three different ways:
positive (+), negative (-) and weak (+/‌-).
Results:Gleason score (Gs) was: <7 in 17 pt, 7 in 48 pt
(3+4 pattern in 39 pt, 4+3 pattern in 9 pt), >7 in 4 pt. All GS <7 pt
were ≤ pT2 and none of them had any biochemical recurrence.
15/‌17 (88,2%) pt with Gs <7 and 12/‌48 (25%) with Gs 7 were
SOCS (+). 11/‌48 (22,9%) pt with Gs 7 and 2/‌4 (50%) pt with Gs
> 7 were SOCS3 (-). In 2/‌17 (11,7%) pt Gs <7, 25/‌48 (52%) pt Gs
7 and 2/‌4 (50%) pts GS > 7 were classified as SOCS3 (+/‌-). None
GS >7 pt were SOCS (+).
55
70
71
Significantly less voiding symptoms after robotassisted radical prostatectomy compared to
retropubic radical prostatectomy – results of a
propensity score matched analysis
Initial results of transrectal
ultrasonography/‌multiparametric magnetic
resonance imaging fused stereotactic prostate
biopsy
Musch Michael, Urology, Pediatric Urology and Urologic Oncology, Kliniken EssenMitte, Essen, Germany
Kunz Inga, Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte,
Essen, Germany
Roggenbuck Ulla, Institute for Medical Informatics, Biometry and Epidemiology,
University of Duisburg-Essen, Essen, Germany
Janowski Maxim, Urology, Pediatric Urology and Urologic Oncology, Kliniken EssenMitte, Essen, Germany
Loewen Heinrich, Urology, Pediatric Urology and Urologic Oncology, Kliniken EssenMitte, Essen, Germany
Klevecka Virgilijus, Urology, Pediatric Urology and Urologic Oncology, Kliniken
Essen-Mitte, Essen, Germany
Kroepfl Darko, Urology, Pediatric Urology and Urologic Oncology, Kliniken EssenMitte, Essen, Germany
Hohenhorst Lukas, Urology, Pediatric Urology and Urologic Oncology, Kliniken
Essen-Mitte, Essen, Germany
Musch Michael, Urology, Pediatric Urology and Urologic Oncology, Kliniken EssenMitte, Essen, Germany
Taskiran Baris, Urology, Pediatric Urology and Urologic Oncology, Kliniken EssenMitte, Essen, Germany
Herholz Roman, Urology, Pediatric Urology and Urologic Oncology, Kliniken EssenMitte, Essen, Germany
Koch Jens-Albrecht, Diagnostic and Interventional Radiology, Kliniken Essen-Mitte,
Essen, Germany
Kroepfl Darko, Urology, Pediatric Urology and Urologic Oncology, Kliniken EssenMitte, Essen, Germany
Introduction & Objectives: Recently multiparametric MRI
[mpMRI] targeted prostate biopsy [PBx] demonstrated improved
prostate cancer [PCA] detection. We evaluated our initial
experience with TRUS/‌mpMRI fused stereotactic PBx in patients
with or without prior PBx.
Introduction & Objectives: We present a propensity score
matched analysis on the comparison of continence and voiding
symptoms three months after robot-assisted [RALP] and
retropubic radical prostatectomy [RRP].
Material & Methods: Between 05/‌12 and 09/‌12 23 patients
with prior negative PBx and 13 patients without prior PBx
underwent TRUS/‌mpMRI fused stereotactic perineal PBx. Based
on mpMRI (i.e. T2-weighted [T2], diffusion weighted [DWI],
dynamic contrast enhanced [DCE] and MR spectroscopic [MRSI]
imaging) each lesion was assigned a PI-RADS [Prostate ImagingReporting and Data System] score. Beside the mpMRI targeted
PBx systematic PBx were also taken to cover all regions of the
prostate. We analyzed the PCA detection rate of the mpMRI
targeted and systematic PBx. In addition, the predictive value of
the PI-RADS score was assessed.
Material & Methods: Between 03/‌04 and 04/‌12 228 underwent
RALP and 293 RRP performed by two surgeons. Following
propensity score matching for age, BMI, ASA, prostate weight,
surgeon, nerve-sparing, pT stage, and the preoperative
domains of the ICSmale short form questionnaire (ICSmale
incontinence symptom score [ICSmaleISS], ICSmale voiding
symptom score [ICSmaleVSS] and ICSmale quality of life question
[ICSmaleQol]) 187 RALP and 187 RRP patients formed the final
study population. Both groups were compared three months
postoperatively according to their ICSmaleISS, ICSmaleVSS and
ICSmaleQol.
Results: The 36 patients had a median age of 69 years, a median
PSA of 9.2 ng/‌m l and a median prostate volume of 71.5 ml. A
median of 26 PBx was taken. PCA was detected in 15 (42%)
patients – in 6 of 13 (46%) patients without prior PBx and in 9 of
23 (39%) with prior PBx. 12 of the 15 (80%) PCA would have
been diagnosed through mpMRI targeted PBx alone. Accordingly,
mpMRI targeted and systematic PBx contained tumor in 15%
and 3% of cases, respectively (p<0.0001). The mpMRI targeted
PBx were taken from a total of 76 mpMRI determined lesions of
which 18 (24%) were tumor-bearing. Considering the PI-RADS
score 10 of 63 (16%) lesions with a score <15 and 8 of 18 (44%)
lesions with a score ≥15 contained tumor (p=0.0208). The rate
of PCA with a Gleason scores ≥7 was 22% in lesions with a PIRADS score <15 and 50% in lesions with a score ≥15 (p=0.3348).
In univariate analysis higher PI-RADS scores were associated
with PCA detection (p=0.038). From its underlying parameters
only T2 imaging was a significant predictor (p=0.004) while DWI
(p=0.279), DCE (p=0.668) and MRSI (p=0.607) imaging were
not. In addition, lower PSA (p=0.024) and higher lesion volume
(p=0.023) also proved to be significant predictors of PCA. In
multivariate analysis accounting for all variables only T2 imaging
remained an independent predictor for PCA detection (p=0.006).
Results: RALP and RRP patients were comparable according to
the variables of the propensity score matching, and additionally
to PSA, cT stage, pN stage and surgical margin status (all
p>0.3). However, RALP patients showed higher biopsy and
prostatectomy Gleason scores, longer operation time, lower
blood loss and shorter catheterization duration (all p<0.001).
Three months after RALP and RRP, respectively, the ICSmaleISS
was not significantly different (mean 5.11±4.40 and 4.32±3.72;
p=0.1421), but the ICSmaleVSS was significantly lower in RALP
patients (mean 2.90±2.92 and 3.93±3.51; p=0.0038). At the
same time, the answers to the ICSmaleQol reflected comparable
interference of quality of life due to urinary symptoms
(p=0.8740).
Conclusions: Three months postopertively RALP patients
experienced significantly less voiding symptoms compared to
RRP patients. At the same time, similar good continence and
quality of life due to urinary symptoms was reported.
56
Conclusions: TRUS/‌mpMRI fused stereotactic PBx obtained
high PCA detection rates in patients with and without prior PBx.
In addition, higher PI-RADS scores were predictive for PCA.
57
Authorlist
A
Abbasfard Adnan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Acar Ömer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Akpek Sergin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Alam Adeel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Alan Cabir. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 44
Al-Batran Salah-Eddin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Alberts Arnout. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Alekseev Boris. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Alessandro Marina. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Alviisi Maria Francesca . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Alvisi Maria Francesca. . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 46
Andrianov Andrey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Andritsos Konstantinos. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Angelini Massimo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Antonov Alexander . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Aoyagi Teiichiro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Archontakis Athanasios. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Aspeslagh Barbel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Ates Ferhat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Atoria Coral. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Aufderklamm Stefan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Aussie Jacqueline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Avuzzi Barbara. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 46
Biagini Francesco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Crouzet Sèbastian. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Bianchi Livia Corinna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Culine Stephane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Biasoni Davide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Cuzick Jack. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Biegmohamadlo Hossein . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Blana Andreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36, 42
D
Blumenstock Gunnar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
D’Agostino Daniele. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Bolomitis Stefanos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Day John . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Bolzicco Giampaolo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Debacker Tibaut. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Bonetta Alberto. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
De Bari Berardino. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Borghesi Simona. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
de Bono Johann S.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 39
Bottomley David . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
De Bruyne Peter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Bott Simon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Decaestecker Karel. . . . . . . . . . . . . . . . 23, 24, 29, 42
Boucher Nigel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Dedik Sergey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Brawer Michael. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Delanghe Joris. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Briganti Alberto . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
De Meerleer Gert. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24, 42
Buglione Michela. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Deng Feng-Ming. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Bunkheila Feisal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
De Smet Jens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Desmonts Alexis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21, 22
C
Dhaenens Peter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Cagna Emanuela. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Dhanasekaran Ananda Kumar. . . . . . . . . . . . . . . . 41
Calarco Alessandro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
D’Hont Christiaan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Callewaert Nico. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Di Marco Adriano . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Caraffini Bruno. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Doerfler Arnaud . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21, 22, 33
Carlsson Sigrid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Dosta Nikolay. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Carroll Peter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Dursun Furkan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Castillo Elisabeth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Dyakov Vladimir. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Center Finn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
B
Baco Eduard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36, 51
Baiocchi Cristina. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Bassi Pierfrancesco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Baştürk Gökhan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 44
Baumunk Daniel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Bazille Celine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21, 22
Bedini Nice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Bellardita Lara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8, 9, 46
Bellarita Rita. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Beltramo Giancarlo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Bensadoun Henri . . . . . . . . . . . . . . . . . . . . . . . . . . 21, 22, 33
Bergantin Achille. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Berge Viktor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Bertoni Filippo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Cermak Ales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
E
Cezayirli Fatin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Eastham James. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Chaussy Christian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Eggesbø Heidi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Checcaglini Franco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Ehdaie Behfar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Cherstvoy Eugeniy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31, 53
Elkin Elena . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Chiche Laurence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Eren Ali Erhan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 44
Chun Felix K.H. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Esen Tarık. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Ciccarelli Stefano . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Evseev Alexey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Colecchia Maurizio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Collette Eelco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 17
F
Comoz François . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21, 22
Fang Fang. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Cooperberg Matthew. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Favretto Maria Silvia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Corazzi Francesca . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Ferranti Francesca. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Cortvriend Jim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Filipensky Petr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Crawford Bruce. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Fisher 18
58
Fizazi Karim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 39
Hsu Chao Yu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
L
Fonteyne Valérie . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24, 29, 42
Hurault de Ligny Bruno. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Lanchbury Jerry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Forer David. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 39
Hussain Muddassar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Lange Carsten. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Fossion Laurent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Laniado Marc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
I
Leer Jan Willem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Invernizzi Marta. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Le Gal Sophie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21, 22
G
Ioannidis Konstantinos. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Liatkouskaya Tatsiana . . . . . . . . . . . . . . . . 31, 34, 53
Gabriele Pietro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Ivanovskaya Margarita. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Loewen Heinrich. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Ganzer Roman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36, 42
Ivanov Vladimir. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Logue John. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Garcia-Vargas Jose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Iyer Subrmanian. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Lombardo Claudia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Freedland Stephen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Gatta Roberto. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Loriot Yohann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Gelet Albert. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
J
Girelli Giuseppe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Jacobs Rens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Glybochko Pyotr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
James Nicola. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
M
Gontero Paolo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Janowski Maxim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Machuca Francisco Javier. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Gordeev Vasily. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Jones LeRoy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Magnani Tiziana. . . . . . . . . . . . . . . . . . . . . . . . . 8, 9, 40, 46
Govorov Alexander. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Joniau Steven. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Magrini Stefano. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Lumen Nicolaas . . . . . . 15, 20, 23, 24, 29, 42
Graefen Markus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Mah’d Mufeed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Groskopf Jack. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
K
Mangoni Monica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Guarnieri Alessia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Kairemo Kalevi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Manikandan Ramaswamy. . . . . . . . . . . . . . . . . . . . . . . . . 41
Gueorguiev Gueorgui . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Kaprin Andrey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Marenghi Cristina. . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 40, 46
Guleryuz Kerem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Karademir Kenan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Marliere François. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Gutin Alexander. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Karim Omar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Martinotti Anna Stefania. . . . . . . . . . . . . . . . . . . . . . . . . . 49
Karnes R Jeffrey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Masaltseva Natalia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
H
Kella Naveen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Masansky Igar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31, 53
Habibian Muriel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Kienitz Carsten. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Masansky Ihar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Hakim Lukman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
King Gary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Meattini Icro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Hammerer Peter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Klaver Sjoerd. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 17
Melamed Jonathan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Hassouna Hussam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Klevecka Virgilijus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Meyer Sarah. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Henkel Thomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Kloß Susanne. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Miglioranza Eugenio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Hennenlotter Jörg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Koch Jens-Albrecht. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Mikheev Artem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Henriet Benjamin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Köhrmann Kai-Uwe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Minciarelli Marco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Herholz Roman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Köllermann Jens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Mortier Margarete. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Hermans Tom. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Kolontarev Konstantin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Motiwala Hanif. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Herrera Bernardo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Korobkin Artem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Munoz Fernando. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Hirmand Mohammad . . . . . . . . . . . . . . . . . . . . . . . . . 38, 39
Krasheninnikov Alexey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Musch Michael. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Hodge Petrea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Krengli Marco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Hoebeke Piet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15, 23
Kroepfl Darko. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
N
Hofheinz Ralf. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Kunz Inga. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Naghizade Mohammad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Hohenhorst Lukas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Kuroda Isao . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Nicolai Nicola. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 40, 46
Hoskin Peter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Nilsson Sten. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Hrabec Roman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Nitkin Dmitry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
59
Nobes Kate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Roosen Alexander. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Stenzl Arnulf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Nyushko Kirill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Rosario Derek. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Stone Steven . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Rosenkrantz Andrew. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Stonier Thomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
O
Rossi Giampaolo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Svindland Aud. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Okcelik Sezgin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Rottey Sylvie. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Swanson Greg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Oosterlinck Willem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20, 29
Roumeguère Thierry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Orczyk Clement. . . . . . . . . . . . . . . . . . . . . . 19, 21, 22, 33
Rozet Francois. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
T
Ost Piet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24, 42
Rud Erik. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Taneja Samir . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Ouzzane Adil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Rusinek Henry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Tasca Andrea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Özdemir Öztürk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Taskiran Baris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
S
Taverna Francesca . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
P
Saad Fred. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Ternovoy Sergey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Pacik Dalibor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Sadeghi Simin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Thueroff Stefan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Palermo Giuseppe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Saez Felipe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Tillou Xavier. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21, 22, 33
Parker Christopher. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Sagalchik Lidia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Todenhöfer Tilman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Pasinetti Nadia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Salomon Georg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Tombal Bertrand. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Pasticier Gilles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Salomon Laurent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Tosco Lorenzo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Paulesu Antonello. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Saltzstein Daniel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Totaro Angelo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Pawar Vivek. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Salvioni Roberto. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 40, 46
Toussaint Nele. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Pegurri Ludovica. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Sanchez-Salas Raul . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Tsavdaris Dimitrios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Pentiricci Andrea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Satariano Ninfa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Turcotte Julie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Pereira Nicola . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Scher Howard I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 39
Tzelepis Vasileios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Pierconti Francesco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Schostak Martin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Pinto Francesco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Schwentner Christian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
U
Puchinskaya Marina. . . . . . . . . . . . . . . . . . . . . . . . . . . . 34, 53
Scremin Enrico. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Upsdell Stephen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Pushkar Dmitry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47, 50
Secco Michael . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21, 22
Senkul Temucin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
V
R
Sentker Ludger. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Valdagni Riccardo. . . . . . . . . . . . . . . . . . . . . . . 8, 9, 40, 46
Rai Hem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Shabbooie Zohre. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Vallati Mauro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Rancati Tiziana. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 40, 46
Shariya Merab. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Van Belle Simon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Rao Amrith. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Sharp Gregory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Vandecasteele Katrien . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Rasner Pavel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Shimodaira Kenji . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Van den Ouden Dies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 17
Ravagnani Fernando . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Shore Neal D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Vanderschaeghe Dieter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Recupero Salvatore Marco. . . . . . . . . . . . . . . . . . . . . . . . . 55
Signor Marco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Van Erps Peter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Rehorek Petr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Sorber Marc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
van Lin Emile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Reid Julia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Soulié Michel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
van Oort Inge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Reuning-Scherer Jonathan. . . . . . . . . . . . . . . . . . . . . . . . . 2
Soydan Hasan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Van Poppel Hein. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Ria Francesco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Spahn Martin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Van Praet Charles. . . . . . . . . . .15, 20, 23, 24, 29
Ricardi Umberto. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Stagni Silvia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
van Tol-Geerdink Julia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Robertson Carry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Stalmeier Peep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Van Velthoven Roland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Robinson Simon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Staudacher Karin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Varga Gabriel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Roggenbuck Ulla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Stefanacci Marco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Vasyliev Alexander. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
60
Venugopal Suresh. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Verbaeys Anthony. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Verbaeys Antony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Vergunst Henk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Vermassen Tijl. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Villa Sergio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8, 9, 40
Villa Silvia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8, 9
Villeirs Geert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24, 42
Villers Arnauld. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Vinarov Andrey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Vite Cristina. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Vlatkovic Ljiljana. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Vorobyev Nikolay. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Voskanyan Georgy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Vural Metin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
W
Wall Joshua. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Ward John . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Weersink Robert. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Wijburg Carl. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Wilson Brian. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Witjes Fred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Witzsch Ulrich . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Y
Yañez Ana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Yesildal Cumhur. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Yilmaz Omer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Z
Zakharava Viktoriya. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Zakharava Viktoryia. . . . . . . . . . . . . . . . . . . . . . . . . . . .31, 53
61
Notes
62
63
12-14 JUNE 2013
le Palais du Pharo
Marseille, France
All the accepted abstracts are published in: ‘Mirrors of Medicine: Proceedings of the 2nd Global
Congress on Prostate Cancer 2013’ (ISSN 2034-8398).
The authors of the three winning posters will receive an award and are invited to give an 8-minute
presentation in the main auditorium.
Other Mirrors of Medicine publications
Proceedings of the 2nd Global Congress
on Prostate Cancer 2013
Summaries of Science for Practice
Available from September 2013
The Mirrors of Medicine Summaries aim at providing condensed, though
in-depth, information facilitating healthcare professionals to make
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within 3 hours.
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64