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tered were studied. The literature was searched for comparative information. Results: The study included 330 patients with age distribution from 37 to 100 years (median of 68). Specimens included 233 TRUS biopsies, 85 TURPs, 8 simple prostatectomies, 3 radical prostatectomies and 1 radical cystoprostatectomy. Indications for TRUS guided biopsy in prostate cancer patients were elevated PSA, abnormal DRE or both in 85%, 5.5% and 9.3, respectively. PSA values ⬍4 ng/ml were found in 13.6% of prostate cancer patients. Among others, adenocarcinoma, BPH alone, BPH with inflammation and inflammation alone were found in 28.5%, 43.3%, 20.3% and 4.2%, respectively. In specimens of TURP or simple prostatectomy for apparently benign disease, incidental prostate cancer was detected in 14/93 (15%). Gleason sum of ⱖ6 was found in 92.8% of patients. Cancers were poorly differentiated (35%), moderately differentiated (61.4%) or well differentiated (3.6%). Conclusions: The incidence of prostate cancer in Saudi Arabia is still low compared to Western countries. However, incidental prostate cancer detected in presumed benign disease is rising. Future studies addressing this issue are needed to confirm the potential rising trend, and its possible etiology. Additionally, this study showed that cancer takes place as high grade disease in this particular population. Our findings support the recommendations to lower the PSA cutoff value for prostatic biopsy to 2.5ng /ml in this population rather than the currently used Western value of 4 ng /ml. UP-2.147 Preoperative Assessment and Postoperative Evaluation of Prostate Cancer After Radical Prostatectomy Nguyen D, Vu L, Vu T, Nguyen A, Nguyen C, Vu P, Nguyen H, Nguyen H, Do T, Tran L Binh Dan Hospital, Department of Urology, Ho Chi Minh City, Vietnam Introduction and Objectives: This study was done for evaluation of preoperative assessments of prostate cancer. Materials and Methods: This is a retrospective study of 86 patients who underwent radical prostatectomy between Jan. 2004 and Dec. 2008 at Binh Dan hospital, HCMC, Vietnam. All of them had preoperative clinical observation, PSA, TRUS guided biopsy, CT scan, bone scan. 28 open and 58 laparoscopic surgeries were done. Preoperative staging and postoperative pathology were used to compare with preoperative diagnosis.
Results: We have 11 T1b, 20 T2a, 20 T2b, 18 T3a, 21 T3b. 8 cases had positive lymph nodes. DRE failed to detect extra capsular extend in 12 cases. CT scan only detected 15/86 cases of lymphadenopathy, and only 8 among them had positive result. It was also failed in evaluate capsular extend in 7 cases. TRUS was useful to determine location of tumor in 79/86 cases and the extent of tumor in 62/86 cases. Preoperative biopsy pathology was exact only in 48/86 cases. 11 cases were overestimated and 27 were underestimated. Conclusion: Even with numerous assessments, preoperative evaluations of prostate cancer were not always exact. Surgeon should combine several methods to determine which case will be good candidate for radical prostatectomy. UP-2.148 Three Months Intermittent Hormone Therapy ⴙ/- 5 Alpha Reductase as an Alternate to Active Monitoring To Separate Latent from Clinically Significant Prostate Cancer Oliver T1, Leibowitz B2, Tucker S2, Shaw G1, ISICAP Collaboration 1 St. Barts & The London Hospital Medical School, QMUL, London, UK; 2UCLA Medical Plaza, Los Angeles, CA, USA Introduction: At least three factors contribute to the lower mortality from prostate cancer in Asians compared to Europeans and even more so in African men. These are decreased intra-prostatic Dihydrotestosterone due to reduced 5 Alpha reductase activity, increased dietary phyto-oestrogens and reduced STDs. This report investigates whether there is any value from addition of 5 alpha blockade to conventional androgen blockade given intermittently and whether its use short-term in patients with early disease produces prolonged off-treatment periods. Materials and Methods: Individual patient data from 12 IHT phase 2 studies with more than 50 cases identified through a PubMed search have been pooled. Most used treatment was LHRH monotherapy or Maximum androgen blockade (MAB). However, a minority received anti-androgens alone and one study gave Combine Androgen Blockade (CAB). CAB patients had 12 months cycles of LHRH analogue ⫹ antiandrogen ⫹ 5 alpha reductase blocking drug, finasteride followed by maintenance finasteride. Results: Patients receiving CAB (n⫽207) had 97% remaining off treatment for 2 or more years after stopping CAB compared to only 29% of those receiving MAB
(n⫽404). This difference persisted at 5 years when there was also less androgen independent patients (1% vs 7%) and better overall survival (99% vs 89%). Although the CAB group had lower initial PSA and more patients of a younger age with T1 & 2 tumours, after attempted correction for these differences, the CAB patients still survived significantly longer. Conclusions: It is clear that selection played a major part in this large difference in time off treatment between CAB and MAB. However, the known biological significance of 5 alpha reductase in prostate endocrine control clearly justifies further investigation of these observations in a randomised control trial. UP-2.149 Does the Pre-Treatment International Prostate Symptom Score Predict Functional Urinary Outcomes Following Prostate Brachytherapy? Pal R, Bhatt J, Duggleby S, Camilleri P, Elwell C, Bell R, Kunkler R Northampton General Hospital, Northampton, UK Introduction: The aim of this study was to prospectively determine the value of pre-treatment International Prostate Symptom Score (IPSS) in predicting urinary morbidity after brachytherapy for organconfined prostate cancer. Materials and Methods: Between May 2002 and September 2008, we recorded pre-treatment IPSS in 201 patients who underwent I125 brachytherapy for localised prostate cancer at our institution using the Bard Proseed® technique. IPSS and urinary retention rates were prospectively recorded at 3, 9 and 18-month follow-up intervals. Linear and logistic regression analyses were used to determine whether pre-treatment IPSS predicted post-treatment urinary morbidity. Results: The mean patient age was 62 years (range 45-80 years). A total of 136 patients had mild lower urinary tract symptoms (LUTS) with a pre-treatment IPSS ⬍8, and 65 had IPSS 8-19 (moderate LUTS). Patients with moderate pre-treatment LUTS had a significantly higher IPSS at 3 (p⬍0.001), 9 (p⬍0.001) and 18 months (p⫽0.004). Compared to men with mild LUTS (IPSS ⬍8), patients with moderate LUTS before brachytherapy had a higher IPSS by 6.85, 6.06 and 5.15 points at 3, 9 and 18 months respectively. Patients with pre-treatment IPSS 8-19 were almost twice as likely to develop urinary retention as those with pre-treatment IPSS ⬍8 although this was not significant (p⫽0.142).
UROLOGY 74 (Supplment 4A), October 2009
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Conclusions: Pre-treatment IPSS is a strong predictor of symptomatic urinary morbidity following brachytherapy for prostate cancer, and is therefore a key criterion in the pre-treatment assessment. Patients with a higher initial IPSS are at greater risk of urinary morbidity.
UP-2.150 Pre-Treatment Maximum Flow Rate Correlates with Poorer Functional Outcomes Following I125 Brachytherapy for Localized Prostate Cancer? Pal R, Bhatt J, Duggleby S, Camilleri P, Elwell C, Bell R, Kunkler R Northampton General Hospital, Northampton, UK Introduction: The aim of this study was to determine the value of pre-treatment uroflowmetry in predicting functional urinary outcomes following brachytherapy for organ-confined prostate cancer. Materials and Methods: We studied 199 patients who between May 2002 and September 2008 underwent I125 brachytherapy at a single institution using the Bard Proseed® technique for localised prostate cancer. Data on pre-treatment maximum flow rate (Qmax) and post-micturition residual volume (PMRV) were prospectively gathered. Following treatment, IPSS and urinary retention rates were recorded at 3, 9 and 18-months. Data were analysed using Pearson’s correlation and the chisquare test. Results: A total of 199 men were evaluated with a mean age of 62 years. The pre-treatment Qmax ranged from 7-49 ml/s (mean 21.0 ml/s). 141 patients had Qmax⬎15ml/s; 58 had Qmaxⱕ15ml/s. The pre-treatment PMRV ranged from 0-289mls (mean 67mls). 139 patients had PMRV⬍100ml; 48 patients had PMRV⬎100mls. A statistically significant inverse correlation between Qmax and post-treatment IPSS at 3 and 9 months (p⬍0.001) was observed. Patients with Qmaxⱕ15ml/s were more than twice as likely to develop urinary retention as those with Qmax⬎15ml/s (p⫽0.019). No significant relationship between pre-treatment PMRV and post-treatment IPSS or retention rates was apparent. Conclusions: A lower pre-treatment maximum flow rate strongly correlates with poor functional urinary outcomes following brachytherapy for prostate cancer. This study demonstrates the value of pretreatment uroflowmetry in the assessment of patients being considered for prostate brachytherapy.
UP-2.151 Impact of Prostate Volume on Pathologic Outcome and Biochemical Recurrence in Prostate Cancer After Radical Prostatectomy: Is It Correlated with Serum Testosterone? Park JS1, Jeong I1, Park C2, Park J2, Cheon S3, Hong J1, Park H1, Ahn H1, Kim C1, You D1 1 Department of Urology, Asan Medical Center, Seoul, South Korea; 2Department of Urology, Gangneung Asan Hospital, Gangneung, South Korea; 3Department of Urology, Ulsan University Hospital, Ulsan, South Korea Introduction and Objective: We examined whether prostate volume was associated with pathologic outcome and biochemical recurrence (BCR) in prostate cancer after radical prostatectomy (RP), and evaluated whether it was correlated with serum testosterone. Materials and Methods: The study population consisted of 698 men treated with RP for prostate cancer between June 1991 and March 2007 with PSA less than 20ng/ ml. We evaluated the association of prostate volume and serum testosterone with adverse pathological outcomes and BCR using logistic regression and Cox proportional hazards regression analysis. Results: A positive correlation was observed between RP specimen weight and pre-operativly measured prostate volume (r ⫽0.665, p⬍0.001). In outcome prediction model including multiple predictor variables, it was found that the predictor variable of prostate volume was significantly inversely associated with the outcomes of high-grade prostate cancer (p⫽0.001), extracapsular extension (p⫽0.034) and BCR (p⫽0.005). A positive correlation was observed between testosterone and prostate volume (r ⫽0.136, p⫽0.043). Lower testosterone correlated with adverse pathologic stage on multivariate analysis, as did pathologic Gleason score 8 or greater (p⫽0.042). However, we found no relationship between testosterone and BCR after adjusting for other covariates. Conclusions: Men with smaller prostate had unfavorable pathologic finding and were at greater risk of progression after RP. But low testosterone was not associated tumor progression. Therefore, further efforts should be made to elucidate actual mechanisms behind the association of prostate volume and androgenicity with aggressiveness of prostate cancer.
UROLOGY 74 (Supplment 4A), October 2009
UP-2.152 Urinary PSA Correlates Negatively with Local Tumor Extent After Prostate Biopsy Pejcic T1, Acimovic M1, Djozic J2, Milkovic B1, Hadzi-Djokic J3 1 Clinical Center of Serbia, Belgrade; 2 Clinical Center of Vojvodina, Urological Clinic, Novi Sad; 3Serbian Academy of Sciences and Arts, Belgrade, Serbia Objectives: To estimate the ratio between urinary prostate specific antigen (uPSA) and tumor volume after prostate biopsy. Materials and Methods: From January 2004 to July 2008, uPSA concentration was determined in 65 patients with organconfined prostate cancer (PCa). All patients underwent six-areas transrectal ultrasound (TRUS)- guided biopsy, with average 12 biopsy cores. In every single core, tumor grade, Gleason score, the percentage of tumor infiltration and the percentage of positive cores were determined. Forty four patients underwent retropubic radical prostatectomy (RRP), while 21 patient underwent radiation therapy. Results: Average uPSA was 301.5 ⫾ 310.1 ng/ml, average PSA was 9.8 ⫾ 5.4 ng/ml, tumor grade 1.7 ⫾ 0.8, Gleason score 5.1 ⫾ 1.5, the percentage of tumor infiltration 27.6 ⫾ 21.8 %, and the percentage of positive cores, 52.2 ⫾ 30.7 %. In the RRP group, average postoperative uPSA was 18.1 ⫾ 39.2 ng/ml, and average postoperative PSA, 0.16 ⫾ 0.13 ng/ml. (Patients with recurrence were excluded from the study). There was a moderate negative correlation between uPSA / tumor grade and uPSA / Gleason score (p ⬍ 0.05) and a strong negative correlation between uPSA / percentage of tumor infiltration and uPSA / percentage of positive cores (p⬍0.01). Conclusion: Urinary PSA concentrations negatively correlate with local tumor extent in the biopsy material. Lower uPSA levels are associated with greater tumor, due to compromised PSA drainage from the peripheral zone. UP-2.153 Comparison Between Target and Random Vesico-Urethral Biopsies in Patients with Biochemical Relapse After Radical Retropubic Prostatectomy Acimovic M1, Pejcic T1, Kajmakovic B1, Dzamic Z1, Tulic C1, Hadzi-Djokic J2 1 Clinical Center of Serbia, 2Serbian Academy of Sciences and Arts, Belgrade, Serbia