ABSTRACTS OF THE 21st ANNUAL MEETING OF THE ITALIAN ...

Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy
1 Urologia, 2 Patologia Clinica, 5 Oncologia Medica, Università
degli studi Federico II, Napoli, Italy;
3 Urologia, Umberto I Nocera Inferiore, Salerno, Italy;
4 Urologia, Istituto dei Tumori Napoli, Napoli, Italy
Background: PSA has been widely used for the detection of
prostate cancer (PCa) for more than two decades. However,
the major drawback of PSA is its relative lack of specificity,
most of all in the critical diagnostic range of 4-10 ng/ml, with
a large consequent number of unnecessary prostate biopsies.
PSA is organ specific but not cancer specific. Thus, serum
levels may be elevated in the presence of benign prostatic
hyperplasia (BPH), prostatitis and other non-malignant
conditions. A significant improvement in the discrimination of
PCa from BPH was achieved by evaluating the serum free-tototal
PSA ratio. Free PSA (fPSA) comprises different
subforms of inactive PSA, such as the pro-enzyme called pro-
PSA. Recently, with this aim, the prostate health index PHI
has been proposed, calculated according to the formula
PHI=(p2PSA/fPSA)×√tPSA, where tPSA is the total PSA and
p2PSA is a PSA isoform. Patients and Methods: We tested the
ability of the PHI to discriminate between benign and
malignant disease in a population composed of 120 patients
[49 with BPH, 38 with PCa and 33 with precancerous lesions,
such as prostatic intraepithelial neoplasia (PIN) and atypical
small acinar proliferation (ASAP)]. Results: We found that
median PHI levels were significantly higher in PCa patients
compared with either BPH or precancerous patients (p=0.005
and 0.034, respectively). ROC curve analysis confirmed this
finding (AUC=0.67 for either comparison, BPH vs. PCa or
PIN, and ASAP vs. PCa). Conclusion: The prostate health
index PHI seems to be able to discriminate PCa from BPH,
PIN and ASAP.
1 Le BV, Griffin CR, Loeb S et al: -2,Proenzyme prostatespecific
antigen is more accurate than total and free prostatespecific
antigen in differentiating prostate cancer from
benign disease in a prospective prostate cancer screening
study. J Urol 183: 1355-1359, 2010.
2 Jansen FH, van Schaik RH, Kurstjens J et al: Prostatespecific
antigen (PSA) isoform p2PSA in combination with
total PSA and free PSA improves diagnostic accuracy in
prostate cancer detection. Eur Urol 57: 921-927, 2010.
3 Sokoll LJ, Sanda MG, Feng Z et al: A prospective,
multicenter, National Cancer Institute Early Detection
Research Network study of -2,proPSA: improving prostate
cancer detection and correlating with cancer aggressiveness.
Cancer Epidemiol Biomarkers Prev 19: 1193-1200, 2010.
200
PATHOLOGICAL OUTCOMES OF CANDIDATES
FOR PRIAS AND JOHNS HOPKINS ACTIVE
SURVEILLANCE PROTOCOLS TREATED WITH
IMMEDIATE RADICAL PROSTATECTOMY
Vito Lacetera1 , Andrea Galosi1 , Alessandro Conti1 ,
Daniele Cantoro1 , Roberta Mazzucchelli2 ,
Rodolfo Montironi2 and Giovanni Muzzonigro1 1Institute of Urology and 2Institute of Pathology, Azienda
Ospedaliera, Universitaria Ospedali Riuniti, Polytechnic
University of Marche Region, Ancona, Italy
Background: Active surveillance (AS) represents an emerging
option for selected patients with low-risk prostate cancer. The
aim of AS is to decrease the rate of definitive therapy and its
side-effects in patients whose biological tumor characteristics
pose a minimal threat to their life expectancy. We tested the
two most commonly used European and American AS
protocols (PRIAS (1) and John Hopkins (JHP) (2),
respectively) in patients who met their selective entry criteria,
but underwent radical prostatectomy (RP) as first-choice
treatment, in particular their ability to correctly select patients
with low-risk prostate cancer, excluding patients with
unfavorable prostate cancer characteristics at final pathological
examination. Patients and Methods: The records regarding a
total of 616 patients were extracted from our institutional
urological oncology database of all men who underwent
radical prostatectomy between 2005-2010. For all patients, full
records of biopsy and RP specimen pathological reports were
available. Following central review of all slides, pathological
tumor volumes were calculated using 3-D stereology (as the
product of tumor area per section and thickness section) based
on a whole-mount section 3-mm step analysis. We selected
two groups of patients: firstly, those who met the PRIAS
inclusion criteria, namely: T1-cT2, biopsy Gleason ≤3+3, PSA
≤10, PSA density