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

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final pathology (all pT3a), no cases with lymph node or seminal vesicle involvement were reported. A Gleason score upgrading between biopsy and RP was recorded in 35/108 (32%) (3+4=7 in 32/35, 4+3=7 in 3/35). Insignificant prostate cancer volume in RP specimens was found in 51/108 patients (47.2%). Conclusion: A total of 23.8% and 17.5% of patients treated with RP were considered potential candidates for PRIAS and JHP AS protocols, respectively. Upstaging rates were 20% and 13.5% for PRIAS and JHP criteria, respectively, while upgrading rates were 38% and 32%, respectively. Using more stringent AS criteria, according to JHP, the risk of seminal vesicle and lymph node invasion is reduced if compared to PRIAS. Insignificant cancer cases were correctly predicted in 41.7% and 47.2% of cases by PRIAS and JHP, respectively. All protocols can underestimate the true nature of prostate cancer by 30%, but JHP performed better than PRIAS in identifying candidates for AS in this patient series. 1 Van den Bergh RC, Vasarainen H, van der Poel HG et al: Short-term outcomes of the prospective multicenter Prostate Cancer Research International Active Surveillance study. BJU Int 105(7): 956-962, 2010. 2 Carter HB, Kettermann A, Warlick C, Metter EJ, Landis P, Walsh PC and Epstein JI: Expectant management of prostate cancer with curative intent: an update of the Johns Hopkins experience. J Urol 178(6): 2359-2364, 2007. 201 PCA3 COMPARISON WITH PROSTATE HEALTH INDEX (PHI) IN REPEAT BIOPSY PATIENTS Sisto Perdonà1 , Matteo Ferro2 , Giuseppe Perruolo3 , Pietro Formisano3 , Giuseppe Portella3 , Ermanno Badi3 , Michele Longo3 , Giuseppe Di Lorenzo4 , Riccardo Autorino5 , Vincenzo Altieri2 and Daniela Terracciano3 1Urologia, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy; 2Urologia, 3Patologia Clinica, 4Oncologia Medica, Università degli studi Federico II, Napoli, Italy; 5Urology, Cleveland Clinic, Cleveland, OH, U.S.A. Background: Prostate cancer (PCa) diagnosis is currently based on serum prostate-specific antigen (PSA) levels and digital rectal examination (DRE). The low specificity of PSA is responsible for a large number of unnecessary prostate biopsies to confirm diagnosis. PCA3 score has been shown to be a non-invasive tool for improving diagnosis. PCA3 measurement requires urine sample after DRE. Recently, the prostate health index (PHI) has been proposed as an easily available blood test with a specificity higher than that of 1918 ANTICANCER RESEARCH 31: 1807-1956 (2011) percentage free PSA (fPCA) to discriminate between benign prostatic hypererplasia (BPH) and PCa. PHI is 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 compared the ability of PHI and PCA3 to identify prostate malignancy in a population of 40 patients selected for re-biopsy [17 with BPH, 14 with PCa and 9 with precancerous lesions such as atypical small acinar proliferation (ASAP)]. Results: We found that the median PCA3 levels were significantly higher in PCa patients compared to BPH cases (p=0.023); the difference in PCA3 levels between PCa and ASAP cases was not statistically significant. On the contrary, we did not observe any significant difference in PHI values between PCa and BPH or ASAP cases. ROC curve analysis showed that PCA3 has a better ability to discriminate BPH and PCa than PHI (AUC= 0.69 and 0.58 for PCA3 and PHI, respectively). Conclusion: Compared to PHI, PCA3 seems to be a better indicator of malignancy before re-biopsy. 1 Groskopf J, Aubin SM, Deras IL et al: APTIMA PCA3 molecular urine test: development of a method to aid in the diagnosis of prostate cancer. Clin Chem 52: 1089-1095, 2006. 2 Marks LS, Fradet Y, Deras IL et al: PCA3 molecular urine assay for prostate cancer in men undergoing repeat biopsy. Urology 69: 532-535, 2007. 3 Haese A, Van Poppel H, Marberger M et al: The value of the PCA3 assay in guiding decision which men with a negative prostate biopsy need immediate repeat biopsy: preliminary European data. Eur Urol Suppl 6: 48 (abs. 101), 2007. 202 URACYST ENHANCES THE ANTITUMOR ACTIVITY OF DRUGS IN BLADDER CANCER CELLS Matteo Ferro1 , Michele Caraglia2 , Gaia Giuberti2 , Alberto Abbruzzese2 , Mariano Marsicano1 and Vincenzo Altieri1 1Urologia, Universitá degli studi Federico II, Napoli, Italy; 2Department of Biochemistry and Biophysics, Second University of Naples, Naples, Italy Background: Non-muscle-invasive bladder cancer (NMIBC) is the most common type of bladder cancer in the Western world. There are multiple risk factors for NMIBC, which include exposure to tobacco and industrial chemicals, ingestion of arsenic-laced water, radiation therapy to organs adjacent to the bladder, therapeutic use of alkylating agents in chemotherapy regimens and infection with the trematode Schistosoma hematobium. The glycosaminoglycan layer on the bladder surface non-specifically blocks the adherence of
Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy bacteria, ions and molecules to the epithelium. It may be an important element in the first line of defense against infection, calculi and even carcinogens for the transitional cells of the bladder. Qualitative or quantitative defects in the glycosaminoglycan(s) present may influence an individual’s susceptibility to the development of bladder tumors (1). Approximately 80% of patients with transitional bladder cell carcinomas can be successfully treated with local endoscopic resection, although a significant number of these cases exhibit recurrence, with or without progression to invasive disease. Currently, there are few options other than cystectomy for the management of NMIBC with intravesical chemotherapy using several drugs, such as gemcitabine (GEM), mitomycin-C (MMC) and doxorubicin (DOX) (2). In this study, we investigated the effects of Uracyst ® (chondroitin sulphate) (3) on the growth inhibition of human bladder cancer cell lines J82, HT-1376 and MCR and the effects of the combination of GEM, MMC and DOX with Uracyst on the antitumor activity of these drugs in vitro. Materials and Methods: Cell proliferation was measured by MTT assay and the drug combination studies were analyzed using CalcuSyn software (4). Apoptosis was evaluated by FACS scan after double labeling with propidium iodide and FITC-annexin V. Results: We found that Uracyst, MMC, DOX and GEM induced a dose- and time-dependent growth inhibition in human bladder J82, HT-1376 and MCR cancer cells. The data suggest that the three cell lines had different sensitivities to the treatment with these drugs and that the MCR cells were the least sensitive among the three cell lines. On the basis of the obtained results, we hypothesized that Uracyst may potentiate the antitumor activity of MMC, DOX and GEM. Specifically, we evaluated the growth inhibition induced by different concentrations of Uracyst in combination with MMC, DOX or GEM at 72 h in the bladder cancer cell line HT-1376. We observed a synergistic effect when the cells were treated with Uracyst in combination with MMC or GEM at an equimolar ratio. On the other hand, an antagonistic effect was observed when the cells were treated with Uracyst in combination with DOX. The synergism observed was also independent of the sequence of administration of the drugs. Moreover, with Uracyst/GEM and Uracyst/MMC combinations at concentrations which were able to induce synergism on growth inhibition, a strong potentiation of apoptosis was recorded. Discussion and Conclusion: In human bladder cancer cell line HT-1376, the pharmacologic combination of Uracyst with GEM or MMC resulted in a strong synergism on cell growth inhibition and apoptosis. This strategy may resolve the multidrug resistance of bladder cancer, and may be used to overcome the tolerance of cancer cells to chemotherapeutic agents. These data encourage further investigations on the combined use of Uracyst with GEM or MMC in the treatment of human bladder cancer. 1 Bodenstab W, Kaufman J and Parsons CL: Inactivation of antiadherence effect of bladder surface glycosaminoglycan by a complete urinary carcinogen (N-methyl-N-nitrosourea). J Urol 129(1): 200-201, 1983. 2 Di Stasi SM, Dutto L and Verri C: Electromotive Drug Administration ® (EMDA) intravescicale con Mitomicina-C nel trattamento dei tumori della vescica non-infiltranti la muscolare. Urologia 75(4): 214-220, 2008. 3 Hurst RE: Exogenous glycosaminoglycans coat damaged bladder surfaces in experimentally damaged mouse bladder. BMC Urology 5: 4, 2005. 4 Chou J and Chou TC: Manual and Software. Biosoft, Cambridge, UK, 1987. 203 ARE 18 CORES BETTER THAN 12 CORES DURING TRANSRECTAL PROSTATE BIOPSY TO DETECT PROSTATE CANCER? OUR EXPERIENCE Michele Malizia, Remigio Pernetti, Fabiano Palmieri, Giorgio Bruno, Enza Lamanna, Calogero Di Stefano and Salvatore Voce Urologia, Ospedale Santa Maria Delle Croci, Ravenna, Italy Background: We retrospectively investigated the detection rates of prostate cancer, high-grade prostatic intraepithelial neoplasia (PIN) and atypical small acinar proliferation (ASAP) by initial 18- and 12-core prostate biopsy. Patients and Methods: A total of 192 consecutive patients with prostatespecific antigen (PSA) between 1.5 and 100 ng/ml underwent 12- (114 patients) or 18- (78 patients) core prostate biopsy under local anesthesia in our department. The biopsies were evenly distributed throughout the prostate in six sectors. In the 12-core prostate biopsies, two samples were obtained from each sector, while in the 18-core prostate biopsies, one additional core was taken from each sector. Results: Cancer detection rate in the 18-core biopsy group was not statistically different from the rate in the 12-core biopsy group (41% and 45.6%, respectively; p=0.25). Similarly, the detection rates of ASAP and high-grade PIN did not differ significantly between the two groups (ASAP: 2.9% and 3.3%, respectively, p=0.49; high-grade PIN: 23% and 27%, respectively, p=0.7). The cancer detection rate was similar in 18- and 12-core prostate biopsies in patients with a prostate volume of 55 cm3 or greater (44 patients; rates of 4% and 18%, respectively; p=0.33) and also in those with a prostate volume smaller than 55 cm3 (75 patients; rates of 20% and 37%, respectively; p=0.41). Discussion: The 18-core prostate biopsy did not detect a greater number of cases with prostate cancer, ASAP or high-grade PIN than the 12-core prostate biopsy. Based on our data, we did not register a significant difference between the 18- and 12-core prostate biopsy. 1919
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