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

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Figure year min follow-up). A total of 20/109 patients had upgrading/upsizing after repeat biopsy, switching to radical treatment. Age, iPSA, PSA density, number of positive cores, percentage of positive cores, absolute biopsy tumor length (ABSmm) and T-stage were all considered factors potentially influencing upgrading/upsizing. GPS was not considered (all patients had GPS=3+3). Backward and forward MVLR resulted in a three-continuous variable best fit model (overall p=0.05): ABSmm (p=0.07, OR=1.20), age (p=0.37, OR=0.97), and PSA density (p=0.24, OR=6.9). A nomogram (see the figure) was built on this result. Conclusion: A nomogram including biopsy details coupled to age and PSA density can help identifying patients who have a higher probability of upgrading/upsizing after a short time in AS. More data are required to strengthen the statistical power of this preliminary analysis. This study was supported by Fondazione Monzino. 217 STEREOTACTIC BODY RADIATION THERAPY FOR ISOLATED NODAL RECURRENCES OF PROSTATE CANCER Maria Grazia Petrongari1 , Sara Gomellini1 , Stefano Arcangeli1 , Biancamaria Saracino1 , Valeria Landoni2 , Simona Marzi2 and Lidia Strigari2 1Radioterapia Oncologica and 2Fisica Medica, Istituto Nazionale Tumori Regina Elena, Roma, Italy Aim: To evaluate the feasibility, tolerability and preliminary outcomes of stereotactic body radiation therapy in patients with nodal recurrences of prostate cancer. Patients and Methods: Between May 2006 and July 2009, 12 patients (10 with isolated nodal recurrences and 2 with multiple adjacent adenopathy) underwent stereotactic body radiation therapy delivered by a linear accelerator (Linac 2100, Varian). The patient age ranged from 51 and 87 (median, 70) years. Primary 1928 ANTICANCER RESEARCH 31: 1807-1956 (2011) treatment was radical prostatectomy in 7 patients, prostatectomy and postoperative radiotherapy in 2 patients and exclusive radiotherapy, androgen deprivation and radiotherapy with rescue prostatectomy in 3 patients. The initial disease category according to the National Comprehensive Cancer Network 2011 was defined as intermediate, high, very high and metastatic (pN1) in 1, 2, 5 and 3 patients, respectively (1 unknown). At the time of radiation therapy, 3 patients did not receive androgen deprivation, 7 patients received some forms of androgen deprivation and the remaining 2 patients were hormone-resistant. Ten patients underwent 11 C-choline positron-emission tomography/computed tomography ( 11 Ccholine PET/CT) examination, while the remaining 2 patients underwent a magnetic resonance imaging (MRI) and a CT scan, respectively, for the diagnosis of the recurrence and in order to exclude the presence of other sites of disease. All patients had a CT scan with contrast centering; 10 mm were added to the macroscopic disease or gross tumor volume (GTV) to create the planning target volume (PTV). Ten patients received a total dose of 30 Gy/3 daily fractions for lesions of dimensions between 1.2 and 2 cm (pelvic disease). Two patients received 35 Gy/5 fractions and 27 Gy/3 fractions, respectively, because of the large size of the adenopathy (5 cm) and its critical location near the bone marrow (para-aortic lymph nodes). Results: There was no report of acute and late toxicity. The mean follow- up was 38 (range, 18-58) months. Eight patients had a complete response to radiotherapy with negative imaging exams ( 11 C-choline PET/CT, MRI and CT) with 3 of them never having received neoadjuvant or concomitant/adjuvant hormonal therapy; 3 patients had stable disease/partial response, and the remaining patient had progressive disease in the irradiated field. Clinical progression was observed in 9 patients after a mean time of 11 (range, 5- 24) months from the completion of the stereotactic body radiation therapy. One patient had regional lymph node progression, while 3 patients had regional and distant nodal progression. Two patients experienced distant metastasis involving bones, while 3had biochemical disease progression.
Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy At the time of analysis (February 2011), 10 patients were alive and 2 dead from disease progression. Discussion and Conclusion: In the single regional lymph nodal recurrence of prostate cancer after primary treatment, locoregional treatment may still play an important role and prevent distant metastasis, and may also delay the onset and duration of action of hormonal therapy. Instead of surgical dissection, which is not always feasible because of patient age and comorbidities, irradiation of isolated nodal recurrence by stereotactic techniques is feasible, with excellent results in terms of local disease control and the almost complete absence of sideeffects (3). In our experience, stereotactic body radiation therapy seems to be a safe, non-invasive and effective treatment. It offers excellent tumor control in the field in the absence of toxicity and could probably be used as an alternative to surgery in selected patients with isolated, early detected, nodal disease. 1 Chang BK and Timmerman RD: Stereotactic body radiation therapy: A comprehensive review. Am J Clin Oncol 30: 637- 664, 2007. 2 Friedland JL, Freeman DE, Masterson-McGary ME et al: Stereotactic body radiotherapy: An emerging treatment approach for localized prostate cancer. Technol Cancer Res Treat 8: 387-392, 2009. 3 Jereczek-Fossa BA, Fariselli L, Beltramo G et al: Linacbased or robotic image-guided stereotactic radiotherapy for isolated lymph node recurrent prostate cancer. Radiother Oncol 93: 14-17, 2009. 218 IS PROSTATE BIOPSY STILL NECESSARY? Franco Di Silverio1 , Stefano Salciccia1 , Gian Maria Busetto1 , Valeria Panebianco2 , Alessandro Sciarra5 , Danilo Lisi2 , Andrea Alfarone2 , Ulderico Parente2 , Alessandro Gentilucci2 , Susanna Cattarino2 , Michele Innocenzi2 , Roberto Passariello2 and Vincenzo Gentile2 1Urologia, 2Radiologia, Sapienza Università di Roma Policlinico Umberto I, Roma, Italy Background: The deficiencies of serum prostate-specific antigen (PSA) as a prostate-cancer-specific diagnostic test are well recognized, thus creating a new diagnostic dilemma: only a fraction of men with increased serum PSA have detectable prostate cancer. Men with at least one negative biopsy often have persistently increased serum PSA, primarily attributable to an enlarged gland and benign prostatic hyperplasia (BPH). However, a significant proportion of men with slightly increased serum PSA (2.5±4.0 ng/ml) either have, or will develop, clinically significant prostate cancer (1). Although biopsy remains the gold standard for prostate cancer detection, more accurate tests with better specificity are needed to decide whether or not to biopsy the prostate. In recent clinical trials, the potential diagnostic value of the PCA3 urine test was established, as well as the role of combined proton 1 H magnetic resonance spectroscopic imaging ( 1 H-MRSI) and dynamic contrast-enhanced imaging magnetic resonance imaging (DCE-MRI) in the management of prostate cancer. The aim of our study was to evaluate the ability of 1 H-MRSI /DCE-MRI combined with PCA3 urinary test to improve prostate cancer detection in cases of PSA increase and precious negative prostate biopsy. Patients and Methods: This was a prospective single-center study on patients with prior negative random transrectal ultrasound (TRUS)-guided prostate biopsy and persistent elevated PSA levels. Including criteria were: a first random TRUS-guided prostate biopsy negative for prostate adenocarcinoma or high-grade prostate intraepithelial neoplasia, persistent elevated PSA levels (mean total PSA: 6.37, range: 4-10 ng/ml) and negative digital rectal examination (DRE). Exclusion criteria for the study were: previous hormonal, surgical or radiation therapies for prostatic diseases, lack of urine sample collected after DRE and prior to prostate biopsy, inadequate prostate biopsy with fewer than 10 cores and cases where an MRI examination with 1 H-MRSI and DCE-MRI was not possible. All patients were submitted to 1 H-MRSI and DCE-MRI. Prior to that the patient’s urine was collected by an expert urologist, following an attentive prostate massage (three compressions for each prostatic lobe), in order to perform PCA3 assay. All biopsies were performed according to a standard biopsy protocol: 10-core laterally directed random TRUS-guided prostate biopsy (two cores from the basal portion lateral and paramedial, two from the mid-gland lateral and paramedical, and one from the apex, on each side of the gland for each patient, plus additional biopsies from other areas suspicious for prostate cancer at MRI. Results: 41/43 urinary samples (95.3%) were analyzed successfully. The performance of the PCA3 test was evaluated in terms of sensitivity and specificity by comparing the PCA3 score to the biopsy results. The overall sensitivity and specificity of a PCA3 score >35 alone for positive biopsy in this cohort were 76.9% and 66.6%, respectively, with positive and negative predictive values of 80% and 62.5%, respectively. With regard to MRI, sensitivity and specificity were 92.8% and 86.6%, respectively, with positive and negative predictive values of 92.8% and 86.6%, respectively. The sensitivity and specificity of PCA3, MRI ( 1 H-MRSI/DCE-MRI) and their combination were explored using receiver operating characteristic (ROC) analysis. The area under the ROC curve was 0.755 for PCA3, 0.864 for MRI and 0.92 for their combination. Discussion and Conclusion: Our results showed that the combination of both diagnostic methods, PCA3 and MRI, may lead to a very high diagnostic accuracy compared to either individual test. If this finding is confirmed in a large prospective study it may lead to the establishment of new 1929
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1Department of Urology, Ospedale Sa
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