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
99.1% and 88.4% when considering PSA-related drop-out. To
date, no unfavorable outcome has been observed. The
following parameters were not significantly associated with
PCa progression: iPSA, age, stage, GPS, number of positive
cores at biopsy, maximum core length containing cancer,
PSADT and DRE. The QoL investigation showed an
improvement with time in coping with the disease.
Specifically, the percentage of patients experiencing
avoidance was reduced from 30% (at AS enrollment) to
18.2% (at 15 months after PRIAS acceptance); anxious
preoccupation and helplessness/hopelessness were reduced
from 11.5% and 3.4% (at AS enrollment) to 2.3% and 0% (at
15 months), respectively. Physical, emotional, social and
functional well-being was high and showed no relevant
changes during the investigated screening period. Conclusion:
AS is feasible in selected men with early prostate cancer.
Ongoing studies are trying to optimize AS protocols in order
to become efficient at detecting patients with disease
progression. The one-year repeat biopsy is an important
examination which can be used as a diagnostic clarification
point. Further follow-up is necessary to detect the effect of
deferred treatment on disease control. Despite the limited
number of patients, the results of the QoL study showed that
exhaustive information, good communication between
patients and clinicians, and on-demand psychological support
can help patients cope with anxiety and uncertainty related to
AS acceptance.
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PROSTATE CANCER UNITS IN EUROPE: FROM
UTOPIA TO DREAM TO REALITY?
Riccardo Valdagni1 , Peter Albers2 , Chris Bangma3 ,
Lawrence Drudge-Coates4 , Tiziana Magnani5 ,
Clare Moynihan6 , Chris Parker7 , Kathy Redmond8 ,
Cora N. Sternberg9 , Louis Denis10 and Alberto Costa11 1Direttore Programma Prostata, Direttore Radioterapia
Oncologica 1, Fondazione IRCCS - Istituto Nazionale dei
Tumori, Milano, Italy;
2Department of Urology, Heinrich-Heine-University,
Dusseldorf, Germany;
3Department of Urology, Erasmus Medical Center,
Rotterdam, the Netherlands;
4King’s College Hospital, London, U.K.;
5Project Manager, Fondazione IRCCS Istituto Nazionale dei
Tumori, Milano, Italy;
6Department of Psychology, The Institute of Cancer
Research and the Royal Marsden NHS Foundation Trust,
Sutton & London, U.K.;
7Department of Radiotherapy, The Royal Marsden NHS
Foundation Trust, Sutton, U.K.;
8European School of Oncology, Milano, Italy;
9Department of Oncology, San Camillo and Forlanini
Hospitals, Roma, Italy;
10Department of Urology, Oncology Centre Antwerp,
Antwerp, Belgium;
11Chirurgia, European School of Oncology, Milano, Italy
The multidisciplinary approach is particularly important in
prostate cancer (PC), where, according to the clinical state of
disease, there are multiple treatment options, as well as
observational strategies, to choose from. Multidisciplinary,
multi-professional management facilitates administration of
high-quality medical procedures, collaboration among
dedicated specialists, and tailoring of treatment and
observational strategies to the patients’ needs. Access to
specialist counseling, supportive care and rehabilitation are
also fundamental. Prostate cancer units (PCU) are places
where men with PC can be cared for by specialists working
within a multidisciplinary team and these appear to be the
most suitable structures for the care of patients at all stages,
from newly diagnosed to advanced disease, including
preventing and managing disease-induced or treatmentinduced
complications, whether physical, emotional or
psychological. Following the German PC model, the British
example with urological malignancies and the example of
European breast cancer units, general recommendations and
mandatory requirements for a PCU were identified. General
recommendations include: European certification process
based on the fulfillment of mandatory requirements, a focus
on research and clinical trials, teaching for junior staff and
students, and management of a PCU budget. Mandatory
requirements include: a critical mass of a minimum size to
serve a population of 300,000 people that is capable of
attracting ≥100 newly diagnosed PC patients (at all ages and
stages) who are willing to accept all treatment and
observational strategy protocols conducted under the direction
of the Unit’s Multidisciplinary team; documentation/audit
recording of data on diagnosis, pathology, radical, adjuvant
and palliative treatments, observational strategies, clinical
outcomes, follow-up, side-effects audit meeting once a year
with written protocols for diagnosis and management of PC at
all stages. There should be a core team whose members (PCU
Clinical Director, ≥1 uropathologist, ≥2 urologists, ≥2
radiation oncologists, ≥1 medical oncologist, at least 1 nurse
specialist in prostate care, ≥1 dedicated data manager, 1
professional responsible for monitoring the compilation of
patient data and scheduling evaluations) all have specialist
training in PC, spend an agreed amount of time working in
PC, attend multidisciplinary meetings (MDM) for case
management and audit purposes; associated services and noncore
personnel are those the PCU should have access to: ≥1
radiologist, ≥1 nominated medical physicist, ≥2 radiation
therapy technologists, ≥1 physiotherapist, ≥1 palliative care
specialist, 1 clinical psychologist with experience in seeing
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