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

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abdominal obesity (AO), body frame (BF) and prostate cancer risk and grade in a group of patients scheduled for prostate biopsy. Patients and Methods: From 2008 onwards, 751 consecutive men undergoing 12-core prostate biopsy at three centers in Italy were enrolled to the study. Indications for a prostatic biopsy were PSA≥4 ng/ml and/or a positive digital rectal examination (DRE). BMI, as well as waist and hip circumference, were measured before biopsy. BF was defined as small up to a wrist circumference of 191 mm. AO was defined as a waist circumference >102 cm. Results: Out of 711 men, 273 (38%) were diagnosed with cancer on biopsy. The median age was 68 years, PSA 6.2 ng/ml, BMI 27.6 kg/m 2 and waist circumference 102 cm. According to BMI measurement, 153 men (21%) were obese. According to waist circumference, 319 (44%) men presented with AO. Large, medium and small BF were observed in 89 (13%), 479 (67%) and 143 (20%) men, respectively. No significant differences between age, prostate volume, PSA, BMI, waist and wrist circumferences, and prostate cancer incidence and Gleason score distribution were observed among the three centers. Out of 273 men with prostate cancer, 149 (55%) had Gleason score 6 (65 (43%) presented with AO) and 124 (45%) a Gleason score ≥7 (68 (55%) presented with AO). On univariate analysis, waist circumference (median value 101 cm in benign disease and 102 cm in cancer, respectively) was not significantly associated with prostate cancer diagnosis (p=0.12). Among men with cancer, higher waist circumference (median value for Gleason score 6 was 102 cm and for Gleason score ≥7 was 104 cm, respectively) on univariate (p=0.029) and multivariate analysis (p=0.04) was associated with high-grade disease (Gleason score ≥7). BF evaluation was not associated with prostate cancer diagnosis (p=0.79) or high-grade disease (p=0.24). Discussion and Conclusion: Among men undergoing prostate biopsy in different centers in Italy, our study confirmed that AO is associated with high-grade disease. However, further studies in a large patient population across multiple institutions and countries are needed to confirm our results and to allow us to better understand which precise factors related to obesity are responsible for the observed increase in high Gleason score tumors. 5 ANDROGEN LEVELS AND HIGH-GRADE PROSTATE CANCER: FREE TO TOTAL TESTOSTERONE RATIO ANALYSIS Simone Albisinni1 , Cosimo De Nunzio1 , Andrea Tubaro1 , Lionel Banez2 and Stephen J. Freedland2 1Sant’ Andrea Hospital, University "La Sapienza", II School of Medicine, Department of Urology, Rome, Italy; 2Duke University School of Medicine, Department of Surgery, Division of Urologic Surgery, Durham, NC, U.S.A. 1812 ANTICANCER RESEARCH 31: 1807-1956 (2011) Background: Prostate cancer (PCa) and androgens have an unclear interrelationship. Some data suggest that low total testosterone levels may enhance tumor aggressiveness, while data on free testosterone remain controversial. We analyzed serum androgen concentrations in men who underwent initial prostate biopsy, focusing on the free (fT) to total testosterone (T) ratio (fT/T) as a predictor of the risk for low- and highgrade PCa. Patients and Methods: Between 2006 and 2010, we collected data on 812 Caucasian Italian men with no history of PCa who underwent 12-core biopsy. Digital rectal examination (DRE), body mass index (BMI), prostate volume, PSA, T and fT were measured on the day of biopsy. The fT/T ratio was computed by dividing free testosterone by total testosterone. T, fT and fT/T were examined as continuous variables. Crude and adjusted multinomial logistic regressions were performed to assess the association between T, fT, fT/T and the outcomes of low- (Gleason ≤6) and high-grade PCa (Gleason ≥7), both relative to the absence of cancer. Multivariate analyses were adjusted for age, PSA, BMI, prostate volume and DRE. The fT/T ratio was also examined using tertiles to evaluate the risk in different fT/T ranges. Results: Overall cancer detection was 40% (321/812): 136 men had low-grade and 185 men had high-grade PCa. Age, PSA, DRE, prostate volume and BMI all showed a significant difference in distribution across the three outcome clusters (all p≤0.001). The fT/T distribution also differed significantly across the outcome groups (p=0.017). On multivariate analysis, T (p>0.11) and fT (p>0.45) were not significantly associated with low- or high-grade PCa. Instead, a higher fT/T ratio was a significant predictor of high-grade PCa on both crude (p=0.01) and multivariate (p=0.02) analysis. No significant association was found with low-grade PCa (p≥0.38). The tertile analysis demonstrated a two-fold increased risk (OR=2.04, 95% CI=1.23-3.37, p=0.005) of high-grade PCa for patients in the highest fT/T tertile relative to the lowest tertile. Discussion and Conclusion: In Caucasian Italian men, a higher fT/T ratio significantly predicts against increased risk of highgrade PCa on initial prostate biopsy. Men in the highest fT/T tertile have a greater than two-fold increased risk of high-grade disease compared to men in the lowest tertile. This study provides evidence that a high fT/T ratio (i.e. high percentage of free testosterone) rather than absolute androgen levels may be associated with high-grade PCa. Nevertheless, the relationships between PCa and androgens remain complex and further studies are needed to confirm our findings. 6 PROSTATE BIOPSY ACCURACY: ANALYSIS OF 20- VERSUS 12-CORE TEMPLATES Cosimo De Nunzio 1 , Luca Cindolo 2 , Cristina Avitabile 1 , Andrea Cantiani 1 , Alfonso Carluccini 1 , Andrea Tubaro 1 and Luigi Schips 2
1Department of Urology, Ospedale Sant’Andrea, University “La Sapienza”, Rome, Italy; 2Ospedale Padre Pio da Pietrelcina, Vasto (CH), Italy Background: Transrectal prostatic biopsy is considered the standard procedure for the diagnosis of prostate cancer. In recent years, sextant biopsy schedule has been replaced by new strategies consisting of sampling at least ten sites in the prostate; however, a standard number of cores is still to be agreed upon. The aim of our study was to evaluate and compare the impact of two different biopsy templates for the diagnosis of prostate cancer. Patients and Methods: From December 2008 to September 2010 all patients referred to our prostate clinics with a PSA value of more than 4 ng/ml or an abnormal digital rectal examination (DRE) were consecutively scheduled for their first TRUS prostatic biopsy with a 12- or a 20-core template, respectively. Patients with a PSA >30 ng/ml were excluded from the series. Prostate biopsy was carried out as an outpatient procedure. Antibiotic prophylaxis by means of levofloxacin 250 mg b.i.d. was started 48 h before the procedure and continued for 72 h after. All patients underwent a TRUS-guided biopsy using a Falcon ultrasound instrument (B-K Medical, Milan, Italy) equipped with a 5-10 MHz bi-convex probe (8808 probe; B- K Medical). A 16-gauge biopsy needle (Magnum 1000; BARD, Rome, Italy) and a dedicated spring-loaded biopsy gun (MG1522; BARD) were used. Periprostatic anesthetic block was performed for each patient 10 min before the biopsy. Differences in cancer detection rate were evaluated. One-way ANOVA and Chi-square were used as appropriate for statistical analysis. Results: A total of 550 patients were consecutively enrolled. The mean age was 69.6±7.4 years, mean body mass index (BMI) was 27.4±3.8 kg/m 2 , the mean PSA value was 8.3±6 ng/ml and the mean prostatic volume was 45±26 ml. 275 patients underwent a 12-core biopsy (group A) and 275 a 20-core biopsy (group B). A total of 69 (25%) patients presented with a positive DRE in group A and 73 (26%) patients in group B (p=0.77). No significant differences for age, BMI, PSA, prostate volume and prostate cancer detection rate were observed between the two groups (see Table I). No significant complications requiring hospitalization were observed in both groups. Table I. Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy 12-Core 20-Core p-Value template template Age (years) 67.7±7.9 66.3±8.3 0.51 BMI (kg/m 2 ) 26.9±3.5 27.6±5.9 0.11 PSA (ng/ml) 7.2±4.6 8±5.3 0.07 Prostate volume (cc) 52.4±24 48±29 0.06 Prostate cancer rate 119/275 (43%) 96/275 (35%) 0.06 Discussion and Conclusion: This study shows that increasing the number of biopsy cores is not associated with an increase in prostate biopsy performance in the detection of prostate cancer. These data suggest that the standard number of cores to be used in the first set of biopsies is still to be determined. 7 BONE SCAN IN NEWLY DIAGNOSED PROSTATE CANCER: EXTERNAL VALIDATION OF A NOVEL RISK STRATIFICATION TOOL Cosimo De Nunzio1 , Costantino Leonardo2 , Andrea Cantiani1 , Giovanni Simonelli2 , Carlo De Domincis2 , Alfonso Carluccini1 , Aldo Brassetti1 and Andrea Tubaro1 1Department of Urology, Sant’Andrea Hospital, University "La Sapienza", Rome, Italy; 2Department of Urology, Policlinico Umberto I, University "La Sapienza", Rome, Italy Aim: To externally validate and test the performance characteristics of a novel risk stratification tool recently proposed by Briganti et al. (1) regarding the need for baseline staging bone scans in patients with newly diagnosed prostate cancer. Patients and Methods: From 2009 onwards, a consecutive series of patients with a diagnosis of prostate cancer were enrolled to the study. Indications for prostatic biopsy were a PSA ≥4 ng/ml and/or a positive digital rectal examination (DRE). All patients were staged with conventional total-body 99m Tc MDP scintigraphy, performed regardless of baseline prostate cancer characteristics. The presence of skeletal metastasis (BM) on bone scan was defined when either solitary or multiple asymmetric areas of increased tracer uptake occurred. Patients with positive or equivocal bone scan findings also underwent computed tomography and/or magnetic resonance imaging to confirm the scintigraphy findings. No patient was on hormonal therapy at the time of the staging imaging. The AUC estimates were used to test the accuracy of the novel risk stratification tool (the regression tree (CART)) proposed by Briganti which recommended staging baseline bone scan for patients with a biopsy Gleason score >7 or with a PSA >10 ng/ml and palpable disease (cT2/T3) prior to treatment. The new tool was compared to the EAU guideline. The specificity, sensitivity, positive and negative predictive values of each model were also calculated Results: A total of 313 patients were consecutively enrolled. The median age was 68 (range 49-95 years), median PSA was 7 ng/ml (range 0.81-2670 ng/ml); median prostatic volume was 40 cc (range 10-189 cc). A total of 20 (6.4%) patients presented with BM at the bone scan. Of these patients, all presented at least a PSA≥30 ng/ml; 8 patients (40%) had a Gleason score 7, and 12 (60%) had a Gleason score >7; 10 patients (50%) presented with palpable 1813
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Nucciotti R, 35 Oderda M, 37, 38, 1
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