357 High risk prostate with pT3-tumor and positive surgical margin – relevance for clinical failure and prostate cancer mortality: Results of a prospective single institution series

Objective: to assess safety, pathological response rate, and long-term oncologic outcomes of radical prostatectomy (RP) after neoadjuvant chemotherapy using docetaxel in prostate cancer (PCa) patients of high and very high risk groups. Materials and methods: 86 patients with high and very high risk PCa (PSA>20 ng/ml, Gleason score 8 and more, or clinical stage cT2c and more) were included, among them 46 received neoadjuvant (NCGT/RP group) treatment followed by RP and 40 patients received RP only. with a median follow-up of 11.4 years after RP. Neoadjuvant treatment included 3-weekly docetaxel (75 mg/m2 for up to 6 cycles) with concomitant degarelix (6 monthly injections). Results: NCGT cycle was started in 39 patients and completed in full dose and planned regimen in 34 (87.2%) patients. Toxicities were moderate. A statistically significant reduction of PSA>50% post-chemohormonal therapy was observed in all 39 cases. Among patients with completed neoadjuvant treatment RP was performed in 33 (97.1%) patients. Lower postoperative stage was noticed in 38.5% in NCGT/RP group compared with 2.7% in RP group. Similarly, positive surgical margin rate was higher in group without neoadjuvant therapy - 43.2% and 25.6% (RP group). Adjuvant or deferred treatment received 25 (67.6%) and 13 (39.4%) in RP and NCGT/RP group, respectively. Conclusion: The use of neoadjuvant chemohormonal therapy before the RP in selected regimen and dose represents a safe strategy resulting in benefit in early oncological results. Given the limitations of the study this concept should be evaluated in large prospective controlled studies.

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637 COMPARISON OF POSITIVE SURGICAL MARGIN RATES IN HIGH RISK PROSTATE CANCER

The Journal of Urology ◽

10.1016/j.juro.2011.02.1539 ◽

2011 ◽

Vol 185 (4S) ◽

Author(s):

Niall Harty ◽

Spencer Kozinn ◽

Jessica DeLong ◽

David Canes ◽

Andrea Sorcini ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Surgical Margin ◽

Positive Surgical Margin ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

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Comparison of radical treatment and mortality in patients with nonmetastatic prostate cancer in England and the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.46 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 46-46

Author(s):

Ashwin Sachdeva ◽

Jan van der Meulen ◽

Paul Cathcart

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Gleason Score ◽

Cancer Mortality ◽

Risk Groups ◽

Tumour Stage ◽

Prostate Cancer Mortality ◽

High Risk Disease ◽

Radical Therapy ◽

The U.S

46 Background: Prostate-cancer mortality in the U.S. is amongst the lowest globally. Given historical differences in management between England and the U.S., this paper aims to determine if risk-adjusted prostate-cancer mortality is inferior amongst men in England compared to the U.S. Methods: Patients diagnosed with non-metastatic prostate-cancer between 2004 and 2008 were identified using English hospital admission records linked to national cancer registry data, and the American Surveillance, Epidemiology and End Results program. Complete data were available for 222,163 patients. Patients were stratified into low-, intermediate-, and high-risk groups according to disease characteristics. Patient demographics from the two countries were compared using the Chi-square test. Competing-risks survival analyses were used to estimate relative six-year prostate-cancer mortality. Results: In comparison to patients in the U.S., English patients were more likely to present at an older age (70 to 79: England 44.2%, USA 29.3%, p<0.001), with higher clinical tumour stage (cT3-4: England 25.1%, USA 8.6%, p<0.001) and higher Gleason score (GS 8-10: England 20.7%, USA 11.2%, p<0.001). They were also less likely to receive radical therapy, with greatest disparity amongst patients with high-risk disease (England 30%, U.S. 83%, p<0.001). After adjusting for age, ethnicity, year of diagnosis, Gleason score, and tumour stage, English patients were more likely to die of prostate cancer (all risk groups: HR 1.9, 95% CI 1.7-2.0, p<0.001). However, this difference was no longer statistically significant on adjustment for radical therapy (all risk groups: HR 1.0, 95% CI 1.0-1.1, p=0.336). Conclusions: After risk adjustment, prostate-cancer mortality is significantly higher in England compared to the U.S. for men with intermediate- and high-risk disease. This difference appears to be explained by decreased use of radical therapy in England.

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