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168 Abstracts

  • Introduction & Objectives

    Prostate cancer treatment is shifting from radical to focal therapy. Instant tumor visualization on a microscopic level is crucial for clinical application of focal therapy. Optical Coherence Tomography (OCT) produces instant tissue visualization on a µm scale. OCT also provides the attenuation as a measure of tissue organization. The objective is to correlate qualitative and quantitative OCT analysis with histopathology.

    Material & Methods

    Twenty prostates were analyzed by needle based OCT after radical prostatectomy. For precise correlation, whole mount histology slides were cut through the OCT trajectory. OCT images were classified in one of eight histological categories (RvK). Two reviewers (AS & BM) independently performed assessments of the OCT images into these categories. Sensitivity and specificity for detection of malignancy on OCT were calculated. Quantitative attenuation coefficient was found to discriminate stroma and malignant tissue. Figure: Correlation of histology and OCT: The arrows in A, B & C indicate the same atrophic cyst. A: Digitized H&E stained whole mount slide with tissue annotation. Both OCT measurement trajectories are visible. B: An OCT scan at the location of the atrophic cyst. C: The longitudinal section of the OCT scan that corresponds with the upper OCT measurement trajectory shown on A.



    Results

    Visual analyses showed that OCT can reliably differentiate between fat, cystic and regular atrophy and benign glands. Differentiation of benign stroma and inflammation and also malignancy Gleason 3 and 4 is more difficult. Sensitivity and specificity for detection of malignancy on OCT were calculated at 77% and 84%. Quantitative analysis by means of the attenuation coefficient for differentiation between stroma and malignancy showed no significant difference (4.39 mm-1 vs. 5.31 mm-1).

    Conclusions

    One to one correlation of histology and OCT helps us to understand what we see and measure on OCT. Visual malignancy detection shows reasonable sensitivity and specificity. Our future studies focus on improving discrimination of malignancy with OCT for example by combining an extra imaging modality.

  • Introduction & Objectives

    Local staging of Prostate Cancer (PCa) has a crucial role in decision-making process about resection or preservation of Neurovascular Bundles (NVB) during radical prostatectomy. The clinical relevance of multiparametric Magnetic Resonance Imaging (mpMRI) in preoperative workup and its influence on planning of radical prostatectomy is still under investigation. The purpose of our study was to evaluate the diagnostic performance of 3-Tesla mpMRI in preoperative staging of PCa in men subjected to endoscopic radical prostatectomy (ERP). We investigated the influence of mpMRI on the extension of resection during ERP.

    Material & Methods

    The study was the retrospective analysis of prospectively collected data of 154 men with PCa in whom mpMRI was performed prior to ERP. Imaging results were compared with pathological reports to investigate diagnostic performance of mpMRI in detecting Extraprostatic Extension (EPE). Initial decision whether to perform NVB sparing surgery was based on EAU guidelines. mpMRI was reevaluated prior ERP to determine feasibility and extent of a NVB preservation.

    Results

    The extent of NVB sparing surgery was changed in 69 (45%) men after reevaluation of mpMRI study. NVB preservation was made in 17 (11%) men, in whom NVB would have been resected, if mpMRI had not been available. The extension of resection was broadened at the expense of narrower NVB preservation in 52 (34%) men, in whom NVB would have been spared, if the decision had been made solely based on guidelines. The change in the extension of resection either to more preserving NVB sparing or more aggressive resection was not correlated with the higher risk of positive surgical margins (PSM). mpMRI had increased diagnostic performance in men with the high-risk cancer (sensitivity 49%, specificity 89%), than in man with low-risk and intermediate-risk cancer (sensitivity 27%, specificity 93%). Despite decreased diagnostic performance of mpMRI in the low-risk and intermediate-risk group, the extension of NVB preservation was narrowed in 17 (63%) and 19 (33%) men, respectively. mpMRI failed to detect or understaged the tumor in nearly half of PSM cases.

    Conclusions

    mpMRI influences decision-making about the extension of resection during ERP irrespective of the prostate cancer risk group. The changes of the extent of resection made basing on the mpMRI result are not related to the increased risk of PSM.

  • Introduction & Objectives

    68Ga PSMA-PET/CT is a novel imaging modality introduced to improve diagnosis and staging of advanced prostate cancer. Due to its naïve nature, robust sensitivity and specificity data outlining 68Ga PSMA-PET positive scans are not available. We aimed to systematically review the current literature and perform a meta-analysis of the reported sensitivity and specificity of 68Ga PSMA-PET.

    Material & Methods

    We performed critical reviews of MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries and Web of Science databases in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Quality assessment was performed using Quality Assessment if Diagnostic Accuracy Studies-2 tool. Summary sensitivity and specificity values were obtained by fitting bivariate hierarchical regression models.

    Results

    Five studies reported on the predictive ability of PSMA-PET imaging with respect to histology proven disease, four on a per-patient basis and four on a per-lesion basis. On per-lesion analysis, the summary sensitivity is 80% and specificity is 97%. On per-patient analysis, the summary sensitivity and specificity is 86% though with the low numbers reported in the contributing studies, the confidence intervals are especially wide.

    Conclusions

    To date, pooled data has identified favourable sensitivity and specificity profiles compared to historical values of alternate PET imaging techniques.

  • Introduction & Objectives

    Enzalutamide significantly suppress the growth of prostate cancer, particularly metastatic Castration-Resistant Prostate Cancer (mCRPC), by targeting androgen receptor signaling pathway. However, there are paucity of evidences on the clinical benefits of enzalutamide in Korea. Here, we analyzed the real-world outcomes of enzalutamide treatment in Korean men with mCRPC following chemotherapy.

    Material & Methods

    We retrospectively reviewed the medical records of 110 mCRPC patients who received oral enzalutamide at a dose of 160 mg per day following chemotherapy in three tertiary centers in Korea between 2014 and 2016. Primary endpoint was Overall Survival (OS). Secondary endpoints were time-to first Skeletal-Related Event (SRE), time-to PSA progression and the PSA responsiveness. Kaplan-Meier analysis and log-rank tests were adopted to compare these oncological outcomes according to the various clinicopathological variables. Multivariate Cox regression model was used to identify the predictors for OS.

    Results

    All-cause mortality rate was 18.4% (N=18). The median overall and PSA progression-free were 18.2 months (95% confidence interval [CI], not yet reached) and 9.5 months (95% CI, 6.4 – 12.5), respectively. Notably, patients with poor ECOG scores (≥ 2), visceral metastasis, prior abiraterone treatment, and no concomitant hormonal therapy showed significant worse OS outcomes in Kaplan-Meier analysis (Fig.1). Conversely, there were comparable PSA responses in these subgroups. After adjusting confounding factors among various clinicopathological factors, we finally identified ECOG scores (≥ 2) [hazard ratio (HR), 3.28; 95% CI, 1.11 – 9.68], prior abiraterone treatment (HR, 5.29; 95% CI, 1.68 – 16.67), and concomitant androgen deprivation therapy (HR, 0.19; 95% CI, 0.05 – 0.76) as the independent predictors for OS.

    Conclusions

    In sum, this is the first report for the real-world outcomes of the post-chemotherapeutic enzalutamide in Korean men with mCRPC. Although our study included a small number of patients, it suggests the valuable information for the treatment of mCPRC in a Korean population.

  • Introduction & Objectives

    Urotensin II (UT-II) is a potent vasoconstrictor peptide and its receptor (UTR) was correlated with human cortico-adrenal carcinoma proliferation. In this retrospective study, we have evaluated the correlation between UTR expression and Gleason score of human prostate adenocarcinoma.

    Material & Methods

    We have evaluated the expression of UTR in 143 human prostate tissue samples of patients affected by prostate adenocarcinoma. All patients underwent prostate biopsy prior Radical Prostatectomy between 2009 and 2011. The mean age was 66,2 years (range from 50 to 74 years). Univariate associations between Gleason Score upgrading and clinical and tumour characteristics were assessed using either the chi square test or the Mann-Whitney U test. Multivariable logistic regression models were used to explore the independent role of UTR expression in predicting Gleason upgrading with respect to a set of base prognostic factors including PSA, primary and secondary Gleason score and muscle invasion. The predictive accuracy of the models was evaluated by ROC curve analysis and measured using the Area Under the Curve (AUC). Comparison among the different AUCs was carried out computing the bootstrap sampling distribution of the difference in the two AUCs.

    Results

    55 (38.5%) patients showed a Gleason score upgrading from biopsy on final pathology. The most frequent pattern (n=20, 36.4%) of upgrading was from a biopsy score of 3+4 to a RPP score of 4+3. At univariate analysis, lower primary Gleason, presence of muscle invasion ad higher UTR expression showed a significant association (p<0.001) with Gleason upgrading. Although patients with GS upgrading were characterized by higher PSA values (median [range] PSA: 6.6 [4.8 to 9.5] vs 5.8 [4.4 7.8]), this difference did not reach statistical significance (p=0.215). In a multivariable logistic model including both primary and secondary Gleason score, PSA, muscle invasion and UTR expression levels, patients with an high UTR expression showed a more than ten-fold increase in the odds of upgrading (O.R. 13.77, C.I. 3.1 to 62.5, p<0.001) with respect to patients with low UTR expression. In ROC analysis, this model predicted Gleason Upgrading with an AUC equal to 0.88 (95% C.I. 0.79 to 0.96, p<0.001). With respect to base model not including UTR, the absolute gain in predictive accuracy of the complete model was equal to 9% (p=0.042).

    Conclusions

    These data suggest that the dosage of UTR could be useful to identify a group of patients with a statistically significant high risk of upgrading from biopsy to radical prostatectomy.

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