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Prostate Disease EAU Highlights 19-20 March 2011

Prostate Disease EAU Highlights 19-20 March 2011. Simon F Brewster Churchill Hospital, Oxford. Apologies to those authors whose good work is not mentioned due to time constraints; Abstract Book number indicated in parentheses; RCT = Randomised Controlled Trial IHC = Immunohistochemistry

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Prostate Disease EAU Highlights 19-20 March 2011

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  1. Prostate Disease EAU Highlights 19-20 March 2011 Simon F Brewster Churchill Hospital, Oxford

  2. Apologies to those authors whose good work is not mentioned due to time constraints; • Abstract Book number indicated in parentheses; • RCT = Randomised Controlled Trial • IHC = Immunohistochemistry • RALP = Robot-assisted Radical Prostatectomy • BCR = Biochemical Recurrence • CSS = Cancer-specific survival

  3. BPH: Basic Science • Ückert (549) showed with IHC PDE5 co-localises with key mediators of the Nitric Oxide pathway in human prostate TZ smooth muscle

  4. BPH: Medical • Gacci (334) RCT: following 2 weeks Tam alone, 60 patients randomised to combination Vardenafil 10mg + Tamsulosin vs. placebo + Tam 12 weeks improved erectile function and storage LUTS; • Hamidi Madani (335) and Roerhborn (336) demonstrated in RCTs (n=132 & n=606) daily Tadalafil improves IPSS (= to alpha-blockers), ED and QoL

  5. BPH: Medical • Van Kerrebroeck (327): Tamsulosin OCAS + Solifenacin RCT (n=930): IPSS improved for patients with BOO and “substantial” storage LUTS using combination; • Roerhborn (329) COMBAT RCT (n=4844) subgroup analysis by prostate volume (PV), demonstrated that after 4 years treatment combination Tamsulosin + Dutasteride significantly improved IPSS, QoL, Qmax at all PV >30cc, except in glands >58cc treated with Dutasteride alone.

  6. BPH: Injection Therapy • Marberger (325) reported RCT (n=380), 47% failing tamsulosin for LUTS/BOO. Intraprostatic injection of BotoxA significantly reduced IPSS vs. placebo in failed Tam cases; • Mirkin (440) mean PSA reduced by 40% 6 months after intraprostatic injection of BotoxA

  7. BPH: surgery • Chandrasekar (114), Geavlete (115), Neyer (116), Mamoulakis (117) & Yip (118) conducted small RCTs of monopolar TURP vs bipolar or plasmakinetic vaporisation: short-term results - complications, catheter time - favoured the newer technologies;

  8. Prostatitis • Abughosh (587) studied 500 Canadian men undergoing TRUS & biopsy: 21 % rectal swabs grew ciprofloxacin-resistant bacteria, mostly E. coli; Trend towards less sepsis in patients given iodine rectal wall cleaning; • Lee (589) reviewed 52 patients with prostatic abscess 2000-2010 in Seoul. TUR drainage resulted in shorter hospital stay & less risk of recurrence vs. TRUS-guided needle drainage.

  9. Cancer: Basic science/translational: • Angulo (401), Ropero (512) & Stadler (510) performed DNA hypermethylation profiling of tumor /benign samples; each identified a panel of genes frequently methylated in high-grade & stage disease and in RP patients experiencing BCR, including tumor suppressor gene APC; • Boormans (406) Gene fusions & Erg expression using IHC may aid PIN and cancer diagnosis within prostate biopsies;

  10. Cancer: Basic science/translational • Dahlman (526) & Hoogland (746) reported IHC for β-microseminoprotein (MSMB) is predictive for BCR in RP specimens, but not in needle-biopsies of RP patients; • Morgan (123) evaluated urinary transcription factor EN2 in 190 PC patients / controls, concluding it is a highly specific and sensitive candidate biomarker of prostate cancer.

  11. Cancer: Basic science/translational • Brown (620) & Yokomizo (833) Statins reduce: Invasive behaviour & colony morphology; AR sensitivity & amplification; • Fankhauser (631) studying CRPC cultures, adrenal androstenedione is major precursor for intraprostatic testosterone synthesis; • Donovan (643) ProTect study: serum IGF-I does not correlate with screen-detected cancer risk, unlike IGFII, -BP2 & 3.

  12. Cancer: PSA Screening Schröeder (15) ERSPC Rotterdam (n=35150): Screening reduced metastatic disease by 30% over a median 11 year follow-up, becoming obvious after 5 years: NNT=23

  13. Cancer: PSA Screening • Frånlund (23) & Roobol (24) reported the presence of LUTS to reduce risk of cancer diagnosis in screened Swedish & Dutch populations; • Zhu (20) Bul (419) & Santti (25): Interval cancers in ERSPC were significantly more aggressive and lethal than screen-detected cancers; could shortening the screening interval below 4-years improve CSS?

  14. Cancer: Screening & Diagnosis Roobol (16) & Van Vugt (17): ERSPC Risk Calculator was upgraded to predict high-grade and advanced disease; it outperforms PSA alone in both screened and clinically-referred men

  15. Cancer: Diagnostics • Miyakubo, Stephan, Semjonow, Lazzeri, Bektic & Nava (128-131, 635,636) studied serum pro-PSA & “prostate health index” ([phi=[-2]proPSA/fPSA)x√tPSA] Beckmann Coulter combined assay): more accurate than total PSA and predicts aggressive disease features; • Arumainayagam (133) evaluated Multi-parametric MRI using TPB reference in 65 patients, finding >85% NPV for significant PC.

  16. Cancer: Biopsy • Roy (307) correlated multiple biopsy procedures to worse potency after NS-RALP; • Ahmed (528), Lecornet (533) & Hameed (313) conducted studies suggesting that men considering repeat biopsy or undergoing Active Surveillance should be evaluated with Transperineal template biopsy after initial TRUS-guided biopsy to reduce risk of under-diagnosis

  17. Radical Prostatectomy • Calza (456) RCT LRP vs RARP (n=100) less opiate and “rescue” analgesia required for robotic cases; • Videos: Trinh (V22), Wagner (V24) & Srivastava (V27) demonstrated the V-Loc™ polyglyconate absorbable barbed suture RCT in posterior reconstruction & vesico-urethral anastomosis, saving 2 - 8 minutes per case

  18. Cancer: Node Staging Joniau (568) LN mapping in 65 RPs using a “super-extended” template: only 39% correctly staged by obt. LND; standard ePLND missed 21% N+ cancer

  19. Cancer: Node Staging • Schiavina (562) & Briganti (567): ePLND improved BCR-free survival regardless of nodal status; • Joniau (563) conducted multivariate analysis of 781 high-risk RP, concluding number of LN removed did NOT correlate with CSS; • Briganti (566) correlated number +ve nodes, regardless of location, with CSS in 372 N+ patients following RP/ePLND

  20. Cancer: Node Staging • Schiavina (565) A monolateral LN dissection on the side of unilateral positive biopsy missed 20-35% contralateral N+

  21. Adjuvant Radiation Therapy • Bolla (218, 227) presented 10-year results of EORTC 22911 Adjuvant RT vs Wait & See (n=1005); No difference in overall survival; Conflicting results of SWOG S8794 possibly explained by > risk factors in SWOG patients; • Gallina (674) reviewed 1123 RP patients, presenting data suggesting full continence recovery may be delayed or prevented by adjuvant RT

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