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AUA 2011 Washington, D.C

Discover key highlights from AUA 2011 Washington, D.C. conference focusing on prostate cancer research and treatments including insights on active surveillance, HIFU, lymph node dissection, and more.

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AUA 2011 Washington, D.C

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  1. AUA 2011Washington, D.C

  2. OUTLINE • Prostate cancer • Urothelial, testis and other • Renal • Discussion and break • The PIVOT trial video • Discussion

  3. PROSTATE CANCER • PIVOT trial a major highlight • Large number of abstracts on RALRP • >70% of all RP in USA • Most interesting abstracts focused on other aspects of the disease • http://www.aua2011.org/index.cfm

  4. ACTIVE SURVEILLANCE • #1292 Fleshner- role of MRI at start • Concept of ‘TDF’ in 22% • Largely anterior and may be predicted by PSA density • #1638 Baltimore- role of 5R inhibitors • Retrospective cohort=> progression • No independent association with unfavourable biopsy at 2 years

  5. PROSTATE CANCER • #1298 Paris HIFU 5yr data • 260 pts at 5yr • Secondary therapy free 84%, 72%, 45% • 56% biopsy, only 55% negative at 3 yrs • Should only be offered to low risk pts • #997 North Carolina • 921 VA pts with RP, looked at lipid profile and risk factors • Chol assoc with increased BCR

  6. PROSTATE CANCER MSKCC – cohort showed decreased BCR, mets and death

  7. PROSTATE CANCER • 706 Van Poppel, Milan • aRTvs early salvage multiinstitutional • 420 pts 75% aRT, 25% early salvage PSA <0.5 • Matched case control design • Significant advantage in BCR for aRT • HR 0.38 p<0.001 • Maintained if earlier salvage, higher dosage 66Gy

  8. INTERMITTENT ADT • #716 Phase III intermittent vscontinous • Lisbon, median f/u 6yrs • Induction course, randomised if >80% drop or <4ng/ml • No change in OS (HR 0.96, p=0.61) • Non sig increase in Ca death offset by CVD death

  9. ABIRATERONE • #705 Molina, Montreal • RCT, double blind, placebo controlled • N=1195 mCRPC, progressed post docetaxel • Vs placebo and prednisone • Significant effect on OS, TTP, rPFS, PSA response • Objective response in 14%, and improved OS 14.8 vs 10.9 months

  10. LYMPH NODE DISSECTION • #473 and #474 • D’Amico low risk does not benefit from (limited) LND • Norfolk, n=211, retrospective • Scardino n=13000 multiinstitutional 1987-2006, median fu 4 yrs • Assoc of LNN with ACM, PCSM • Adjusted for age, yr, Ca characteristics • No assoc in any D’Amico risk group

  11. PROSTATE CANCER • #1783 Vickers • Analysis of Holmberg trial • 4.6% reduction in death at 10yrs is an amalgam • Young, high risk up to 17%

  12. UPPER TRACT UROTHELIAL • #665 Tolley, Scotland • N=62 over 10yrs • More ureterictumours in open group • No difference in any oncological parameter

  13. NMI BLADDER • #1648 Romania • Hexaminolevulinate Blue light cystoscopy • Prospective RCT 362 pts • BL=> higher detection and worse disease • 10% reduction in recurrence at 1 and 2 years • Largely ‘other site recurrence’

  14. MI BLADDER CANCER • Genetic evaluation/ profiles important • Selection for neoadjuvant therapy • Increasing trend for high risk disease

  15. MI BLADDER CA • #1599 St Louis • 181 pts median age 81 • Retrospectively compared RC vs other • No diff in tumor or comorbidity b/w groups • Univariate RC median survival 48 vs 16 months • Multivariate OS HR 0.47 (0.25-0.89)

  16. PENILE CANCER • #836 Munich • Prospective study of PET in assessing LNs • Specificity 98%, sens 88% • #975 Hungary • Dynamic SNB using gamma probe • All SNs identified n=36 • No recurrence if SNB –ve • ?Ideal in medium risk patients

  17. GERM CELL CANCER • #586 Durham, NC • Radiation exposure by stage and treatment modality • 10yr period NCCN guidelines • SGCT – s369mSv (23 AP CT), chemo 1.2, radiation 22 • NSGCT- s 339mSv (21 AP CT), chemo 114 • Guidelines need revision

  18. RENAL • Nephron sparing evolving to ‘zero ischaemia’ • Novel techiques • Hilarmicrodissection #940 • Temporary vascular occlusion Lumagel #1214 (animal model) • Wet monopolar knife #1217

  19. CVD∞GFR- an explanation • Diastolic dysfunction/ LVH • Renal • Abnormal calcium handling • 200mg/d excretion=>25mg day • Extra load from catabolic bone • Massive vascular depositon • Also positive phosphorous balance

  20. RENAL • http://www.siattend.com/MyAccount.aspx • Gill • Vascular and tumor anatomy 0.5 cm cuts with 3D recons • Hilarmicrodissection and micro bulldogs • Intraoperative ultrasound

  21. SURVEILLANCE SRM • #1663 Philadelphia • Pooled analysis of 18 series, n=936 • 2% mets • 33% zero growth with no mets • Mets assoc with faster growth, older pt and higher tumour size • If objective competing risks, then delayed intervention can be performed without negative sequelae

  22. NEPHROMETRY • #1271 • RENAL Nephrometry score to describe size/location/diffculty • Help decision making and comparison • NS is an independent predictor of ischaemia time • Esp 3 components of RNL

  23. RENAL BIOPSY • #704 Boston 1997-2010 • N=277/899- correlation with surg path • Not all core biopsy • PPV= 0.98 • NPV= 0.31 • Grade concordance 78%

  24. CYTOREDUCTION • #1776 San Diego • N=35 retrospective review of initial nephrectomyvs planned Nx post TKI • Groups similar • Non response to TKI (7/18) portends the worst prognosis • Nephrectomy post neoadj TKI did better than adj group

  25. CYTOREDUCTION • #1998 Wood, Madison WI • 75 pts with sunitinib with RCC in situ • >10% reduction in 90dd = early response and correlates with OS HR 0.18 (0.05-0.62) • May be a group to offer cytoreductivenehrectomy to?

  26. PIVOT • http://webcasts.prous.com/AUA2011/html/1-en/template.aspx?section=20&idl=18108&idcl=1

  27. PIVOT • Randomised, ITT, low contamination, minimised ascertainment bias • N=731, up to 75 yrs (mean 67) • Median f/u 10yrs (1994-2002) • Excluded cT3 • 50% palpable, 21% high risk, 70% <=Gl6 • 40% low risk

  28. PIVOT • All comers • No diff in OM or PCSM • D’Amico high risk (a priori?) • PCSM 8% ARR (HR 0.4) • PSA >10 • OM 13.2% ARR • PCSM 7.2%ARR (HR 0.38)

  29. THANK YOU

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