Login to Access Video or Poster Abstract: MP53-13
Sources of Funding: None

Introduction

Up front tailor-made wide excision surgery is sometimes offered to men as part of combined modality treatment with adjuvant radiotherapy +/- androgen deprivation therapy (ADT) for high risk and non-metastatic prostate cancer. Particularly young men want to avoid long periods of ADT which is required for primary radiotherapy treatment. Upfront surgery is therefore seen as a reasonable alternative to achieve cure without ADT. We prospectively assessed short term PSA recurrence rates, the need for adjuvant radiotherapy and ADT._x000D_

Methods

278 patients with high risk PCa (47.5% were locally advanced), underwent laparoscopic or robotic radical prostatectomy with pelvic lymphadenectomy from July 2007 to July 2016 at three inner London tertiary referral centres. D&[prime]Amico criteria (cT2c, PSA>20, Gleason grade 8-10) were used to define high risk._x000D_ Supersensitive PSA measurements were used. PSA recurrence was defined as two tests results above 0.02. Kaplan-Meier survival estimates were generated. A small number of patients were offered radiotherapy +/- ADT for undetectable PSA nadir based on the presence of pathological risk factors. Some patients were randomised to the RADICALS study(CRUK/07/008)._x000D_ Uni and multivariate analysis was performed on all available variables. Kaplan-Meier estimates were calculated. Cox multivariate regression analysis was computed to identify pre- and post-operative factors associated with PSA recurrence.

Results

Median follow up was 34 months (range 0.9-98 months). Of all patients 55.4% did not have PSA recurrence, 38.1% required radiotherapy and 25.2% ADT. Positive margins (p=0.014)and tumour volume (p=0.041) were independently predictive of PSA recurrence. _x000D_ Tumour volume >4cm3 may be predictive of almost certain biochemical recurrence with supersensitive PSA. 5 year free recurrence survival was 51% globally and 50.3% and 18.4% for tumour volume <4cm3 and >4cm3 respectively.

Conclusions

Young men may have a high chance to avoid ADT (75% in three years) if treated with surgery alone or in combination with radiotherapy. _x000D_ Tumour volume in addition to margin status is a strong predictor of biochemical recurrence in high risk prostate cancer. _x000D_ Since tumour volume can now be obtained pre-operatively with later generation CAD (computer-aided design) software it could be a meaningful pre-operative risk stratification tool for treatment selection and new study designs._x000D_

Funding

None