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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

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
  • RALP = Robot-assisted Radical Prostatectomy
  • BCR = Biochemical Recurrence
  • CSS = Cancer-specific survival
bph basic science
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
bph medical
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
bph medical1
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.
bph injection therapy
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
bph surgery
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;
  • 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.
cancer basic science translational
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;
cancer basic science translational1
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.
cancer basic science translational2
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.
cancer psa screening
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

cancer psa screening1
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?
cancer screening diagnosis
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

cancer diagnostics
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.
cancer biopsy
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
radical prostatectomy
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
cancer node staging
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

cancer node staging1
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
cancer node staging2
Cancer: Node Staging
  • Schiavina (565) A monolateral LN dissection on the side of unilateral positive biopsy missed 20-35% contralateral N+
adjuvant radiation therapy
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