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AUA 2011 Washington, D.C

AUA 2011 Washington, D.C. OUTLINE. Prostate cancer Urothelial , testis and other Renal Discussion and break The PIVOT trial video Discussion. PROSTATE CANCER. PIVOT trial a major highlight Large number of abstracts on RALRP >70% of all RP in USA

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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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