Mp14-02 Identify the Optimal Candidates for Adjuvant Androgen Deprivation Therapy Among Patients With Detectable Psa After Radical Prostatectomy

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II (MP14)1 May 2024MP14-02 IDENTIFY THE OPTIMAL CANDIDATES FOR ADJUVANT ANDROGEN DEPRIVATION THERAPY AMONG PATIENTS WITH DETECTABLE PSA AFTER RADICAL PROSTATECTOMY Francesco Pellegrino, Ugo G. Falagario, Sophie Knipper, Alberto Martini, Olof Akre, Markus Aly, Marcio C. Moschovas, Carlo A. Bravi, Joshua Tran, Yasmin Heiniger, Antonius von Kempis, Robin Schaffar, Giuseppe Carrieri, Alberto Briganti, Francesco Montorsi, Charles-Henry Rochat, Alexandre Mottrie, Thomas E. Ahlering, Hubert John, Vipul Patel, Markus Graefen, and Peter Wiklund Francesco PellegrinoFrancesco Pellegrino , Ugo G. FalagarioUgo G. Falagario , Sophie KnipperSophie Knipper , Alberto MartiniAlberto Martini , Olof AkreOlof Akre , Markus AlyMarkus Aly , Marcio C. MoschovasMarcio C. Moschovas , Carlo A. BraviCarlo A. Bravi , Joshua TranJoshua Tran , Yasmin HeinigerYasmin Heiniger , Antonius von KempisAntonius von Kempis , Robin SchaffarRobin Schaffar , Giuseppe CarrieriGiuseppe Carrieri , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Charles-Henry RochatCharles-Henry Rochat , Alexandre MottrieAlexandre Mottrie , Thomas E. AhleringThomas E. Ahlering , Hubert JohnHubert John , Vipul PatelVipul Patel , Markus GraefenMarkus Graefen , and Peter WiklundPeter Wiklund View All Author Informationhttps://doi.org/10.1097/01.JU.0001009428.69695.82.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The ideal management of patients with detectable PSA after Robot assisted radical prostatectomy (RARP) remain unclear. While salvage radiotherapy (RT) appears to improve oncologic outcomes in selected patients, the benefit from androgen deprivation therapy (ADT) has to be confirmed. We aimed to develop a model to predict cancer-specific mortality (CSM) and to test the impact of ADT on survival in this setting. METHODS: Retrospective analysis of the ERUS scientific working group international multicenter database including men who underwent RARP between 2002-2012. We included men with detectable PSA (≥0.1) 1-3 months after RARP and with a postoperative follow-up ≥10 yr for survival. A multivariable COX model predicting CSM was developed in patients who did not receive ADT using PSA at 1-3 mths after surgery, pT stage (<3 vs ≥3), pN stage (pNx-0 vs pN1), ISUP grade group (GG <4 vs ≥4), and positive surgical margins. The 10-yr CSM risk was calculated for each patient using the multivariable coefficients. We tested an interaction with groups (postoperative ADT vs no ADT) and the probability of dying from PCa according to the newly developed model. This analysis was adjusted for salvage RT. The LOWES function was used to explore the relationship between baseline CSM risk and 10-yr CSM rates according to postoperative ADT. RESULTS: Among 9875 men undergoing RARP, 3173 men had a PSA ≥0.1 after RP and were included in the present study. Overall, 45% and 2.5% of the patients were pT ≥3 and pN1, respectively. 9% of the patients had ISUP GG ≥4. Median PSA at 1-3 months was 0.10 (IQR 0.1-0.1). Moreover, 61 and 35 patients received ADT and RT after RARP, respectively. At a median follow-up for survival of 129 mths, 47 patients died for prostate cancer. At COX, PSA at 1-3 months after surgery, pT and pN stage, and GG were significantly associated with CSM (p<0.004). Our prediction model showed excellent accuracy (AUC 0.87). Median nomogram-predicted probability of 10-yr CSM was 4% (IQR 2-8%). Postoperative ADT was beneficial when the predicted risk of CSM was ≥6% (p 0.001 by an interaction test) Figure 1. CONCLUSIONS: Adjuvant ADT improves oncological outcome in some patients with persistent PSA after RP. Particularly, ADT should be considered in patients with detectable PSA after RP and a 10-yr CSM risk ≥6%. Download PPT Source of Funding: No © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e219 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Pellegrino More articles by this author Ugo G. Falagario More articles by this author Sophie Knipper More articles by this author Alberto Martini More articles by this author Olof Akre More articles by this author Markus Aly More articles by this author Marcio C. Moschovas More articles by this author Carlo A. Bravi More articles by this author Joshua Tran More articles by this author Yasmin Heiniger More articles by this author Antonius von Kempis More articles by this author Robin Schaffar More articles by this author Giuseppe Carrieri More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Charles-Henry Rochat More articles by this author Alexandre Mottrie More articles by this author Thomas E. Ahlering More articles by this author Hubert John More articles by this author Vipul Patel More articles by this author Markus Graefen More articles by this author Peter Wiklund More articles by this author Expand All Advertisement PDF downloadLoading ...