Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 9

27TH CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
Free papers and posters
01 Initial management of prostate cancer: First year
experience of extended registration within the Norwegian
National Prostate Cancer Registry (NoPCR)
E Hernes* 1' E Hem2' A Kyrdalen3- R Kvále1,0 Klepp4' K Axcrona5' SD Fossá3
'Cancer Registry ofNonvay, Oslo University Hospital, The Norwegian Radium
Hospital, !Dept. ofSurgery, Akerhus University Hospital, Nordbyhagen,
3Cancer Clinic, Oslo University Hospital, The Norwegian Radium Hospital,
4Dept. ofOncology, Álesund Hospital, 5Dept. ofSurgery, Oslo University
Hospital, The Norwegian Radium Hospital, Norway
Eiwr.Hernes@kreftregisteret.no
Background: Evaluation of a country's management of prostate
cancer patients requires population-based prognostic and
therapeutic parameters, thus, in 2004 a Norwegian Prostate
Cancer Registry (NoPCR) was established as a sub-registry of
the CR. Initial management of the year 2004 pts was evaluated
based on 2003 EAU guidelines.
Method: TNM categorization, PSA and Gleason score were
recorded together with initial treatment. Patients with T1-3N0-
XM0-X disease, age <75 years, and good health were identified
as "candidates for immediate curative local treatment"
(CurCands), and were allocated to risk groups.
Results: Compared to CR registration the NoPCR compliance
rate was 96% (N=3833). Among 1650 CurCands such treatment
was performed in 57% of low-risk pts (287 of 500), and in 64%
of intermediate- and high-risk pts (735 of 1150). In low-risk
pts curative treatment was more likely with T2 tumours. In
intermediate- and high-risk CurCands, PSA was the strongest
factor determining the performance of curative treatment.
Adjuvant post-RP radiotherapy was applied in only 4 of 142 pts
with tumour-involved margins.
Conclusion: According to the NoPCR initial prostate cancer
management in Norway was largely in accordance with
the 2003 EAU guidelines, though there was some evidence
for "undertreatment" of intermediate- and high-risk pts.
Some improvement of the NoPCR's data collection is
warranted. National prostate cancer registries may contribute to
improvement of these pts' medical care.
02 Tumour negative prostate biopsies prior to later
cancer diagnosis and radical prostatectomy
C Gade, M Mortensen, M Borre
Departmenl of Urology, Aarhus University Hospital, Skejby, Denmark
christinagade@hotmail.com
Aim: To characterize patients with tumour negative prostate
biopsies at first test prior to later prostate cancer diagnosis and
radical prostatectomy (RP).
Patients and materials: Data concerning 535 radical
prostatectomized patients prospectively collected for "the
Aarhus PC-project".
Results: Totally 79 (13%) radical prostatectomized patients had
tumour negative prostate biopsies prior to later cancer diagnosis
being characterized as typical young (<63 years; p=0.005) men
with PSA > 10 ng/mL (p<0.001), cTlc (65%), Gleason 6 or 7
(75%) tumours in a few (1-2) positive biopsies (p=0.02). They
postoperatively typically harboured pT2c tumours (62%), while
only 13 (16%) had pT3 disease (p=0.01). After treatment there
existed no statistically significant difference in risk of disease
recurrence (p=0.97) compared to patients with tumour positive
biopsies at first biopsy test.
Conclusion: Radical prostatectomized patients with a set
of tumour negative prostate biopsies are characterized as
relative young men with non-palpable tumours and high PSA.
Postoperatively these patients match radical prostatectomized
patients with no previously tumour negative biopsy tests and
have a similar outcome. Relatively young men with inexplicable
high PSA should be re-biopsied if biopsies at first test do not
point out tumour.
03 Perineal biopsies of the prostate in patients with
previous negative biopsies
M Dimmen, K Axcrona, B Brennhovd
Radiumhospitalet, Deptfor Surgical Oncology, Rikshospitalet HF, Oslo, Norway
magne.dimmen@radiumhospitalet.no
Aim: To evaluate the diagnostic yield of perineal prostate
biopsies in patients with elevated PSA and previous negative
transrectal biopsies.
Material: 57 patients referred to our hospital for perineal
prostate biopsies over a period of 18 months. Patients were
given iv sedation and local anaesthetic, biopsies were obtained
TRUS-guided. 43 patients had an MRI of the prostate prior to
biopsy.
Results: 57 patients had previously had a mean of 2,47 biopsy
series (0-7, median 2), pre biopsy PSA was mean 20,4 (4,3-229,
median 12). A mean of 19,5 biopsy cores were taken (1-36).
Of 57 patients, 32 were diagnosed with cancer. 13 patients have
been operated with robotic assisted prostatectomy and 8 are
scheduled for operation. 2 patients have started AD and EBRT.
1 patient had a recurrence of rectal cancer and died within a few
months. 7 patients are followed on active surveillance. Of 13
patients operated, 5 had a stage pT2c with Gleason grade 3+4 or
4+3, 7 had a pT3 with Gleason grades 4+3 (3), 4+4 (3) and 4+5
(1). Few complications were registered relating to the biopsy
procedure; one patient had bacteraemia and two patients had
acute urinary retention.
Conclusion: Perineal prostate biopsy is a simple technique, but
requires iv sedation. The technique can be used in patients with
a closed anal orifice after previous surgical treatment.
Prostate cancer was diagnosed in 56% of the patients, 78% of
these were regarded as clinically significant and have started
active treatment.
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