Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 12

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
value of preoperative prediction of recurrence by combining
the D'Amico risk group stratification and the fraction of tumour
positive biopsies was 0.82 and 0.41 respectively.
Conclusion: Radical prostatectomized patients harbouring
extra capsular (pT3) tumours have a highly significantly poorer
oncological outcome than those with localized (pT2) disease. For
T3 tumour patients the preoperative prediction and the choice
of optimal therapy remain controversial and important future
challenges.
11 Decreased seeds migration with Mick-applicated
Loose 125l-seeds in prostate brachytherapy
M Hojgaard1, AAJassem1, N Norgaard1, K Andersen2, KJ Mikines1
1Department ofUrology and 2Department ofOncology, Copenhagen University
Hospital Herlev, Denmark
martin@hojgaard.com
Introduction: Previous studies of seeds migration in prostate
brachytherapy have found an increased migration of loose seeds
compared to stranded seeds. In December 2006 we changed
from RAPID strand (Oncura, Arlington Heights IL) to loose 1-125
seeds (Bard, Covington GA) implanted using a Mick-applicator
(Mick Radionuclear Instruments, Mount Vernon NY).
To compare seeds migration we studied 49 consecutive patients
with complete 1 year follow-up implanted with loose seeds (LS),
and 47 consecutive patients with complete 1 year follow up who
had RAPID strand seeds (RS) implanted.
Methods: All patients had plain film radiographs of the prostate
(AP-plane and 2 angulated) after 1 day (1 d), 30 days (30 d) and
1 year (360 d) of the seed implantation. Seeds were counted at
implantation at day 0 and number of migrated seeds, prostate
volume, patient age, pre-treatment PSA and Gleason score
were recorded. All implants were performed by the same two
surgeons.
Results: The two groups had comparable pre-operative
characteristics.
Table 1: Population characteristics
LS (mean (SEM)) RS (mean(SEM))
Age (years) 63.2 (6.9) 63.0 (5.6)
Prostate Size (cc) 34.3 (7.7) 36.7 (6.7)
PSA pre-treatment (ng/ml) 6.6 (3.3) 7.1 (3.4)
Gleason score 6.3 (0.9) 6.3 (0.9)
Both LS and RS seeds exhibited small, but significant migration
throughout the 360 day follow up. 31 of 47 (66%) RS patients had
seeds migration after 360 days, which was significantly more
compared to the migration in the LS group with 20 out of 49
(41%) (p<0.01, Chi2).
The absolute amount of migrated seeds after 360 days was
significantly higher in the RS group (62) compared to the LS
group (32) (p<0.005).
Table 2: Seeds migration - seed loss at 1, 30 and 360 days
Total Seeds Loss 1 d Loss 30d Loss 360d
LS 2842 12(0.4%)* 26 (0.9%)* 32 (1.1%)*§
RS 3171 5 (0.2%)f 35 (1.1 %)f 62 (2.0%)tt
LS group:* p<0.006 compared to seeds implanted at day 0 § p=0.013 compared to seeds at day 30 RS group: t p<0.02 compared to seeds implanted at day 0 t p<0.001 compared to seeds at day 30
Conclusions: Small but significant seeds migration occurs
with both LS and RS during the entire first year. Loose strand
seeds exhibit less migration, compared to Rapid Strand seeds.
Whether this decreases the risk of PSA-failure requires further
studies.
12 A phase III study of endocrine treatment with or
without radiotherapy in locally advanced or high-risk
localized prostate cancer
SD Fossá on behalf of participants in SPCG-7/SFUO-3
Oslo University Hospital, The Norwegian Radium Hospitai, Oslo, Norway
sdf@radiumhospitalet.no
Aim: This phase III trial compares the efficacy of radiotherapy
+ continuous hormone treatment (RT + HT) compared to HT
alone in locally advanced or high-risk localized prostate cancer.
Methods: Between 1996 and 2002, patients with locally
advanced or histologically high-risk localized prostate cancer
were randomized to RT + HT (N: 439) or HT (N: 436) with
cancer-specific mortality as primary end-point. HT consisted of
3 months of total androgen blockade followed by continuous
treatment with flutamide. Mortality and side-effects were
evaluated in February 2008.
Results: After a median follow-up of 7.6 years 79 men in the HT
and 37 men in the Rt + HT group had died of prostate cancer, the
cumulative prostate cancer-specific mortality at 10 years being
23.9% and 11.9% respectively. The comparable rates for overall
mortality were 39.4% and 29.6% respectively. Age at diagnosis
(s75 years) and initial PSA (s70 pg/1) did not influence on the
superiority in the RT + HT group. After 5 years the rates of
urinary, rectal and sexual problems were slightly higher in the
RT + HT than in the HT group.
Conclusion: In patients with locally advanced or high-risk
localized prostate cancer the addition of RT to HT doubles
cancer-specific survival and substantially reduces overall
mortality, with an acceptable profile of long-term treatment-
induced morbidity. These findings justify that RT + HT should
become standard treatment for these patients.
13 The CASODEX EPC program - 10 years of follow-up
P Iversen1, D McLeod2, M Wirth3, W See4, T Morris5
'Department of Urology, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark; 2Walter Reed Army Medical Center, Washington,
DC, USA; 3Technical University of Dresden, Dresden, Germany; 4Medical
College of Wisconsin, Milwaukee, Wisconsin, USA; 5AstraZeneca,
Alderley Park, Macclesfield, UK
piv@rh.regionh.dk
Aim: The Early Prostate Cancer program is the largest hormonal
12 LÆKNAblaðið 2009/95