AUA Abstract Roundup

Little Use of Neoadjuvant Chemotherapy Prior to Radical Cystectomy

The 108th American Urological Association (AUA) Annual Meeting held May 4-8 in San Diego, California, contained over 2,000 presentations focused on urologic medicine. This entry contains summaries of four abstracts focused on urothelial, testicular, and prostate cancer.Despite offering several potential benefits, neoadjuvant chemotherapy prior to radical cystectomy remains underutilized, a review of a large surgical database showed.

From 2005 to 2010, 8.9% of almost 900 cystectomy candidates received preoperative chemotherapy. Analysis of 135 variables failed to identify any compelling arguments against neoadjuvant chemotherapy.

“There is no increase in overall complication rate associated with neoadjuvant chemotherapy on bivariable analysis,” David Johnson, MD, of the Division of Urologic Surgery, Department of Surgery, at the University of North Carolina at Chapel Hill, concluded at a presentation.

“On multivariable analysis, there is no difference in postoperative complications, reoperation rate, wound dehiscence, wound or organ-space infection, or operative time for patients receiving neoadjuvant chemotherapy versus those who did not get neoadjuvant chemotherapy when accounting for all significant confounding variables,” he continued.

US Testicular Cancer Rates Increasing, Especially Among Hispanic Men

The favorable comparison makes a case for increasing the use of neoadjuvant chemotherapy prior to radical cystectomy, particularly given the well-documented 5-year survival benefit conferred by preoperative administration of platinum-based combination regimens, said Johnson. (Abstract 137)Another study reported at the AUA meeting documented a continued rise in the incidence of testicular cancer in the United States. Previous studies showed an increased rate of testicular cancer from 1992 to 2003.

Spanning the years 2003 to 2009, the new data from the National Cancer Institute Surveillance, Epidemiology, and End Results program showed that Caucasian men have the highest rate of testicular germ-cell tumors (8.6 cases/100,000 in 2009, compared with 7.5/100,000 in 1992. However, the largest increase occurred among Hispanic males (4.0/100,000 in 1992 versus 6.3/100,000 in 2009). Reasons for the increase are unknown, but speculation has included environmental factors and various types of in utero exposures, said Scott Eggener, MD, associate professor of Surgery/Urology at the University of Chicago Medical Center. (Abstract 933)

Better Survival With Radical Prostatectomy Over Radiotherapy

Long-term results from a Swedish study pointed to better survival with radical prostatectomy versus radiation therapy for prostate cancer. The analysis included 34,515 men with prostate cancer listed in a national registry. The study population consisted of 21,533 patients treated surgically and 12,982 treated by radiation therapy.

With a 15-year follow-up, the investigators found that prostatectomy improved survival for patients with localized prostate cancer, and results were similar between the two modalities for locally advanced/metastatic cancer.

More Urinary Incontinence in Older Prostate Cancer Patients

Hazard ratios showed significant benefits for surgery with respect to prostate cancer-specific mortality in men with low- and intermediate-risk disease, younger patients, and those with lower comorbidity scores. Radiotherapy was superior for older men (65-74) with advanced cancer, Peter Wiklund, MD, professor, Urology Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden and colleagues reported. (Abstract 335)An analysis of urinary incontinence and bother in older prostate cancer patients suggested a higher burden of urinary health problems than previously recognized. About 60% of 706 men 65 or older reported incontinence. Multivariate analysis showed that surgical management was associated with a prevalence ratio (PR) of 4.68 versus similar-age patients without prostate cancer, followed by those treated with androgen deprivation therapy (PR 2.01), active surveillance (PR 1.92), and radiation therapy (PR 1.64). Only radiation therapy was not associated with an increased rate of urinary bother, Ryan Kopp, MD, of the Division of Urology at the University of California, San Diego, and colleagues reported in a poster presentation. (Abstract 435)

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