Surgery for high-risk prostate cancer: The results of first 80 cases Fuad GULIYEV MD, FEBU National Center of Oncology Baku, Azerbaijan Dear colleques, dear friends!!! At first I would like to thanks the organizing committee for their kind invitation and the opportunity to participate on this woundeful meeting. In next 15 minutes I will try briefly explain the current situation with Pca in Azerbaijan and share our experience of radical prostatectomies for high risk Pca

Cure the patient Achieve the local control Decrease the tumor burden   Cure the patient Achieve the local control Decrease the tumor burden Prolong the disease-free and overall survival Achieve the success in adjuvant treatment Decrease the probability of metastases Maintain the QoL I will not discuss the advantages of surgery and compare it with another treatment modalities, but I mention the basic goals of oncologic surgery

Locally advanced LN + HRPCa PIN Organ confined Disseminated 2 decades ago we stayed at this point. But today the indication for surgery moved toward advanced diseases Disseminated

Please pay your attention to the date on tis picture Please pay your attention to the date on tis picture. 2005, at that time Prof van Poppel discussed the eligibility of surgery for locally advanced Pca. Of course there is no strict border between high-risk and locally advanced Pca? But we have to know that in both situations surgery can be curable, or at least be a part of multimodal treatment.

Dynamics of incidence and mortality for PCa in Azerbaijan   If we look at this slide, we noted the slight increase in At first I would like briefly to explain the current situation with Pca in Azerbaijan. If we look at incidence and mortality rates for Pca in last 15 years we can note the slight increase in these rates. Of course the increasing rates mostly due to the increased number of newly diagnosed cases

Most common cancers in men population   Worldwide IARC (24 countries) Europe (28 countries) US Azerbaijan* 1 Lung Prostate 2 Colorectal 3 Gastric 4 Bladder 5 Liver Kidney Brain When we compare the results of incidence between the US, European countries and Azerbaijan we noted that Prostate Cancer takes the 4 forth place State Statistical Committee of Azerbaijan Republic Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray, F. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. http://globocan.iarc.fr

  72 (22,9%) 138 (44%) 104 (33,1%) In last year approximately 45 % cases were applied to NCO with localized disease

Preoperative data Age, mean±SD (years) 62,9±0,7 (49-73)   Age, mean±SD (years) 62,9±0,7 (49-73) Total PSA, mean±SD (ng/ml) 18,9±1,3 (4,5-49,3) Free PSA, mean±SD (ng/ml) 3,2±0,5 (0,79-11,0) Free/Total PSA, mean±SD (%) 21,1±3,2 (4-77) PSA dansity, mean±SD (ng/ml/cm3) 0,43±0,33 (0,05-1,4) Gleason score , mean±SD 6,6±0,7 (6-9) Positive core number, mean±SD 5,4±0,4 (1-10) Maximal tumor per core, mean±SD (%) 60,7±4,3 (20-100) Number of cores with %50 tumor, mean±SD 2,3±0,4 (0-9) Clinical stage, (%) ≤ T2 46 (57,5%) > T3 34 (42,5%)

“Small surgery for big cancer, and Big surgery for small cancer”. P.C. Walsh “Small surgery for big cancer, and Big surgery for small cancer”.

Apical dissection SV removal Nerve-sparing ??? Denonvilliers fascia   Apical dissection SV removal Nerve-sparing ??? Denonvilliers fascia Wide excision of bladder neck Extended lymph node dissection

Postoperative findings   February 2010 – November 2015 Non-nerve sparing RRP Lymph node metastases - 11 (13,7%) patients Removed LN, (n) 26,4±1,9 (22-39) Positive LN, (n) 3,1±0,6 (1-6) Tumor volume, (%) 40,4±2,9 (5-85) Gleason score 6,6±0,1 (6-9)

Postoperative findings   pT2a pT2b pT2c pT3a pT3b cT1c - 2 4 cT2a cT2b 6 8 cT2c 18 30 cT3a 10 20 cT3b 14 44 80

Biochemical free survival   18 (22,5%) patients BCR 8 (10%) patients SM (+) Follow-up 17,9±1,3 (12-66) months Time to BCR 8,1±1,3 (3-18) months

Biochemical free survival   Variables P value Age at diagnosis 0,461 Total PSA 0,967 PSA dansity 0,885 Positive core number 0,830 Maximal tumor per core 0,169 Number of cores with %50 tumor 0,713 Tumor volume 0,937 Gleason score (RRP) 0,018 Surgical margin 0,111 Pathological stage 0,017 LN metastases <0,001

Complications I II IIIa IIIb IVa IVb V Lymphorrhoea (>7 days) 3   Complications I II IIIa IIIb IVa IVb V Lymphorrhoea (>7 days) 3 Lymphocele 2 Urinary leakage 4 Hematuria 1 Obstruction of distal ureter Pneumonia Acute coronary syndrome Gastric atony Catheter-associated UTI Deep venous thrombosis Overall 7 6

Radical Prostatectomy Complications   EAU Prostate cancer guidlines 2012, Walz J, Acute and late morbidity of surgery, ESTRO Multidisciplinary prostate cancer course, Madrid 2013

  “Poiseuille equition” Increased length = Decreased flow

 

Thank you very much for your attention