1. 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

2. 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

3. 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

4. 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.

5. 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

6. 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;

7. 72 (22,9%)
138 (44%)
104 (33,1%)
In last year approximately 45 % cases were applied to NCO with localized disease

8. 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%)

9. “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”.

10. 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

11. Postoperative findings
February 2010 – November 2015
Non-nerve sparing RRP
Lymph node metastases (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)

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

13. 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

14. 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

15. 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

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

17. “Poiseuille equition”
Increased length = Decreased flow

20. Thank you very much for your attention