Physician-scientists from NewYork-Presbyterian Hospital/Columbia University Medical Center will present their latest research findings at the American Urological Association Annual Meeting in San Francisco, May 29 to June 3. Among the most significant presentations are the following:
•Statin Drugs, Prostate-Specific Antigen and Biochemical Outcome Following Radical Prostatectomy
Dr. Mitchell Benson
Urologist-in-chief at NewYork-Presbyterian Hospital/Columbia University Medical Center, and the George F. Cahill Professor and chairman of the Department of Urology at Columbia University College of Physicians and Surgeons
Statin use has significantly increased in recent years and studies suggest that these medications may decrease the risk of prostate cancer, particularly advanced disease. Statins have also been shown to lower PSA levels but there is limited data regarding their effect on biochemical outcome following local therapy. Dr. Benson and his co-investigators sought to determine the association between statin use, pre-operative PSA and biochemical recurrence (BCR) following radical prostatectomy. They found that pre-operative PSA levels are lower for statin users than non-users. Furthermore, statin use may decrease BCR-free survival following radical prostatectomy, and this may be partly due to the PSA lowering effect which would thereby delay diagnosis and/or mask aggressive disease at the time of surgery.
•The Correlation Between Number of Lymph Nodes Removed During Radical Prostatectomy and Surgical Margin Status
Dr. Mitchell Benson
Urologist-in-chief at NewYork-Presbyterian Hospital/Columbia University Medical Center, and the George F. Cahill Professor and chairman of the Department of Urology at Columbia University College of Physicians and Surgeons
In patients undergoing radical prostatectomy (RP) for prostate cancer, variability in surgeon technique has been shown to be associated with surgical margin status, which in turn has been shown to be associated with risk for biochemical recurrence (BCR). As such, surgical technique may play a role in a patient's risk of BCR. It has been shown the number lymph nodes (LN) removed correlates with overall survival. Furthermore the number of LN removed could serve as a surrogate for the quality of RP. The investigators sought to determine whether number of LN removed — a surrogate for surgeon technique — is predictive of margin status during RP. They found that patient race, preoperative PSA, pathological Gleason score, and pathological T-stage were associated with and independent predictors of a positive surgical margin. However, the number of LN removed, which has been associated with overall survival, was not found to correlate with negative surgical margin rate. Therefore it is unlikely that the benefit provided by the number of LN removed is due to the impaired control of the primary tumor.
•The Impact of Diabetes and Metformin Use in Clinically Localized Prostate Cancer Treated by Radical Prostatectomy
Dr. James McKiernan
Director of urologic oncology at NewYork-Presbyterian Hospital/Columbia University Medical Center, and the John and Irene Given Associate Professor of Urology at Columbia University College of Physicians and Surgeons
There is a growing body of literature supporting an inverse association between a history of diabetes and subsequent risk of prostate cancer. In addition, epidemiologic and pre-clinical studies have suggested metformin, an oral anti-hyperglycemic medication commonly used in the management of Type 2 diabetes, having a potential anti-cancer effect with respect to prostate cancer. The researchers looked at the relationship between metformin use in diabetics and outcomes after radical prostatectomy (RP) for clinically localized cancer. They found that, in contrast to data suggesting an antitumor activity associated with metformin use, there was no evidence that metformin improved outcomes. Conversely, diabetes regardless of metformin use was significantly associated with an increased likelihood of recurrence after RP.
•Flexible CO2 Laser-Assisted Neurovascular Bundle Dissection for Robotic Prostatectomy
Dr. Ketan Badani
Director of robotic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, and assistant professor of urology at Columbia University College of Physicians and Surgeons
Carbon dioxide (CO2) lasers are known to be effective at targeting tumors without damaging adjacent healthy tissue, and are widely used in head and neck oncology surgery and neurosurgery. Until recently, use of the CO2 laser as a surgical tool has been limited by the necessity for delivery through a rigid, rather than a fiber-based flexible, delivery system. Excess thermal spread during neurovascular bundle (NVB) dissection can affect potency in men following radical prostatectomy. Dr. Badani and his co-investigators report on a novel delivery of CO2 laser energy through a flexible fiber to enhance the accuracy of dissection of the NVB during robotic-assisted laparoscopic prostatectomy (RALP). They found that the flexible CO2 laser fiber was easily manipulated and identification of fascial layers during nerve sparing was facilitated with the fiber. Long-term follow-up is necessary to determine the efficacy of this technology versus conventional techniques on the NVB. Larger studies are currently in progress to determine if use of the flexible CO2 laser fiber results in improvements in functional outcomes with regards to return of sexual potency following robotic prostatectomy.
SOURCE Columbia University Medical Center
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