Atarzadeh, Fatemeh

Farhan, Farshid

Jaladat, Amir Mohammad

Kashi, Amir Shahram Yousefi

Moeini, Reihane

Mofid, Bahram

Mosalaie, Ahmad

Motevalian, Abbas

Rakhsha, Afshin

Rezaeizadeh, Hossein

Electronic physician

Elsevier - Publisher Connector 

S20                                                                                     CARO 2016 
_________________________________________________________________________________________________________ 
49 
CAPRA-S PREDICTS OUTCOME FOR ADJUVANT AND SALVAGE EBRT 
AFTER RADICAL PROSTATECTOMY  
Guila Delouya1, Michel Zimmerman2, Abdullah M. Alenizi2, Emad 
Rajih2, Kevin Zorn2, Daniel Taussky2 
1CHUM-Hôpital Notre-Dame, Montreal, QC 
2Université de Montréal, Montreal, QC 
 
Purpose: The Cancer of the Prostate Risk Assessment 
Postsurgical Score (CAPRA-S) can predict for recurrence and 
mortality post radical prostatectomy (RP) with a c-index > 0.70. 
We evaluated its predictive value for patients treated with RP 
followed by subsequent external beam radiotherapy (EBRT).  
Methods and Materials: A total of 373 patients were identified 
in the institutional database who were treated with EBRT 
between January 2000 and June 2015. Follow up and complete 
CAPRA-S score were available for 334 (89.5%) patients. CAPRA-S 
scores were sorted into previously defined categories of low- 
(score 0-2), intermediate- (3-5), and high-risk (6-12). Time to 
biochemical recurrence (BCR) was defined as PSA > 0.20 ng/mL 
after EBRT. Survival analyses were performed using the Kaplan-
Meier method and comparisons were made using the log-rank 
test. 
Results: Median age at time of EBRT was 64 years (IQR: 59-68). 
Median time from RP to EBRT was 18 months (IQR: 8-36). Median 
dose was 66 Gy (range 64-70 Gy) and median follow up following 
EBRT was 48 months (IQR: 28-78). In 65%, the PSA before EBRT 
was ≤ 0.5 ng/mL. Twenty-two (6.6%) patients died during follow 
up, nine from metastatic prostate cancer. 84.3% of patients were 
classified as intermediate- or high-risk in the CAPRA-S grouping 
system. Concomitant androgen deprivation therapy (ADT) was 
administered in 36% for a median of nine months. CAPRA-S as a 
categorical variable (low-, intermediate-, high-risk group) was 
predictive of time to BCR (p < 0.001) and time to palliative ADT 
(p = 0.017) and borderline significant (p = 0.058) of overall 
survival. On multivariate analysis, the CAPRA-S was predictive of 
time to BCR only (low-risk versus intermediate-risk; HR 0.14, 95% 
CI0.043-0.48, p = 0.001). When looking only at the CAPRA-S high-
risk group, overall survival at five and 10 years were 90% and 
83%, respectively. After five years, 62% had not received ADT for 
recurrence and at 10 years, 47%. The last PSA value before EBRT 
as a continuous and grouped variable proved highly significant in 
predicting all outcomes tested, including OS (p ≤ 0.002).  
Conclusions: We present the first Canadian data on post-
operative EBRT. Together with the PSA before EBRT, CAPRA-S is 
a useful tool to predict time to palliative ADT, and was 
borderline significant for OS. Our results emphasize the 
importance of a low PSA before EBRT and the fact that EBRT is 
effective in avoiding ADT even in patients with several high-risk 
features.  
 
50 
AN EVALUATION OF COMPETING CAUSES OF DEATH IN PATIENTS 
TREATED FOR SEMINOMA WITH RADIATION THERAPY 
Rima Pathak1, Scott Tyldesley2, Gaurav Bahl1 
1British Columbia Cancer Agency, Abbotsford, BC 
2British Columbia Cancer Agency, Vancouver, BC 
 
Purpose: To review the long-term outcomes and evaluate the 
competing causes of death in patients treated with radiation 
therapy for Seminoma in British Columbia. 
Methods and Materials: In total 538 patients diagnosed with 
Seminoma, and treated with radiation therapy (RT), between 
January 1990 and January 2010, were identified from the BC 
Cancer Registry. Median age was 38 years (range: 19 – 77). The 
median RT dose was 25 Gy (range: 14 Gy – 40 Gy). Most common 
RT fractionations used were: 25 Gy/15 (n = 260), 25 Gy/20 (n = 
119), 30 Gy/20 (n = 90). Time to testicular-cancer mortality 
(TCM), second cancer related mortality (SCM), cardiovascular 
mortality (CVM), and all-cause mortality (ACM) were calculated 
from diagnosis date. Survival estimates were calculated using the 
Kaplan-Meier method. Competing-risks analysis was used to 
evaluate the Cumulative Incidence of the mortality outcomes. 
Results: After a median follow up of 18 years, 57 patients had 
died, and the 15-year overall survival was 90.8%. Thirteen 
patients died from progressive testicular cancer, 12 from Second 
Cancers, 13 from cardio-vascular disease, seven from accidents 
and falls, three treatment related toxicity, and nine from other 
causes. The cumulative rates of ACM at 10, 15, and 20 years were 
5.8%, 9.2%, and 11.2%, respectively. All testicular cancer related 
mortality occurred within the first six years, and the 10- and 15-
year rates of TCM were both 2.41%. Cardiovascular and second 
cancer-related mortality rates increased with time: 10-year CVM 
= 1.12%, 15-year CVM = 2.36%, 20-year CVM = 2.66%; 10-year SCM 
= 0.94%, 15-year SCM = 1.84%, and 20-year SCM = 2.53%. 
Conclusions: Long-term outcomes for patients with Seminoma 
continue to be excellent. At 20 years post-radiation therapy, the 
mortality rate from second cancers (2.53%) and cardiovascular 
disease (2.66%) is similar to the testicular cancer-related 
mortality (2.41%). 
 
51 
PREVENTIVE EFFECT OF MALVA ON URINARY TOXICITY AFTER 
RADIATION THERAPY IN PROSTATE CANCER PATIENTS: A 
MULTICENTRIC, DOUBLE-BLIND, RANDOMIZED CLINICAL TRIAL  
Amir Shahram Yousefi Kashi1, Bahram Mofid1, Hossein 
Rezaeizadeh2, Amir Mohammad Jaladat3, Fatemeh Atarzadeh2, 
Reihane Moeini2, Abbas Motevalian4, Ahmad Mosalaie3, Farshid 
Farhan2, Afshin Rakhsha1, 
1Shahid Beheshti University of Medical Sciences, Tehran, Iran 
2Tehran University of Medical Science, Tehran, Iran 
3Shiraz University of Medical Sciences, Shiraz, Iran 
4Iran University of Medical Sciences, Tehran, Iran 
 
Purpose: For patients receiving external beam radiation therapy 
(EBRT) after radical prostatectomy as adjuvant treatment or 
patients receiving EBRT as definitive treatment, partial 
irradiation of the urinary bladder is common. Many of such 
patients experience some degree of radiation-induced cystitis 
during or after EBRT. There is currently no efficient treatment 
for preventing radiation cystitis. The aim of this study was to 
evaluate the effectiveness of one of the safe mucilaginous herbs 
(Malva) in preventing radiation-induced dysuria in patients who 
are undergoing EBRT for prostate cancer. 
Methods and Materials: From April 2013 to August 2014, 68 
patients were randomized into two groups using four block 
randomization, 34 to the drug (Malva) group and 34 to the 
placebo group. Of the 68 patients who began the study, 60 
completed it. They were instructed to use the medication, i.e., 
Malva or the placebo, three times a day for six weeks. They were 
followed by a physician every two weeks for eight weeks, and 
urinary function was assessed in each visit by asking questions 
based on the Visual Prostate Symptom Score (VPSS) and a dysuria 
severity score. The changes in the VPSS and dysuria severity 
score between baseline and each follow up visit were compared 
between the two groups in the study using repeated measures 
analysis of variance (ANOVA) and t-tests. 
Results: The median age of the 68 patients was 66. Twenty-one 
of 27 patients in the control group (77.7%) suffered from dysuria, 
while dysuria was detected in 23 of 33 patients (69.6%) who 
received Malva (odds ratio = 2.70 for dysuria). After two weeks, 
four weeks, and six weeks of treatment with Malva, dysuria due 
to EBRT was milder in the treatment group than in the control 
group, and the differences were statistically significant (p = 
0.005, p = 0.004, p = 0.001, respectively). 
Conclusions: To the best of our knowledge, our study is the first 
study to assess the protective effect of a 
mucilaginous herb (Malva) against urinary toxicity induced by 
EBRT. The positive results of this study warrant further studies 
in this field. 
 
 
 
 
 


51: Preventive Effect of Malva on Urinary Toxicity after Radiation Therapy in Prostate Cancer Patients: A Multicentric, Double-Blind, Randomized Clinical Trial 

Bahram Mofid

Hossein Rezaeizadeh

Amir Mohammad Jaladat

Reihane Moeini

Abbas Motevalian

Ahmad Mosalaie

Farshid Farhan

Afshin Rakhsha

Amir Shahram Yousefi Kashi

Directory of Open Access Journals