Després, Philippe

Foster, William

Fradet, Vincent

Ivers, Hans

Martin, André-Guy

Savard, Josée

Savard, Marie-Hélène

Vigneault, Eric

Elsevier - Publisher Connector 

S52                                                                                     CARO 2016 
_________________________________________________________________________________________________________ 
multivariate analysis adjusted for disease aggressiveness, age 
and BMI. A TT> 10.4 nmol/l was associated with a hazard ratio of 
1.78 (95% CI 1.06-2.98, p = 0.03) for BCR. This difference in BCR 
appeared as a split on the Kaplan-Meier curve only five years 
after treatment. TT did not have an influence on overall survival 
(p = 0.28). 
Conclusions: Low baseline TT level is an independent prognostic 
factor associated with a lower BCR rate. This effect appears only 
five years after radiotherapy treatment. The results are to the 
contrary to what has been shown from patients treated with 
radical prostatectomy. 
139 
WHAT ARE PROSTATE CANCER PATIENTS’ PREFERENCES FOR 
INFORMATION AND DECISION SUPPORT? A SYSTEMATIC SURVEY OF 
PATIENTS DIAGNOSED IN EACH OF THREE PROVINCES 
Michael Brundage1, Deb Feldman-Stewart1, Christine Tong1, 
John Robinson2, Jackie Bender3, Hannah Carolan4, Joseph Chin5, 
Joyce Davison6, Arminee Kazanjian4 
1
2Tom Baker Cancer Centre, Calgary, AB 
3University Health Network, Toronto, ON 
4University of British Columbia, Vancouver, BC 
5London Health Sciences Centre, London, ON 
6University of Saskatchewan, Saskatoon, SK  
Purpose: Current clinical practice guidelines support the 
engagement of prostate cancer patients in their cancer care. 
However, the optimal timing of, and the most preferred sources 
of information provision and decision support desired by prostate 
cancer patients has not been systematically explored. In order 
to inform the design of strategies for information provision and 
decision support, we sought to determine prostate cancer 
patients’ preferences by conducting a systematic survey of 
recently diagnosed patients. 
Methods and Materials: Surveys were conducted in British 
Columbia, Alberta and Saskatchewan. Based on power 
calculations and estimated response rates, a random sample of 
prostate cancer patients in each provincial registry diagnosed in 
late 2012 was invited to participate. 
Results: Provincial response rates were 46%-55%, total n = 1007. 
Across provinces, mean age was 69 years. During the interval 
between diagnosis and the treatment decision, preferred 
information sources (not mutually exclusive) were the urologist 
(90%), family physician (85%), and radiation oncologists (58%). 
The Radiation Oncologist being identified as information source 
was highly dependent on whether the patient was managed with 
prostatectomy only (39%) versus primary radiotherapy (92%, p < 
0.01) whereas both groups identified the urologist as an 
important source (98% versus 94% respectively). Across all 
patients, 73% wanted printed information and 58% wanted 
information from the internet. Barriers to obtaining information 
from physicians included patients’ perception of physicians not 
having enough time (27%), worrying about physician time (21%), 
and worrying about asking too many questions (15%). Barriers to 
obtaining information from books and from the internet, 
respectively, included uncertain quality (37% and 46%, 
respectively), unclear if personally applicable (39% and 41%), and 
poor search skills (31% and 20%). Recommended facilitators for 
providing information included a person to guide its acquisition 
(71%), providing printed information (69%), and someone to 
answer questions: in person (77%), over the phone (53%), or via 
email (43%). Even if access was easy, 27% would not want 
information from the internet, and 13% would not want any 
printed information. Regarding decision making, 18% would have 
liked more help with their decision, though half of that group 
(53%) indicated that they felt well informed. 77% of all 
respondents either used decision support or would have wanted 
to if they had known about it. Recommended timing for decision 
support included before meeting any specialists (11%), at the 
urologist visit (31%), and after all specialist visits before the 
decision is made with a doctor (35%). 
Conclusions: Most prostate cancer patients want information 
and decision support but vary in where, when, and preferred 
medium. Optimal support needs to be multi-faceted and flexible. 
140  
INDENTIFICATION OF CURCULATING MIRNA ASSOCIATED WITH 
DEVELOPMENT OF CASTRATE RESISTANCE IN HIGH-RISK AND 
BIOCHEMICALLY RECURRENT PROSTATE CANCER PATIENTS 
Shawn Malone1, Grant Howe2, Huijun Zhao2, Scott Grimes1, 
Gregory Pond3, Scott Morgan1, Libni Eapen1, Julia Craig1, Brad 
Musclow1, Christina Addison2 
1The Ottawa Hospital, Ottawa, ON 
2Ottawa Hospital Research Institute, Ottawa, ON 
3McMaster University, Hamilton, ON 
Purpose: We previously identified circulating miRNA in 
metastatic prostate cancer patients that are associated with 
early castrate resistance (< 2 years). The current study 
determined whether the predictive miRNA were associated with 
time to castrate resistance (CRPC) in PSA recurrent and high-risk 
adjuvant patients. 
Methods and Materials: Patients from a prospective biomarker 
trial were categorized into three groups: 1) CRPC within two 
years of ADT, 2) CRPC greater than two years, and 3) patients 
remaining ADT sensitive. Total RNA was isolated from pre-
treatment plasma using the miRNeasy kit (Qiagen). For quality 
control, known concentrations of cel-miR-39 were added prior to 
RNA isolation. Isolated miRNA was subjected to reverse 
transcription (RT) using the miScript II RT Kit and primers specific 
to miRNA of interest. Quantification of individual miRNAs was 
performed by qPCR using the miScript SYBR Green PCR Kit and 
specific primers for miRNAs of interest following RT. 
Quantification of relative levels of miRNAs between samples was 
determined following comparison of the CT method of relative 
quantification following normalization to cel-miR-39 and the 
endogenous control SNORD61. 
Results: Previous work in metastatic patients identified 3 miRNA 
associated with development of early versus delayed CRPC. In 
the current study similar trends were observed for the third 
miRNA which was increased in early CRPC compared to other two 
groups. The second miRNA showed more variable expression 
amongst the three cohorts, and was generally lower in those 
patients who developed early CRPC. First miRNA was also lower 
in patients with early CRPC as compared other two groups, 
similar to our original findings in metastatic patients. 
Conclusions: A previously identified miRNA signature of early 
castrate resistance in metastatic patients appears to be 
applicable to PSA recurrent and high-risk patients. Future work 
will validate these findings in additional patients from our trial 
and independent cohorts. 
141  
VALIDATION OF A FRENCH CANADIAN VERSION OF THE EXPANDED 
PROSTATE CANCER INDEX COMPOSITE INSTRUMENT (EPIC) 
Eric Vigneault, Josée Savard, Hans Ivers, Marie-Hélène Savard, 
Vincent Fradet, Philippe Després, William Foster, André-Guy 
Martin 
Centre de recherche CHU de Québec, Québec, QC 
Objectives: To assess the psychometric properties of a French 
Canadian version of the Expanded Prostate Cancer Index 
Composite Instrument (EPIC-50), among a clinical sample of 
prostate cancer patients. 
Methods and Materials: The validity of the French Canadian 
version of the EPIC-50 was assessed among patients from the 
radiation oncology and urology departments of CHU de Québec. 
A total of 251 patients were recruited. Participants taking part 
in the sensitivity to change study (n = 51) were asked to complete 
a battery of self-report scales at their consultation and at a 
follow up visit at the hospital, approximately six months after 
the initiation of their treatment. Another subsample of 68 
patients completed the EPIC on two occasions separated by two 
weeks to estimate temporal stability. The battery comprised the 
Cancer Centre of Southern Ontario, Kingston, ON
CARO 2016                                                                                                                                                                  S53 
_________________________________________________________________________________________________________ 
following questionnaires: the EPIC-50, the International Prostate 
Symptom Score (IPSS), the Sexual Health Inventory for men 
(SHIM), and the EORTC QLQ PR25. Analyses were conducted using 
the SAS 9.3 software (2012, SAS Institute, Cary, NC, USA) and the 
alpha level was set at 5%. 
Results: The internal consistency of the EPIC was demonstrated 
by significant item-total correlations and elevated Cronbach’s 
alpha for each subscale (urinary: r = .25-.80; α = .85; intestinal: 
r = .27 - .73; α = .84; sexual: r = .48 - .80; α = .92; hormonal: r = 
.21-.71; α = .80). Strong and significant correlations were found 
between EPIC-urinary subscale and IPSS total score (r =- .71, p < 
.01) and between EPIC-sexual subscale and SHIM total score (r = 
.79, p < .01), thus supporting the convergent validity of the EPIC. 
The test-retest reliability was excellent with strong and 
significant correlations obtained between the two 
administrations (urinary: r = .90; intestinal: r = .84; sexual: r = 
.88; hormonal:  r = .79) and the absence of significant differences 
between T1 and T2 mean scores. Finally, a significant 
deterioration was found on all EPIC subscales from pre- to post-
treatment thus indicating that the tool is sensitive to clinical 
change. 
Conclusions: Our French Canadian version of the EPIC-50 appears 
to provide a reliable and valid assessment of quality of life in 
prostate cancer patients. Future analyses will investigate its 
factorial structure and the psychometric properties of the 
abbreviated version. 
 
142 
THE INFLUENCE OF DOSIMETRY ON ACUTE URINARY TOXICITY IN 
HDR PROSTATE BRACHYTHERAPY  
Nancy El-Bared, Talar Desrashodian, Georges Wakil, Marise 
Mondat, Djamal Berbiche, Marjorie Jolicoeur 
University of Sherbrooke, Greenfield Park, QC  
 
Purpose: Although high-dose rate (HDR) brachytherapy boost is 
widely used in intermediate and high-risk prostate cancer 
treatment, the appropriate dose constraints are still evolving. 
The aim or our study is to analyze the influence of patient 
characteristics as well dosimetric parameter specifically the 
V150 (volume receiving 150% of the dose), on acute urinary 
toxicities.  
Methods and Materials: We retrospectively analyzed 231 
consecutive patients treated, between May 2012 and September 
2014, with HDR brachytherapy boost in our institution. The 
CTCAE V3 criteria were used to grade the urinary symptoms. 
However, we wanted to separately analyze patients with urinary 
obstruction requiring urinary catheter for longer than 24 hours. 
For the purpose of our analysis, we used a value of 35% as a cut 
off for the V150. Other dosimetric parameters were also 
analyzed. Pearson’s correlations as well as logistic regressions 
were performed. 
Results: During a median follow up of 18.6 months, 29% of 
patients had no urinary toxicity, 28% had Grade 1 and 38% had 
Grade 2 or 3 urinary toxicities. Eleven patients (5%) needed a 
urinary catheter for longer than 24 hours because of urinary 
obstruction. Although not significant (p = 0.0951), we found an 
important difference between the mean prostate volume of 
patients needing urinary catheter (51 cc) versus those who did 
not (42 cc). Among different patient characteristics such as 
tobacco use, dyslipidemia, hypertension, coronary heart disease 
and hormone therapy treatments, only the use of hormone 
therapy at the time of HDR treatment significantly increased 
urinary toxicity (p = 0.0462). A V150 ≥ 35% did not significantly 
influence Grade 1 (p = 0.2204) or Grade 2-3 (p = 0.8162) urinary 
toxicity, nor did it significantly influence the need for urinary 
catheter placement (p = 0.1678). However, in the 11 patients for 
whom a urinary catheter was needed, the median V150 and Dmax 
to the urethra (maximal dose to the urethra) were 42% and 
124.78% respectively. 
Conclusions: In conclusion, the only significant prognostic factor 
for urinary retention requiring prolonged catheter placement 
was the use of hormone therapy. We did not find a significant 
influence of dosimetric parameters, specifically the V150, on 
acute urinary toxicity. However, due to the small sample size of 
patients requiring a urinary catheter we cannot conclude on the 
influence of the V150 for those patients. Nevertheless, we 
strongly believe that the V150 should be kept as low as possible 
since in our cohort the median V150 for the patients requiring a 
urinary catheter for obstructive symptoms was 42%. 
 
143 
 
Abstract withdrawn 
 
144 
EVALUATION OF MILK OF MAGNESIA TO REDUCE VARIATION IN 
RECTAL FILLING IN IMAGE GUIDED VOLUMETRIC MODULATED 
ARCH THERAPY OF PROSTATE CANCER 
Ali Hosni, Tara Rosewall, Timothy Craig, Vickie Kong, Andrew 
Bayley, Charles Catton, Peter Chung 
Princess Margaret Cancer Centre, University of Toronto, Toronto, 
ON 
 
Purpose: To investigate the effect of milk of magnesia (MoM) on 
consistency of interfraction rectal filling and acute rectal 
toxicity. 
Methods and Materials: Two groups were retrospectively 
identified, each consisting of 40 patients with localized prostate 
cancer treated with VMAT to prostate +/- seminal vesicles, to 
prescribed dose of 78 Gy in 39 fractions over eight weeks. The 
first group were instructed to follow a bowel regimen with 
antiflatulent diet and MoM started three days prior to planning 
CT scan (P-CT) and continued during RT, while the second group 
followed simple dietary advice to achieve an empty rectum. The 
rectum between the upper and lower borders of the clinical 
target volume (CTV) was delineated by a single observer on the 
P-CT and on eight, weekly cone beam CT (CBCT). Rectal filling 
was assessed by measurement of anterio-posterior diameter of 
the rectum at the superior and mid levels of CTV, and by 
calculation of rectal volume (RV) and the average cross-sectional 
rectal area (CSA; defined as the rectal volume divided by length). 
The differences in these measurements were compared between 
the two groups by repeated measures analysis. Data relating to 
acute toxicity was extracted from patients’ medical charts. 
Results: A total of 720 images, including 80 P-CT and 640 CBCT 
images from 80 patients were analyzed. All images showed 
satisfactory visualisation of the rectum at the level of CTV. Using 
linear mixed models, and after adjusting for baseline values at 
the time of P-CT to test the differences in rectal dimensions 
between both groups over the eight-week treatment period, 
there were no significant differences either in rectal volume (p 
= 0.58), average CSA (p = 0.63), anterio-posterior diameter of 
rectum at superior level of CTV (p = 0.95) or at mid level of CTV 
(p = 0.28). In the MoM group, the mean volume of MoM taken by 
patients was 31 cm3 (range, 15–45 cm3) in the first week and 13 
cm3 (range, 0–30 cm3) in the last week. The proportion of 
patients who took MoM decreased from 100% in the first week to 
60% in the last week. Acute RTOG rectal toxicity in MoM/non-
MoM groups consisted of G2 diarrhea (n = 3/2), G1 diarrhea (n = 
21/7), G1 proctitis (n = 5/5). 
Conclusions: MoM did not appear to reduce the interfraction 
variation in rectal filling compared to simple dietary advice. MoM 
may cause diarrhea and a substantial proportion of patients 
discontinued its use by the end of radiation treatment. 
 
145 
LONG-TERM OUTCOMES OF STAGE II SEMINOMAS  
Rima Pathak1, Scott Tyldesley2, Gaurav Bahl1 
1University of British Columbia, Abbotsford, BC 
2British Columbia Cancer Agency, Vancouver, BC 
 
Purpose: To review the long-term outcomes for patients with 
Stage II Seminoma treated at our institute. 
Methods and Materials: We included all patients referred and 
registered with Stage I or II Seminoma in our Cancer Registry, 
from 1984. Patients with unknown stage or histology were 


141: Validation of a French Canadian Version of the Expanded Prostate Cancer Index Composite Instrument (EPIC) 

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141: Validation of a French Canadian Version of the Expanded Prostate Cancer Index Composite Instrument (EPIC)

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