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function, we evaluated the pre-and post-treatment serum brain natriuretic peptide (BNP), which is a marker for left ventricular cardiac load, in prostate cancer patients who received GnRH antagonists or agonists as a neoadjuvant therapy before definitive surgery or radiotherapy.METHODS: We retrospectively identified 86 patients who received GnRH antagonists (n[41) or agonists (n[45) as neoadjuvant therapy and then were followed more than 12 months. BNP measured before and 6 months after ADT were collected and the changes in BNP was assessed using the paired t-test. All CVD events occurred after ADT were recorded and compared between patients receiving GnRH antagonists and agonists.RESULTS: There were no significant differences between two groups in CVD risk-associated parameters including smoking, history of hypertension, hyperlipidemia, diabetes, and CVD, except for that the patients who received GnRH antagonists were significantly older than those received agonists (median 74 vs 65, p<0.01). Pre-existing CVD was present in 4 (10%) of the 41 patients who received antagonists and 6 (13%) of the 45 patients who received agonists. The patients who received GnRH antagonists showed no change in BNP levels, however those who received agonists showed significant increase in BNP (mean change 17.4 pg/ml, 95% CI: 7.5 e 27.2, paired t-test p<0.01, Figure). CVD events were observed 1 (2%) of the 41 patients who received GnRH antagonists and 2 (4%) of the 45 patients who received agonists, and the incidence of CVD events were not different between these two groups.CONCLUSIONS: GnRH agonists significantly increased BNP in prostate cancer patients while antagonists did not cause significant change. The selection of ADT modality may affect the cardiovascular outcomes.

355 Background: While neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) improves survival compared to RC alone for urothelial carcinoma of the bladder (UCB), the bulk of this survival benefit has been attributed to patients who achieve ypT0 status at RC. The implications of having residual UCB (rUCB) at RC after NAC are less clear. As such, we evaluated whether the outcomes for patients with rUCB after NAC differ from stage-matched RC patients who did not receive NAC. Methods: Patients undergoing RC for UCB between 1981-2010 at Mayo Clinic were identified. All RC pathology was re-reviewed by a single genitourinary pathologist. Patients who received NAC were matched 1:2 to patients not exposed to NAC based on pT and pN-stage, margin status, and year of RC. Kaplan Meier and Cox regression analyses were used to evaluate the associations between NAC and cancer-specific (CSS) and overall survival (OS), stratified by presence of rUCB (i.e. (y)pT0N0 and non-(y)pT0N0). Results: We matched 111 patients who underwent NAC + RC to 222 RC-alone patients. Median age was 68 years (IQR 60,74); 59 (18%) were female. Median follow-up among survivors was 7.2 years (IQR 6,16). A total of 248 patients died; 148 died from UCB. In patients without rUCB at RC, there were no differences in 5-yr CSS (86% vs. 90%, p=0.85) or OS (82% vs. 84%, p=0.46) between patients who did and did not receive NAC. Moreover, on multivariable analysis, NAC exposure was not associated with CSS (HR=1.0; 95%CI 0.3-3.1; p=0.9) or OS (HR=0.9; 95%CI 0.4-1.9; p=0.8) in this subgroup. Among patients with rUCB, receipt of NAC was associated with significantly worse 5-yr CSS (32% vs. 56%, p<0.001) and OS (25% vs. 48%, p<0.001). NAC exposure remained independently associated with worse CSS (HR=2.2; 95%CI 1.6-3.1; p<0.001) and OS (HR=2.0; 95%CI 1.5-2.7; p<0.001) among these patients. Conclusions: While patients who achieve a complete response to NAC have excellent survival outcomes, patients with residual UCB at RC after NAC have a worse prognosis compared to stage-matched RC patients not exposed to NAC. Such patients should be considered for enrolment in novel adjuvant therapy trials.

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