1129 FACTORS AFFECTING EARLY RECOVERY OF CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY URODYNAMIC STUDY, URETHRAL LENGTH, AND NEUROVASCULAR BUNDLE SPARING

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METHODS: A total of 476 patients with a mean age of 60.2 ⫾ 0.3 years were evaluated (11/2006 to 1/2010). Data was assimilated through an IRB approved blinded prospective database by an independent third party committee. Data was collected prospectively both at the time of surgery as well as throughout the initial 30 days postoperatively. The Modified Clavien system was utilized to grade complications with grade I and II representing minor and grade III, IV, and V major complications. Our initial experience and that of our most recent were compared. Age, BMI, ASA, Gleason grade, PSA, prostate volume, and complications were compared. RESULTS: The first and last 100 cases were found to have similar age (p⫽0.27), BMI (p⫽0.11), ASA (p⫽0.09), and Gleason grade (p⫽0.28). The last 100 cases were found to have a greater prostate volume and PSA (p⬍0.05). The Major and Overall complication rates for the first and last 100 cases were 7% and 19% vs. 1% and 19%, respectively. The major complication rates were significantly different (p⫽0.019). When the major complications between each of the 100 patient quintiles were compared it was found that the first (7%) and second (2%) were significantly different (p⬍0.05). The subsequent quintiles exhibited no significant change in major complications (Table 1). CONCLUSIONS: As a surgeon progresses through the learning curve there is a stable overall complication rate with a drop in major complications. After the first 100 cases a significantly lower rate of major complications can be expected.

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(61.92%). Among those who had prostatectomy and available information on tumor size (71% unknown), 56.3% had clinically relevant tumor size (⬎ 1cm). Patients who did not receive definitive treatment were more likely to be 75 years or older (13.88% vs 5.44%, p-value⬍0.001). Cancer-specific mortality was higher for those who did not receive definitive treatment (0.45% vs 0.18%, p-value⫽0.045). Similar findings were seen with overall mortality (7.92% vs 2.86%, p-value⬍0.001), the highest noted in patients 75 and older (18.63% vs 5.50%). CONCLUSIONS: Using a large, modern cohort of AfricanAmerican men with early-onset, low-risk prostate cancer, our study revealed that the majority of these patients received definitive treatment; and of those who did, most received radiotherapy. Based on the available data, the majority of the patients who underwent prostatectomy had pathologically significant tumor volume. Those who received definitive treatment had significantly less cancer-specific and overall mortality irrespective of age.

Source of Funding: None

1129 FACTORS AFFECTING EARLY RECOVERY OF CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY: URODYNAMIC STUDY, URETHRAL LENGTH, AND NEUROVASCULAR BUNDLE SPARING Source of Funding: None

1128 AFRICAN-AMERICAN MEN WITH LOW RISK PROSTATE CANCER: MODERN TREATMENT AND OUTCOME TRENDS Augustine Obirieze, MBBS, MPH*, Ambria Moten, BS, Delenya Allen, MD, MPH, Chiledum Ahaghotu, MD, FACS, Washington, DC INTRODUCTION AND OBJECTIVES: To investigate the clinical characteristics and treatment patterns for African-American men with low risk prostate cancer using a national, population-based dataset. METHODS: We conducted a retrospective review of the Surveillance Epidemiology and End Results database for the period 20042008. African-American men aged 40 years or older with low risk prostate cancer (stage T2a or lower, a PSA level ⱕ 10ng/mL, and a Gleason score of 6 or lower) were identified. We reviewed all recorded treatment modalities. Definitive treatment was defined as having either a radiation therapy (external beam therapy, and/or radioisotope/radioactive implant as listed in SEER), prostatectomy (radical, or local excision) or targeted prostate cryoablation. Chi square test was used for bivariate analysis of categorical variables. RESULTS: A total of 7,246 patients met our inclusion criteria. The majority of the patients were less than 65 years at diagnosis (59%), had PSA level between 4.1-6.9 ng/mL (57.31%), and Gleason score of 6 (96.25%). 74% received definitive treatment, comprising radiation therapy alone (47%), prostatectomy alone (25.24%), prostate cryoablation alone (0.87%), and prostatectomy with radiotherapy (0.66%). Of those who received radiation therapy, most received external beam

Young Hoon Choi, Sung Ik Bang, Jae Hyun Ahn, Seung Soo Lee, Hong Koo Ha*, Dong Gil Shin, Soo Dong Kim, Sang Don Lee, Jeong Zoo Lee, Moon Kee Chung, Busan, Korea, Republic of INTRODUCTION AND OBJECTIVES: We analyzed factors associated with early recovery of continence after laparoscopic radical prostatectomy. METHODS: Among 450 patients treated with laparoscopic radical prostatectomy for localized prostate cancer between 2008 and 2010, 90 patients who underwent preoperative urodynamic study were enrolled. Patients⬘ age, Gleason score, PSA and prostate volume are recorded. Preoperative urodynamic parameters (maximal cystometric capacity (MCC), compliance and maximal detrusor pressure (Pdet)), membranous and prostatic urethral length on MRI and nerve sparing technique are analyzed. Patients were considered early recovery of continence when they need no pad within 3 months after surgery. RESULTS: 62 patients are early recovery group and 28 are late recovery group. Mean patients⬘ age is 66.26⫾6.56 (51-81) and 67.54⫾6.46 (54-79) years old. Mean prostate volume is 34.08⫾14.59 (14.00-101.00) and 33.11⫾9.77cc (19.00-54.90). Mean Gleason score is 6.74⫾0.99 (5-10) and 7.04⫾1.20 (6-10). Mean serum PSA is 11.35⫾11.43 (0.84-83.66) and 16.92⫾21.40ng/ml (4.30-92.75). PSA was related with recovery timing (p⫽0.023). Membranous urethral lengths are 10.82⫾2.36 (7.03-16.88) and 9.59⫾1.78mm (6.75-12.66). Prostatic urethral lengths are 40.06⫾5.25 (27.0259.07) and 41.34⫾4.55mm (34.43-52.31). Membrane-total urethral length ratio are 0.21⫾0.04 (0.13-0.32) and 0.19⫾0.03 (0.13-0.25). Prostatic-to-total urethral length ratio is 0.79⫾0.04 (0.68-0.87) and 0.81⫾0.03 (0.75-0.87). Membranous and prostatic urethral length are not associated with recovery timing, but membranous-to-total and prostatic-to-total urethral length ratio are related (p⫽0.033 and 0.033,

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respectively). MCC are 383.61⫾114.01 (161-602) and 367.96⫾125.65 ml (106-669). Compliance are 55.78⫾38.46 (1.70-200.70) and 60.24⫾63.33 ml/cmH2O (8.80-334.50). Pdet are 61.94⫾20.28 (21-142) and 57.46⫾24.10 (18-112). No, unilateral and bilateral neurovascular bundle sparing surgery were underwent to 3, 44 and 15 patients in early group, and 5, 16 and 7 patients in late group, respectively. Urodynamic parameters and neurovascular bundle sparing techniques are not associated with recovery timing. CONCLUSIONS: Preoparative PSA, MRI measuring membranous-to-total and prostatic-to-total urethral length ratio are related with early recovery of continence after laparoscopic radical prostatectomy. Source of Funding: None

1130 PURE VERSUS ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY: SINGLE CENTRE, SINGLE SURGEON EXPERIENCE Cristian Fiori, Ivano Morra, Francesca Ragni, Susanna Grande, Marco Lucci Chiarissi, Fabrizio Mele, Massimiliano Poggio, Francesco Porpiglia*, Orbassano, Italy INTRODUCTION AND OBJECTIVES: Radical prostatectomy (RP) is the standard surgical treatment for localized prostate cancer. Laparoscopic RP (LRP) and later, robot assisted laparoscopic prostatectomy (RALP) were introduced to minimize perioperative and post operative morbidities. The aim of the prospective, randomized trial is to compare perioperative and early functional results of these two techniques performed by the same surgeon at the same Institution. METHODS: From January 2010 to January 2011, 120 patients with clinically localized prostate cancer (T1-T2), to whom we proposed LRP were involved in the study which was approved by Ethic Committee. After obtaining a complete informed consent, the patients were randomized with a randomization plan generated by using a specific web site: 60 patients underwent LRP (LRP group), and 60 patients underwent RALP (RALP group). Demographic, perioperative and pathological data were considered. Functional results were focused until the third month after intervention. Continence was defined as no pad or 1 pad/die for safety. RESULTS: Demographic and pathological data taken from biopsies were comparable. As regards intraoperative data, operative times were slightly longer for RALP (147 min vs 138 min; p⫽ns) even if the time to complete urethro-vescical anastomosis was significantly lower in RALP group than in LRP group (12 vs 15.4’ respectively). No post-operative differences were recorded and no complications ⬎ grade III according to Clavien were observed. The pathological data were comparable and no differences were recorded in terms of disease stage (according to TNM) and positive surgical margins (PSM) rate. After three months, in the RALP and LRP group the maintained potency (with or without PDE5 –inhibitors) was 62.8% and 42.8% respectively (p⫽ns), when considering patients treated with nerve sparing techniques (35 vs 35). At catheter removal, continence rate was 60% for RALP group and 26.6 % for LRP group (p⬍0.01), these rates moved to 43.3% versus 23.3 % respectively (p⬍0.01) 48 hours after catheter removal and to 55% vs 33.3 % (p⬍0.01) 30 days after catheter removal. After 3 months from surgery, continence rate was 80% in RALP group and 61.6 % for LRP group (p⬍0.01). CONCLUSIONS: The results of our study demonstrated that RALP and LRP were equally safe and effective in the treatment of localized prostate cancer. With the drawbacks of costs and longer operative times, RALP allowed better early functional results in terms of continence. Further studies are required to confirm these data. Source of Funding: None

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1131 RADICAL PROSTATECTOMY IN ELDERLY PATIENTS, TEMPORAL TRENDS AND FUNCTIONAL RESULTS OF URINARY CONTINENCE ONE YEAR POSTOPERATIVE Jens Hansen*, Uwe Michl, Hans Heinzer, Alexander Haese, Thorsten Schlomm, Hartwig Huland, Markus Graefen, Hamburg, Germany INTRODUCTION AND OBJECTIVES: Due to an increasing life expectancy, more men at advanced age seem to undergo radical prostatectomy (RP) for prostate cancer (PCa) in recent years. According to the literature, elderly patients (⬎70 years) seem to be at higher risk for urinary incontinence (UC) after RP, [Nilsson et al., BJUI 2011] although UC rates after RP have improved over the last years, due to innovations of surgical techniques. [Schlomm et al., Eur Urol 2011] The objective of the current study was to examine UC rates one year after RP in elderly patients in most recent years. METHODS: Data of patients treated with RP for clinically localized PCa by five high volume surgeons at a single European tertiary referral center between 01/2006 and 07/2010 were examined. Patients were categorized in two groups according to age (ⱕ70 years vs. ⬎70 years). A validated questionnaire was routinely used 1 year after surgery. UC was defined as use of 0 pads or 1 security pad within 24 hours. Only patients with available questionnaire were included in the analyses. Statistical analyses consisted of descriptive analyses for assessment of temporal trends and of multivariable logistic regression models (MVA) predicting UC one year after RP. RESULTS: A number of 3333 men were included in the analyses. Of those, 2997 (89.9%) were ⱕ70 years and 336 (10.1%) were ⬎70 years. Within the study cohort, the rate of elderly patients treated with RP increased from 7.3% (n⫽39) in 2006 to 11.8% (n⫽46) in 2010 (p⫽0.09). UC rates in patients ⬎70 years increased from 51.3% (n⫽20) in 2006 and 72.5% (n⫽50) in 2007 to 89.7% (n⫽70) in 2009 and 87.0% (n⫽40) in 2010. Even though, rates for younger patients were higher with 83.7% (n⫽412), 78.9% (n⫽532), 93.9% (n⫽642) and 94.8% (n⫽327), respectively. In MVA adjusting for BMI, prostate volume, pT stage, Gleason score, and NS, elderly men (⬎70 years) were less likely (Odds ratio: 0.51, p ⬍0.001) to be continent one year after RP relative to younger men. Men treated in 2010 were 3.7-fold more likely to be continent one year after RP than men treated in 2006 (p⬍0.001). CONCLUSIONS: An increasing rate of elderly patients undergoing RP for PCa could be observed over the last 5 years. Even if elderly men are still at higher risk of urinary incontinence one year after RP, UC rates in elderly patients improved over time. Anyhow, very good UC rates could be observed. These findings should be considered for treatment decision-making and patient counseling in elderly patients with newly diagnosed PCa. Source of Funding: None

1132 THE EXPANDED PROSTATE CANCER INDEX COMPOSITE FOR CLINICAL PRACTICE (EPIC-CP) IS SENSITIVE TO TREATMENTRELATED QUALITY OF LIFE CHANGES OVER TIME: VALIDATION USING THE PROST-QA COHORT Peter Chang*, Jonathan Chipman, Meredith Regan, Boston, MA; John Wei, Ann Arbor, MA; Rodney Dunn, Ann Arbor, MI; Mark Litwin, Los Angeles, CA; Martin Sanda, The PROST-QA Study Group, Boston, MA INTRODUCTION AND OBJECTIVES: Providing patient-centered care in prostate cancer (PCa) requires consideration of both baseline health-related quality of life (HRQOL) and post-treatment HRQOL consequences. EPIC for Clinical Practice (EPIC-CP) was recently developed and validated to measure PCa-related HRQOL in the clinical setting at the point of care (Chang et al, J Urol Sep 2011). EPIC-CP is sensitive to differentiate treated from untreated patients,