1467 OUTCOME COMPARISONS FOR MINIMALLY INVASIVE AND RETROPUBIC RADICAL PROSTATECTOMY

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THE JOURNAL OF UROLOGY姞

potential in the management of localized prostate cancer clearly however a prospective, long-term study is needed to validate these findings. Source of Funding: The COLD Registry is sponsored by an unrestricted research grant from Endocare. Data are held and analyzed by Watermark, an independent research company under the direction of an independent physician board.

1467 OUTCOME COMPARISONS FOR MINIMALLY INVASIVE AND RETROPUBIC RADICAL PROSTATECTOMY Heather Willis*, Arthur Hartz, Tao He, Christopher Dechet, Salt Lake City, UT INTRODUCTION AND OBJECTIVES: Minimally invasive prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs than for retropubic radical prostatectomy (RRP). A previous study comparing the effectiveness of the two approaches relied on claims databases, which have imprecise information about two important consequences of prostatectomy: incontinence and impotence. The present study compared the two procedures using patient self-report information as outcomes. METHODS: A questionnaire about current and presurgical urinary and sexual function was mailed to 1500 randomly selected prostate cancer patients from the Utah Cancer Registry (UCR) who met the following criteria: prostatectomy more than one year previously, age 70 or younger, no metastatic disease, and no other cancer therapy. Information about chronic diseases, in-hospital complications, and length of stay was obtained from the UCR and the uniform hospital discharge abstract. Regression analysis was used to compare patient outcomes measured for MIRP and RRP after taking into account a number of patient risk factors including age, general health, diabetes, and pre-surgical sexual function. RESULTS: 767 participants who had surgery between 1988 and 2008 completed a questionnaire, and 678 met inclusion criteria. After eliminating responding patients who did not meet inclusion criteria, had perineal surgery, were treated by a low volume surgeon, or were treated by an unidentified or out of state surgeon, there were 464 patients evaluated in this analysis; 58 had MIRP and 406 had RRP. The respective rates of a poor outcome for MIRP and RRP were 22% versus 19% (NS) for leaking urine more than once a day, 45% versus 32% (P⫽0.06) for not having an erection, 10% versus 19% (P⫽0.09) for a complication, and 16% versus 13% (NS) for not being satisfied with care. The respective mean lengths of hospital stay were 1.4 days versus 2.4 days (P⬍0.0001). After adjusting for patient characteristics using regression analysis, the only statistically significant difference between the MIRP and RRP groups was for length of stay. CONCLUSIONS: This preliminary study suggests that MIRP definitely reduces length of stay and may reduce complication rate, but probably does not substantially improve quality of life. Source of Funding: National Cancer Institute, Utah State Department of Health, University of Utah, Huntsman Cancer Institute

1468 INTRAFASCIAL BILATERAL NERVE SPARING RADICAL PROSTATECTOMY: DOES THE ROBOTIC-ASSISTED APPROACH PREDISPOSE TO HIGHER RISK OF POSITIVE SURGICAL MARGINS? IMPORTANCE OF PATIENT SELECTION Nazareno Suardi*, Andrea Gallina, Niccolo` Buffi, Emanuele Scapaticci, Matteo Zanoni, Giulio Gadda, Giovanni Lughezzani, Aldo Bocciardi, Luciano Nava, Alberto Briganti, Andrea Cestari, Patrizio Rigatti, Giorgio Guazzoni, Francesco Montorsi, milan, Italy INTRODUCTION AND OBJECTIVES: The effect of the type of intrafascial approach (open vs robotic assisted) on the rate of positive surgical margins (PSM) has not been addressed yet. We hypothesized

Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011

that RA intrafascial BNSRP might be associated with a higher risk of PSM due to a surgical dissection plane potentially closer to the prostatic capsule. METHODS: Between 2004 and 2009, 501 consecutive patients underwent either open or RA intrafascial BNSRP for clinically localized PCa. Exclusion criteria for intrafascial approach were: clinical stage T3 disease, PSA⬎20 ng/ml or biopsy Gleason sum (GS) ⱖ8. Patients were stratified according to surgical approach (open vs RA). Uni and multivariable logistic regression models tested the association between surgical approach and the risk of positive surgical margins (PSM), after adjusting for PSA, biopsy GS, clinical stage and % of positive cores. The same analyses were repeated in patients with pre-operative very low-risk patients (PSA⬍10 ng/ml, clinical stage T1, biopsy GSⱕ 6 and % positive cores ⱕ33%). RESULTS: 293 (58.5%) and 208 (41.5%) patients were treated with open RP and RA BNSRP, respectively. Patients treated with RALP were younger (mean age: 60.1 vs. 63.5 yrs, p⬍0.001) and had lower PSA (6.1 vs. 7.1, p⫽0.008). Clinical stage (T2 in 34.6% vs. 16.7%; p⬍0.001) and Biopsy GS(7 in 28.6% vs. 7.7%) were higher in the open group (p⬍0.001). Patients in RALP group had significantly lower % of positive cores (35.7% vs. 28.4% respectively, p⫽0.02). The rate of PSM was higher in patients submitted to RA BNSRP in the overall population (22.1% vs. 12.5% respectively, p⫽0.005) as well as in patients with pathologically organ-confined disease (20.0 vs. 9.4%, respectively, p⫽0.02). At multivariable analyses, the surgical approach independently associated with PSM (p⫽0.01). Patients treated with RALP had a 2.8 fold increased risk of PSM as compared to open. However, when only patients with very low-risk disease were considered (n⫽84), patients treated with RALP had the same rate of PSM as compared to open(8.7 vs. 2.6% respectively, p⫽0.2). In this category, the surgical approach was not associated with a higher risk of PSM (p⫽0.3). CONCLUSIONS: We demonstrated that patients treated with RA intrafascial BNSRP the has an higher risk of PSM. However, in patients with very low-risk disease open and RALP intrafascial BNSRP achieve the same PSM rates. Therefore, only highly selected patients (PSA⬍10 ng/ml, clinical stage T1, biopsy GSⱕ 6 and 33% positive cores) should be candidated to intrafascial RA BNSRP. Source of Funding: None

1469 RETROSPECTIVE, SINGLE-INSTITUTION COMPARISON OF RADICAL PROSTATECTOMY AND EXTERNAL-BEAM RADIATION THERAPY FOR HIGH-RISK PROSTATE CANCER Ranko Miocinovic*, Ryan K Berglund, Kevin Stephans, Jay P. Ciezki, Arul Mahadevan, Eric A. Klein, Andrew J. Stephenson, Cleveland, OH INTRODUCTION AND OBJECTIVES: Even thought radical prostatectomy (RP) and external-beam radiotherapy (EBRT) ⫹ androgen deprivation (AD) are established treatment options for high-risk prostate cancer (PC), no prospective randomized trials of RP vs EBRT ⫹ AD have been successfully conducted. We retrospectively evaluated their relative impact on prostate cancer-specific mortality (PCSM), metastasis-free survival (MFS), and use of AD therapy. METHODS: A retrospective chart review was conducted on 890 men diagnosed with high risk prostate cancer who were treated with RP (N⫽277) or EBRT (N⫽613) between 1993 and 2005. High-risk PC was defined as clinical stage ⱖ T2C, PSA ⱖ 20 ng/ml, or Gleason score (GS) 8-10. Multivariable Cox regression analysis was used to determine the association of treatment modality with PCSM, MFS, and freedom from AD, after controlling for age, Charlson Comorbidity Index (CCI) score, clinical stage, GS, and PSA covariates. RESULTS: Median follow-up for RP and EBRT was 92 months (range, 6 –176) and 76 months (range, 1–188), respectively. Patients undergoing EBRT were more likely to have adverse disease characteristics (p⬍0.001), higher comorbidity index (p⫽0.04), and to of African American ethnicity (p⬍0.001). Since 1998, proportionately more