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1477 WHEN TO RE-BIOPSY MEN WITH HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA?
Vol. 189, No. 4S, Supplement, Tuesday, May 7, 2013
specific tumor marker. The modest data set here continues to indicate that this biomarker is a useful adjunct for reduction of the inherent sampling error of prostate biopsy.
THE JOURNAL OF UROLOGY姞
e605
CONCLUSIONS: We found a striking correlation between CCP in CaP tissues and in benign tissue in other regions of the same prostate. These findings suggest that prognostic CCP scores could be generated from needle biopsies containing few cancer glands. If the correlation is confirmed by further studies, CCP analysis could also aid in choosing a second biopsy in patients with a negative initial biopsy. Source of Funding: Myriad Genetics, Fundação para a Ciência e a Tecnologia, Portugal.
1476 PROSTATE CANCER STAGES FOUND IN PATIENTS WITH MULTIPLE NEGATIVE SYSTEMATIC BIOPSIES Grabski Björn, Azis Ramankulov, Flensburg, Germany; Annemie Loch, Westerland, Germany; Udo Paul, Tillmann Loch*, Flensburg, Germany
Source of Funding: All funding sources are Canadian: Industrial Research Assistance Program, FedNor, Northern Ontario Heritage Foundation, Mitomics Inc.
1475 EVIDENCE FOR A CELL CYCLE PROLIFERATION “FIELD EFFECT” IN PROSTATE CANCER Filipe Carvalho, Baltimore, MD; William Welbourn, Julia Reid, Salt Lake City, UT; Elizabeth Humphreys, Misop Han, Baltimore, MD; Jerry Lanchbury, Alexander Gutin, Steven Stone, Salt Lake City, UT; David Berman*, Kingston, Canada INTRODUCTION AND OBJECTIVES: In men newly diagnosed with prostate cancer (CaP), discriminating between men who will and will not benefit from definitive therapy is often a challenge. Gleason grading provides a strong predictor of risk, but due to sampling issues, diagnostic biopsies often misclassify patients. A classifier that was less affected by sampling error could improve risk assessment in biopsies. High expression of cell cycle proliferation genes (CCP) has been correlated with high risk of CaP-specific mortality. To address the potential utility of CCP assays in overcoming sampling error, we measured CCP in prostate tumors and in cancer-free prostate tissues at various distances from the index tumor. METHODS: Under an institutionally approved protocol, 35 entirely submitted radical prostatectomy specimens (2001-2011) with unilateral CaP were selected. Patients with prior hormone therapy were excluded. Gleason score (2005 ISUP criteria), stage, and margin status were reviewed by a urologic pathologist. Median preoperative PSA was 5.2. Gleason scores were ⬍7 (n⫽17), 7 (n⫽13) or ⬎7 (n⫽5). Pathologic stage was pT2 (n⫽28) and pT3a (n⫽7). Margins were negative in all but 3 cases. Unstained archival specimens were analyzed in tumor samples and in benign tissues at 3 distances from the tumor: 3mm and 10mm (ipsilateral), and more than 20mm (contralateral). CCP scores were generated as in previous studies. RESULTS: For tumors, CCP scores varied from -1.7 to ⫹3. These values corresponded to the lowest and highest risk categories found in previous studies, respectively. The average tumor CCP score was -0.05. CCP scores in benign regions correlated with Tumor CCP score (R⫽0.46-0.67; p⫽0.0013 ? 8.9 ⫻ 10E-6). Interestingly, the correlation improved when we compared the CCP score from the average of tumor and benign adjacent to the average of benign near and contralateral (R⫽ 0.77). CCP values in benign prostate tissue declined slightly with increasing distance from cancer, losing, on average, only 0.08 units at each successively distant site.
INTRODUCTION AND OBJECTIVES: Ten to twelve systematic random biopsies (SRB) are today’s standard in the diagnosis of prostate cancer. In a prospective study we evaluated prostate cancer (PCA) in patients with multiple negative SRB. The Gleason grade and clinical stage of prostate cancer was analyzed in order to try to answer the question: Are we missing significant cancer or are we looking for insignificant tumors in patients with negative biopsies? METHODS: We evaluated 132 patients that had at least 1 series of negative SMBs in their history. All patients were subjected to a computerized transrectal ultrasound examination (C-TRUS). The system identified cancer suspicious areas by means of digital comparisons to known and surgically removed prostate cancers. Areas of similarities with cancer patterns underwent between 1 and 6 targeted biopsies. The Gleason Score (GS) was analyzed. The clinical tumor stage was determined by histopathology and C-TRUS imaging in respect to the prior negative SMB. RESULTS: The 132 man had a mean of 2 SMB sets with a median of 12 individual biopsy cores. The prostate volume ranged from 12 und 186 ml with a median of 42 ml. Prostate cancer could be identified in 66 of the 132 patients. 31 of the 66 patients had between 6 and 20 biopsy cores before C-TRUS guided biopsies. 19 men had 2 previous sets with 10-51 biopsy cores. 9 had 3 sets with 17 to 34 and 7 had 4-6 sets with 24-72 biopsy cores. The minimum number of was 6 and the maximum 72 cores total. Of the 66 men 5 had a GS of 5, 25 of 6, 22 of 7, 8 of 8 and 7 a GS of 9. The clinical stage was determined as 21 T2a, 13 T2b, 16 T2c and 16 ⬎T3a by correlating the pathology with the documented biopsy site. CONCLUSIONS: The result of this prospective study demonstrated that PCA found after multiple negative SMB are in the fast majority significant cancers. Only 5 (7,5%) of 66 patients with a median of 12 negative biopsies had a GS 5 PCA. The majority (71,2%) had Gleason score 6 and 7 PCA. GS of 8 and 9 was present in 22% of the patients. Even a high number of negative SMB do not exclude high grade and high stage prostate cancer. Source of Funding: None
1477 WHEN TO RE-BIOPSY MEN WITH HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA? Juan Maria Bastaros*, Ignacio Iztueta, Cristian Konstantinidis, Anna Celma, Jose Placer, Jacques Planas, Juan Morote, Barcelona, Spain INTRODUCTION AND OBJECTIVES: High grade prostatic intraepithelial neoplasia (HGPIN) is considered a premalignant lesion that frequently coexists with undetected prostate cancer (PC). Consensus to repeat prostate biopsy (PB) after isolated HGPIN finding has been changing over the time. Nowadays the recommendation is to repeat PB after at least one year and according to PSA velocity (0.75 ng/ml/year). The aim of this study is to verify if we are doing well.
e606
THE JOURNAL OF UROLOGY姞
METHODS: 219 consecutive men with isolated HGPIN at the first TRUS guided biopsy (PB), due to elevated serum PSA or abnormal digital rectal exam, were advised to repeat PB between 2009 and 2012. The median age was 66 years (43-72). We analyse 149 men subjected to a second PB after 4 to 39 months of follow up, 23 with less than 12 months (18%), 85 between 12 to 24 (66.4%) and 20 with more than 24 months (15.6%). The number of cores with HGPIN involvement was assessed as well as baseline PSA density and percent free PSA. PSA velocity (PSAV) and PSA doubling time (PSADT) were calculated with at least three serum determinations. PSAV was higher than 0.75 ng/ml/year in 24 men (16.1%). Every PB obtained 10 cores plus 1 to 8 additional ones according to age and prostate volume. PC was detected in 34 men (22.8%). Univariate and multivariate analysis were done. RESULTS: Binary logistic regression analysis showed that number of HGPIN involved cores was the only independent predictor of PC at repeated biopsy, OR: 1.64 (95%CI: 1.31-2.05), p ⬍0.001. PC was founded in 5 of 79 men with 1 or 2 HGPIN involved cores (6.3%), in 21 of 61 men with 3 to 7 involved cores (34.4%) and 8 of 9 men with more than 7 HGPIN involved cores (88.9%), p ⬍0.001. PC was detected in 4 of 23 (17.4%) men rebiopsied during the first 12 months of follow up, in 20/85 (23.5%) after 12 to 24 months and 7 of 20 (35.0%) later than 24 months, p ⫽0.392. PC was detected in 28/125 (22.4%) men with PSAV lower than 0.75 ng/ml/year and 6 of 24 (25.0%) men with higher PSAV, p ⫽0.817. In the specific subset of men with 3 to 7 HGPIN involved cores PSAV and time period between PBs were neither associated to PC detection. CONCLUSIONS: The number of HGPIN involved cores at first PB predicts PC at repeated one, however PSAV and time period to repeat the biopsy seem not be associated to PC detection. Men with 1 or 2 HGPIN involved cores may not be rebiopsied because the probability to find PC was lower than 7%. In contrast, men with massive HGPIN involvement of the prostate gland (more than 7 cores) should be advise to immediate rebiopsy because a PC probability greater than 80%. The attitude in front of men with 3 to 7 HGPIN cores involvement remains unclear and more predictive parameters should be founded. Source of Funding: None
1478 PATHOLOGIC OUTCOMES AFTER REPEAT PROSTATE BIOPSIES FOR ATYPICAL SMALL ACINAR PROLIFERATION Olivia Lee*, Kasey Rowe, Blythe Durbin-Johnson, Michael VanNess, Regina Gandour-Edwards, Ralph deVere White, Christopher Evans, Marc Dall’Era, Sacramento, CA INTRODUCTION AND OBJECTIVES: Atypical small acinar proliferation (ASAP) is considered a lesion suspicious for but nondiagnostic of prostate cancer. When found on prostate needle biopsy, the general recommendation is for men to undergo immediate repeat biopsy and studies suggest that the risk of cancer after a finding of ASAP is up to 40%. We sought to determine the pathologic outcomes after repeat prostate biopsies for ASAP at our institution compared to men undergoing repeat biopsies after a benign biopsy. METHODS: With approval from the IRB, we identified all men undergoing 2 or more prostate biopsies at our institution from 20002010. In this retrospective study, the primary outcome was prostate cancer on final biopsy stratified by Gleason grade. Baseline predictors of the primary outcome included pathologic result at first biopsy described as benign and high-grade prostatic intraepithelial neoplasia (HGPIN), ASAP, or Gleason 3⫹3 prostate cancer. We also evaluated the covariates: age, DRE findings, family history, PSA velocity, PSA density, and number of biopsies as possible predictors of final pathology. Multivariable analysis using logistic regression and proportional odds logistic regression was used. RESULTS: We identified 143 men who had an initial benign or HGPIN pathology, 59 men had initial ASAP, and 37 had initial low volume Gleason grade 6 prostate cancer that met criteria for active surveillance (AS). The predicted probability of finding cancer for each
Vol. 189, No. 4S, Supplement, Tuesday, May 7, 2013
initial pathologic subgroup: benign/HGPIN, ASAP, and AS, were 11%, 19%, 72%, respectively. When we further broke down the probability of cancer into low, intermediate and high Gleason grade, ASAP predicted a slightly higher risk of each Gleason grade when compared to the benign group, but significantly less than those with known cancer. Age (7.6% increased odds for each year of age), suspicious digital rectal exam (5.2 times higher odds), PSA density (5.3% increase in odds for each 0.01 increase in PSA density), and men on active surveillance, were significant predictors of finding cancer on final pathology. CONCLUSIONS: Cancer detection rates after ASAP at our institution (20%) are less than that described in the literature. Half of those who had cancer had intermediate to high Gleason grade cancers. ASAP had only a slight increased predicted probability of finding cancer on repeat biopsy when compared to patients with initial benign/HGPIN pathology. These findings affect how we counsel our patients who receive a pathologic diagnosis of ASAP. Source of Funding: None
1479 NURSE-PRACTITIONER LED PROSTATE (TRANSRECTAL ULTRASOUND-GUIDED) BIOPSY SERVICE: AUDIT OF ITS SAFETY AND EFFECTIVENESS Bruce Turner*, London, United Kingdom; Rozh Jalil, United Kingdom; Jhumur Pati, Vinod Nargund, James Green, London, United Kingdom INTRODUCTION AND OBJECTIVES: Poster Presentation: Increasing demand is being placed upon urology services, with UK Government directives to reduce waiting times for patients suspected to have cancer leading to cost-effective and innovative ways of working. Historically prostate biopsies were undertaken by medical staff in the UK. In order to shorten patient journey and accelerate management of prostate cancer, we introduced a Nurse Practitioner led one-stop rapid access prostate biopsy clinic. In this clinic patients are clinically assessed and transrectal ultrasound biopsy is done at the same time when indicated. METHODS: All patients underwent TRUS biopsy according to a set protocol which recorded, prostate volume, number of cores, ultrasound appearance. Retrospective analysis of patient records to ascertain: ● number of patients requiring biopsy (n⫽264) ● incidence of prostate cancer (n⫽142) ● grade of prostate cancer ● Time period from diagnosis to treatment ● Complication rates ● Incidence of failing to obtain prostate tissue RESULTS: In total 264 patients required prostate biopsy. ● 142 cancer diagnosed (57%) ● (Histological outcomes provided) (grades of cancer demonstrated on a graph). ● 100% of samples contained prostate tissue COMPLICATIONS ● Ten patients bled after the procedure (outcomes provided mostly self limiting) ● One patient had acute urinary retention. ● Three patients had vasovagal syncope and did not need any after treatment. ● There were no cases of sepsis. CONCLUSIONS: In our experience, nurse practitioner led onestop prostate biopsy is effective, efficient and safe. Since the introduction of this service doctors have been released to spend more time performing more complex tasks, surgery and outpatient clinics, which, in turn, has reduced the urology waiting times. The majority of patients have expressed a preference to having immediate biopsy than having to return to get the biopsy performed at another time. Further developments currently underway are pre-biopsy MRI scan. Preparation of the
specific tumor marker. The modest data set here continues to indicate that this biomarker is a useful adjunct for reduction of the inherent sampling error of prostate biopsy.
THE JOURNAL OF UROLOGY姞
e605
CONCLUSIONS: We found a striking correlation between CCP in CaP tissues and in benign tissue in other regions of the same prostate. These findings suggest that prognostic CCP scores could be generated from needle biopsies containing few cancer glands. If the correlation is confirmed by further studies, CCP analysis could also aid in choosing a second biopsy in patients with a negative initial biopsy. Source of Funding: Myriad Genetics, Fundação para a Ciência e a Tecnologia, Portugal.
1476 PROSTATE CANCER STAGES FOUND IN PATIENTS WITH MULTIPLE NEGATIVE SYSTEMATIC BIOPSIES Grabski Björn, Azis Ramankulov, Flensburg, Germany; Annemie Loch, Westerland, Germany; Udo Paul, Tillmann Loch*, Flensburg, Germany
Source of Funding: All funding sources are Canadian: Industrial Research Assistance Program, FedNor, Northern Ontario Heritage Foundation, Mitomics Inc.
1475 EVIDENCE FOR A CELL CYCLE PROLIFERATION “FIELD EFFECT” IN PROSTATE CANCER Filipe Carvalho, Baltimore, MD; William Welbourn, Julia Reid, Salt Lake City, UT; Elizabeth Humphreys, Misop Han, Baltimore, MD; Jerry Lanchbury, Alexander Gutin, Steven Stone, Salt Lake City, UT; David Berman*, Kingston, Canada INTRODUCTION AND OBJECTIVES: In men newly diagnosed with prostate cancer (CaP), discriminating between men who will and will not benefit from definitive therapy is often a challenge. Gleason grading provides a strong predictor of risk, but due to sampling issues, diagnostic biopsies often misclassify patients. A classifier that was less affected by sampling error could improve risk assessment in biopsies. High expression of cell cycle proliferation genes (CCP) has been correlated with high risk of CaP-specific mortality. To address the potential utility of CCP assays in overcoming sampling error, we measured CCP in prostate tumors and in cancer-free prostate tissues at various distances from the index tumor. METHODS: Under an institutionally approved protocol, 35 entirely submitted radical prostatectomy specimens (2001-2011) with unilateral CaP were selected. Patients with prior hormone therapy were excluded. Gleason score (2005 ISUP criteria), stage, and margin status were reviewed by a urologic pathologist. Median preoperative PSA was 5.2. Gleason scores were ⬍7 (n⫽17), 7 (n⫽13) or ⬎7 (n⫽5). Pathologic stage was pT2 (n⫽28) and pT3a (n⫽7). Margins were negative in all but 3 cases. Unstained archival specimens were analyzed in tumor samples and in benign tissues at 3 distances from the tumor: 3mm and 10mm (ipsilateral), and more than 20mm (contralateral). CCP scores were generated as in previous studies. RESULTS: For tumors, CCP scores varied from -1.7 to ⫹3. These values corresponded to the lowest and highest risk categories found in previous studies, respectively. The average tumor CCP score was -0.05. CCP scores in benign regions correlated with Tumor CCP score (R⫽0.46-0.67; p⫽0.0013 ? 8.9 ⫻ 10E-6). Interestingly, the correlation improved when we compared the CCP score from the average of tumor and benign adjacent to the average of benign near and contralateral (R⫽ 0.77). CCP values in benign prostate tissue declined slightly with increasing distance from cancer, losing, on average, only 0.08 units at each successively distant site.
INTRODUCTION AND OBJECTIVES: Ten to twelve systematic random biopsies (SRB) are today’s standard in the diagnosis of prostate cancer. In a prospective study we evaluated prostate cancer (PCA) in patients with multiple negative SRB. The Gleason grade and clinical stage of prostate cancer was analyzed in order to try to answer the question: Are we missing significant cancer or are we looking for insignificant tumors in patients with negative biopsies? METHODS: We evaluated 132 patients that had at least 1 series of negative SMBs in their history. All patients were subjected to a computerized transrectal ultrasound examination (C-TRUS). The system identified cancer suspicious areas by means of digital comparisons to known and surgically removed prostate cancers. Areas of similarities with cancer patterns underwent between 1 and 6 targeted biopsies. The Gleason Score (GS) was analyzed. The clinical tumor stage was determined by histopathology and C-TRUS imaging in respect to the prior negative SMB. RESULTS: The 132 man had a mean of 2 SMB sets with a median of 12 individual biopsy cores. The prostate volume ranged from 12 und 186 ml with a median of 42 ml. Prostate cancer could be identified in 66 of the 132 patients. 31 of the 66 patients had between 6 and 20 biopsy cores before C-TRUS guided biopsies. 19 men had 2 previous sets with 10-51 biopsy cores. 9 had 3 sets with 17 to 34 and 7 had 4-6 sets with 24-72 biopsy cores. The minimum number of was 6 and the maximum 72 cores total. Of the 66 men 5 had a GS of 5, 25 of 6, 22 of 7, 8 of 8 and 7 a GS of 9. The clinical stage was determined as 21 T2a, 13 T2b, 16 T2c and 16 ⬎T3a by correlating the pathology with the documented biopsy site. CONCLUSIONS: The result of this prospective study demonstrated that PCA found after multiple negative SMB are in the fast majority significant cancers. Only 5 (7,5%) of 66 patients with a median of 12 negative biopsies had a GS 5 PCA. The majority (71,2%) had Gleason score 6 and 7 PCA. GS of 8 and 9 was present in 22% of the patients. Even a high number of negative SMB do not exclude high grade and high stage prostate cancer. Source of Funding: None
1477 WHEN TO RE-BIOPSY MEN WITH HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA? Juan Maria Bastaros*, Ignacio Iztueta, Cristian Konstantinidis, Anna Celma, Jose Placer, Jacques Planas, Juan Morote, Barcelona, Spain INTRODUCTION AND OBJECTIVES: High grade prostatic intraepithelial neoplasia (HGPIN) is considered a premalignant lesion that frequently coexists with undetected prostate cancer (PC). Consensus to repeat prostate biopsy (PB) after isolated HGPIN finding has been changing over the time. Nowadays the recommendation is to repeat PB after at least one year and according to PSA velocity (0.75 ng/ml/year). The aim of this study is to verify if we are doing well.
e606
THE JOURNAL OF UROLOGY姞
METHODS: 219 consecutive men with isolated HGPIN at the first TRUS guided biopsy (PB), due to elevated serum PSA or abnormal digital rectal exam, were advised to repeat PB between 2009 and 2012. The median age was 66 years (43-72). We analyse 149 men subjected to a second PB after 4 to 39 months of follow up, 23 with less than 12 months (18%), 85 between 12 to 24 (66.4%) and 20 with more than 24 months (15.6%). The number of cores with HGPIN involvement was assessed as well as baseline PSA density and percent free PSA. PSA velocity (PSAV) and PSA doubling time (PSADT) were calculated with at least three serum determinations. PSAV was higher than 0.75 ng/ml/year in 24 men (16.1%). Every PB obtained 10 cores plus 1 to 8 additional ones according to age and prostate volume. PC was detected in 34 men (22.8%). Univariate and multivariate analysis were done. RESULTS: Binary logistic regression analysis showed that number of HGPIN involved cores was the only independent predictor of PC at repeated biopsy, OR: 1.64 (95%CI: 1.31-2.05), p ⬍0.001. PC was founded in 5 of 79 men with 1 or 2 HGPIN involved cores (6.3%), in 21 of 61 men with 3 to 7 involved cores (34.4%) and 8 of 9 men with more than 7 HGPIN involved cores (88.9%), p ⬍0.001. PC was detected in 4 of 23 (17.4%) men rebiopsied during the first 12 months of follow up, in 20/85 (23.5%) after 12 to 24 months and 7 of 20 (35.0%) later than 24 months, p ⫽0.392. PC was detected in 28/125 (22.4%) men with PSAV lower than 0.75 ng/ml/year and 6 of 24 (25.0%) men with higher PSAV, p ⫽0.817. In the specific subset of men with 3 to 7 HGPIN involved cores PSAV and time period between PBs were neither associated to PC detection. CONCLUSIONS: The number of HGPIN involved cores at first PB predicts PC at repeated one, however PSAV and time period to repeat the biopsy seem not be associated to PC detection. Men with 1 or 2 HGPIN involved cores may not be rebiopsied because the probability to find PC was lower than 7%. In contrast, men with massive HGPIN involvement of the prostate gland (more than 7 cores) should be advise to immediate rebiopsy because a PC probability greater than 80%. The attitude in front of men with 3 to 7 HGPIN cores involvement remains unclear and more predictive parameters should be founded. Source of Funding: None
1478 PATHOLOGIC OUTCOMES AFTER REPEAT PROSTATE BIOPSIES FOR ATYPICAL SMALL ACINAR PROLIFERATION Olivia Lee*, Kasey Rowe, Blythe Durbin-Johnson, Michael VanNess, Regina Gandour-Edwards, Ralph deVere White, Christopher Evans, Marc Dall’Era, Sacramento, CA INTRODUCTION AND OBJECTIVES: Atypical small acinar proliferation (ASAP) is considered a lesion suspicious for but nondiagnostic of prostate cancer. When found on prostate needle biopsy, the general recommendation is for men to undergo immediate repeat biopsy and studies suggest that the risk of cancer after a finding of ASAP is up to 40%. We sought to determine the pathologic outcomes after repeat prostate biopsies for ASAP at our institution compared to men undergoing repeat biopsies after a benign biopsy. METHODS: With approval from the IRB, we identified all men undergoing 2 or more prostate biopsies at our institution from 20002010. In this retrospective study, the primary outcome was prostate cancer on final biopsy stratified by Gleason grade. Baseline predictors of the primary outcome included pathologic result at first biopsy described as benign and high-grade prostatic intraepithelial neoplasia (HGPIN), ASAP, or Gleason 3⫹3 prostate cancer. We also evaluated the covariates: age, DRE findings, family history, PSA velocity, PSA density, and number of biopsies as possible predictors of final pathology. Multivariable analysis using logistic regression and proportional odds logistic regression was used. RESULTS: We identified 143 men who had an initial benign or HGPIN pathology, 59 men had initial ASAP, and 37 had initial low volume Gleason grade 6 prostate cancer that met criteria for active surveillance (AS). The predicted probability of finding cancer for each
Vol. 189, No. 4S, Supplement, Tuesday, May 7, 2013
initial pathologic subgroup: benign/HGPIN, ASAP, and AS, were 11%, 19%, 72%, respectively. When we further broke down the probability of cancer into low, intermediate and high Gleason grade, ASAP predicted a slightly higher risk of each Gleason grade when compared to the benign group, but significantly less than those with known cancer. Age (7.6% increased odds for each year of age), suspicious digital rectal exam (5.2 times higher odds), PSA density (5.3% increase in odds for each 0.01 increase in PSA density), and men on active surveillance, were significant predictors of finding cancer on final pathology. CONCLUSIONS: Cancer detection rates after ASAP at our institution (20%) are less than that described in the literature. Half of those who had cancer had intermediate to high Gleason grade cancers. ASAP had only a slight increased predicted probability of finding cancer on repeat biopsy when compared to patients with initial benign/HGPIN pathology. These findings affect how we counsel our patients who receive a pathologic diagnosis of ASAP. Source of Funding: None
1479 NURSE-PRACTITIONER LED PROSTATE (TRANSRECTAL ULTRASOUND-GUIDED) BIOPSY SERVICE: AUDIT OF ITS SAFETY AND EFFECTIVENESS Bruce Turner*, London, United Kingdom; Rozh Jalil, United Kingdom; Jhumur Pati, Vinod Nargund, James Green, London, United Kingdom INTRODUCTION AND OBJECTIVES: Poster Presentation: Increasing demand is being placed upon urology services, with UK Government directives to reduce waiting times for patients suspected to have cancer leading to cost-effective and innovative ways of working. Historically prostate biopsies were undertaken by medical staff in the UK. In order to shorten patient journey and accelerate management of prostate cancer, we introduced a Nurse Practitioner led one-stop rapid access prostate biopsy clinic. In this clinic patients are clinically assessed and transrectal ultrasound biopsy is done at the same time when indicated. METHODS: All patients underwent TRUS biopsy according to a set protocol which recorded, prostate volume, number of cores, ultrasound appearance. Retrospective analysis of patient records to ascertain: ● number of patients requiring biopsy (n⫽264) ● incidence of prostate cancer (n⫽142) ● grade of prostate cancer ● Time period from diagnosis to treatment ● Complication rates ● Incidence of failing to obtain prostate tissue RESULTS: In total 264 patients required prostate biopsy. ● 142 cancer diagnosed (57%) ● (Histological outcomes provided) (grades of cancer demonstrated on a graph). ● 100% of samples contained prostate tissue COMPLICATIONS ● Ten patients bled after the procedure (outcomes provided mostly self limiting) ● One patient had acute urinary retention. ● Three patients had vasovagal syncope and did not need any after treatment. ● There were no cases of sepsis. CONCLUSIONS: In our experience, nurse practitioner led onestop prostate biopsy is effective, efficient and safe. Since the introduction of this service doctors have been released to spend more time performing more complex tasks, surgery and outpatient clinics, which, in turn, has reduced the urology waiting times. The majority of patients have expressed a preference to having immediate biopsy than having to return to get the biopsy performed at another time. Further developments currently underway are pre-biopsy MRI scan. Preparation of the