- Email: [email protected]
ENDOSCOPIC MODIFIED INGUINAL LYMPHADENECTOMY: LEG ENDOSCOPIC GROIN (LEG) PROCEDURE
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Tuesday, April 28, 2009
through a trocar inserted in the abdominal wall is sometimes difficult and not satisfactory.Availability of laparoscopic instruments for soft tissue dissection is limited to the use of forceps and scissors,obviously without any option to hand dissection (unless one perform a hand assisted proceeding). We present a new device,DIT,to facilitate intrabdominal manipulation of lax tissues. METHODS: We present a video showing the use of a new instrument called DIT designed for laparoscopic surgery to facilitate lax connective tissue dissection.In a pilot study that we carried out, we practiced 34 operations in 7 pigs to stand out the usefulness and security of this instrument.In all cases,images from outside and inside were recorded and all incidents were registered. RESULTS: The urological proceedings done were nephrectomy and prostatectomy. Images displayed focus on the steps in which the DIT is used in this surgical operations. Hysterectomy,iliac lymphadenectomy, gastroesophagical fundoplication and the dissection of the rectum in low anterior resection were also performed by other specialists.In one case there was a mechanical problem of the finger and in five cases latex bundle presented some laceration at the end of the proceeding. Surgeons satisfaction was high in all cases outstanding how intuitive is the manipulation of this instrument.There was no secondary bleeding due to DIT.It was very useful for gentle suspension or separation of any viscera. CONCLUSIONS: The DIT is a handling instrument for laparoscopic surgery created to facilitate the dissection of lax spaces. It also can be used as a deflecting probe insight the abdomen.Its mechanical functioning is correct.Its manipulation is easy for the surgeon and save for the patient. Source of Funding: Fundació Caixa de Sabadell Comisión Interministerial de Ciencia y Tecnología (CICYT)
V1678 A NOVEL USE FOR THE CAMERA PHONE: CAPTURING ENDOUROLOGIC VIDEO ADEQUATE FOR DEMONSTRATION Michael L Garcia-Roig*, Edouard J Trabulsi, Demetrius H Bagley, Philadelphia, PA INTRODUCTION AND OBJECTIVES: To describe a novel use of video-equipt camera phones as practical, readily available, cost effective, and adequate method of recording video during endoscopic and open surgical cases in the urologic setting in an era of costly and complex video recording options. METHODS: We used camera phones with video capabilities (Palm Treo 650, Palm Treo 755, and Samsung SGH-A717) with a resolution of 320 x 240 in the palm devices and 176 x 144 in the Samsung device to capture video images from cathode ray tube (CRT) and liquid crystal display (LCD) screens during operative cases in the operating room. The videos were saved to Secure Digital and Mini Secure Digital memory cards and transferred to a personal computer. Cameraphone video was edited using Quicktime Pro on an Apple Macbook Pro laptop computer. RESULTS: The video captured with this method was of adequate quality for demonstration. We were able to identify anatomic structures (intrarenal tissue and ureteral oriface), laser fibers, working instruments, and treatment of stones and tumor. The best quality images were obtained from the LCD screen, as video recorded from CRT contained a flicker. Video from the Palm Treo 755 suffered from intermittent freezing, the Palm Treo 650 captured video adequate for presentation, and video from the Samsung SGH-A717 was often washed out and of too low a resolution for demonstration. Videos were easily edited using preinstalled camera phone software and personal computer software. CONCLUSIONS: With adequate camera phone resolution camera phone video is practical, cost effective, and easily incorporated into demonstrations. Source of Funding: None
605
V1679 PROSPECTIVE COMPARISON OF PERIOPERATIVE AND PATHOLOGIC OUTCOMES BETWEEN ROBOTIC AND OPEN RADICAL CYSTECTOMY Gerald J Wang*, Casey K Ng, Eric C Kauffman, Ming-Ming Lee, Brandon J Otto, Philip S Li, Douglas S Scherr, New York, NY INTRODUCTION AND OBJECTIVES: Open radical cystectomy (RC) is the gold standard for treatment of muscle-invasive bladder cancer. Efforts to reduce the operative morbidity of RC have fostered interest in minimally invasive approaches. Here, we present our series of roboticassisted RCs and provide a prospective comparison with a concurrent series of open RCs of perioperative and pathologic outcomes, as well as 30 and 90-day complication rates. METHODS: From February 2002 to July 2008, 187 consecutive patients underwent RC by a single surgeon at our institution. One-hundred four were performed open, while 83 utilized the daVinci robotic system (Intuitive Surgical, Sunnyvale, CA). Urinary diversion was performed extracorporeally. Thirty and 90-day complication rates were assessed using the Modified Clavien Classification of Surgical Complications. Data was collected prospectively and analyzed using the chi-square, Fisher’s exact, and Student’s t-tests. RESULTS: There was no difference in gender, BMI, ASA class, clinical stage and grade, history of prior surgery or radiation, or neoadjuvant chemotherapy between the 2 groups. Mean operative time was 18 minutes longer in the robotic group (375 vs. 357 min), but this was not statistically significant (p=0.3). The robotic cohort demonstrated decreased blood loss (460 vs. 1172 ml, p < 0.001), transfusion requirement (1.4 vs. 3.7 units, p < 0.001), and shorter hospitalization (5.5 versus 8.0 days, p < 0.001). At both 30 and 90 days, the robotic group demonstrated fewer major complications (10 vs 30%, 18 vs. 32%, p < 0.05). There was no difference in grade or stage of the primary tumor, but there were more patients with node-positive disease in the open group (31 vs. 17%, p < 0.05). The robotic group also demonstrated equivalent lymph node yield (18 vs. 16, p=0.2) and surgical margin status (7 vs 9%, p=0.8). CONCLUSIONS: Our experience with robotic-assisted RC suggests potential advantages compared to the standard open approach. The robotic group demonstrated equivalent operative time, as well as decreased blood loss, transfusion requirement, and hospital stay. The pathologic outcomes of early oncologic efficacy, such as total lymph node yield and margin status, were equivalent between the 2 groups. At both 30 and 90 days, we found fewer major complications in the robotic cohort. However, long-term functional and oncologic outcomes are needed to better define the role of robotic-assisted RC in the surgical management of bladder cancer. Source of Funding: None
V1680 ENDOSCOPIC MODIFIED INGUINAL LYMPHADENECTOMY: LEG ENDOSCOPIC GROIN (LEG) PROCEDURE Wayland Hsiao*, Lindsey Herrel, Keith A. Delman, Kenneth Ogan, Viraj A. Master, Atlanta, GA INTRODUCTION AND OBJECTIVES: Diverse genitourinary malignancies can develop metastatic disease to the inguinal lymph nodes. Commonly, this occurs in penile cancer, but also in more rare disease states such as scrotal cancer and Paget’s disease of the scrotum. Inguinal lymphadenectomy is performed in selected patients for both diagnostic and potentially therapeutic purposes. Historically, open inguinal lymphadenectomy is associated with a high percentage of significant complications, especially flap necrosis. Since the first description of an endoscopic approach to groin dissection in 1992 by Bishoff, this type of approach has been described by only 1 other group. METHODS: We describe and demonstrate our step-by-step technique of modified inguinal lymphadenectomy utilizing an endoscopic approach in a 56 year old man with pT3 penile cancer and palpable bilateral inguinal lymphadenopathy. The limits of dissection and well as techniques used in this procedure are shown and discussed.
THE JOURNAL OF UROLOGY®
606
RESULTS: Laparoscopic modified inguinal lymphadenectomy was successfully completed on both sides. The procedure took 120 minutes per leg. We demonstrate the limits of dissection as well as useful anatomic landmarks used in the procedure. The patient did well without complication. On pathologic review, we obtained 9 and 10 nodes, respectively. CONCLUSIONS: A endoscopic approach to modified inguinal lymphadenectomy is a versatile technique which can be performed in a stepwise manner for a variety of disease conditions. In our experience, oncologic efficacy is maintained. We have demonstrated our technique as well as discuss useful anatomic landmarks. This technique may potentially lead to reduced complications. At our institution, we have performed this surgery in 5 patients (10 legs) without any wound complications. Source of Funding: None
V1681 ROBOT ASSISTED PARTIAL CYSTECTOMY: A NOVEL TECHNIQUE USING SIMULTANEOUS CYSTOSCOPIC AND LAPAROSCOPIC MONITORING WITH STAPLE CONTROL OF TUMOR Alok Shrivastava*, Louis S Krane, Mani Menon, James O Peabody, Detroit, MI INTRODUCTION AND OBJECTIVES: We describe a novel technique of robot assisted partial cystectomy with simultaneous endoscopic and laparoscopic monitoring using the Tile-ProTM. Endovascular stapler was used to prevent potential tumor spillage. METHODS: 78 year old female with recurrent transitional cell carcinoma on the dome of the bladder underwent robotic assisted partial cystectomy with a 6-port approach. Cystoscopy was performed simultaneously in order to delineate the tumor by direct vision and transillumination and this was monitored with side by side video imaging using the Tile-ProTM feature of daVinciTM Surgical System. After identification of the tumor and required tumor margin the endovascular stapler was used to cut across the bladder and to isolate the tumor in an attempt to prevent intra-abdominal tumor spillage. The resected partial cystectomy specimen was then placed in an specimen bag. The staple line on the bladder was then resected and sent for frozen section to assess the completeness of resection. The bladder was then closed in two layers. The patient then underwent an extended pelvic lymph node dissection and bilateral salpingo-oophorectomy. RESULTS: The post-operative bladder volume was 250 ml, length of hospitalization was 1 day and the catheter was removed in one weeks. Final tumor pathological stage was T3a. The surgical margin was free of tumor. CONCLUSIONS: This novel approach to partial cystectomy has the potential advantage of identifying the location of the tumor by simultaneous monitoring both laparoscopically and cystoscopically. Use of the endovascular stapler prevents spillage and stapler line resection confirms the completeness of resection without requiring the extraction of the specimen prior to bladder reconstruction.
Vol. 181, No. 4, Supplement, Tuesday, April 28, 2009
Prostate Cancer: Localized (V) Moderated Poster 55 Tuesday, April 28, 2009
3:30 pm - 5:30 pm
1682 CLINICAL RESULTS OF LONG TERM FOLLOW-UP OF A LARGE ACTIVE SURVEILLANCE COHORT Laurence H Klotz*, Robert Nam, Adam Lam, Alex Mamedov, Andrew Loblaw, Toronto, ON, Canada INTRODUCTION AND OBJECTIVES: In 1995, a prospective phase 2 trial of active surveillance was initiated at our centre. This approach was offered to men with favorable risk prostate cancer as an alternative to radical intervention. Patients were closely followed with serial PSA and periodic biopsy, and intervention was offered based on PSA kinetics or grade progression. Our initial results were reported in 2002 on 231 patients. This report is our 2nd analysis of this group, which now constitutes 453 men. METHODS: This is a prospective, single arm cohort study. Patients with favorable clinical parameters (screen diagnosed patients with Gleason <=6, PSA <=10) were managed with active surveillance. Initially a subset of men > 70 were included with Gleason 3+4 or PSA 10-15. In 2000, the study was restricted to favorable risk disease. Definitive intervention was offered to those patients with a PSA doubling time of < 3 years, Gleason score progression (to 4+3 or greater), or unequivocal clinical progression. PSA doubling time was calculated using the General Linear Mixed Model. RESULTS: Since November 1995, 453 patients have been entered on the program. Median age is 70 (range 45-86). The median followup is 7.2 years (range 1-13 yrs). Overall survival is 83%, and prostate cancer survival is 99%. 5 of 453 patients have died of prostate cancer. 35% of patients have been reclassified as higher risk and offered definitive therapy. The commonest indication for treatment was a PSA DT < 3 years (14%) or Gleason upgrading (6%). Of 137 patients treated radically, the PSA failure rate was 52%. Patients with biochemical failure after radical therapy constitute 15% of the overall cohort. The ratio of non-prostate cancer to prostate cancer mortality was 16 CONCLUSIONS: A policy of watchful waiting with selective delayed intervention based on defined criteria of disease risk reclassification is associated with a low prostate cancer mortality. Patients with favorable risk parameters at baseline who subsequently demonstrate a PSA doubling time < 3 years or pathologic progression to Gleason 4+3 represent a high risk cohort, reflected in a 52% rate of biochemical progression after radical therapy. This strategy offers the benefit of an individualized approach based on reclassification of the risk of progression over time. It may decrease the burden of therapy in patients with indolent disease, while providing definitive therapy for those with more aggressive disease. Source of Funding: Prostate Cancer Research Foundation of Canada
Source of Funding: None
1683 PROSPECTIVE PROTOCOL BASED ACTIVE SURVEILLANCE FOR EARLY PROSTATE CANCER: SHORT-TERM RESULTS OF 500 PATIENTS IN THE PRIAS STUDY Roderick C n van den Bergh*, Rotterdam, Netherlands; Hanna Vasarainen, Helsinki, Finland; Tom Pickles, Vancouver, BCCanada; Riccardo Valdagni, Milan, Italy; Frederic Staerman, Reims, France; Antti Rannikko, Helsinki, Finland; Stijn Roemeling, Monique J Roobol, Fritz H Schröder, Chris H Bangma, Rotterdam, Netherlands INTRODUCTION AND OBJECTIVES: Active surveillance (AS) for early prostate cancer (PCa) may provide a partial solution to the overtreatment dilemma. AS programs, including the multicenter prospective observational PRIAS study, have been initiated to acquire prospective evidence for this strategy. To assess the effect of applying a
Vol. 181, No. 4, Supplement, Tuesday, April 28, 2009
through a trocar inserted in the abdominal wall is sometimes difficult and not satisfactory.Availability of laparoscopic instruments for soft tissue dissection is limited to the use of forceps and scissors,obviously without any option to hand dissection (unless one perform a hand assisted proceeding). We present a new device,DIT,to facilitate intrabdominal manipulation of lax tissues. METHODS: We present a video showing the use of a new instrument called DIT designed for laparoscopic surgery to facilitate lax connective tissue dissection.In a pilot study that we carried out, we practiced 34 operations in 7 pigs to stand out the usefulness and security of this instrument.In all cases,images from outside and inside were recorded and all incidents were registered. RESULTS: The urological proceedings done were nephrectomy and prostatectomy. Images displayed focus on the steps in which the DIT is used in this surgical operations. Hysterectomy,iliac lymphadenectomy, gastroesophagical fundoplication and the dissection of the rectum in low anterior resection were also performed by other specialists.In one case there was a mechanical problem of the finger and in five cases latex bundle presented some laceration at the end of the proceeding. Surgeons satisfaction was high in all cases outstanding how intuitive is the manipulation of this instrument.There was no secondary bleeding due to DIT.It was very useful for gentle suspension or separation of any viscera. CONCLUSIONS: The DIT is a handling instrument for laparoscopic surgery created to facilitate the dissection of lax spaces. It also can be used as a deflecting probe insight the abdomen.Its mechanical functioning is correct.Its manipulation is easy for the surgeon and save for the patient. Source of Funding: Fundació Caixa de Sabadell Comisión Interministerial de Ciencia y Tecnología (CICYT)
V1678 A NOVEL USE FOR THE CAMERA PHONE: CAPTURING ENDOUROLOGIC VIDEO ADEQUATE FOR DEMONSTRATION Michael L Garcia-Roig*, Edouard J Trabulsi, Demetrius H Bagley, Philadelphia, PA INTRODUCTION AND OBJECTIVES: To describe a novel use of video-equipt camera phones as practical, readily available, cost effective, and adequate method of recording video during endoscopic and open surgical cases in the urologic setting in an era of costly and complex video recording options. METHODS: We used camera phones with video capabilities (Palm Treo 650, Palm Treo 755, and Samsung SGH-A717) with a resolution of 320 x 240 in the palm devices and 176 x 144 in the Samsung device to capture video images from cathode ray tube (CRT) and liquid crystal display (LCD) screens during operative cases in the operating room. The videos were saved to Secure Digital and Mini Secure Digital memory cards and transferred to a personal computer. Cameraphone video was edited using Quicktime Pro on an Apple Macbook Pro laptop computer. RESULTS: The video captured with this method was of adequate quality for demonstration. We were able to identify anatomic structures (intrarenal tissue and ureteral oriface), laser fibers, working instruments, and treatment of stones and tumor. The best quality images were obtained from the LCD screen, as video recorded from CRT contained a flicker. Video from the Palm Treo 755 suffered from intermittent freezing, the Palm Treo 650 captured video adequate for presentation, and video from the Samsung SGH-A717 was often washed out and of too low a resolution for demonstration. Videos were easily edited using preinstalled camera phone software and personal computer software. CONCLUSIONS: With adequate camera phone resolution camera phone video is practical, cost effective, and easily incorporated into demonstrations. Source of Funding: None
605
V1679 PROSPECTIVE COMPARISON OF PERIOPERATIVE AND PATHOLOGIC OUTCOMES BETWEEN ROBOTIC AND OPEN RADICAL CYSTECTOMY Gerald J Wang*, Casey K Ng, Eric C Kauffman, Ming-Ming Lee, Brandon J Otto, Philip S Li, Douglas S Scherr, New York, NY INTRODUCTION AND OBJECTIVES: Open radical cystectomy (RC) is the gold standard for treatment of muscle-invasive bladder cancer. Efforts to reduce the operative morbidity of RC have fostered interest in minimally invasive approaches. Here, we present our series of roboticassisted RCs and provide a prospective comparison with a concurrent series of open RCs of perioperative and pathologic outcomes, as well as 30 and 90-day complication rates. METHODS: From February 2002 to July 2008, 187 consecutive patients underwent RC by a single surgeon at our institution. One-hundred four were performed open, while 83 utilized the daVinci robotic system (Intuitive Surgical, Sunnyvale, CA). Urinary diversion was performed extracorporeally. Thirty and 90-day complication rates were assessed using the Modified Clavien Classification of Surgical Complications. Data was collected prospectively and analyzed using the chi-square, Fisher’s exact, and Student’s t-tests. RESULTS: There was no difference in gender, BMI, ASA class, clinical stage and grade, history of prior surgery or radiation, or neoadjuvant chemotherapy between the 2 groups. Mean operative time was 18 minutes longer in the robotic group (375 vs. 357 min), but this was not statistically significant (p=0.3). The robotic cohort demonstrated decreased blood loss (460 vs. 1172 ml, p < 0.001), transfusion requirement (1.4 vs. 3.7 units, p < 0.001), and shorter hospitalization (5.5 versus 8.0 days, p < 0.001). At both 30 and 90 days, the robotic group demonstrated fewer major complications (10 vs 30%, 18 vs. 32%, p < 0.05). There was no difference in grade or stage of the primary tumor, but there were more patients with node-positive disease in the open group (31 vs. 17%, p < 0.05). The robotic group also demonstrated equivalent lymph node yield (18 vs. 16, p=0.2) and surgical margin status (7 vs 9%, p=0.8). CONCLUSIONS: Our experience with robotic-assisted RC suggests potential advantages compared to the standard open approach. The robotic group demonstrated equivalent operative time, as well as decreased blood loss, transfusion requirement, and hospital stay. The pathologic outcomes of early oncologic efficacy, such as total lymph node yield and margin status, were equivalent between the 2 groups. At both 30 and 90 days, we found fewer major complications in the robotic cohort. However, long-term functional and oncologic outcomes are needed to better define the role of robotic-assisted RC in the surgical management of bladder cancer. Source of Funding: None
V1680 ENDOSCOPIC MODIFIED INGUINAL LYMPHADENECTOMY: LEG ENDOSCOPIC GROIN (LEG) PROCEDURE Wayland Hsiao*, Lindsey Herrel, Keith A. Delman, Kenneth Ogan, Viraj A. Master, Atlanta, GA INTRODUCTION AND OBJECTIVES: Diverse genitourinary malignancies can develop metastatic disease to the inguinal lymph nodes. Commonly, this occurs in penile cancer, but also in more rare disease states such as scrotal cancer and Paget’s disease of the scrotum. Inguinal lymphadenectomy is performed in selected patients for both diagnostic and potentially therapeutic purposes. Historically, open inguinal lymphadenectomy is associated with a high percentage of significant complications, especially flap necrosis. Since the first description of an endoscopic approach to groin dissection in 1992 by Bishoff, this type of approach has been described by only 1 other group. METHODS: We describe and demonstrate our step-by-step technique of modified inguinal lymphadenectomy utilizing an endoscopic approach in a 56 year old man with pT3 penile cancer and palpable bilateral inguinal lymphadenopathy. The limits of dissection and well as techniques used in this procedure are shown and discussed.
THE JOURNAL OF UROLOGY®
606
RESULTS: Laparoscopic modified inguinal lymphadenectomy was successfully completed on both sides. The procedure took 120 minutes per leg. We demonstrate the limits of dissection as well as useful anatomic landmarks used in the procedure. The patient did well without complication. On pathologic review, we obtained 9 and 10 nodes, respectively. CONCLUSIONS: A endoscopic approach to modified inguinal lymphadenectomy is a versatile technique which can be performed in a stepwise manner for a variety of disease conditions. In our experience, oncologic efficacy is maintained. We have demonstrated our technique as well as discuss useful anatomic landmarks. This technique may potentially lead to reduced complications. At our institution, we have performed this surgery in 5 patients (10 legs) without any wound complications. Source of Funding: None
V1681 ROBOT ASSISTED PARTIAL CYSTECTOMY: A NOVEL TECHNIQUE USING SIMULTANEOUS CYSTOSCOPIC AND LAPAROSCOPIC MONITORING WITH STAPLE CONTROL OF TUMOR Alok Shrivastava*, Louis S Krane, Mani Menon, James O Peabody, Detroit, MI INTRODUCTION AND OBJECTIVES: We describe a novel technique of robot assisted partial cystectomy with simultaneous endoscopic and laparoscopic monitoring using the Tile-ProTM. Endovascular stapler was used to prevent potential tumor spillage. METHODS: 78 year old female with recurrent transitional cell carcinoma on the dome of the bladder underwent robotic assisted partial cystectomy with a 6-port approach. Cystoscopy was performed simultaneously in order to delineate the tumor by direct vision and transillumination and this was monitored with side by side video imaging using the Tile-ProTM feature of daVinciTM Surgical System. After identification of the tumor and required tumor margin the endovascular stapler was used to cut across the bladder and to isolate the tumor in an attempt to prevent intra-abdominal tumor spillage. The resected partial cystectomy specimen was then placed in an specimen bag. The staple line on the bladder was then resected and sent for frozen section to assess the completeness of resection. The bladder was then closed in two layers. The patient then underwent an extended pelvic lymph node dissection and bilateral salpingo-oophorectomy. RESULTS: The post-operative bladder volume was 250 ml, length of hospitalization was 1 day and the catheter was removed in one weeks. Final tumor pathological stage was T3a. The surgical margin was free of tumor. CONCLUSIONS: This novel approach to partial cystectomy has the potential advantage of identifying the location of the tumor by simultaneous monitoring both laparoscopically and cystoscopically. Use of the endovascular stapler prevents spillage and stapler line resection confirms the completeness of resection without requiring the extraction of the specimen prior to bladder reconstruction.
Vol. 181, No. 4, Supplement, Tuesday, April 28, 2009
Prostate Cancer: Localized (V) Moderated Poster 55 Tuesday, April 28, 2009
3:30 pm - 5:30 pm
1682 CLINICAL RESULTS OF LONG TERM FOLLOW-UP OF A LARGE ACTIVE SURVEILLANCE COHORT Laurence H Klotz*, Robert Nam, Adam Lam, Alex Mamedov, Andrew Loblaw, Toronto, ON, Canada INTRODUCTION AND OBJECTIVES: In 1995, a prospective phase 2 trial of active surveillance was initiated at our centre. This approach was offered to men with favorable risk prostate cancer as an alternative to radical intervention. Patients were closely followed with serial PSA and periodic biopsy, and intervention was offered based on PSA kinetics or grade progression. Our initial results were reported in 2002 on 231 patients. This report is our 2nd analysis of this group, which now constitutes 453 men. METHODS: This is a prospective, single arm cohort study. Patients with favorable clinical parameters (screen diagnosed patients with Gleason <=6, PSA <=10) were managed with active surveillance. Initially a subset of men > 70 were included with Gleason 3+4 or PSA 10-15. In 2000, the study was restricted to favorable risk disease. Definitive intervention was offered to those patients with a PSA doubling time of < 3 years, Gleason score progression (to 4+3 or greater), or unequivocal clinical progression. PSA doubling time was calculated using the General Linear Mixed Model. RESULTS: Since November 1995, 453 patients have been entered on the program. Median age is 70 (range 45-86). The median followup is 7.2 years (range 1-13 yrs). Overall survival is 83%, and prostate cancer survival is 99%. 5 of 453 patients have died of prostate cancer. 35% of patients have been reclassified as higher risk and offered definitive therapy. The commonest indication for treatment was a PSA DT < 3 years (14%) or Gleason upgrading (6%). Of 137 patients treated radically, the PSA failure rate was 52%. Patients with biochemical failure after radical therapy constitute 15% of the overall cohort. The ratio of non-prostate cancer to prostate cancer mortality was 16 CONCLUSIONS: A policy of watchful waiting with selective delayed intervention based on defined criteria of disease risk reclassification is associated with a low prostate cancer mortality. Patients with favorable risk parameters at baseline who subsequently demonstrate a PSA doubling time < 3 years or pathologic progression to Gleason 4+3 represent a high risk cohort, reflected in a 52% rate of biochemical progression after radical therapy. This strategy offers the benefit of an individualized approach based on reclassification of the risk of progression over time. It may decrease the burden of therapy in patients with indolent disease, while providing definitive therapy for those with more aggressive disease. Source of Funding: Prostate Cancer Research Foundation of Canada
Source of Funding: None
1683 PROSPECTIVE PROTOCOL BASED ACTIVE SURVEILLANCE FOR EARLY PROSTATE CANCER: SHORT-TERM RESULTS OF 500 PATIENTS IN THE PRIAS STUDY Roderick C n van den Bergh*, Rotterdam, Netherlands; Hanna Vasarainen, Helsinki, Finland; Tom Pickles, Vancouver, BCCanada; Riccardo Valdagni, Milan, Italy; Frederic Staerman, Reims, France; Antti Rannikko, Helsinki, Finland; Stijn Roemeling, Monique J Roobol, Fritz H Schröder, Chris H Bangma, Rotterdam, Netherlands INTRODUCTION AND OBJECTIVES: Active surveillance (AS) for early prostate cancer (PCa) may provide a partial solution to the overtreatment dilemma. AS programs, including the multicenter prospective observational PRIAS study, have been initiated to acquire prospective evidence for this strategy. To assess the effect of applying a