MID-TERM ONCOLOGICAL RESULTS AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY

388 LONG-TERM FUNCTIONAL OUTCOME AFTER TREATMENT OF PROSTATE CANCER: RADICAL PROSTATECTOMY VS. BRACHYTHERAPY Trojan L., Harrer K., Bolenz C., Heinrich E., Schaefer J., Welzl W.G., Wenz F., Alken P., Michel M.S.

389 PROSTATE CANCER SPECIFIC SURVIVAL OF A COHORT OF OVER 20,000 MEN TREATED EITHER CONSERVATIVELY OR WITH DEFINITIVE TREATMENT (RADIOTHERAPY OR RADICAL PROSTATECTOMY) Leung R.A.1, Ding H.2, Tu J.J., Yadav R.1, Jhaveri J.K.1, Rao S.R.1, Te A.E.1, Horninger W.4, Field T.2, Bartsch G.4, Vaughan E.D.1, Tewari A.K.1

University Clinic Mannheim, Dept. of Urology, Mannheim, Germany 1

Introduction & Objectives: Radical Prostatectomy (RP) and brachytherapy (BT) are standard treatment options for patients with prostate cancer. However, only few reports on long term results of the functional outcome for the two treatment options are available. Aim of the study is therefore the comparison of the functional outcome after RP and BT in a retrospective uni-centre analysis. Material & Methods:  SDWLHQWV DIWHU 53   DQG  DIWHU %7   DUH LQFOXGHG LQ WKLV VWXG\ 7KH IXQFWLRQDO RXWFRPH ZDV HYDOXDWHG E\ ZULWWHQ VXUYH\ PRGLᚏHG ,&60DOH 4XHVWLRQQDLUH DQG EORTC-PR25). Mean age at time of operation was 64 yrs for RP and 68 yrs for BT. The follow-up of patients was between 1,5 and 14 yrs. Results: The return rate of questionnaires was 72% for patients after RP and 65% after BT. Incontinence was more predominant in patients after 53GD\SQLJKWS ZKLOHVLJQLᚏFDQWPRUHSDWLHQWVUHSRUWHG on dysuria and urge symptoms after BT (4,4% vs. 1,0%, p<0,0001 and YVS UHVSHFWLYHO\ 'LᚎHUHQFHLQUHFWDOLQFRQWLQHQFH EHWZHHQ53DQG%7ZDVQRWHYLGHQWYVS  $EVHQFHRI erections was lower after BT compared to RP (42% vs. 72%, p<0,0001). Conclusions: RP and BT are treatment options for prostate cancer with GLᚎHUHQWVLGHHᚎHFWV3UHVHUYDWLRQRIFRQWLQHQFHLVKLJKHUDIWHU%7FRPSDUHG to RP. Urge symptoms after RP and BT are higher than expected. These data must be taken in mind when counselling the patient with prostate cancer before therapy.

Weill Cornell Medical College, Dept. of Urology, New York, United States of America, 2University Of Massachusetts, Clinical and Population Health Research, Wooster, United States of America, Weill Cornell Medical College, Dept. of Pathology, New York, United States of America, 4Innsbruck Medical University, Dept. of Urology, Innsbruck, Austria Introduction & Objectives: To report the survival probability in more than PHQZLWKSURVWDWHFDQFHUWUHDWHGHLWKHUFRQVHUYDWLYHO\RUE\GHᚏQLWLYH treatment (radiotherapy or radical prostatectomy). Material & Methods: The HMO Cancer Research Network (CRN) consists of the research programs, enrolled population, and data systems of 12 health PDLQWHQDQFH RUJDQL]DWLRQV +02V  LQ WKH 86 :H FROOHFWHG GDWD RQ  PHQZLWKELRSV\FRQᚏUPHGSURVWDWHFDQFHUEHWZHHQDQG0HGLFDO records were reviewed. Data of interest included, information on comorbidities, prostate cancer treatment selection, and tumour grade. We performed a Cox proportional hazards model to compare survival in patients who were treated conservatively versus survival in patients treated with radiotherapy or radical prostatectomy. Results: The overall survival rate at 15 years for a man treated conservatively (n  ZDVFRPSDUHGWRPHQWUHDWHGZLWKUDGLRWKHUDS\DQGUDGLFDO SURVWDWHFWRP\  DQG  UHVSHFWLYHO\ &DQFHU VSHFLᚏF VXUYLYDO rates between men treated with radiotherapy versus radical prostatectomy were 5.25% and 2.79% respectively. Conclusions: The present study has shown, that compared with conservative management, both radiotherapy and radical prostatectomy increase survival for men with localized prostate cancer.

390 CANCER SPECIFIC AND OVERALL SURVIVAL IN PATIENTS WITH ORGAN CONFINED PROSTATE CANCER TREATED WITH RADICAL PROSTATECTOMY Isbarn H.1, Ahyai S.2, Wanner M.1, Chun F.2, Budaues L.1, Salomon G.1, Schlomm T.1, Huland H.1, Graefen M.1 1

Martini-Clinic, Prostate Cancer Centre Hamburg-Eppendorf, Dept. of Urology, Hamburg, Germany, 2University Hospital Hamburg-Eppendorf, Dept. of Urology, Hamburg, Germany Introduction & Objectives: We retrospectively analysed the long-term outcome based RQ ELRFKHPLFDO UHODSVH FDQFHUVSHFLᚏFVXUYLYDO &66  DQG RYHUDOO VXUYLYDO 26  LQ SDWLHQWV ZLWK RUJDQFRQᚏQHG SURVWDWH FDUFLQRPD 3&D  IROORZLQJ UDGLFDO SURVWDWHFWRP\ (RP). Material & Methods: The study cohort consisted of 196 patients (mean age at surgery: 61 years) with a pT2, pN0 PCa who underwent RP at least ten years ago in our institute. High JUDGHWXPRUGHᚏQHGDV*OHDVRQVFRUHุZDVREVHUYHGLQSDWLHQWV &OLQLFDO follow-up information included biochemical recurrence (PSA > 0.1 ng/ml and rising), clinical progression, salvage treatment, OS, and CSS. None of the patients received adjuvant therapy prior to evidence of cancer recurrence. Multivariate Cox regression analysis was performed to assess the association of preoperative PSA, Gleason score of the prostatectomy specimen, and surgical margins with biochemical recurrence (BCR). Results: The mean follow-up was 116 months (range: 2 - 175 months). BCR was observed in 24 patients (12%). Twenty patients died during the follow-up period. Cancer related death was documented in two patients, resulting in an OS-rate of 89% and a CSS-rate of 99%. In multivariate analysis a statistically independent correlation with BCR was only observed for prostatectomy Gleason score (p= 0.004). However, the rate of positive surgical margins in our series was small (nine patients, 4.6%), limiting the statistical impact of this adverse pathological feature. Recurrence rate with high grade cancer was observed in 15 patients (19%), vs. eight patients (8%) with Gleason score < 7. Salvage therapy was performed in 14 cases (radiotherapy and/or hormonal therapy, 58%) whereas the remaining 10 patients are still under observation with no therapeutic intervention due to a low PSA-velocity after recurrence (42%). Conclusions: Our data indicate that RP is an excellent therapeutic option for patients ZLWK RUJDQ FRQᚏQHG WXPRXUV $OPRVW  RI WKH SDWLHQWV UHPDLQ UHFXUUHQFH IUHH DIWHU approximately ten years with a CSS of nearly 99%. In our series, prostatectomy Gleason score was the only important factor indicating treatment failure.

Eur Urol Suppl 2008;7(3):168

391 MID-TERM ONCOLOGICAL RESULTS AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY Hruza M., Schulze M., Klein J., Stock C., Teber D., Rassweiler J.J. SLK-Kliniken, Dept. of Urology, Heilbronn, Germany Introduction & Objectives: Laparoscopic radical prostatectomy (LRP) as an alternative to open surgery is now used at a growing number of urological centres in Europe and throughout the world. However, there is few data published concerning mid-term oncological UHVXOWVRI/53$VRQHRIWKHᚏUVWLQVWLWXWLRQVSHUIRUPLQJ/53LQGDLO\FOLQLFDOSUDFWLFHZHDUH able to present mid-term oncological data of a great number of patients. Material & Methods: About 2000 patients underwent LRP at our institution between 1999 DQG  7KH ᚏUVW  FDVHV ZHUH IROORZHG XS FRQVHTXHQWO\ E\ XVLQJ VWDQGDUGL]HG TXHVWLRQQDLUHV0HDQIROORZXSWLPHZDVPRQWKVUDQJHPRQWKV ,QSDWLHQWV S7RUS7WXPRXUVZHUHIRXQGZLWKLQWKHVSHFLPHQSDWLHQWVKDGSDWKRORJLFDOWXPRXU VWDJHS7RUS7 Results: 7KHUHZDVD36$UHFXUUHQFHLQSDWLHQWV LWRFFXUUHGDWDPHDQRI PRQWKVUDQJHWRPRQWKV ,QSDWLHQWVZLWKS7DQGS7WXPRXUVFDVHV RI 36$UHFXUUHQFHZHUHREVHUYHGFRPSDUHGWRFDVHV LQSDWLHQWVZLWKS7DQG S7WXPRXUV7KHRYHUDOO36$SURJUHVVLRQIUHHUDWHVZHUHRISDWLHQWVDW\HDUV  DQGRISDWLHQWVDW\HDUV ,QWKHᚏUVWSDWLHQWVZKRXQGHUZHQW /53 36$ SURJUHVVLRQ IUHH UDWH DIWHU  \HDUV ZDV   LQ WKH VHFRQG WKLUG DQG IRUWK group of 250 consecutive patients, it was 90.4 %, 89.2 % and 90.8 %. Clinical progression ZDV IRXQG LQ     RI DOO S7 DQG S7SDWLHQWV  RI WKHP ORFDO UHFXUUHQFH  RI WKHPPHWDVWDVHV ,QS7DQGS7SDWLHQWVFDVHV RIFOLQLFDOSURJUHVVLRQZHUH registered, local recurrence in 19 and metastases in 14 cases. There were no port site metastases at all. The clinical progression-free rates were 1107 of 1141 patients (97.0 %) at \HDUVDQGRISDWLHQWV DW\HDUV,QWKHᚏUVWFRQVHFXWLYH/53SDWLHQWV WKH\HDUVORFDOUHFXUUHQFHIUHHUDWHZDVLQVHFRQGWKLUGDQGIRUWKJURXSRI FRQVHFXWLYHSDWLHQWVLWZDVDQG2IWKHSDWLHQWVREVHUYHG KDYHGLHGXQWLOQRZRYHUDOOVXUYLYDO ZLWKLQPRQWKVDIWHUPRQWKV DIWHUPRQWKVDIWHUPRUHWKDQ\HDUVDIWHUVXUJHU\SDWLHQWVGLHGIURPSURJUHVVLRQ RISURVWDWLFFDQFHU7KHLUSDWKRORJLFDOWXPRXUVWDJHVZHUHS7DS7EDQGS7DOORIWKHP EHORQJHG WR WKH ᚏUVW  FDVHV WUHDWHG ZLWK /53 2YHUDOO SURVWDWH FDQFHU VSHFLᚏF VXUYLYDO was therefore 99.8 %. 18 patients died from other causes (i.e. cardiac or renal failure, heart attack, stroke, non-prostatic cancers, suicide, cerebral aneurysm). Conclusions: Laparoscopic radical prostatectomy shows a high grade of oncological safety in short- and mid-term follow up. After a short learning curve, a stable level of low cancer recurrence rates is reached.