MP-13.06 Complications of Open Radical Prostatectomy: More Than 18 Years Experience at One Center

MODERATED POSTER SESSIONS

urethral fistulae. Of 13 patients continent at baseline with known post-operative status, 100% remained continent (leak free, pad free) following first treatment, and 93% (n⫽12) following re-treatment. Of those men (n⫽8) with good pre-operative erectile function and a known postoperative status, 100% preserved function 6 months following first treatment, falling to 63% (n⫽5) 9 months (3-18months) following re-ablation. Conclusion: Re-do ablation using HIFU appears to be safe and feasible with comparable outcomes to primary focal therapy. However, prospective focal therapy trials are now required that evaluate retreatment outcomes within a larger group of men over a longer follow-up period.

MP-13.04 Clinical Significance of Surgical Margins Status in Patients Subjected to Radical Prostatectomy Dobruch J1, Nyk L1, Skrzypczyk M1, Chlosta P2, Dzik T3, Borówka A1 1 Postgraduate Medical Education Centre, Department of Urology, European Health Center Otwock, Poland; 2Dept. of Urology Institute of Oncology, Kielce, Poland; 3 Dept. of Anatomic Pathology, Central Railway Hospital, Warsaw, Poland Introduction and Objective: Positive surgical margins (PSM) after radical prostatectomy (RP) are well known negative prognostic factors. Adiuvant radiotherapy done after RP in patients with PSM improves their survival although many of them do not experience biochemical recurrence. The aim of the study is to evaluate the clinicopathological prostate cancer features that would predict the presence of PSM and the biochemical recurrence (BR) of the prostate cancer. Additionally, the role of PSM magnitude is analyzed. Materials and Methods: Data of men who were subjected to radical prostatectomy from 1st January 2001 to 30th May 2010 were analyzed. Those, with prior neoadiuvant hormonal therapy and those who were found to have positive lymph nodes were excluded from the analysis. Specimens with PSM were again evaluated to confirm the presence of positive margins. Results: Data of 266 men operated due to prostate cancer were analyzed. PSM were found in 75 (28.2%) patients, although in only 8 of them PCa was organ confined. Mean value of maximum percent of cancer within the biopsy core was significantly greater in patients with PSM in comparison to those with negative mar-

gins, the values were 59.3% (⫾30.0) and 51.4% (⫾27.9) respectively (p⬍0.05). Mean age, mean PSA, PSAD, prostate volume and Gleason score evaluated before and after RP did not differ significantly between the groups. Biochemical recurrence was found in 43 (16,9%) men, among them, 18 (24,0%) had PSM and 25 (13,1%), had negative margins. The risk of BR in those with “focal” PSM did not differ from the risk of BR observed in patients without PSM. In contrast, the likelihood of BR was significantly greater in cases of PSM which maximum longitude exceeded 5 mm. Reevaluation of the PSM specimens revealed lack of margins positivity in 7 cases. In one out of these, the recurrence was observed and successfully managed by radiotherapy. Among others with confirmed margins positivity, BR was found in 7 (18.4%) cases, although in the majority it concerned the PSM which were extensive and their magnitude exceeded 40 mm2. Conclusions: Positive surgical margins constitute negative prognostic factor although in the majority of cases no biochemical recurrence is observed. Data available from the biopsy protocol are associated with the risk of PSM. Their magnitude significantly influences the risk of biochemical failure. Reevaluation of prostate specimen might lead to surgical margins state modification. Decision which concerns adjuvant radiotherapy should be carefully discussed.

MP-13.05 Five Years’ Experience with HighIntensity Focused Ultrasonography for Prostate Cancer Treatment: A MidTerm Follow Up Heinrich E1, Ferber A2, Schoen G2, Schiefelbein F2, Trojan L1, Egner T2 1 Dept. of Urology, University Medical Center Mannheim, Mannheim, Germany; 2 Dept. of Urology, Missionaerztliche Klinik Wuerzburg, Wuerzburg, Germany Introduction and Objectives: To report on the mid-term functional and oncological outcome, from one institution, of highintensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Materials and Methods: A total of 151 patients with histology proven localized prostate cancer have been treated using the Ablatherm device. The mean follow-up including 96 patients was 36.4 months (range 12 to 55). Mean age was 73.8 years (range 51 to 89). According to DÁmico risk stratification 53.1% had a low, 37,5% an intermediate and 9,4% a

UROLOGY 78 (Supplement 3A), September 2011

high risk prostatic carcinoma. Biochemical failure was defined according to the Phoenix definition (PSA nadir ⫹ 2ng/ml). Follow-up included PSA measurement, IPSS, DRE, post voiding residual urine, maximum urinary flow rate, TRUS and transrectal biopsy in case of biochemical failure or suspicious digital rectal examination. Results: The median PSA nadir after HIFU therapy was 0.63 ng/ml (range 0 to 9.94). Median PSA at follow-up examination was 0.84 ng/ml. Biochemical failure was recognized in 23.9% of patients (low risk: 15.6%, intermediate risk: 31%, high risk 44.4%). Sextant biopsies in case of biochemical failure revealed 39.1% local recurrence. There were 34.8% who developed metastatic disease and 26.1% of PSA elevations were without detectable reason. Intraoperative no major complications were noted. Three patients developed epididymitis and further three patients had mild abdominal pain after cystostomie removement. There were 15.8% who underwent transurethral resection after HIFU because of bladder outlet obstruction. Two (2.1%) patients developed relapsing bladder neck sclerosis. Mean of International Prostate Symptom Score improved significantly from 10.25 to 8.6 (p⫽0.02). Six percent of patients reported stress incontinence using 1 pad during daytime, but no severe stress incontinence (grade 2 to 3) was observed. Better or unchanged quality of life was indicated by 77%. Conclusion: Our results confirm efficacy and low invasiveness of HIFU in the treatment of localized prostate cancer. Patients with low risk carcinomas are likely to be most suitable for efficient HIFU treatment.

MP-13.06 Complications of Open Radical Prostatectomy: More Than 18 Years Experience at One Center Soloway M, Ji H, Iremashvili V, Manoharan M Dept. of Urology, Miller School of Medicine, University of Miami, Miami, USA Introduction and Objective: We reviewed the postoperative complications of open radical prostatectomy with a special focus on patients who experienced bladder neck stenosis. Materials and Methods: This study included patients with at least 3 months of postoperative follow-up. Between January 1992 and July 2010, a total of 1927 patients underwent open radical prostatec-

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tomy at our center. Surgery was a modified version of the Walsh technique. Lymph node dissection and bladder neck preservation were used whenever possible.

MP-13.07, Table 1. Patient characteristics according to surgical margin status Variable No. of patients Median age at surgery, years (IQR) Median preoperative PSA, ng/ml (IQR)1 No. biopsy Gleason score (%): 2-6 7 (3⫹4) 7 (4⫹3) 8-10 No. clinical stage (%): T1 T2 T3 No. pathological Gleason score (%): 2-6 7 (3⫹4) 7 (4⫹3) 8-10 No. EPE (%): No. SVI (%): No. LNI (%): Median visually estimated percent of carcinoma, % (IQR)2 No. nerve-sparing procedure (%) Median follow-up, years No. biochemical recurrence (%) Overall survival, %

MP-13.06, Table 1. Postoperative Complications Complication n (%) Bladder Neck Stenosis 62 (3.2) Hematuria 17 (0.8) Wound Infection 13 (0.6) Meatal Stenosis 8 (0.4) Wound Hematoma 7 (0.4) Incisional Hernia 6 (0.3) Urinary Retention 5 (.24) Urinary tract infection 5 (0.24) Wound Dehiscence 4 (0.2) Lymphocele 3 (0.15) Wound Abscess 3 (.015) Deep vein thrombosis 3 (0.15) Overall 136 (7.1)

Results: The mean age was 60.8 (range 35-81). There were 136 (7.1%) perioperative complications in 129 patients (Table 1). The most prevalent complication was bladder neck stenosis. Forty of 62 cases of bladder neck stenosis were successfully treated after one procedure with either dilation or incision. Salvage prostatectomy was associated with both a higher occurrence of bladder neck stenosis and increased number of recurrences. One patient experienced a pulmonary embolism within 90 days of surgery. Three patients died within 90 days of surgery (two from myocardial infarction and one from unknown causes). Conclusion: Open radical prostatectomy is a safe procedure and is associated with perioperative complications in only 7.1% of the cases. Bladder neck stenosis was the most common postoperative complication and usually was successfully corrected with one treatment session of either dilation or incision. Salvage open radical prostatectomy was associated with increased occurrence and severity of this complication.

MP-13.07 Surgical Margin Status is not Associated with Overall Survival After Radical Prostatectomy Soloway M1, Manoharan M1, Jorda M2, Rosenberg D1, Iremashvili V1 1 Dept. of Urology, Miller School of Medicine, University of Miami, Miami, USA; 2Dept. of Pathology, Miller School of

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Margin positive 520 61.6 (55.5-67.1) 6.9 (4.9-9.5)

Margin negative 1085 61.4 (55.8-66.1) 5.4 (4.3-7.4)

281 (54.0) 126 (24.2) 43 (8.3) 70 (13.5)

708 (65.3) 230 (21.2) 81 (7.5) 66 (6.1)

319 (61.3) 189 (36.3) 12 (2.3)

747 (68.8) 308 (28.4) 30 (2.8)

169 (32.5) 176 (33.8) 87 (16.7) 88 (16.9) 130 (25.0) 68 (13.1) 13 (2.5) 13 (7-23)

531 (48.9) 348 (32.1) 121 (11.2) 85 (7.8) 106 (9.8) 47 (4.3) 0 (0) 6 (2.5-12)

⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001

371 (71.4) 3.7 (1.3-6.7) 164 (31.5) 96.3

839 (77.3) 3.2 (1.3-6.1) 133 (12.3) 95.9

⬍0.001 0.084 ⬍0.001 0.699

p 0.723 ⬍0.001 ⬍0.001

0.003

⬍0.001

IQR – interquartile range; PSA – prostate-specific antigen; EPE – extraprostatic extension; SVI – seminal vesicle invasion; LNI – lymph node involvement 1

– not available for two patients;

2

– not available for 104 patients

Medicine, University of Miami, Miami, USA Introduction and Objective: The presence of a positive surgical margin (PSM) is a risk factor for recurrence after radical prostatectomy (RP). However, the prevalence and potential effects of PSMs vary in different studies. We analyzed the influence of different types of PSMs on biochemical outcomes and overall survival in a large group of patients who underwent RP at our center. Materials and Methods: Our analysis included 1,605 men who had open RP performed by one surgical team between January 1992 and November 2010. None of the patients received neoadjuvant or adjuvant treatment. A PSM was defined as the presence of prostate cancer cells at the inked margin. Biochemical recurrence was defined as a post-operative PSA ⱖ0.2 ng/ml. For each type of surgical margin (positive apical/anterior, positive at other locations, and negative) postoperative survival was estimated using the KaplanMeier method. A Cox proportional hazard

model was used to determine independent predictors of overall and biochemical recurrence-free survival. Results: At a median follow-up 3.2 years, 297 (18.5%) patients had biochemical recurrence and 63 (3.9%) died. The PSM rate was 32.4%. Both clinical and pathological characteristics indicated more aggressive tumors in patients with a PSM (Table 1). Although both subtypes of positive margins were statistically significant independent risk factors for biochemical recurrence, overall survival was not associated with surgical margin status (Table 2). Conclusions: While PSM is associated with aggressive tumors and biochemical recurrence, overall survival is not affected by surgical margin status. Longer follow-up is needed to confirm the effects of PSM on treatment outcomes.

MP-13.08 The Hybrid Interactive Method in Permanent Prostate Brachytherapy Reduces Excess Seeds Iwata T1, Okihara K1, Kamoi K1,

UROLOGY 78 (Supplement 3A), September 2011