ONCOLOGICAL OUTCOME AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY: 10 YEARS EXPERIENCE

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THE JOURNAL OF UROLOGY®

these specimens were investigated using Ki-67 immunostaining and TUNEL assay, respectively. RESULTS: Various levels of clusterin expression were noted in 169 of 172 prostate cancer specimens, while 32 of the 172 normal prostate tissues did not exhibit any clusterin staining. Clusterin H[SUHVVLRQLQSURVWDWHFDQFHUWLVVXHVZDVVLJQL¿FDQWO\UHODWHGWR*OHDVRQ VFRUHEXWQRWZLWKRWKHUSDUDPHWHUVLQFOXGLQJDJHSURVWDWHVSHFL¿F antigen, pathological stage, perineural invasion, tumor volume and lymph node metastasis. In addition, cell proliferative activity in prostate FDQFHUVSHFLPHQVZDVVLJQL¿FDQWO\DVVRFLDWHGZLWKFOXVWHULQH[SUHVVLRQ while there was no correlation between the apoptotic index and clusterin expression. In this series, 34 of 172 patients (19.8%) developed ELRFKHPLFDO UHFXUUHQFH DQG WKHUH ZDV QR VLJQL¿FDQW GLIIHUHQFH LQ biochemical recurrence-free survival between patients with strong clusterin expression and those with weak expression. CONCLUSIONS: Despite its detection in the majority of SURVWDWHFDQFHUWLVVXHVFOXVWHULQH[SUHVVLRQIDLOHGWRVKRZDVLJQL¿FDQW association with prognosis in patients undergoing RP without NHT, suggesting that clusterin protein plays a limited role in the disease SURJUHVVLRQRIFOLQLFDOO\RUJDQFRQ¿QHGSURVWDWHFDQFHULQWKHDEVHQFH of proapoptotic therapeutic stimuli. Source of Funding: None

1633 ONCOLOGICAL OUTCOME AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY: 10 YEARS EXPERIENCE Karim Touijer, Angel M Cronin, Andrew J Vickers, Fernando P Secin, Fernando J Bianco, Bertrand D Guillonneau*. New York, NY. ,1752'8&7,21 $1' 2%-(&7,9( :H DQDO\]HG WKH oncological outcome after laparoscopic radical prostatectomy (LRP) in a consecutive series of patients with prostate cancer. METHODS: from 1998 to 2007, 1564 consecutive patients PHGLDQDJH\HDUV,4UDQJH ZLWKFOLQLFDOO\ORFDOL]HGSURVWDWH cancer (cT1c-cT3a) were treated with LRP at IMM (Paris, France) RU 06.&& 1HZ 90%, 89% to 71% and < 70% respectively. RESULTS: the overall 5-year probability of freedom from progression was 79% (95% CI 74%-82%). For low, intermediate and high risk cancer, the 5-year progression free probability was 92% (95% CI 85%-95%) 77% (95% CI 71%-82%) and 53% (95% CI 40%-65%) respectively. Surgical margins were positive in 12.5% of cases. The 5-year progression free probability was 49% (95%C.I. 35%- 61%) when the surgical margins were positive vs. 83% (95%C.I. 79%- 86%) in negative surgical margins cases. Nodal metastases were detected in 3% of the patients after limited pelvic lymph node dissection and in 10% after a standard pelvic lymph node dissection (p<0.0001). The 3 year probability of freedom from progression for node positive patients was 46%. There were 22 overall deaths and 2 deaths from prostate cancer. CONCLUSIONS: Laparoscopic radical prostatectomy SURYLGHG\HDUFDQFHUFRQWUROLQRISDWLHQWVZLWKFOLQLFDOO\ORFDOL]HG prostate cancer and 53% of those with high risk cancers. A pelvic lymph node dissection limited to the external iliac nodal group is inadequate for detecting nodal metastases. Source of Funding: None

1634 COMPARISON OF OBSERVED BIOCHEMICAL RECURRENCE FREE SURVIVAL IN PATIENTS WITH LOW PSA VALUES UNDERGOING RADICAL PROSTATECTOMY TO THE PREDICTIONS OF A PREOPERATIVE NOMOGRAM Ryan K Berglund*, Andrew J Stephenson, Angel M Cronin, Andrew J Vickers, James A Eastham, Eric A Klein, Bertrand D Guillonneau. New York, NY, and Cleveland, OH. INTRODUCTION AND OBJECTIVE: A preoperative nomogram is an effective tool for assessing the risk of disease

Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008

SURJUHVVLRQIROORZLQJUDGLFDOSURVWDWHFWRP\IRUORFDOL]HGSURVWDWHFDQFHU However, the nomogram may be less accurate for patients with atypical FOLQLFDOSDUDPHWHUVVXFKDVDYHU\ORZSUHRSHUDWLYHSURVWDWHVSHFL¿F antigen (PSA) value (less than 2.5 ng/mL) as these patients have not historically been considered for prostate biopsy in the absence of other risk factors (such as an abnormal prostate digital rectal examination). To better understand the performance of nomograms for these patients, we compared the observed progression-free probability versus that predicted by a validated preoperative nomogram. METHODS: A total of 3762 patients from Baylor and Memorial Sloan-Kettering treated from 1987 to 2006 and 2368 patients from &OHYHODQG&OLQLFIURPWRZHUHDQDO\]HGWRWDO .DSODQ Meier methods were used to estimate the recurrence-free probabilities based on PSA grouping (< 2.5 vs > 2.5 ng/mL). Cox proportional KD]DUGVUHJUHVVLRQZDVXVHGWRHYDOXDWHZKHWKHU36$JURXSLQJZDV associated with biochemical recurrence controlling for preoperative nomogram probability. RESULTS: 399/6130 (6.5%) patients had PSA < 2.5. These patients had a lower mean age and Gleason grade, but had a higher clinical stage than those with PSA > 2.5. Patients with PSA < 0.5 had WKHKLJKHVWUDWHRIQRQRUJDQFRQ¿QHGGLVHDVHYVIRU36$ 0.6-3 vs. 25% for PSA > 3). The median follow-up for recurrence-free patients was 2.4 years, and 10 patients with PSA < 2.5 and 597 patients with PSA > 2.5 recurred (total 607/6130). With adjustment for the SUHRSHUDWLYHQRPRJUDPSUREDELOLW\WKHUHZDVQRVLJQL¿FDQWGLIIHUHQFH LQUHFXUUHQFHE\36$JURXSLQJKD]DUGUDWLRIRU36$YV! &,S   CONCLUSIONS: Patients with a low PSA comprise a small proportion of those treated, and the majority have palpable disease. Patients with especially low PSA values (< 0.5) have a high rate of QRQRUJDQFRQ¿QHGGLVHDVH7KHSUHRSHUDWLYHQRPRJUDPLVDUREXVW model with good discrimination and accuracy across the spectrum of PSA values. Source of Funding: None

1635 POST PROSTATECTOMY MULTIMODALITY ADJUVANT THERAPY FOR PATIENTS AT HIGH RISK FOR PROSTATE CANCER RELAPSE Kamyar Ebrahimi*, Herbert Ruckle, Jonathan D Harper, David K Ornstein, Thomas E Ahlering, Frank Howard, Michael Lilly. Loma Linda, CA, Orange, CA, and Corona, CA. INTRODUCTION AND OBJECTIVE: Adjuvant systemic therapy is a well-established treatment that improves survival for many loco-regional cancers. While many subjects with prostate cancer (CaP) have long-term control with current therapy, subjects with high risk disease are more likely to relapse and die of CaP. It has been shown that docetaxel (doc) plus prednisone chemotherapy improves survival in subjects with hormone-refractory CaP. We have conducted a pilot study of multimodality adjuvant therapy (MAT) following radical prostatectomy (RP) to evaluate its ability to delay biochemical failure in high-risk subjects. Therapy was modeled after current adjuvant treatment of breast cancer. 0(7+2'66XEMHFWVZLWKKLJKULVN&D3SUHGLFWHG¿YH\HDU relapse risk >25% by 1999 Kattan post-op nomogram and/or persistent PSA after surgery) were offered MAT. Therapy consisted of 6 cycles of combination chemotherapy Q 3wks (doc 70mg/m2, estramustine 280mg TID x 5d, or doc 70mg/m2, carboplatin AUC5), followed by 5yr of androgen deprivation (leuprolide plus bicalutamide). Subjects with S7']RUPXOWLSOHSRVLWLYHPDUJLQVZHUHDOVRRIIHUHGDGMXYDQWUDGLDWLRQ therapy following chemotherapy. RESULTS: Twenty-eight high-risk subjects received MAT. Rx started an average of 78d after RP. Clinical parameters include: mean DJH\U*OHDVRQS7ES71SRVLWLYH margins 57.1%. Mean predicted relapse risk by Kattan nomogram was 63.6% (2yr) and 76.4% (5yr). Avg chemo cycles=5.8. Twenty subjects received doc/estramustine, and eight received doc/carboplatin. 7/28 received XRT as part of therapy. Maximum followup is 76.6 mos, avg followup is 31 mos from RP. There have been no biochemical (PSA) relapses and 26/28 (93%) remain free of disease progression. 2/28 (7%) VXEMHFWVUHODSVHGFOLQLFDOO\QHLWKHUKDGDQHOHYDWHG36$DWUHODSVHDQG