P076 Histoscanning in diagnosing of prostate cancer relapse after HIFU ablation

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failure following radical prostatectomy in patients with localized and locally-advanced prostate cancer. Material & Methods: Medical data of 386 consecutive patients with localized and locally-advanced prostate cancer who underwent radical prostatectomy from 1997 to 2011 were analyzed. Median age was 61.0 years. Median PSA before surgery – 10.3 ng/ml. Plasma levels of VEGF, VEGFR2, VEGFR3, TGF-β1, CD105, IL-6 were measured using Enzyme Linked-Immuno-Sorbent Assay (ELISA) before radical prostatectomy in 77 patients. Postoperatively the tumours were categorized as pT2 in 288 (59.1%), pT3 – in 144 (37.3%), pT4 – in 14 (3.6); pN+ – in 34 (8.8%) cases. Gleason score <7 was present in 254 (65.8%), ≥7 – in 132 (34.2%) specimens. Perineural invasion was identified in 188 (48.7%), angiolymphatic invasion – in 126 (32.6) cases. Results: Biochemical recurrence occurred in 64 (16.6%) out of 386 patients at a median follow-up of 30.5 (12–164) months. Independent predictors of biochemical recurrence were PSA (HR 0.161 (95% CI: 0.058–0.449); p=0.001), Gleason sum in surgical specimens (HR 0.496 (95% CI: 0.268–0.917); p=0.025), pN (HR 0.415 (95% CI: 0.181–0.955); p=0.039). The patients were divided into 3 prognostic groups: good (0 factor), intermediate (1 factor), poor (2 factors) and very poor (3 factors) (AUC: 0.720 (95% CI: 0.656–0.784)). High preoperative levels VEGF (≥67 pg/ml) (p=0.005), VEGFR2 (≥3149 pg/ml) (p=0.036), VEGFR3 (≥2268 pg/ml) (p=0.001), TGF-β1 (≥14473 pg/ml) (p=0.052) were identified as unfavorable prognostic factors for survival without PSAfailure. Conclusions: Independent prognostic factors of biochemical recurrence after prostatectomy were PSA, Gleason sum and pN. Joint effect of the factors allows to predict PSA-relapse with accuracy 0.720. Preoperative serum levels VEGF, VEGFR2, VEGFR3, TGF-β1 potentially are perspective markers for PSA-failure after surgical treatment prostate cancer, further trials are needed. P074 Active surveillance & template prostate biopsies; 7-year outcome, long-term role R.H. Zakri, I. Naranji, M. Hussain, B.S.I. Montgomery, S.R.J Bott. Frimley Park Hospital, Dept. of Urology, Surrey, United Kingdom Introduction & Objectives: Over treatment of low-risk prostate cancer and increasing availability of template prostate biopsies has led to growing trends towards active surveillance (AS). The aim of this study was to determine whether template prostate biopsies at the time of starting AS, reduced the number of patients subsequently having radical treatment. This is through correct identification of patients with more significant disease at the outset. Material & Methods: A prospective database on all patients undergoing template biopsies is kept at Frimley Park Hospital. We reviewed 164 patients on our active surveillance program between December 2005 and December 2012. All patients met Royal Marsden inclusion criteria for AS. The role of template biopsies as a primary diagnostic or restaging modality was assessed. Results: Patient age range: 50–79 years. Median PSA at presentation 7 g/ml, ranging from PSA 1.8–21. 39% of all templates were primary and 61% re-staging. Following small volume disease on TRUS biopsies, 9.1% (n=15) undergoing template biopsies were found to have benign disease. Of those patients suitable for AS on TRUS, 28% were found to have more significant disease on template biopsies. 83.5% (n=137) were classified as Gleason 3+3 and 7.3% (n=12) as Gleason 3+4. According to the D’Amico risk classification 81.7% of patients were categorized as low risk, 19.5% intermediate risk and 1.21% as high risk. 92.2% of patients continue on the AS program. Of those referred for radical treatment n=9 went on to have brachytherapy, n=2 had hormones and external beam radiotherapy, 1 patient had radical surgery and 1 patient origi-

nally referred for radical surgery was started on hormones due to pulmonary oedema. Median follow-up was 27.5 months; ranging from 1 month to 6 years. Conclusions: Template biopsies have a clear role in the accurate assessment of men considered suitable for AS both at diagnosis and also for long-term follow-up. This avoids over zealous treatment of low-risk patients whilst still keeping all treatment doors open. Primary template biopsies help reduce procedure-associated morbidity and avoids delayed management decisions. P075 Pathological and long-term biochemical outcomes after radical prostatectomy in patients eligible for ERSPC (PRIAS) active surveillance criteria E.A. Sokolov, E.I. Veliev, O.B Loran. Russian Medical Academy of Postgraduate Education, Dept. of Urology and Surgical Andrology, Moscow, Russia Introduction & Objectives: Active surveillance (AS) is a treatment strategy with the aim of reducing the ratio of overtreatment in patients with clinically confined very-low risk prostate cancer. Appropriate selection of patients for AS is still controversial. The purpose of the study is to evaluate pathological results and longterm biochemical outcomes after radical prostatectomy (RP) in patients with prostate cancer, meeting ERSPC (PRIAS) AS criteria. Material & Methods: We retrospectively reviewed our institutional database of 1367 patients, treated with RP between 1997 and 2010. 152 patients, eligible for ERSPC (PRIAS) criteria (clinical stage cT1c-cT2a, preoperative prostate-specific antigen (PSA) level ≤10 ng/ml, PSA density ≤0.2, Gleason sum ≤6, ≤2 positive biopsy cores in at least 10-core prostate biopsy) and free of any neoadjuvant treatment were included in the study. Median age was 64 years (IQR: 59–69), median PSA level 6 ng/ml (IQR: 4.9– 7.2), median follow-up period after surgery 67 months (IQR: 52– 89). Pathological results after RP were analyzed for negative features (Gleason upgrading, upstaging, positive surgical margins). Kaplan-Meier method was used to evaluate 5- and 10-year biochemical recurrence-free survival (BCRFS). Results: Extracapsular extension was found in 4.6%, seminal vesicle invasion in 1.3% of patients. One patient (0.7%) had N+ disease and one (0.7%) had pT0 stage after surgery. Gleason sum upgrading was found in 7.9% of patients: in 4.6% Gleason sum was 7 (3+4), in 2% – 7 (4+3) and in 1.3% – ≥8. Positive surgical margins rate was 5.2%. In total, negative pathological features were found in 14.5% of patients (one feature in 15 patients, two in 6 patients and three in 1 patient). Noticeably, there were no biochemical recurrences in patients with negative pathological features after RP with median follow up in this subgroup 64 months (IQR: 51–74). 5- and 10-year BCRFS was 97% and 88.2%, respectively. Conclusions: Pathological and long-term biochemical results after RP in patients meeting ERSPC (PRIAS) criteria are suboptimal, although negative pathological features rate was much lower than in other RP series. Precise preoperative examination and staging are essential before selection of candidates for active surveillance. P076 Histoscanning in diagnosing of prostate cancer relapse after HIFU ablation T. Ganzha 1 , P.V. Glybochko 1 , A.V. Amosov 1 , G.E. Krupinov 1 , A.A. Obukhov 1 , J. Lerner 2 . 1 First Moscow State Medical University named after I.M.Sechenov, Dept. of Urology, Moscow, Russia; 2 First Moscow State Medical University named after I.M.Sechenov, Dept. of Pathology, Moscow, Russia Introduction & Objectives: Histoscanning (HS) is a method born

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in striving for adequate visualization of the oncologic process, which may allow to evaluate the effectiveness of the treatment of prostate cancer by alternative focal methods. Material & Methods: 124 patients (pts), who have been previously (in a period of 7 days to 9 years) VIFU-therapy for prostate cancer, since September 2011 held the HS. The study was conducted again at 1, 3, 6 and 12 months. HS performed using diagnostic system Histoscanning. For the detection of recurrence of the disease was used Stuttgart criterion, or prostate biopsy under ultrasound guidance with further morphological verification. Results: Prostate biopsy was made in the first year after surgery in 37 pts, at a later date – 45. Biopsy in the first year after surgery in 38% (14 pts) histological material comprised mainly of fibrosis, in 56% – of necrotic tissue (21 pts) and in 22% – of prostate adenocarcinoma (8 pts). Advantageously occurred combination of this findings with hyperplasia, lymphoid infiltrate and between itselves. Result of HS (on laterality and location of the lesion) coincided with the histological findings in 22% (8 pts), were falsepositive in 32% (12 pts prostate cancer was not detected, despite the suspicious tissue structure on the results of the HS), falsenegative results were not observed. When during a biopsy, these histological changes were presented in 72% (32 pts), 26% (12 pts) and 42% (19 pts), respectively. Mostly there has been a combination of them together, hyperplasia and lymphoid infiltration were less common. Result of HS (on laterality and location of the lesion) coincided with the histological findings in 36% (16 pts), were false-positive in 52% (23 pts) and false-negative results in 6% (3 pts). 42 pts biopsy was not performed, 12 of them relapsed set on the basis of the criterion of Stuttgart. In this group false positive result was in 21% (9 pts) and in 5% it was false negative (patient 2). Of the total number of pts in the study of the volume of suspicious tissue structures in 68 people has made – less than 0.2 cm3 , in 32 people – from 0.2 cm3 to 0.5 cm3 , in 24 people – more than 0.5 cm3 . The first group of pts relapse was diagnosed in 2 pts (3%). Second group – relapse was diagnosed in 15 pts (47%). A third group – 22 pts (88%). In assessing the false-positive and false-negative results in the first group sensitivity of HS was 100%, specificity of 3%, in the second group – 82% and 47%, in the third group – 100% and 88%, respectively. Conclusions: HS is a highly informative method capable of detecting prostate cancer foci of 0.2 cm3 with a high degree of sensitivity and specificity. At a volume less than 0.2 cm3 specificity of procedure is insignificant, although clinically malignant process such volumes are likely to be insignificant. Also, given the small size of the foci, is not ruled out aiming error when performing a biopsy, which finally do not denies the data obtained at the HS. Best informativeness of HS is marked with the identification of suspicious areas of more than 0.5 cm3 . The specificity of the method depends on the degree of sclerotic changes in the prostate tissue: the more they are expressed, that is the lower. Sclerotic process after HIFU ablation of the prostate becomes more pronounced with time. Therefore, the HS is more specific in the first year following the patient. Thus, the HS may result in improved outcomes in pts prostate cancer through early detection of recurrence of the disease and to enable timely treatment. P077 Comparative analysis in a consecutive series of 160 brachytherapies and 153 prostatectomies C. Baena Villamarin, J.M. Conde Sánchez, C.B. Congregado Ruiz, I. Osman García, E. Argüelles Salido, J.M. Pena Outeriño, R.A. Medina López. Hospital Universitario Virgen del Rocío, Urology, Sevilla, Spain Introduction & Objectives: The recent increase in the use of minimal invasive techniques to treat prostate cancer such as robotic

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prostatectomy and brachytherapy (BT) has arisen the interest of both medical managers and surgeons. However, there are not enough comparative studies providing solid evidence in relation to such techniques. We present a comparative study and survival analysis of a consecutive series of 160 prostate BT and 153 robotic-assisted laparoscopic radical prostatectomies using the “Da Vinci” (DV) surgical system. Material & Methods: 313 patients with low-risk localized prostate cancer: 160 patients underwent low-dose I-125 RapidStrand BT at a prescribed dose of 145 Gy and 153 underwent robotic-assisted radical prostatectomy (Da Vinci). The patients who met the inclusion criteria for each technique have chosen the procedure on the basis of a validated Decision-Making-Tool.We analysed the following parameters: age, PSA level, stage, Gleason score, prostate volume at the time of diagnosis, IPSS (pre and post-treatment), flowmetry and global and disease-free survival. The oncologic follow-up of patients was carried out one month after the intervention, every three months during the first year and every six months subsequently. We carried out a descriptive and comparative analysis of oncologic follow-up and survival-related variables. Results: No differences have been found as regards the number of patients showing complications in each series (3% vs 6.5%). However, we observed differences as regards the severity of the complication (according to Clavien-Dindo classification) as 4 patients in the DV series required a new intervention. 8% of the patients undergoing BT presented with biochemical progression vs 15% in the case of patients undergoing DV. Conclusions: IPSS and flowmetry worsen remarkably in the BT series. Fatigue, duration and hospital stay are lesser in the BT group. Complications and severity of complications are less common in the BT group. Less progressions are observed in the BT group (8%) than in the DV group (15%) without consequences as regards PFS or GS. P078 Health related quality of life and coping in patients on active surveillance: Two-year follow-up M.F. Alvisi 1 , L. Bellardita 1 , T. Rancati 1 , S. Villa 1 , C. Marenghi 1 , N. Bedini 2 , S. Villa 2 , D. Biasoni 3 , N. Nicolai 3 , R. Salvioni 3 , T. Magnani 1 , R. Valdagni 4 . 1 Fondazione IRCCS Istituto Nazionale Tumori, Prostate Cancer Program, Milan, Italy; 2 Fondazione IRCCS Istituto Nazionale Tumori, Radiation Oncology 1, Milan, Italy; 3 Fondazione IRCCS Istituto Nazionale Tumori, Urology, Milan, Italy; 4 Fondazione IRCCS Istituto Nazionale Tumori, Prostate Cancer Program, Radiation Oncology 1, Milan, Italy Introduction & Objectives: Active Surveillance (AS) is receiving increasing consensus as a viable alternative to radical treatment for low risk prostate cancer (PCa). Recent studies highlighted that men on AS reported high levels of health-related QoL (HRQoL) and adjustment to cancer. Nonetheless, longer term follow-up is needed as the possibility of decrease in the levels of QoL was highlighted. The aim of this study was to investigate the changes in HRQoL and adjustment to cancer over the first two years on AS. Material & Methods: Between Nov 2007 and Jan 2013, 208 patients were included in PRIAS-QoL study and completed questionnaires at enrolment in the AS protocol (T0). Evaluations after 10 months (T1) from diagnostic biopsy, 12 months (after the first re-biopsy – T2) and 24 months (T3) were completed by 156, 109 and 62 patients, respectively. Validated self-report questionnaires assessing QoL were administered, including: a) Functional Assessment of Cancer Therapy – Prostate Version (FACT-P), measuring HRQoL in terms of: physical wellbeing (PWB), social wellbeing (SWB), emotional wellbeing (EWB), functional wellbeing (FWB), and wellbeing related to prostate cancer symptoms (PCS); b) Mini Mental Adjustment to Cancer (Mini-MAC), evaluating the