- Email: [email protected]
POD-07.05: One-day hospitalization after open pyeloplasty can be performed safely
PODIUM SESSIONS
assessment of continence and bladder function 3, 6 and 12 months after operation. Results: Median age was 17 years (3– 44). Median follow up was 38 months (7– 60). The underlying diagnosis was neurogenic bladder in 17 patients and posterior urethral valve in 4. Median preoperative bladder volume was 150mls (45–185) and post operatively was 312mls (110 – 450 cc; (P⬍0.001). The median in bladder compliance increased from 2.5 ml/cm water (3-6) preoperatively to 17 ml/cm (10-27) postoperatively (P⬍0.001). Post-operatively, all patients remained dry, 4 cases required intermittent catheterization, 4 others needed to use anti cholinergic to relieve urgency symptoms. Renal transplantation was performed in 8 cases within 4 –9 months after ureterocystoplasty. Conclusion: Ureterocystoplasty in patients with dilated ureter and poorly compliant bladder was safe and effective. Our study emphasizes the need to preserve dilated ureters for potential ureterocystoplasty in those who have non-functioning kidneys and insufficient bladder capacity especially in candidates for renal transplantation. Abstract Withdrawn POD-07.03 The Mitrofanoff continent external urinary diversion in children: indications and results Hadj Slimen M, Guedrib W, Bouacida M, Ben Abdellah I, Jallouli H, Chabchoub K, Bahloul A, Mhiri MN Department of Urology, CHU H. Bourguiba, Sfax, Tunisia Introduction: To evaluate the short and long terms results after the Mitrofanoff continent external urinary derivation in children. Methods: Between 1992 and 2006, thirty three children between 5 and 14 years old (average ⫽ 10 years) underwent a continent external urinary diversion by Mitrofanoff procedure. They were 15 boys and 18 girls. The underlying aetiologies were neuropathic bladder (32 cases) and posterior urethral valve (1 case). We followed-up all of them regularly during one to 12 years (mean: 8 years). Results: A perfect day and night continence was achieved in 31 cases (93%). The complications were: stomal stenosis (5 cases) witch required surgical revision in 3 cases, low urinary tract infection (10 cases) treated by ant biotherapy, stone bladder (2 cases) treated by open surgery
24
and finally stenosis of ureteric-bladder junction witch was observed in 2 cases required reimplantation. Among 18 children who had renal insufficiency, postoperative renal function was normalized in 8 cases, stabilized in 9 cases and evolved to the stage of haemodialysis in only one case. The catheterizations were easy and painless in all cases. The daily and leisure activities were acceptable in 28 cases (84%). finally, 26 children (78%) successfully retook their schooling. Conclusion: The Mitrofanoff procedure can simplify catheterization in children who are dependent upon intermittent catheterization. it offered an excellent stomal continence and improved the quality of life. POD-07.04 Change of renal parenchymal thickness according to the age of pyeloplasty in children with unilateral ureteropelvic junction obstruction Baek M, Park DS, Paick SH, Jeong SJ, Hong SK, Choi H Department of Urology, Seoul National University Hospital, Seoul, Korea Introduction: Prenatal sonographic identification of hydronephrosis resulted in increase in the number of early pyeloplasties. This study was undertaken to determine whether there is a difference in postoperative renal parenchymal thickness increment according to the age of pyeloplasty. Methods: We retrospectively reviewed the medical records of 144 children with unilateral ureteropelvic junction obstruction (UPJO) underwent dismembered pyeloplasties by single surgeon between June 1986 and September 2005. Ultrasonographies at 1 year and 5 years after surgery were analyzed and compared with preoperative ultrasonography. The ratio of ipsilateral to contralateral renal parenchymal thickness (I/C ratio) of younger infants (⬍ 6 months of age) was compared with that of older children (⬎ 6 months of age). The younger infants group was divided into three subgroups (⬍ 1 month, 2-3 months, and 4-6 months of age), and subgroup analysis was also performed. Results: Seventy nine pyeloplasties were performed on infants younger than 6 months (3⫾1.5 months, ranged from 1 week to 6 months) and 65 pyeloplasties on children older than 6 months (45⫾41 months, ranged from 7 months to 13 years). Preoperative I/C ratio in younger group and older group were 0.39⫾0.15 and 0.48⫾0.23 respectively (p⬍0.01).
One-year postoperative I/C ratio were 0.61⫾0.21 and 0.58⫾0.22, and 5-year postoperative I/C ratio were 0.69⫾0.27 and 0.70⫾0.25. The increment of I/C ratio in younger group was significantly larger than older group in postoperative 1 year (p⬍0.01). In subgroup analysis, the increment of I/C ratio was the most remarkable in infants younger than 1 month of age. Conclusion: Postoperative renal parenchymal thickness increment was more dramatic in younger infants group. Renal parenchyme can be recovered by early pyeloplasty, achieving more benefit in the youngest of kidneys. POD-07.05 One-day hospitalization after open pyeloplasty can be performed safely Palmer JS Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA Introduction: A detailed critical pathway was developed to determine if the open pyeloplasty could be performed in pre-adolescent and adolescent children with ureteropelvic junction (UPJ) obstruction with patients safely discharged after a one-day hospitalization. Methods: We evaluated all children less than 18 years of age undergoing an open dismembered pyeloplasty for the treatment of UPJ obstruction and following a critical pathway for preoperative education, operative management, and postoperative care. Patients receive a pre-incision caudal block for preventive analgesia unless technically not possible, and receive postoperative ketorolac (Toradol) unless contraindicated. Postoperatively, a child is required to fulfill 5 strict criteria in order to be discharged from the hospital. Results: A total of 38 children with UPJ obstruction underwent a pyeloplasty following the critical pathway. There were 27 boys and 11 girls with the ages ranging from 2.4 months to 16.7 years of age (mean of 3.9 years). Thirty six of the 38 patients (95%) were discharged on the first postoperative day with a mean length of hospitalization of 1.1 days (range of 1 to 3 days). All patients younger than 6 years of age (28 patients) were discharged on the first postoperative day. Thirty seven of 38 patients (97%) who received a caudal block were discharged on the first postoperative day. All patients tolerated the procedure well without major complications. Conclusion: This critical pathway for open pyeloplasty to treat UPJ obstruction enabled all children less than 6 years of age and 95% of all patients to be discharged on the first postoperative day. Also, this study demonstrates that a caudal block is technically possi-
UROLOGY 70 (Supplment 3A), September 2007
PODIUM SESSIONS
ble in the older age patient and suggests that when inserted it assists in postoperative pain control.
POD-08: Prostate Cancer: Detection and Screening Tuesday, September 4 15:00-16:30 POD-08.01 Is it appropriate to apply age-specific PSA reference to clinical practice based on PSA cutoff 3.0 ng/ml in Korean men? Jeong SJ, Han JH, Chang IH, Yu JH, Han BK, Moon KH, Hong SK, Byun SS, Lee SE Seoul National University Bundang Hospital, Seongnam, Korea Introduction: There have been many reports on the normal range of age-specific PSA reference in Korean men but its role in the detection of prostate cancers has not been explained. The present study aims to examine changes of rate in the biopsy and cancer detection when applying age-specific PSA reference to Korean men in clinical practice based on PSA cutoff 3.0ng/ml. In addition, we analyzed the pathological characteristics of cancers that may not be detected if agespecific PSA reference is applied. Methods: We made retrospective analysis of 1,385 cases aged 40-79 who had had TRUS-guided biopsy at our institution from January 2004 to May 2006 due to the rise of PSA over 3.0ng/ml or abnormal findings in DRE or TRUS. Of the cases, 66.1% had biopsy only due to the rise of PSA. Age-specific PSA reference in Korean men was set at 2.0ng/ml for 40s, 2.5ng/ml for 50s, 3.9ng/ml for 60s and 5.4ng/ml for 70s as suggested as upper limits in domestic literatures. The mean changes of rate in the biopsy and cancer detection were analyzed only in 60s and 70s whose reference range was higher than the cutoff value (3.0ng/ml) of our clinical practice. Results: Prostate cancer was detected in 30.3% (n⫽420) as a whole, and 11.2% (10/ 89) in 40s, 19.3% (45/233) in 50s, 31.5% (216/686) in 60s, and 39.5% (149/377) in 70s according to age. When the PSA cutoff was 3.0ng/ml, the positive predictive value of PSA to detect cancer was 31.1%. When age-specific reference of 2.0ng/ml was applied to 40s, the number of biopsies and detected cancers were more increased by 3 (3.7%) and 1 (12.5%) compared with clinical cutoff value (3.0ng/ml). When age-spe-
cific reference of 2.5ng/ml was applied to 50s, the number of biopsies were more increased by 2 (0.9%) but the number of detected cancers were the same. When 3.9ng/ml was applied to 60s, the number of biopsies were decreased by 96 (14.8%) but 20 (9.6%) cancers were missed. In addition, 5.4ng/ml was applied to 70s, the number of biopsies were decreased by 85 (24%) and 23 (16%) cancers were missed. On the average, the number of biopsies were decreased by 18.1%, but 12.2% of cancers were missed in 60s and 70s when age-specific PSA reference was applied. We investigated the pathological characteristics of the 43 missed cancers. The mean age and PSA were 68.8(⫾5.0) and 3.8(⫾0.6)ng/ml. Of the missed cancers, 35% had GS 7 or over. Radical prostatectomy was conducted in 31 missed cancers, and the mean tumor volume was 3.4(⫾2.9)cc. Only 18(58%) tumors were confined and GS below 7. Conclusion: When age-specific PSA reference was applied to Korean men over sixties in the clinical practice based on PSA cutoff 3.0ng/ml, TRUS-guided biopsies were decreased by 18.1%, but 12.2% of cancers were missed. In particular, 42% of missed cancers showed GS 7 or over or extraprostatic extension. Thus, in Korean men over sixty, the application of age-specific PSA reference is considered inappropriate.
POD-08.02 Prostate biopsy indications: practice patterns and the potential role of PCA3 Tombal B1, van Poppel H2, Schulman C3, Irani J4, de la Taille A5, Berges R6, Haese A7, Mulders P8, de Reijke T9, Emberton M10, Gillatt D11 1 Cliniques universitaires Saint-Luc UCL, Brussels, Belgium; 2University Hospital Gasthuisberg, Leuven, Belgium; 3Erasme Hospital, University Clinics of Brussels, Belgium; 4Centre Hospitalier Universitaire “La Mile´trie”, Poitiers, France; 5Ho ˆ pital Henri Mondor, Creteil, France; 6PANKlinik am Neumarkt, Cologne, Germany; 7 University Medical Centre Eppendorf, Hamburg, Germany; 8Radboud University Medical Centre, Nijmegen, the Netherlands; 9Academisch Medisch Centrum, Amsterdam, the Netherlands; 10University College London, London, UK; 11 Southmead Hospital, Bristol, UK Introduction: Many men with a suspicious DRE and/or elevated serum PSA have a negative prostate biopsy (PB). PB is costly and also induces anxiety, pain and complications. Therefore, a more PCaspecific test is needed to reduce the num-
UROLOGY 70 (Supplment 3A), September 2007
ber of unnecessary PBs. The PROGENSATM PCA3 Assay is the first genetic test* that is highly PCa-specific and available in Europe as a urine test. A web-based survey investigated current PB practice patterns and the potential role of PCA3 in diagnosing PCa. * CE-marked Methods: In October 2006, 1322 urologists from 5 European countries received an e-mail invitation. Results: 139 urologists (11%) participated. Around 90% agreed that their PB practice had become more aggressive over the past 5 years with an increasing number of men diagnosed and treated for PCa. Two thirds performed ⱕ 100 initial PBs/year, 19% 101-150 and 16% ⬎ 150. Only 9% biopsied 6 cores; the majority biopsied 10 (31%) or 12 cores (30%). Initial PB was primarily recommended for men with a suspicious DRE and/or PSA ⱖ 4 ng/mL. Almost 2/3 of respondents indicated a negative initial PB in ⬎ 40% of cases; 1/5 had a negative initial PB rate of ⬎ 60%. The use of PCA3 was assessed on a scale from 1 (not at all) to 9 (very likely). 79% of respondents would use PCA3 in men with an initial negative PB to guide decision on repeat PB (score ⱖ 7). Also in men with an initial PSA ⱖ 2-10 ng/mL, around 50% of respondents would apply PCA3 to guide decision on initial PB; particularly for a PSA of 2-4 ng/mL. Conclusion: The survey showed an increased PB rate with more cores resulting in an increased number of men diagnosed with and treated for PCa. A high percentage of negative initial PBs was also demonstrated. Approximately 80% of urologists would use PCA3 to guide biopsy decision in men with a previous negative PB and at least 50% considered the PCA3 Assay useful to reduce the number of unnecessary initial PBs. POD-08.03 Antibiotic prophylaxis in transrectal prostate biopsy in the Netherlands Pelser CHI, Lock MTWT University Medical Center Utrecht, Urology, Utrecht, The Netherlands Introduction & Objectives: There is no uniformity about type, duration and initiation moment of antibiotic prophylaxis before prostate biopsy. Urologists fear infections and use their personal preference. Often, this results in higher doses and prolonged use of antibiotics. It is known that these factors can contribute to antibiotic resistance. Therefore it is important to implement guide-
25
assessment of continence and bladder function 3, 6 and 12 months after operation. Results: Median age was 17 years (3– 44). Median follow up was 38 months (7– 60). The underlying diagnosis was neurogenic bladder in 17 patients and posterior urethral valve in 4. Median preoperative bladder volume was 150mls (45–185) and post operatively was 312mls (110 – 450 cc; (P⬍0.001). The median in bladder compliance increased from 2.5 ml/cm water (3-6) preoperatively to 17 ml/cm (10-27) postoperatively (P⬍0.001). Post-operatively, all patients remained dry, 4 cases required intermittent catheterization, 4 others needed to use anti cholinergic to relieve urgency symptoms. Renal transplantation was performed in 8 cases within 4 –9 months after ureterocystoplasty. Conclusion: Ureterocystoplasty in patients with dilated ureter and poorly compliant bladder was safe and effective. Our study emphasizes the need to preserve dilated ureters for potential ureterocystoplasty in those who have non-functioning kidneys and insufficient bladder capacity especially in candidates for renal transplantation. Abstract Withdrawn POD-07.03 The Mitrofanoff continent external urinary diversion in children: indications and results Hadj Slimen M, Guedrib W, Bouacida M, Ben Abdellah I, Jallouli H, Chabchoub K, Bahloul A, Mhiri MN Department of Urology, CHU H. Bourguiba, Sfax, Tunisia Introduction: To evaluate the short and long terms results after the Mitrofanoff continent external urinary derivation in children. Methods: Between 1992 and 2006, thirty three children between 5 and 14 years old (average ⫽ 10 years) underwent a continent external urinary diversion by Mitrofanoff procedure. They were 15 boys and 18 girls. The underlying aetiologies were neuropathic bladder (32 cases) and posterior urethral valve (1 case). We followed-up all of them regularly during one to 12 years (mean: 8 years). Results: A perfect day and night continence was achieved in 31 cases (93%). The complications were: stomal stenosis (5 cases) witch required surgical revision in 3 cases, low urinary tract infection (10 cases) treated by ant biotherapy, stone bladder (2 cases) treated by open surgery
24
and finally stenosis of ureteric-bladder junction witch was observed in 2 cases required reimplantation. Among 18 children who had renal insufficiency, postoperative renal function was normalized in 8 cases, stabilized in 9 cases and evolved to the stage of haemodialysis in only one case. The catheterizations were easy and painless in all cases. The daily and leisure activities were acceptable in 28 cases (84%). finally, 26 children (78%) successfully retook their schooling. Conclusion: The Mitrofanoff procedure can simplify catheterization in children who are dependent upon intermittent catheterization. it offered an excellent stomal continence and improved the quality of life. POD-07.04 Change of renal parenchymal thickness according to the age of pyeloplasty in children with unilateral ureteropelvic junction obstruction Baek M, Park DS, Paick SH, Jeong SJ, Hong SK, Choi H Department of Urology, Seoul National University Hospital, Seoul, Korea Introduction: Prenatal sonographic identification of hydronephrosis resulted in increase in the number of early pyeloplasties. This study was undertaken to determine whether there is a difference in postoperative renal parenchymal thickness increment according to the age of pyeloplasty. Methods: We retrospectively reviewed the medical records of 144 children with unilateral ureteropelvic junction obstruction (UPJO) underwent dismembered pyeloplasties by single surgeon between June 1986 and September 2005. Ultrasonographies at 1 year and 5 years after surgery were analyzed and compared with preoperative ultrasonography. The ratio of ipsilateral to contralateral renal parenchymal thickness (I/C ratio) of younger infants (⬍ 6 months of age) was compared with that of older children (⬎ 6 months of age). The younger infants group was divided into three subgroups (⬍ 1 month, 2-3 months, and 4-6 months of age), and subgroup analysis was also performed. Results: Seventy nine pyeloplasties were performed on infants younger than 6 months (3⫾1.5 months, ranged from 1 week to 6 months) and 65 pyeloplasties on children older than 6 months (45⫾41 months, ranged from 7 months to 13 years). Preoperative I/C ratio in younger group and older group were 0.39⫾0.15 and 0.48⫾0.23 respectively (p⬍0.01).
One-year postoperative I/C ratio were 0.61⫾0.21 and 0.58⫾0.22, and 5-year postoperative I/C ratio were 0.69⫾0.27 and 0.70⫾0.25. The increment of I/C ratio in younger group was significantly larger than older group in postoperative 1 year (p⬍0.01). In subgroup analysis, the increment of I/C ratio was the most remarkable in infants younger than 1 month of age. Conclusion: Postoperative renal parenchymal thickness increment was more dramatic in younger infants group. Renal parenchyme can be recovered by early pyeloplasty, achieving more benefit in the youngest of kidneys. POD-07.05 One-day hospitalization after open pyeloplasty can be performed safely Palmer JS Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA Introduction: A detailed critical pathway was developed to determine if the open pyeloplasty could be performed in pre-adolescent and adolescent children with ureteropelvic junction (UPJ) obstruction with patients safely discharged after a one-day hospitalization. Methods: We evaluated all children less than 18 years of age undergoing an open dismembered pyeloplasty for the treatment of UPJ obstruction and following a critical pathway for preoperative education, operative management, and postoperative care. Patients receive a pre-incision caudal block for preventive analgesia unless technically not possible, and receive postoperative ketorolac (Toradol) unless contraindicated. Postoperatively, a child is required to fulfill 5 strict criteria in order to be discharged from the hospital. Results: A total of 38 children with UPJ obstruction underwent a pyeloplasty following the critical pathway. There were 27 boys and 11 girls with the ages ranging from 2.4 months to 16.7 years of age (mean of 3.9 years). Thirty six of the 38 patients (95%) were discharged on the first postoperative day with a mean length of hospitalization of 1.1 days (range of 1 to 3 days). All patients younger than 6 years of age (28 patients) were discharged on the first postoperative day. Thirty seven of 38 patients (97%) who received a caudal block were discharged on the first postoperative day. All patients tolerated the procedure well without major complications. Conclusion: This critical pathway for open pyeloplasty to treat UPJ obstruction enabled all children less than 6 years of age and 95% of all patients to be discharged on the first postoperative day. Also, this study demonstrates that a caudal block is technically possi-
UROLOGY 70 (Supplment 3A), September 2007
PODIUM SESSIONS
ble in the older age patient and suggests that when inserted it assists in postoperative pain control.
POD-08: Prostate Cancer: Detection and Screening Tuesday, September 4 15:00-16:30 POD-08.01 Is it appropriate to apply age-specific PSA reference to clinical practice based on PSA cutoff 3.0 ng/ml in Korean men? Jeong SJ, Han JH, Chang IH, Yu JH, Han BK, Moon KH, Hong SK, Byun SS, Lee SE Seoul National University Bundang Hospital, Seongnam, Korea Introduction: There have been many reports on the normal range of age-specific PSA reference in Korean men but its role in the detection of prostate cancers has not been explained. The present study aims to examine changes of rate in the biopsy and cancer detection when applying age-specific PSA reference to Korean men in clinical practice based on PSA cutoff 3.0ng/ml. In addition, we analyzed the pathological characteristics of cancers that may not be detected if agespecific PSA reference is applied. Methods: We made retrospective analysis of 1,385 cases aged 40-79 who had had TRUS-guided biopsy at our institution from January 2004 to May 2006 due to the rise of PSA over 3.0ng/ml or abnormal findings in DRE or TRUS. Of the cases, 66.1% had biopsy only due to the rise of PSA. Age-specific PSA reference in Korean men was set at 2.0ng/ml for 40s, 2.5ng/ml for 50s, 3.9ng/ml for 60s and 5.4ng/ml for 70s as suggested as upper limits in domestic literatures. The mean changes of rate in the biopsy and cancer detection were analyzed only in 60s and 70s whose reference range was higher than the cutoff value (3.0ng/ml) of our clinical practice. Results: Prostate cancer was detected in 30.3% (n⫽420) as a whole, and 11.2% (10/ 89) in 40s, 19.3% (45/233) in 50s, 31.5% (216/686) in 60s, and 39.5% (149/377) in 70s according to age. When the PSA cutoff was 3.0ng/ml, the positive predictive value of PSA to detect cancer was 31.1%. When age-specific reference of 2.0ng/ml was applied to 40s, the number of biopsies and detected cancers were more increased by 3 (3.7%) and 1 (12.5%) compared with clinical cutoff value (3.0ng/ml). When age-spe-
cific reference of 2.5ng/ml was applied to 50s, the number of biopsies were more increased by 2 (0.9%) but the number of detected cancers were the same. When 3.9ng/ml was applied to 60s, the number of biopsies were decreased by 96 (14.8%) but 20 (9.6%) cancers were missed. In addition, 5.4ng/ml was applied to 70s, the number of biopsies were decreased by 85 (24%) and 23 (16%) cancers were missed. On the average, the number of biopsies were decreased by 18.1%, but 12.2% of cancers were missed in 60s and 70s when age-specific PSA reference was applied. We investigated the pathological characteristics of the 43 missed cancers. The mean age and PSA were 68.8(⫾5.0) and 3.8(⫾0.6)ng/ml. Of the missed cancers, 35% had GS 7 or over. Radical prostatectomy was conducted in 31 missed cancers, and the mean tumor volume was 3.4(⫾2.9)cc. Only 18(58%) tumors were confined and GS below 7. Conclusion: When age-specific PSA reference was applied to Korean men over sixties in the clinical practice based on PSA cutoff 3.0ng/ml, TRUS-guided biopsies were decreased by 18.1%, but 12.2% of cancers were missed. In particular, 42% of missed cancers showed GS 7 or over or extraprostatic extension. Thus, in Korean men over sixty, the application of age-specific PSA reference is considered inappropriate.
POD-08.02 Prostate biopsy indications: practice patterns and the potential role of PCA3 Tombal B1, van Poppel H2, Schulman C3, Irani J4, de la Taille A5, Berges R6, Haese A7, Mulders P8, de Reijke T9, Emberton M10, Gillatt D11 1 Cliniques universitaires Saint-Luc UCL, Brussels, Belgium; 2University Hospital Gasthuisberg, Leuven, Belgium; 3Erasme Hospital, University Clinics of Brussels, Belgium; 4Centre Hospitalier Universitaire “La Mile´trie”, Poitiers, France; 5Ho ˆ pital Henri Mondor, Creteil, France; 6PANKlinik am Neumarkt, Cologne, Germany; 7 University Medical Centre Eppendorf, Hamburg, Germany; 8Radboud University Medical Centre, Nijmegen, the Netherlands; 9Academisch Medisch Centrum, Amsterdam, the Netherlands; 10University College London, London, UK; 11 Southmead Hospital, Bristol, UK Introduction: Many men with a suspicious DRE and/or elevated serum PSA have a negative prostate biopsy (PB). PB is costly and also induces anxiety, pain and complications. Therefore, a more PCaspecific test is needed to reduce the num-
UROLOGY 70 (Supplment 3A), September 2007
ber of unnecessary PBs. The PROGENSATM PCA3 Assay is the first genetic test* that is highly PCa-specific and available in Europe as a urine test. A web-based survey investigated current PB practice patterns and the potential role of PCA3 in diagnosing PCa. * CE-marked Methods: In October 2006, 1322 urologists from 5 European countries received an e-mail invitation. Results: 139 urologists (11%) participated. Around 90% agreed that their PB practice had become more aggressive over the past 5 years with an increasing number of men diagnosed and treated for PCa. Two thirds performed ⱕ 100 initial PBs/year, 19% 101-150 and 16% ⬎ 150. Only 9% biopsied 6 cores; the majority biopsied 10 (31%) or 12 cores (30%). Initial PB was primarily recommended for men with a suspicious DRE and/or PSA ⱖ 4 ng/mL. Almost 2/3 of respondents indicated a negative initial PB in ⬎ 40% of cases; 1/5 had a negative initial PB rate of ⬎ 60%. The use of PCA3 was assessed on a scale from 1 (not at all) to 9 (very likely). 79% of respondents would use PCA3 in men with an initial negative PB to guide decision on repeat PB (score ⱖ 7). Also in men with an initial PSA ⱖ 2-10 ng/mL, around 50% of respondents would apply PCA3 to guide decision on initial PB; particularly for a PSA of 2-4 ng/mL. Conclusion: The survey showed an increased PB rate with more cores resulting in an increased number of men diagnosed with and treated for PCa. A high percentage of negative initial PBs was also demonstrated. Approximately 80% of urologists would use PCA3 to guide biopsy decision in men with a previous negative PB and at least 50% considered the PCA3 Assay useful to reduce the number of unnecessary initial PBs. POD-08.03 Antibiotic prophylaxis in transrectal prostate biopsy in the Netherlands Pelser CHI, Lock MTWT University Medical Center Utrecht, Urology, Utrecht, The Netherlands Introduction & Objectives: There is no uniformity about type, duration and initiation moment of antibiotic prophylaxis before prostate biopsy. Urologists fear infections and use their personal preference. Often, this results in higher doses and prolonged use of antibiotics. It is known that these factors can contribute to antibiotic resistance. Therefore it is important to implement guide-
25