Ml) Need Prostate Biopsy?

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2001. All patients were examined to exclude a dissemination and then, treated radically, using radiotherapy alone or with endocrine therapy. PSA levels before start of treatment were between 0.9 to 332 ng/ml. Gleason grading was 2-4 (G1) in 48 pts, 5-7 (G2) in 51 pts, 80 (G3) in 23, and was unknown for 39 pts. ␹2 statistical test was used to analyze Gleason score. There were estimated mean, maximum and minimum PSA level for patients with ED and the other patients. Confidence interval was estimated with probability of 0.95. Results: ED depends on Gleason score 8 or higher (p⫽0,001). PSA level at the beginning of the treatment varied from 8 to 332 ng/ml (mean 66.4) in ED patients and from 0.9 to 189 ng/ml (mean 23.2) in the other patients. Confidence interval for ED patients is 16.7 - 116.2 ng/ml. It means that 95% of ED patients presented starting PSA level greater than 16.7. Conclusion: About 10% of radically treated PC patients could be disseminated during diagnosis and this dissemination could not be recognized using standard procedure. Only patients with starting PSA level less then 8 ng/ml were safe from ED in the analyzed group. UP.59 Quality-Of-Life Outcomes in Patients Undergoing Emerging Techniques for the Treatment of Localised Prostate Cancer: A Prospective Study Thanigasalam R1, Stricker P2, Brenner P2, Baumert H3, Earnest A1, Patel V4, Henshall S1, Rasiah K1,5 1 Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia; 2St.Vincent’s Hospital and St. Vincent’s Clinic, Darlinghurst, Australia; 3Dept of Urology, Saint Joseph Hospital, Paris, France; 4 Dept of Robotic and Minimally Invasive Urologic Surgery, Ohio State University, Columbus, USA; 5Dept of Urology, Royal North Shore Hospital, St. Leonard’s, Australia Introduction and Objectives: Quality-oflife (QoL) outcomes have become increasingly important in men with localised prostate cancer (PCa) in terms of guidance towards a particular treatment choice. This is particularly true in men with localised PCa as radiotherapy and radical prostatectomy (RP) have significant effects on psychosocial status, physical function and sexual function and bother. It has been reported that monotherapy for localised PCa with RP, external beam radiotherapy or brachytherapy produce equivalent outcomes. Methods and Materials: Though a num-

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ber of groups have compared QoL outcomes after RP and external beam radiotherapy, to our knowledge, there are no published studies using the validated EPIC instrument comparing QoL outcomes for all forms of prostatectomy (open vs. robotic vs. laparoscopic) with seed brachytherapy, external beam radiotherapy and active surveillance as treatment for localised PCa. There are also no active randomised control trials to compare these therapies. Such data are necessary to fully inform patients about treatment options and to address individual patient preferences for the possible outcomes. Results: The EPIC instrument is a prostate specific questionnaire and includes questions covering urinary, bowel and sexual function and bother. Patient recruitment commenced in May 2007 following ethics approval. Once patients had chosen their own therapy, they were mailed the EPIC instrument at baseline (pre-treatment), 6 weeks, 3 months, 6 months and 1-year post treatment by an independent researcher. Patient’s responses were prospectively recorded on a secure database. Conclusions: We present the baseline QoL status in patients undergoing the above treatments for localised PCa, in our prospective cohort study. UP.60 Issues Faced in the Transition From Open to Robot-Assisted Laparoscopic Radical Prostatectomy in the Contemporary Era Thanigasalam R1, Stricker P2 1 Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia; 2St.Vincent’s Hospital and St. Vincent’s Clinic, Darlinghurst, Australia Introduction and Objectives: Robot Assisted Laparoscopic Prostatectomy (RALP) is becoming an increasingly accepted alternative to open radical prostatectomy (ORP) for the treatment of localized prostate cancer (CaP). We present the early issues faced in transferring skills from ORP to RALP. Materials and Methods: Prospectively collected clinical and pathological data of the first 100 consecutive RALPs and the preceding 100 open RPs performed between 2006 and 2008 by a single surgeon (PS) respectively were analyzed. The analysis was performed in this sequence to highlight the level of expertise the surgeon had reached in open RP before commencing RALP. The surgeon had no previous experience with laparoscopic surgery, but had performed over 1600 ORPs. Anal-

yses of the clinical characteristics, pathological characteristics and early clinical outcomes were performed. Results: There was a statistical difference in the mean PSA between the ORP and RALP groups (5.9ng/ml vs. 7.2ng/ml, p⫽0.004) respectively. No statistically significant differences were noted between groups for prostate weight, tumor volume, Gleason score, pathological stage and pT2 positive margin status. However, the difference in pT3 positive margin status was significant between the groups (13% vs. 26%, ORP vs. RALP, p⫽0.02). Bilateral nerve sparing procedures were more commonly performed in the open group (82% vs. 60%, ORP vs. RALP, p⫽0.03). There were no conversions to open surgery, no bowel injuries, no blood transfusions and no deaths during the first 100 RALP cases. 97% of RALP patients had ⬍500mls blood loss, compared with 56% of ORP patients. Median hospital stay was 3 days vs. 4 days, and median catheterization time was 6 vs. 7 days for RALP and ORP patients, respectively. The mean ORP operating time was 147 mins. The RALP learning curve, to a 4-hour proficiency, was 25 patients. Conclusions: An experienced open surgeon with no prior laparoscopic experience was able to convert safely to the robotic platform following a mentoring program and gradual implementation of robotic cases. Patients that have a high probability of having pT3 disease should be offered RALP with caution. UP.61 Does Every Patient with High PSA (>100ng/Ml) Need Prostate Biopsy? Kim Y, Lee J NHIC Ilsan Hospital, Ilsan, South Korea Introduction and Objectives: Prostate biopsy is essential for definitive diagnosis of prostate cancer, but prostate needle biopsy is an invasive procedure which could cause complications such as UTI and acute urinary retention (AUR). It may be almost all of the prostate biopsies in the patients with high PSA (⬎100ng/ml) are positive. Prostate cancer with high PSA may be adenocarcinoma. The prostate cancer with PSA greater than 100ng/ml may be advanced disease, and the treatment strategy would not changed according to pathological reports. So, we assessed the role of the prostate biopsy in order to diagnose prostate cancer in the patients with high PSA. Materials and Methods: We reviewed the records of 745 cases (35 to 88 years old) undergoing TRUS guided prostate

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initial biopsy because of PSA ⬎ 4.0ng/ml. The patients with UTI and AUR were excluded. We figured out the positive predictive value (PPV) according to initial PSA level. Results: Total prostate cancer detection rate was 31.8% (237 cases) on initial biopsy. The PSA level of the patients with positive biopsy is 4.5-7176ng/ml (median 196.5ng/ml). The PSA level of the patients with negative biopsy is 4.1-85.5ng/ml (median 12.3ng/ml). PPV for prostate cancer was 14.9% at initial PSA 4.110.0ng/ml, 30.4% at 10.120.0ng/ml, 52.8% at 20.130.0ng/ml, 72.7% at 30.140.0ng/ml, 62.5% at 40.150.0ng/ml, 80.0% at 50.160ng/ml, 93.3% at 60.1100.0ng/ml and 100% at initial PSA greater than 100ng/ml on initial biopsy, respectively. Furthermore, only one negative biopsy result among patients with initial PSA greater than 60ng/ml was diagnosed as prostate cancer on repeat biopsy 6 months later. Pathological diagnosis was adenocarcinoma in all patients with initial PSA greater than 100ng/ml. Among patients with high PSA (⬎100ng/ml), 19 patients (36.5%) had lymph node metastasis and 31 patients (59.6%) had bone metastasis. All of them received hormonal therapy after diagnosis. Conclusions: Unless there are not UTI and AUR, all of the prostate initial biopsies in patients with high PSA (⬎100ng/ ml) were positive. Furthermore all of them were adenocarcinoma. All of them received hormonal therapy. Therefore we believe that performing prostate biopsy in the patients with PSA level greater than 100ng/ml should be a considerable matter. UP.62 Advanced Robotic Assisted Laparoscopic Prostatectomy Training: Building The Foundation of a Reproducible Operation Davis J, Matin S UT MD Anderson Cancer Center, Houston, USA Introduction and Objectives: We have hypothesized that the robotic assisted laparoscopic prostatectomy (RALP) may achieve optimal results with a shorter learning curve if trainees are exposed to a thorough curriculum. We previously studied our experience with beginner trainees and found that they required 66% more time to complete steps and spent most of their first 30 cases addressing basic steps. We report the results of 3 trainees with prior robotic experience learning more advanced steps.

Materials and Methods: Three trainees with prior robotic rotations each spent 8 weeks rotating with a single surgeon (JWD) during which they were evaluated for console performance time and accuracy. Case volume included 2 days/week in the OR averaging 5 RALP cases/week. For each case, either the staff was at console and the trainee as 1st assist or vice versa (i.e. no 2nd assistants involved). Eleven steps were outlined and grades assigned as A ⫽ equal to staff, B ⫽ minor corrections required, and C ⫽ major corrections required. Staff times were recorded as a benchmark. Results: For the eleven steps of the case (including lymph node dissection), the staff average was 124 minutes and trainees averaged 73% more time. Trainees averaged 28.5 minutes/case on the console (range 4-84). Sixty cases from the 3 trainees were reviewed in which at least 1 console step was performed by a trainee with the staff at bedside. The goals of teaching advanced technique were: more efficient basic tissue dissection (n⫽21), suturing (n⫽27), bladder dissection (n⫽11), and nerve bundle/urethra dissection (n⫽11). Less than 10% of all steps required minor corrections by staff, and there were no major corrections. Conclusions: Trainees with prior exposure to RALP and basic console experience can proceed to advanced steps and perform at a level similar to staff. They require more operative time and occasional minor correction. To test our hypothesis that RALP is a trainable and reproducible operation, further study is needed to evaluate these same trainees performance when staffing their own cases and to compare these outcomes to their mentoring institution. UP.63 Widespread Indications for Radical Prostatectomy: Does It Make Sense? Djozic J1, Bogdanovic J, Seljmesi N, Culibrk B, Djozic M, Djozic S, Marusic G, Djozic E 1 Clinic of Urology, Clinical Center of Vojvodina, Novi Sad, Serbia; 2Medical Center Subotica, Subotica, Serbia Introduction and Objectives: Established indications (by EAU) for Radical Prostatectomy (RP) are well known (PSA ⬍20, ⬍cT3a, Gleason⬍8). But can we also offer radical surgery to young patients (pts) with PSA 20-50ng/ml, high grade (Gleason ⬎80), localized disease on CT/MRI (T2-T3a) and no enlarged lymph nodes, normal bone scan (BS), and no co-morbidity, strongly motivated for sur-

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gery? With this small prospective study, we would like to open discussion about surgical treatment of this controversial group of pts. Materials and Methods: During the period December 2006-February 2008, 11 pts with PSA between 25-48.5ng/ml (average⫽36.30), Gleason 80, localized disease on CT/MRI with no enlarged lymph nodes, normal BS, underwent radical non nerve-sparing prostatectomy, in two Medical Centers: Novi Sad and Subotica. Average age of pts was 58.3 years (range 4962) with no co-morbidity, strongly motivated for radical surgery. Eight pts received LHRH agonist Zoladex 3,6 gr/per month, 3 months prior surgery. Another 3 pts underwent surgery within 6 week after positive biopsy. Results: Seven of 11(63,63%) pts had no positive ly.nodes, tumor margins and seminal vesicles, and for them surgery was curative procedure. Three pts (27%) had positive ly.nodes and got adjuvant hormonal therapy, 4 pts (36,36%) had positive margins and followed without therapy, 1(9%) pt had involved only seminal vesicles with additional radiation therapy, 2 (18%) pts had ly. nodes and seminal vesicles involvement and radiation and hormonal therapy was carried out on them. In follow-up period (15 months), all pts are alive, continent, with no progression (DRE, CT, US, BS) with PSA between 0.040,5ng/ml. Conclusions: In selective cases of pts in high-risk groups, radical prostatectomy has its sense, as a part of multimodal therapy or alone by itself. Our group of pts is small and we need bigger studies for relevant conclusions. UP.64 The Effects of Naftopidil on Lower Urinary Tract Symptoms After Radical Prostatectomy Ishizaka K1, Machida T1, Tanaka M1, Kawamura N1, Nakamura K1, Kamai T2, Honda M2, Arai K2, Yoshida K2 1 Kanto Central Hospital, Tokyo, Japan; 2 Dokkyo University School of Medicine, Tochigi, Japan Introduction and Objectives: We studied the effects of naftopidil, a selective ␣1-adrenoceptor antagonist, on lower urinary tract symptoms (LUTS) of patients after radical prostatectomy. Materials and Methods: Twenty-seven patients with International Prostatic Symptom Scores (IPSS) equal to or are more than 8 who had been treated for localized prostatic cancer at least 1 year before they were enrolled in the study. They did

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