18 (32.7%) and 2 (3.6%) men, respectively. 1 man had positive local lymph nodes (1.8%) and no patients had metastatic disease. Overall, 28 of 55 men (50.9%) had unfavorable disease. However, only 7 men (12.7%) had both GS  4+3 and T3 disease. Furthermore, 7 of all 280 men (2.5%) experienced biochemical failure on post-surgical follow-up, all of whom were salvaged successfully using radiotherapy. CONCLUSIONS: There are high rates of unfavorable disease among men who undergo delayed RP after AS. These tumors are higher grade and more extensive than would be expected in men on AS. However, the short surveillance period suggests misclassification of tumor on diagnostic biopsy rather than true tumor progression. More extensive template sampling and earlier confirmatory biopsy may assist in reducing rates of unfavorable disease. Nevertheless, our results support the overall safety of AS, with low rates of PSA failure and un- salvageable disease. Source of Funding: None MP46-09 INDICATIONS FOR INTERVENTION DURING ACTIVE SURVEILLANCE OF PROSTATE CANCER: A COMPARISON OF THE JOHNS HOPKINS AND PRIAS PROTOCOLS Max Kates*, Jeffrey Tosoian, Bruce Trock, Zhaoyong Feng, Ballentine Carter, Alan Partin, Baltimore, MD INTRODUCTION AND OBJECTIVES: Active surveillance is an alternative to immediate intervention that may reduce overtreatment in men with low risk prostate cancer. The widespread acceptance of active surveillance, however, has been limited by a lack of consensus on criteria for monitoring and intervention. Two outstanding questions include the need for yearly biopsy and the use of PSA kinetics as a trigger for intervention. We analyzed how patients enrolled in our bi- opsy-based surveillance program would fare under the PRIAS protocol which utilizes PSA kinetics. METHODS: Since 1995, 1,125 men with favorable risk prostate cancer have enrolled in the AS program at Johns Hopkins Hospital. Entrance criteria include: clinical stage T1c, PSA density < 0.15 ng/mL, and prostate biopsy findings (Gleason score ¡ € U 6, ¡ € U 2 cores involved, ¡ € U 50% cancer involvement of any core). Surveillance protocol involves semi-annual PSA and annual biopsy, and pathological reclassification triggers definitive therapy. The PRIAS protocol obtains PSA measure- ment every 3 months and scheduled biopsies in years 1, 4, and 7. PSA doubling time triggers definitive therapy (if PSADT <3 yrs) or repeat biopsy (if PSADT 3-10 yrs). Patients enrolled in the JHH AS program were retrospectively reviewed to evaluate how the use of PRIAS pro- tocol would alter the timing and identification for curative intervention. The primary outcome was pathological reclassification on pros- tate biopsy. RESULTS: Over follow-up time of 2.9 yrs, 427 (38%) men experienced biopsy reclassification. Of those, 260 (61%) were detected at biopsy intervals corresponding to PRIAS criteria (222 at 1 yr, 28 at 4 yrs, and 10 at 7 yrs). In 67 (16%) men, reclassification was detected between PRIAS biopsy years (55 at 2-3 yrs, 9 at 5-6 yrs, 3 after 7 yrs), with a median delay in detection of 1.9 yrs (range 0.1€ C 2.5 yrs). Of 204 men with >5 yrs of follow up without biopsy reclassification, 32 (16%) had PSADT <3 yrs that would have triggered immediate intervention under PRIAS, and 54 (26%) had PSADT 3-10 yrs that would have triggered biopsy. 22 (11%) men went on to be reclassified at a median of 4.7 yrs after their date of PSADT progression. CONCLUSIONS: For patients enrolled in active surveillance, use of the PRIAS monitoring protocol would have delayed identification of biopsy reclassification in 16% of men with a median delay of 1.9 yrs as compared to an annual biopsy schedule. Progression based on PSA kinetics would result in over-treatment of 5% of men, while initiating earlier intervention (by median 4.7 yrs) in 11% of patients with eventual reclassification. Source of Funding: none MP46-10 PROSPECTIVE RANDOMIZED CLINICAL PHASE-III TRIAL OF LIMITED VS EXTENDED PELVIC LYMPHADENECTOMY IN INTERMEDIATE AND HIGH RISK PROSTATE CANCER (PCA) e FIRST DESCRIPTIVE RESULTS (SEAL, AUO AP 55/09) Julia Schwerfeld-Bohr*, Susanne Krege, Krefeld, Germany; Markus Graefen, Hamburg, Germany; J€ orn Witt, Gronau, Germany; Axel Heidenreich, Aachen, Germany INTRODUCTION AND OBJECTIVES: The role of extended pelvic lymphadenectomy in men with intermediate/high risk PCA is discussed controversially. We present initial data of a prospective ran- domized clinical phase-III trial on extended (EPLA) versus limited (LPLA) in this patient cohort. METHODS: A total of 244 intermediate/high risk PCA patients have been recruited and randomized to EPLA and LPLA, resp from 8/ 2001 to 7/2013 in the still ongoing trial. The primary endpoint of the trial is an improvement in progression-free survival of 15% at 5 years. Therefore, a total of 450 patients have to be randomized. Macroscopic lymph node metastases and bone metastases were excluded by abdominal/pelvic CT and bone scan. Age was limited to 75 years. No neoadjuvant therapy was allowed. LPLA included the obturator fossa only, EPLA included the obturator fossa, the external, internal and common iliac artery up to the ureteral crossing. RESULTS: 126 and 118 patients were randomized to LPLA and EPLA, resp.. 34 patients (14%) had positive lymph nodes, 19 (16.1%) in the EPLA and 13 (10.5%) in the LPLA group, resp. (p < 0.03). The median number of positive nodes was 2 for limited and 1 for extended LA. In EPLA 31% of the LNM were located in the obturator fossa, 28% in the external, 29% in the internal and 12% in the common iliac artery region. 16 (47%) and 18 patients (53%) exhibited an intermediate and high risk PCA, resp.. Radical prostatectomy specimens showed the following tumor stages in node positive patients: 4 (12%) pT2, 10 (30%) pT3a, 18 (53%) pT3b and 1(3%) pT4, one unknown. All node positive patients had a Gleason score of 7 (n¼17) and 8-10 (n¼16). The mean OR time was 170 and 200 min in the LPLA and EPLA group, resp. Lymphoceles developed significantly ore often in the EPLA group (17% vs 8%, p < 0.03), however, only 4 (13.3%) required an intervention. There were additional 6 Clavien grade II to IIIb complications with no differences between LPLA and EPLA. CONCLUSIONS: EPLA results in significantly higher lymph node yields without increasing the risk of significant Clavien grade III-V complications. The therapeutic benefit is still unknown, however, we will present further results on PSA relapses at time of the AUA meeting once a mean follow-up of 2 years is achieved. Source of Funding: Ferring Pharma GmbH MP46-11 HIGH INTENSITY FOCUSED ULTRASOUND IN PROSTATE CANCER. MULTICENTRIC, LONG TERM RETREATMENT RATE DECREASE Stefan Thueroff*, Munich, Germany; Christian Chaussy, Regensburg, Germany; Eduard Baco, Victor Berge, Oslo, Norway; Andreas Blana, Fuerth, Germany; Sebastian Crouzet, Albert Gelet, Lyon, France; G. Pasticier, Bordeaux, France; Paulesu Antonello, Giario Conti, Como, Italy; C. N. Robertson, Raleigh, NC; John F. Ward, Houston, TX INTRODUCTION AND OBJECTIVES: High intensity focused ultrasound (HIFU) performed by Ablathermâ is clinical routine as pri- mary treatment of localized prostate cancer for non-surgical cases since 1993. The objective of this study is to report the development of the HIFU retreatment rates as well as salvage treatment rates on a large multicentric cohort. METHODS: 2,634 patients with prostate cancer (PCa) staged <T3, No, Mo, PSAi< 20ng/ml treated by 3 consecutive generations of HIFU Ablathermâ (EDAP-TMS, Lyon, France) of european HIFU cen- ters with sufficient follow up informations were included. Online HIFU Vol. 191, No. 4S, Supplement, Monday, May 19, 2014 THE JOURNAL OF UROLOGY â e513