Eur Urol Suppl 2011;10(2):313 1005 PrediCtability of Psa doubling tiMe for unfavorable Pathology at radiCal ProstateCtoMy: results froM a ProsPeCtive jaPanese aCtive surveillanCe Cohort Sugimoto M. 1 , Shiraishi T. 2 , Tsunemori H. 1 , Saito Y. 3 , Kamoto T. 4 , Kakehi Y. 1 1 Kagawa University, Dept. of Urology, Kagawa, Japan, 2 Mie University, Dept. of Pathologic Oncology, Mie, Japan, 3 Shizuoka Cancer Center, Dept. of Urology, Shizuoka, Japan, 4 Miyazaki University, Dept. of Urology, Miyazaki, Japan introduction & objectives: The objective of this study is to investigate relationship between PSA doubling time (PSADT) during active surveillance (AS) and pathological fndings at radical prostatectomy. Materials & Methods: This is a multi-center prospective one-arm observational study. Seven cancer center hospitals and six university hospitals in Japan participated in this study. 184 patients with biopsy proven prostate cancer that met the following criteria were enrolled into the present study between January 2000 and December 2003. The selection criteria included (1) stage T1cN0M0, (2) age 50–80, (3) serum prostate specifc antigen (PSA) <20 ng/ml, (4) one or two positive cores per 6–12 systematic biopsy cores, (5) Gleason score <6, and (6) maximum cancer involvement in positive core <50%, while (4), (5), (6) were confrmed by a central pathologist (TS). Candidate patients were encouraged to choose AS and 165 patients consequently started AS. Triggers to start curable treatment were PSADT of 2 years or shorter or pathological progression at 1-year re-biopsy. Until March 2010, 37 patients underwent radical prostatectomy for various reasons during active surveillance program. Elapsed time to operation was 3-65 months (median 15 months). Radical prostatectomy (RP) was carried out due to on-protocol triggers in 21 patients. Patients were stratifed according to PSADT (cut-off: 2 years or 3 years), and compared them with pathological fndings in prostatectomy specimens between each groups. PSADT was assessed based on all PSA measurements prior to RP. results: Of 37 patients, PSADT in 8 patients showed 2 years or less and 12 patients showed 3 years or less. Pathological parameters including Gleason score, lymphatic invasion, venous invasion, capsular invasion and perineural infltration were compared between shorter and longer PSADT cohorts, but failed to fnd any signifcant difference (Table). Conclusions: PSADT during AS did not adequately predict pathological outcomes of RP following AS. Results of the present study indicate signifcance of repeat biopsy during AS. PSADT < 2yrs >2yrs < 3yrs >3yrs (n=8) (n=29) (n=12) (n=25) pathological Gleason score 6 or less 3 10 4 9 3+4 4 10 6 8 4+3 0 7 1 6 8 or more 1 2 p=0.459 1 2 p=0.623 Gleason score 3+4 or less 7 20 10 17 4+3 or more 1 9 p=0.296 2 8 p=0.326 lymphatic invasion (+) 2 4 3 3 (-) 6 25 p=0.446 9 22 p=0.315 venous invasion (+) 1 1 1 1 (-) 7 28 p=0.316 11 24 p=0.585 capsular invasion (+) 2 7 3 6 (-) 6 22 p=0.960 9 19 p=0.947 perineural invasion (+) 4 11 5 10 (-) 4 18 p=0.538 7 15 p=0.923 1006 Correlation of bioPsy gleason sCore and gleason sCore of the CorresPonding radiCal ProstateCtoMy sPeCiMen in Patients who Met the inClusion Criteria for aCtive surveillanCe Skradski V., Bektic J., Horninger W. Universitätsklinik Innsbruck, Dept. of Urology, Innsbruck, Austria introduction & objectives: The aim of the study was to investigate the correlation of biopsy Gleason score and Gleason Score of the corresponding radical prostatectomy specimen, in patients who met the inclusion criteria for active surveillance and underwent radical retropubic prostatectomy. Materials & Methods: Consecutive biopsy and prostatectomy specimens from 212 cases of prostate cancer, which were diagnosed by prostatic needle biopsy and underwent consecutive radical prostatectomy, were reviewed retrospectively. We defned arbitrary thresholds as inclusion criteria for active surveillance: PSA<10, Gleason score ≤6 and ≤2 cancer-positive cores in needle biopsy. results: 88 patients (41,5%) had identical Gleason scores on needle biopsy and prostatectomy specimens. Undergrading of needle biopsy specimen was seen in a total of 90 cases (42,4%) and overgrading was seen in 34 subjects (16,1%). Conclusions: We could show that a main part of patients treated by radical prostatectomy at our institution who would have met the inclusion criteria for active surveillance, had a higher Gleason score than obtained at the needle biopsy, and therefore would not have been destined to be treated in an active surveillance strategy. This should be considered in the preoperative decision process regarding the treatment of patients with localized prostate cancer. 1007 what is the role of transPerineal teMPlate bioPsies in the assessMent of Men on aCtive surveillanCe? Ayres B.E. 1 , Montgomery B.S.I. 1 , Barber N.J. 1 , Pereira N. 1 , Langley S.E.M. 2 , Denham P. 3 , Bott S.R.J. 1 1 Frimley Park Hospital, Dept. of Urology, Camberley, United Kingdom, 2 Royal Surrey County Hospital, Dept. of Urology, Guildford, United Kingdom, 3 Frimley Park Hospital, Dept. of Histopathology, Camberley, United Kingdom introduction & objectives: There has been a stage migration in prostate cancer with an increasing incidence of localized disease. Active surveillance (AS) aims to reduce treatment-related morbidity by restricting radical treatment to patients whose cancer becomes more aggressive. The optimal method of surveillance remains unknown. Previously we have found that 16% of men on AS have more signifcant disease on repeat transrectal biopsies, which is consistent with other published AS cohorts. However, transperineal template biopsies in the diagnostic setting are more accurate than transrectal biopsies and we examined their role in the follow-up of men on AS. Materials & Methods: All patients suitable for AS (age ≤75yrs, PSA ≤15 ng/ml, Gleason ≤6, clinical stage T1-2a, ≤50% cores positive, ≤10mm cancer in a single core (similar to Royal Marsden criteria) and ft enough for radical therapy) were followed prospectively. results: Between May 2006 and June 2010, 101 men on AS underwent restaging template biopsy after a median interval of 12 months (1-57) from diagnosis. At diagnosis the median age was 68 years (51-75) and median PSA was 6.5 ng/ ml (0.9-15). 34% of men had more signifcant prostate cancer (increase in grade or volume) on restaging template biopsy. 44% of these men had disease predominantly in the anterior part of the gland, an area often undersampled by transrectal biopsies. PSA velocity and PSA doubling time did not correlate with upgraded / upstaged tumours. In total, 33% of men stopped AS and had radical treatment. Conclusions: Around a third of men had more signifcant prostate cancer on transperineal template biopsies, which for most led to a change of management from AS to active treatment. PSA seems to be a poor indicator in AS. 1008 the PCa3 sCore aCCurately PrediCts tuMor voluMe and Might helP in seleCting Prostate CanCer Patients for aCtive surveillanCe Ploussard G., Durand X., Xylinas E., Moutereau S., Radulescu C., Forgue A., Terry S., Allory Y., Loric S., Salomon L., Vacherot F., De La Taille A. INSERM U955, Team 7, Dept. of Urology, CHU Mondor, Creteil, France introduction & objectives: The optimal selection of active surveillance (AS) prostate cancer (PCa) patients is currently being debated. To assess the impact of urinary PCA3 score as AS criterion instead of and in addition to the current criteria. Materials & Methods: We studied prospectively 106 consecutive low-risk PCa (PSA £10 ng/ml, clinical stage T1c-T2a and biopsy Gleason score 6) patients who underwent a PCA3 urine test before radical prostatectomy (RP). Performance of AS criteria (biopsy criteria, PCA3 score, PSA density and MRI fndings) was tested in predicting 4 prognostic pathologic fndings in RP specimens as follows: (i) pT3- pT4 disease; (ii) overall unfavourable disease (OUD) defned by a pT3-4 disease and/or a pathological primary Gleason pattern 4; (iii) tumor volume <0.5 cm 3 ; (iv) insignifcant PCa.