Eur Urol Suppl 2011;10(2):93 introduction & objectives: Focal salvage therapy for recurrent localised prostate cancer following external beam radiation therapy (EBRT) has been proposed as a strategy to reduce the genito-urinary and bowel complications that occur after whole-gland salvage therapies. We evaluated the side-effects and early cancer control rates of focal and whole-gland salvage HIFU. Materials & Methods: A registry-based analysis was conducted between 2004 and 2009 of 430 patients who underwent high intensity focused ultrasound (HIFU). Forty had whole-gland and 27 had focal salvage HIFU for localised recurrence after EBRT. Disease was localised using template prostate mapping biopsies or multi- parametric MRI in combination with concordant transrectal biopsies. Validated questionnaires were used to assess functional outcomes. Biochemical failure was deined by ASTRO-Phoenix (PSA nadir + 2ng/ml). results: Mean pre-HIFU PSA was lower in the focal therapy group (3.4 versus 8.2, p=0.06). Median follow-up was 25.6 months (range 19.2-38.0) and 11 months (2.4-22.2), respectively for whole-gland and focal salvage groups. International Index of Erectile Function-5 scores at 3 months remained signiicantly higher in the focal therapy group (mean score 21.4 versus 11.6). UCLA-EPIC Urinary domain scores showed pad-free, leak-free continence rates were signiicantly lower for those undergoing whole-gland salvage (44.4% vs. 73.9, p=0.03). The actuarial progression free survival rates at 1 and 2-years were 81% and 61% for whole- gland therapy, and 68% and 47% for focal salvage (p=0.93; Hazard Ratio 1.05 [range 0.28-3.99]). Conclusions: Focal salvage therapy holds promise in reducing toxicity and may have potential in the treatment for localised recurrence after EBRT. Long-term randomised comparative data are required. 226 long terM disease free survival following salvage CryotheraPy for bioPsy Proven radio- reCurrent Prostate CanCer Williams A.K. 1 , Martinez C. 1 , Lu C. 1 , Ng C.K. 2 , Pautler S.E. 1 , Chin J.L. 1 1 University of Western Ontario, Dept. of Urology and Oncology, London, Canada, 2 Tan Tock Seng Hospital, Dept. of Urology, Singapore, Singapore introduction & objectives: The optimum treatment of Prostate cancer recurrence following external beam radiation therapy (EBRT) remains a controversial topic. The primary problem with comparing salvage techniques following EBRT is the lack of long term data. We reviewed the long term overall survival, disease speciic survival and disease free survival of patients who have undergone salvage cryotherapy to the prostate gland for biopsy proven recurrent prostate cancer. Materials & Methods: A retrospective analysis was performed on all patients undergoing salvage cryotherapy (CRYO) for biopsy proven locally recurrent prostate cancer after EBRT by a single surgeon at a single institution from 1995- 2004. Routine biopsy were performed prior to CRYO and at 6,12 and 24 months following CRYO. Patients preoperative, perioperative and postoperative data was reviewed and recorded. Should a patient no longer be followed by the urology service, the patients themselves himself and the patient’s primary care physician or urologist were contacted. Mortality data, Prostate Speciic Antigen (PSA) results, bone scan results and any details of hormone therapy were recorded for this study. results: 187 patients were included in the current study from which 176 patients had records available for follow up giving a follow up rate of 94%. Mean follow up was 7.46 years (1-14 years). 52 patients were followed for greater than 10 years. Average time to prostate cancer recurrence in patients who developed recurrenced was 2.3 years and average time to hormone therapy in these patients was 2.8 years. Overall survival at 10 years was high at 87%. Risk factors for recurrence of tumour identiied were pre salvage PSA, pre radiation and pre salvage gleason score. Pre –radiation gleason score had little impact on survival. PSA nadir of >1.0ng/ml dl was highly predictive of early recurrence. Conclusions: CRYO has a deinite role in the management of prostate cancer, representing a minimally invasive salvage treatment with acceptable 10 year disease free survival (DFS) of upwards of 39% and speciic groups attaining 10 year DFS of 64%. Pre salvage PSA and Gleason score are the best predictors of disease recurrence, whilst pre radiation gleason score did not correlate with risk of disease recurrence. A PSA Nadir greater than 1 ng/ml indicates a poor prognosis in which early ADT should be strongly considered. 227 adjuvant radiotheraPy after radiCal ProstateCtoMy in Patients with PathologiCally high risk Prostate CanCer: 10-year follow-uP results Van Poppel H. 1 , Bolla M. 2 , Tombal B. 3 , Vekemans K. 4 , Da Pozzo L. 5 , De Reijke Th.M. 6 , Verbaeys A. 7 , Bosset J.F. 8 , Van Velthoven R. 9 , Colombel M. 10 , Van De Beek C. 11 , Verhagen P. 12 , Van Den Bergh A.C.M. 13 , Sternberg C. 14 , Gasser T. 15 , Van Tienhoven G. 16 , Scalliet P. 17 , Haustermans K. 18 , Collette L. 19 . EORTC ROG and GU Groups, Belgium 1 Universitair Ziekenhuis Gasthuisberg, Dept. of Urology, Leuven, Belgium, 2 Centre Hospitalier Régional de Grenoble-La-Tronche, Dept. of Radiotherapy, Grenoble, France, 3 Cliniques Universitaires Saint Luc, Dept. of Urology, Brussels, Belgium, 4 Virga Jesse Hospital, Dept. of Urology, Hasselt, Belgium, 5 Università Vita-Salute HSR Milan, Dept. of Urology, Milan, Italy, 6 Academisch Medisch Centrum, Dept. of Urology, Amsterdam, The Netherlands, 7 Universitair Ziekenhuis Ghent, Dept. of Urology, Ghent, Belgium, 8 Centre Hospitalier Régional de Besançon, Hôpital Jean Minjoz, Dept. of Radiotherapy, Besançon, France, 9 Institut Jules Bordet, Dept. of Urology, Brussels, Belgium, 10 Centre Hospitalier Universitaire De Lyon, Hôpital Edouard Herriot, Dept. of Urology, Lyon, France, 11 Academisch Ziekenhuis Maastricht, Dept. of Urology, Maastricht, The Netherlands, 12 Erasmus University Hospital, Dept. of Urology, Rotterdam, The Netherlands, 13 University Medical Center Groningen, Dept. of Radiotherapy, Groningen, The Netherlands, 14 San Camillo Forlanini Hospital, Dept. of Medical Oncology, Rome, Italy, 15 Kanton Spital Basel, Dept. of Urology, Basel, Switzerland, 16 Academisch Medisch Centrum, Dept. of Radiotherapy, Amsterdam, The Netherlands, 17 Cliniques Universitaires Saint Luc, Dept. of Radiotherapy, Brussels, Belgium, 18 Universitair Ziekenhuis Gasthuisberg, Dept. of Radiotherapy, Leuven, Belgium, 19 EORTC Headquarters, Dept. of Statistics, Brussels, Belgium introduction & objectives: From 1992 to 2001, 1005 patients (pts) entered the randomized EORTC trial 22911 comparing immediate external beam irradiation (RT) versus wait-and-see (WS) for pts with positive surgical margins or pT3 after radical prostatectomy (RP) (Lancet 2005). We report the 10-year follow-up results. Materials & Methods: Eligible pts were ≤75 years with WHO PS 0-1; cT1- 3N0M0 (UICC 1983) prostate cancer who had undergone RP with pN0 and ≥ 1 pathological risk factors of: capsular perforation, positive surgical margins, and/ or invasion of the seminal vesicles. RT (60Gy in 6 wks to the surgical bed) started within 4 months of RP. The primary trial endpoint was biochemical progression-free survival (time from randomization to twice conirmed PSA increase over nadir or irst clinical failure or death). Results at 5 years were presented after an interim analysis (P<0.02). Updated results are presented at the 2-sided signiicance level α=0.047. The trial is registered with ClinicalTrials.gov, number NCT00002511. results: A total of 503 pts entered the RT arm and 502 the WS arm. Patients’ median age was 65 years (range 47-75). Median pre-operative PSA was 12.4 ng/ ml; 69.5% of pts had a postoperative PSA≤0.2 ng/ml. After 10.6 years median follow-up, the 10-year biochemical progression-free survival rate was 60.6% (CI: 55.7-65.9%) with RT versus 41.1% on WS (CI: 36.4-45.8%); HR=0.49 (CI: 0.41- 0.59), P<0.0001. The 10-y clinical progression-free survival rate was 70.3% (CI: 65.5-74.6) and 64. 8% (CI: 59.8-69.3%), respectively (HR= 0.81, CI: 0.65-1.01, P=0.054). With RT, the 10-year cumulative incidence of loco-regional failure was decreased from 16.6% to 7.3% (P<0.0001). The 10-year cumulative incidence of distant metastases (11.0% vs. 10.1% with RT; P>0.1) nor overall survival (10-y survival rates 76.9% vs. 80.7% with RT, P>0.1) were impacted. The results were similar when the analysis was restricted to patients with postoperative PSA≤0.2 ng/ ml. In the WS group, 56.4% of relapsing patients received salvage irradiation and 22.9% androgen deprivation therapy, 3.4% other treatments and the remainder no active treatment thus far. Salvage treatment was initiated upon PSA relapse in most relapsing patients. The cumulative rate of grade 3 toxicity at 10 years was 5.3% after RT and 2.5% after WS (P=0.052). Subgroup analyses suggest a signiicant interaction between patient age (≤70 vs. >70 years) and beneit from immediate RT (interaction P<0.05 for biochemical progression-free survival, clinical progression- free survival and overall survival). Conclusions: At 10 years, conventional post-operative RT improves biochemical progression-free survival and local control without signiicantly impacting distant metastases or overall survival. 228 adjuvant radiotheraPy leads to suPerior bio- CheMiCal reCurrenCe free survival CoMPared to early salvage radiotheraPy in Patients with loCally advanCed Prostate CanCer: results of a MatChed-Controlled Multi-institutional analysis Briganti A. 1 , Budiharto T. 2 , Joniau S. 2 , Capitanio U. 1 , Cozzarini C. 3 , Haustermans K. 2 , Tombal B. 2 , Di Muzio N. 4 , Rigatti P. 1 , Van Poppel H. 2 1 Urological Research Institute, Vita-Salute San Raffaele University, Dept. of Urology, Milan, Italy, 2 University of Leuven, Leuven Cancer Institute, Dept. of Urology, Leuven, Belgium, 3 Urological Research Institute, Vita-Salute San Raffaele University, Dept. of Radiotherapy, Milan, Italy, 4 Urological Research Institute, Vita- Salute San Raffaele University, Dept. of Nuclear Medicine, Milan, Italy, introduction & objectives: Previous prospective randomized trials have shown a signiicant beneit of adjuvant RT (aRT) in presence of positive surgical margins or locally advanced prostate cancer (PCa). It is currently unknown whether similar results can be achieved by administering early salvage RT (eSRT). This analysis aimed at comparing the effect of aRT vs eSRT on biochemical recurrence (BCR) free survival in a large European multi-institutional cohort of men undergoing radical prostatectomy (RP), pelvic lymph node dissection and subsequent aRT or eSRT. Materials & Methods: Within a study population of 515 patients treated with RP and either aRT or eSRT at three tertiary care centres, 420 pT2-4 R0-R1 pN0 patients (81.5%) who received either immediate aRT with undetectable PSA after surgery (n=313, 74.5%) or eSRT (deined as RT administered with a PSA value <0.5 ng/ml; n=107, 25.5%) were identiied . We explored the effect of aRT vs eSRT on BCR-free survival rates by relying on a retrospective matched case-control analysis. Exact matches (ratio 1:2) were made for pT stage (pT2 vs pT3 vs pT4), RP-Gleason sum (6 vs 7-10) and surgical margin (SM) status (SM+ vs SM-). The