Eur Urol Suppl 2007;6(2):111 353 MEdICAl ThERAPY IN ACUTE URINARY RETENTION dUE TO bENIghN PROSTATIC hYPERPlASIA Salehi M., Poor Reza F., Ghasemi H., Fouladi Mehr M. URC, Gums, Urology, Rasht, Iran Introduction & Objectives: Comparison of prazosin with combination of prazosin and inasteride in success spontaneous voiding for 48 hours after removing of urethral catheter in men with AUR due to BPH. Material & Methods: In a randomized double blind placebo controlled clinical trial patients with irst episode of AUR due to only BPH were included in this survey. After insertion of urethral indwelling Foley catheter and study the urinary system by sonography and laboratory tests such as BUN/Cr and FBS and CBC and FBS; patients who had indwelling urethral catheter for 72hours received combination of prazosin and placebo or combination of prazosin and inasteride in a randomly allocation. Prazosin dose was 0.5 mg in irst two night and 0.5 mg BD thereafter. Finasteride or placebo dose were one tablet in each day. Thereafter urethral catheter was extracted and success of trial without catheter for future 48 hours was assessed. Data was analyzed with Chi square test Results: Eighty patients with mean age of 66.05+ 7.13 divided in two groups. Group A had 40 patients with mean age of 65.9+7.21 and group B had 40 patients with mean age of 65.8+7.40. Group A patients received prazosin and placebo and group B patients received prazosin and inasteride. Mean Weight of prostate and mean urinary residue after insertion of urethral catheter was 48±11.4 and 592±167.5 in group A and 50.23±9.3 and 677.2±165.5 in group B respectively. 23 from 40 patients (57.5%) of group A patients had success of trial without catheter for 48 hours after extraction of catheter and 17 patients (42.5%) failed for trial without catheter. 35 from 40 patients (87.5%) of group B patients had success of trial without catheter for 48 hours after extraction of catheter and 5 patients (12.5%) failed for trial without catheter. No any side efect was detected. Patients of two groups hadn’t any signiicant diferences in numbers and mean prostatic weight (P=0.523) and urinary residue after insertion of urethral catheter (P=0.524). Success of early trial without catheter in patients who received combination of prazosin and inasteride had signiicant diferences with success of trial without catheter in patients who received combination prazocin and placebo. Conclusions: Success of trial without catheter in patients who received combination of prazocin and inasteride is greater than prazocin alone. Prazosin eicacy is due to resolution of dynamic obstruction of prostatic in bladder outlet and inasteride added eicacy to prazosin probably by early inhibition of vascular endothelial growth factor and angiogenesis and reduction of anatomical obstruction of prostatic suburethral vascular cushion. We advised combination of prazocin and inasteride for early elimination of acute urinary retention due to benign prostatic hyperplasia. O9 MANAgEMENT OF AdvANCEd UROThElIAl TUMOURS 1 Thursday, 22 March, 12.15-13.45, Room 3 354 ClINICAl OUTCOME ANd FACTORS PREdICTINg CANCER SPECIFIC SURvIvAlOF PATIENTS WITh PT0 dISEASE FOllOWINg RAdICAl CYSTECTOMY Colombo R. 1 , Briganti A. 1 , Scattoni V. 1 , Saccà A. 1 , Sozzi F. 1 , Salonia A. 1 , Gallina A. 1 , Karakiewicz P.I. 2 , Raber M. 1 , Rigatti P. 1 , Montorsi F. 1 1 University Vita-Salute, Scientiic Institute San Rafaele, Urology, Milan, Italy, 2 Cancer Prognostics and Health Outcomes Unit, University of Montreal, Urology, Montreal, Canada Introduction & Objectives: The aim of the study was to evaluate the clinical outcome of patients with pT0 disease following radical cystectomy and to assess predictive factors of cancer speciic survival in this subset of patients. Material & Methods: Between January 1991 and August 2006, 822 consecutive patients underwent radical cystectomy for transitional cell carcinoma at our Institution. Of these, 102 (12.4%) patients had no residual tumor at pathological evaluation (i.e. pT0 disease). No patients received any neo-adjuvant therapy. Clinical and pathological data included age, pT stage and grade at trans-urethral resection of the tumor (TUR), N stage, number of lymph nodes removed. Kaplan-Meier curves assessed overall survival and cancer speciic survival. Moreover, univariable and multivariable Cox regression analyses tested the association between prognostic factors (including age, T stage, tumor focality at TUR prior to cystectomy, N stage, number of lymph nodes removed) and bladder cancer speciic survival. Results: Mean age was 66 years (39-83). TUR stage was available in 72 patients (70.5%) and revealed T1 and T2 disease in 23 (31.9%) and 49 (68.1%) patients, respectively. Grade was II in 6 (16.7%) and III in 66 (83.3%) patients, respectively. Four patients (4.9%) had lymph node invasion (LNI). Mean number of lymph nodes removed was 15.2 (range 5-65). Overall, clinical follow-up was available in 70 (68.6%) patients. After a median follow up of 32 months (mean 50.5; range: 1-190), 10 patients (14.3%) died of bladder cancer, while 5 (7%) died of other causes. The actuarial cancer speciic survival rate at 1,3 and 5 years was 91, 85 and 77%, respectively. Overall survival rate at 1,3 and 5 years was 88, 80 and 70%, respectively. At multivariate analysis number of lymph nodes removed and presence of LNI were the only multivariate signiicant predictors of bladder cancer speciic survival (p=0.017 and p=0.016, respectively). Conclusions: To our knowledge this is the largest study aimed at assessing the outcome of patients with pT0 disease following radical cystectomy. A non-negligible percentage of patients (23%) died of bladder cancer at 5-year follow-up. Presence of lymph node invasion and extent of pelvic lymph node dissection represented the only multivariate predictors of bladder cancer speciic survival in this cohort of patients. 355 lONg TERM FOllOW-UP OF blAddER CANCER PATIENTS WITh dISSEMINATEd Ck-20 POSITIvE TUMOR CEllS IN bONE MARROW FOllOWINg RAdICAl CYSTECTOMY Retz M. 1 , Rotering J. 2 , Stöckle M. 2 , Gschwend J. 1 , Lehmann J. 2 1 Technische Universität München, Urology, München, Germany, 2 Saarland University, Urology, Homburg, Germany Introduction & Objectives: Systemic progression is the leading cause of death in bladder cancer patients following radical cystectomy. The aim of the present study was to assess the prognostic signiicance of circulating tumor cells detected by Cytokeratin 20 reverse-transcriptase polymerase chain reaction (CK-20 RT-PCR) in bone marrow from bladder cancer patients. Material & Methods: Bone marrow samples from 46 bladder cancer patients were drawn prior to radical cystectomy. The range of tumor stages were pT1/CispN0M0 n=7, pT2pN0M0 n=14, pT3/pT4apN0M0 n=14 and pT2-pT4apN1/pN2M0 n=11. CK- 20 positive cells were detected by RT-PCR and analysed with respect to the endpoints of tumor progression and cancer death. CK-20 gene expression was also compared to clinical and histopathological parameters for prognostic signiicance by univariate and multivariate analysis (Cox regression). Clinical follow-up data were available on 44 patients (median: 44.5 months; range:1-95 months). Results: 13 of 44 (29.5%) bladder tumor patients of all stages were positive for CK- 20 detection in bone marrow. Progression free survival rate after 84 months was signiicantly shorter in the CK-20 positive group with 25.6% as compared to CK- 20 negative patients with 59.8% (log-rank: p=0.004). The median progression free survival time was 11 months for CK-20 positive bladder cancer patients and 68.6 months for the CK-20 negative group. Furthermore, CK-20 positive tested patients had a signiicantly shorter 7 year tumor speciic survival rate of 38.5% than CK-20 negative patient group with 65.8% (p=0.006). The median tumor speciic survival time was 17.2 months for CK-20 positive patients whereas the CK-20 negative group displayed 45.9 months. Multivariate analysis revealed that CK-20 as well as lymph node status and tumor stage provided independent prognostic information with respect to tumor speciic survival. Conclusions: The detection of disseminated CK-20 positive tumor cells in bone marrow from bladder cancer patients is an independent prognostic factor and should be included in decisions concerning adjuvant therapies in early tumor stages. 356 INdEPENdENT PREdICTORS OF CANCER-SPECIFIC SURvIvAl IN TRANSITIONAl CEll CARCINOMA OF ThE UPPER URINARY TRACT: MUlTI-INSTITUTIONAldATASET FROM 3 EUROPEAN CENTERS Gottardo F. 1 , Dal Piaz O. 2 , Novara G. 1 , De Marco V. 1 , Galfano A. 1 , Bouygues V. 3 , Artibani W. 1 , Patard J.J. 3 , Ficarra V. 1 1 University of Padua, Department of Oncological and Surgical Sciences, Urology Clinic, Padua, Italy, 2 University of Verona, Department of Urology, Verona, Italy, 3 Rennes University Hospital, Department of Urology, Rennes, France Introduction & Objectives: To identify the variables predictive of cancer-speciic survival in patients with non metastatic transitional cell carcinoma of the upper urinary tract (UUT-TCC) Material & Methods: The clinical and pathological data of 269 patients who had undergone nephro-ureterectomy for UUT-TCC from 1980 to 2004 in 3 urological European centers were retrospectively collected. The survival interval was deined as the time between surgery and the last clinical evaluation or death. Cancer-speciic survival was estimated using the Kaplan-Meier method. Log rank test was used for univariate analysis. Cox proportional hazards regression was used for multivariate analysis. Results: Two hundred and ifty patients underwent nephroureterectomy, while 19 patients had contemporary nephroureterectomy and cystectomy for synchronous muscle-invasive bladder cancer. The pathological stage of the UUT TCC was T0 in 4 cases, Ta in 42, T1 in 76, T2 in 55, T3 in 76, and T4 in 16, respectively. Twenty-seven patients had pathologically positive nodes. The median follow-up of the whole cohort was 34 months (interquartile range 13-66). The median follow-up of the patients alive and disease free was 52 months (interquartile range 19-80). At follow-up, we censored 57 cancer related deaths (21.2%), 34 deaths due to other causes (12.6%). One hundred and sixty- nine patients (62.8 %) were alive and disease free. On univariate analysis, the following variables were associated with cancer-speciic survival probabilities: history of previous bladder cancer (log rank p=0.003), pathological stage of the primary tumor (log rank p<0,0001), pathological node stage (log rank p<0,0001), tumor grade (log rank p=0,0002), presence of lymphatic and/or vascular invasion (log rank p=0,0002), surgical margin status (log rank p=0,013), tumor site (log rank p=0,008), synchronous muscle invasive bladder TCC (log rank p<0,0001), and tumor multifocality (p<0,0001). On multivariate analysis, the following variables were independent predictors of cancer-speciic survival probabilities: pathological stage of the primary tumor (H.R: 3.984; p<0.0001), pathological lymph node stage (H.R: 3.890; p<0.0001), tumor multifocality within the UUT (H.R.2.244; p=0.023), synchronous muscle invasive bladder TCC (H.R. 2.525; p=0.02), and history of bladder TCC before the diagnosis of UUT-TCC (H:R:2.022; p=0.026). Conclusions: In our multi-institutional dataset of patients who had undergone nephroureterectomy for UUT TCC, we showed that pathological stage of the primary tumor, lymph node stage, history of bladder TCC before the diagnosis of UUT-TCC, tumor multifocality within the UUT, and synchronous muscle invasive bladder cancer were independent predictors of cancer-speciic survival probabilities.