Eur Urol Suppl 2007;6(2):278 1021 ExTERNAl vAlIdATION OF A NOMOgRAM FOR PREdICTION OF SIdE SPECIFIC ExTRACAPSUlAR ExTENSION AT RObOTIC RAdICAl PROSTATECTOMY Gallina A. 1 , Zorn K.C. 2 , Walz J. 1 , Trinh Q.D. 1 , Hutterer G.C. 1 , Traumann M. 1 , Shalhav A.L. 2 , Zagaja G.P. 2 , Gofrit O.N. 2 , Orvieto M.A. 2 , Valiquette L. 3 , Karakiewicz P.I. 1 1 University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Canada, 2 University of Chicago, Urology, Chicago, United States of America, 3 University of Montreal Health Center, Urology, Montreal, Canada Introduction & Objectives: The accuracy of staging tools developed in patients treated with open radical prostatectomy (RP) is unknown in patients treated with robotic assisted laparoscopic radical prostatectomy (RALP). Since RALP patients may have diferent clinical and pathological characteristics, the accuracy of staging tools may be compromised. We externally validated a previously published nomogram predicting side-specifc (SS) extracapsular extension (ECE) in a large population of patients subject to RALP. Material & Methods: Predictors included PSA, clinical stage, biopsy Gleason sum, percentage of positive cores and percentage of cancer in the biopsy cores). As in the original report, all variables, except for PSA, where defned in a side-specifc fashion. A patient with palpable cancer on both lobes was considered to have T2c in each lobe. Performance characteristics (observed vs. predicted probability) of the nomogram coefcients were graphically explored using calibration plot and the area under the ROC curve (AUC) was calculated. We applied the previously validated SS-ECE nomogram to a RALP cohort and tested its predictive accuracy. Results: Mean age at RP was 60.4 years (median 60). Mean and median PSA were 6.64 and 5.43, respectively. Side specifc clinical stage was T1c in 993 (86.2), T2a in 115 (10.0%), T2b in 28 (2.4%) and T2c in 16 (1.4%) prostate lobes. Side specifc biopsy Gleason sum was 5 in 2 (0.2%), 6 in 572 (49.7%), 3+4 in 128 (11.1%), 4+3 in 58 (5.0%) and 8-10 in 32 (2.8%) prostate lobes. Unilateral prostate cancer at biopsy was found in 360 (62.5%) patients. The mean SS percentage of positive core was 26.2% (median 20.0%) and the mean SS percentage of cancer was 15.1% (median 5.0%). At fnal pathology, 107 (18.6%) patients had an extracapsular disease and a SS-ECE was detected in 117 out of 576 patients (20.3%). The nomogram showed excellent performance characteristics and the AUC in this cohort was 88.8%. Conclusions: Our results show that staging tools developed in patients treated with open RP may be safely adopted to RALP patients. 1022 COMPARINg ThE OUTCOME OF PATIENTS WIThAdjUvANT OR SAlvAgE TREATMENT IN ClINICAl UNIlATERAl T3APROSTATE CANCER Hsu C.y. 1 , Joniau S. 1 , Oyen R. 2 , Roskams T. 3 , Van Poppel H. 1 1 KULeuven, Urology, Leuven, Belgium, 2 KULeuven, Radiology, Leuven, Belgium, 3 KULeuven, Pathology, Leuven, Belgium Introduction & Objectives: In locally advanced prostate cancer, surgery alone will cure only a small part of the patients (30-44%). Multimodality treatment consisting of radical prostatectomy (RP) with adjuvant or salvage androgen deprivation therapy (ADT) or radiotherapy (RT) is often needed. It is however not well studied whether patients who received adjuvant treatment fare better or worse than those who receive salvage treatment. Material & Methods: Between 1987 and 2004, 200 patients were assessed as unilateral cT3a prostate cancer by digital rectal examination at our institution. All patients underwent RP and bilateral extended lymphadenectomy. No patient received neo-adjuvant treatment by either hormones or radiation. Adjuvant treatment is defned as either RT or ADT given within 90 days after RP; salvage treatment is defned as either RT or ADT given postoperatively after 90 days. The Kaplan–Meier method was used to analysis the survival rates. Results: Forty-four (22%) patients received adjuvant treatment because of detectable PSA post-surgery or because of positive surgical margins, salvage treatment was given in 68 (34%) patients because of late biochemical or late clinical failure (PSA ≥ 0.2 ng/ml and rising). The mean follow-up from RP was 74.7 months (range 7 to 184). A signifcant diference was found in mean pre-operative PSA between adjuvant and salvage groups (26.08 vs. 13.97 ng/ml, p=0.0019). Also, signifcant diferences between these two groups were recorded in positive lymph node (p<0.0001) and positive margin rate (p=0.0181). However, Kaplan-Meier analysis showed there were no signifcant diferences in cancer specifc survival (CSS) (p=0.29) and overall survival rate (OS) (p=0.29) between both groups. Conclusions: Multimodality treatment, consisting of surgery and RT or ADT, is often necessary in the treatment of locally advanced prostate cancer. CSS and OS rates do not seem to difer between both groups after a follow-up op 74.7 months. 1023 ThE RElATIONShIP bETWEEN bOdY MASS INdEx ANd ClINICAl UNIlATERAl T3A PROSTATE CANCER Hsu C.Y. 1 , Joniau S. 1 , Oyen R. 2 , Roskams T. 3 , Van Poppel H. 1 1 KULeuven, Urology, Leuven, Belgium, 2 KULeuven, Radiology, Leuven, Belgium, 3 KULeuven, Pathology, Leuven, Belgium Introduction & Objectives: Body mass index (BMI) is used to study obesity, with overweight defned as an index of more than 25. BMI has been correlated with worse outcome after radical prostatectomy (RP), but this observation has been mainly noticed in clinically localized disease. The objective of this study is to analyze the relationship between BMI and outcome of surgery for locally advanced prostate cancer in a single center series. Material & Methods: Two hundred patients with clinical unilateral T3a (cT3a) prostate cancer underwent RP and bilateral extended lymphadenectomy between 1987 and 2004. The BMI of each patient was recorded before surgery. The mean age was 63.3 years (range 41 to 79). The mean follow-up was 70.6 months (range 7 to 177). Patients were divided into 2 groups: BMI <25 and ≥25. The Cox proportional hazard analysis was used to study the diferences in outcome between these two groups. Results: Ninety-three patients had BMI <25, and 107 patients had BMI ≥25. There were no signifcant diferences between BMI <25 and ≥25 in the incidence of node positive disease (p=0.20) and margin status (p=0.45). Neither were there signifcant diferences between these two groups in pre- operative PSA (p=0.15) and cancer volume (p=0.07). In the Cox proportional hazard analysis, BMI was not a signifcant predictor in biochemical progression free survival (BPFS), clinical progression free survival (CPFS), cancer specifc survival (CSS) and overall survival (OS). Conclusions: Although BMI has been correlated with worse outcome after RP in clinically localized disease, we cough not confrm this observation in cT3a disease. However, while oncological outcomes do not seem to difer, this surgery may be very demanding and postoperative short-term morbidity might be higher in BMI ≥25. 1024 ClINICAl T3 PROSTATE CANCER TREATEd WITh RAdICAl PROSTATECTOMY: PAThOlOgICAl ANd lONg-TERM OUTCOMES Jeldres C. 1 , Gallina A. 1 , Walz J. 1 , Scattoni V. 2 , Eastham J.A. 3 , Scardino P.T. 3 , Klein E. 4 , Reuther A. 4 , Saad F. 5 , Montorsi F. 2 , Rigatti P. 2 , Graefen M. 6 , Huland H. 7 , Karakiewicz P.I. 1 1 University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Canada, 2 Vita-Salute University, Urology, Milan, Italy, 3 Memorial Sloan Kettering Cancer Center, Urology, New York, United States of America, 4 Cleveland Clinic Foundation, Urologic Oncology, Cleveland, United States of America, 5 University of Montreal Health Center, Urology, Montreal, Canada, 6 Martini-Clinic, Prostate Cancer Centre, Hamburg, Germany, 7 University Medical Centre Eppendorf, Urology, Hamburg, Germany Introduction & Objectives: Locally advanced prostate cancer (cT3) is found in up to 5 percent of newly diagnosed men. However, the role of radical prostatectomy (RP) in these patients is controversial. We assessed the rate of favourable pathology at RP and of BCR- free survival in men with cT3. Material & Methods: Of 15,767 patients, 208 (1.3%) were cT3, and were treated with RP at 6 diferent institutions in North America and Europe. Statistical analyses addressed pathological stage at RP and Kaplan-Meier analyses addressed the rate of BCR after RP. Results: Mean age was 61 years (range 39 - 79) and mean PSA was 13.8 ng/ml (range 0.12 - 47.3). Of all cT3 patients, 87 (41.8%) had favourable pathological fndings at RP manifested by 9.1% OC stage or specimen confned (32.7%) disease (ECE positive, negative SVI, negative LNI and negative surgical margins), or pathological Gleason sum ≤6 regardless of pathological stage (7.2%). The actuarial median time to BCR was 5.6 vs. 1.8 years, respectively for those with favourable outcomes vs. the others (p<0.001). At 5 years, 68 (32.8%) patients were BCR-free vs. 16.2% for those with unfavourable pathology (p<0.001).Figure 1. BCR-free survival in men with favourable vs. unfavourable pathological characteristics Conclusions: Despite clinically adverse presentation (cT3), almost half of these patients show favourable pathological characteristics at fnal pathology and 52.1% of those with favourable pathology are BCR-free at 5 years. These fndings suggest that RP is a valid treatment option for patients with cT3 PCa.Figure 1: