Eur Urol Suppl 2011;10(2):303 970 CritiCal assessMent of the PerforManCe of Psa kinetiCs for the PrediCtion of [11C]Choline Pet/Ct in Prostate CanCer Patients with bioCheMiCal failure after radiCal ProstateCtoMy Briganti A. 1 , Garcia Parra R. 2 , Giovacchini G. 2 , Picchio M. 3 , Di Trapani D. 1 , Di Trapani E. 1 , Fossati N. 1 , Passoni N.M. 1 , Gianolli L. 4 , Messa C. 5 1 Urological Research Institute, Vita-Salute San Raffaele University, Dept. of Urology, Milan, Italy, 2 University of Milano Bicocca, Dept. of Molecular Bioimaging, Milan, Italy, 3 National Research Council, Dept. of Bioimaging and Molecular Physiology, Milan, Italy, 4 Vita-Salute San Raffaele University, Dept. of Nuclear Medicine, Milan, Italy, 5 National Research Council, Dept. for Bioimaging and Molecular Physiology, Milan, Italy introduction & objectives: Previous studies have shown that the positive detection rate of [ 11 C] choline positron emission tomography/computed tomography (PET/CT) depends on PSA levels. However, the role of different PSA kinetics in the prediction of PET/CT has been poorly addressed. We tested the role of PSA velocity (PSAV) and PSA doubling time (PSADT) to predict PET/CT fndings in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). Materials & Methods: PSAV and PSADT were calculated in 170 consecutive PCa patients with BCR after RP undergoing PET/CT for restaging of the disease. PSADT was calculated as PSADT= ln2/m, where m is the slope of the regression line of natural log of PSA values. At least 3 PSA measurements were used (median: 4; range: 3-16) separated by at least 3 months, each with a minimum increase of 0.20 ng/mL. Similarly, PSAV was calculated as the slope of the linear regression line of all PSA values available from BCR to trigger PSA. All patients had also complete clinical and pathological data. PET/CT fndings were validated using criteria based on histological analysis and follow-up data. Statistical analysis was performed using t-test, Chi-Square test, univariable and multivariable logistic regression models predicting the presence of .positive PET/CT. results: Median PSA was 1.25 ng/ml (0.23–48.6 ng/ml), median PSAV was 0.99 ng/ml/yr (0.11–98.9 ng/ml/yr), and median PSADT was 7.0 months (0.97–45.3 months). Patients with positive PET/CT (n=75) had signifcantly higher PSAV and shorter PSADT than patients with negative PET/CT (n=95) (PSAV: 6.93±13.08 vs. 1.23±2.03 ng/ml/yr; PSADT: 6.45±5.71 vs. 11.75±7.54 months; all p<0.05). The percent of patients with positive PET/CT was 21% for PSAV<1 ng/ml/yr, 56% for PSAV between 1 and 2 ng/ml/yr, and 76% for PSAV>2 ng/ml/yr. The rate of patients with positive PET/CT was 27% for PSADT>6 months, 61% for PSADT between 3 and 6 months, and 81% for PSADT <3 months. The quality of ftting (r 2 ) of PSA values according to the exponential function (PSADT) was signifcantly (P<0.05) better than the quality of ftting according to the linear function (PSAV) in the whole sample and in all anatomical regions. At univariate analysis, trigger PSA, PSADT, PSAV, androgen deprivation therapy and pathological stage were signifcantly (P<0.05) associated with an increased risk of positive PET/CT. However, at multivariate analysis, only trigger PSA and PSADT maintained the statistical signifcance. Conclusions: Both PSAV and PSADT can be used to stratify the risk of positive [ 11 C] choline PET/CT in PCa patients with BCR. However, only PSADT was signifcantly associated with positive PET/CT . The greater statistical power of PSADT compared to PSAV could be related to the better capability of ftting time- dependent changes in PSA values, better refecting the natural history of PCa. 971 health-related Quality of life after salvage high intensity foCused ultrasound treatMent (hifu) for loCally radioreCurrent Prostate CanCer Berge V. 1 , Baco E. 1 , Dahl A. 2 , Karlsen S.J. 1 1 Oslo University Hospital, Dept. of Urology, Aker, Oslo, Norway, 2 Oslo University Hospital, Dept. of Oncology, DNR, Oslo, Norway introduction & objectives: To evaluate health related quality of life (HRQOL) after salvage high intensity focused ultrasound (HIFU) for locally radiorecurrent prostate cancer (PCa). Materials & Methods: Fifty seven patients treated with salvage HIFU were offered the University of California, Los Angeles Prostate Cancer Index (UCLA-PCI) questionnaire at baseline and at follow up 3 months or later. Scores ranged from 0 (worst) to 100 (best). Clinically signifcant change was defned as a minimum difference of 10 scores between baseline scores and the scores at follow up. The SF-12 is a general HRQOL instrument, which is included in the UCLA-PCI questionnaire. The Physical component summary (PCS-12) score and the Mental component summary (MCS-12) score are calculated from SF-12 according to established algorithms. The mean score of PCS-12 and MCS-12 in the Norwegian general population is 50. results: Forty-six patients (81%) were evaluable. The mean time lapse between HIFU treatment and questionnaire response was 17.5 months, (range 6-29months). The mean score for urinary function decreased from 79.7 ± 12.1 before HIFU to 67.4 ± 17.8 after HIFU (p< 0.001). Patients using 1-2 pads a day increased from 11% to 44% and patients using ≥3 pads increased from 0% to 16% before and after HIFU, respectively (p<0.001). The mean score for sexual function decreased from 32.1 ± 24.1 before HIFU to 17.2 ±17.0 after HIFU (p< 0.001). Patients reporting intercourse last 4 weeks decreased from 29% at baseline to 15% post-HIFU (p=0.1). The bowel and hormonal functions were not signifcantly affected. There was a statistically signifcant reduction in the mean score of PCS-12 score from 52.7 ± 4.0 before HIFU to 50.4 ±4.9 after HIFU (p< 0.001). The MSC score was not signifcantly changed. Conclusions: Treatment of localized radiorecurrent CaP by salvage HIFU is associated with clinically signifcant reduction in urinary function after mean follow up of 17.5 months. The reduction of sexual function is probably of less signifcance in this population. The results are comparable to similar studies done for salvage cryotherapy and seem to show less side effects compared to salvage prostatectomy HRQOL studies. 972 Carbon footPrint of laParosCoPy in the united states Power N., Guillonneau B., Touijer K. Memorial Sloan-Kettering Cancer Center, Dept. of Surgery, New York, United States of America introduction & objectives: Laparoscopic surgical techniques and indications have expanded over the past 30 years since its inception in medical practice. Due to recent advances in robotic surgery, the number of laparoscopic robotic assisted procedures is on the rise as well. Carbon dioxide is the principal gas used in these procedures for insuffation. Carbon dioxide contributes 9-26% of the Greenhouse effect, mostly due to fossil fuel use, implicating it in the current global warming trend since the industrial revolution of the 20 th century. Materials & Methods: Data regarding the number of laparoscopic surgeries performed both for inpatient and outpatient settings in the United States are only available for 2006 in national databases. Inpatient common laparoscopic procedures were identifed using ICD-9 CM codes in the Nationwide Inpatient Sample collected by the Healthcare Cost and Utilization Project. This data was cross referenced with inpatient and ambulatory statistics compiled by the United States Department of Health and Human Services and the Centers for Disease Control and Prevention. Outpatient laparoscopic procedures were extracted from this dataset. Average operative times for each procedure were estimated using fgures available in the literature and our institution’s data. The number of cylinders and CO2 emissions were calculated from this data. Contributions to indirect CO2 emissions were identifed as all other processes involved before and after the actual laparoscopic procedure. Calculable processes prior to surgery were broadly categorized as CO2 capture/compression and transportation of CO2 to hospitals. Post-procedure CO2 emissions were calculated relating to single use equipment unique to laparoscopy and their requirement of incineration as biomedical waste. The Environment Input-Output Life-Cycle Assessment (EIOLCA) model was used to estimate CO2 emission involved in CO2 capture/compression. results: There were 2,616,522 procedures included. The total number of hours of operative time was estimated at 2,961,498 that translated into 806,948 CO2 cylinders. The total CO2 direct emissions were 56.5 tons. The subtotal of CO2 emission for industrial gas manufacturing, power generation and supply, and gas extraction was calculated as 1,862,700 tons. The overall CO2 emissions from laparoscopic surgery were estimated at 1,866,106.5 tons/year. It amounts to driving a medium sized car 83,626 times around the earth at the equator or 3 million fights from New York City to London. Still another way, laparoscopy in the United States amounts to more CO2 emission/year than 129 entire country’s yearly CO2 emissions as listed by the UN from 2007 data. It would rank 84 th overall between Estonia and Lithuania . Conclusions: The carbon dioxide emission of laparoscopy in the United States has a signifcant environmental impact. This should be considered in larger strategies to reduce healthcare’s carbon footprint while maximizing healthcare quality. Poster session 81 interstitial Cystitis Monday, 21 March, 14.00-15.30, hall C 973 atP release froM bladders is inCreased in-vivo and suPPressed by alPha-1 adrenoCePtor bloCker in a rat Model of bladder outlet obstruCtion Akino H., Nagase K., Watanabe N., Tanase K., Oyama N., Miwa Y., Yokoyama O. University of Fukui, Dept. of Urology, Fukui, Japan introduction & objectives: We have previously reported that a diffusible substance released from the mucosa may enhance SCs and the effect of the substance is pronounced by bladder outlet obstruction (BOO). However, the released amount of ATP, the most likely candidate of the substance, from bladder strips in-vitro was decreased in rats with BOO (1). This result prompted us to measure the ATP release from bladders in-vivo in BOO rats. The aim of this study was to examine the amount of ATP released from the inner surface of the bladder in-vivo and the