Eur Urol Suppl 2009;8(4):275 619 ROLe OF TUMOR vOLUMe On BIOcHeMIcaL RecURRence aFTeR RadIcaL pROSTaTecTOMY Alvarez M. 1 , Capitán C. 1 , Hernández V. 1 , Amaruch N. 1 , Martín D. 2 , De La Peña E. 1 , De La Morena J.M. 1 , Llorente C. 1 1 Hospital Universitario Fundación Alcorcón, Dept. of Urology, Madrid, Spain, 2 Hospital Universitario Fundación Alcorcón, Dept. of Preventive Medicine, Madrid, Spain Introduction & Objectives: The role of tumor volume (TV) on Biochemical recurrence (BR) after radical prostatectomy (RP) is controversial. Measurement of prostate cancer volume is a time-consuming examination not routinely realized in many centers. However, biological signifcant cancer are commonly categorized according to its size. We evaluate the role of prostate cancer volume in radical prostate specimen as a risk factor for biochemical recurrence after surgery. Material & Methods: Prospective, cohort study that included patients who underwent RP from 1999-2007 in our institution. All specimen were sectioned at 3 mm intervals with sagital sections in apex and bladder neck. Sections were entirely embedded and studied microscopically by a single pathologist. Tumor volume was assessed based on the size and number of sections afected. BR was considered with a value exceeding 0.4 ng/ml. The following variables were gathered in a database: age, clinical tumour stage, preoperative PSA, Gleason score, pT stage, prostate and tumor volume, ratio tumor volume/prostate volume, site and extent of PSM and postoperative PSA. A logistic regression model was used to evaluate factors associated with BR after RP. Results: 403 patients with a median follow up of 39.3 months (18 – 66) were included. Mean age was 63.7 (5.7) years. Median preoperative PSA value was 6.3 (4.8-6.8) ng/ml. Pathological data showed a pT2 tumor in 79.3% of patients and pT3 in 20.7%. Median Gleason score was 6. Positive surgical margins were found in 36%, with a signifcant drop-out to 13.6% in last year. Median tumor volume and median ratio, were, respectively, 2.1 (0.8 – 5.6) cc and 0.04 (0.01 – 0.12). At median follow up, overall BR-free survival was 96%. Univariate analysis showed a statistically signifcant association between BR and preoperative PSA (p<0.0001), clinical stage (p<0.001), Gleason score 7 or higher (p<0.001), positive surgical margins (p<0.0001), pT (p<0.0001), TV and ratio (p 0.006 and 0.003) Logistic regression model showed that factors associated to BR after RP were clinical stage (OR = 2,4, CI 95% 1,2 – 5,5), Gleason (OR = 2,6, CI 95% 1,3 – 5,5), pT (OR = 2,7, CI 95% 1,4 – 5,7) and positive surgical margins (OR = 3,1, CI 95% 1,5 – 6,4) conclusions: Based on this study, tumor volume is not a prognostic factor for BR after RP in multivariate analysis. Main factor implicated were clinical stage, Gleason, pT and positive surgical margins. 620 peRcenTaGe OF pOSITIve cOReS STROnGLY InFLUenceS THe RaTe OF GLeaSOn SUM aGReeMenT BeTWeen pROSTaTe BIOpSY and RadIcaL pROSTaTecTOMY Abdollah F., Briganti A., Gallina A., Suardi N., Scattoni V., Dehò F., Bianchi M., Passoni N.M., Maccagnano C., Matloob R., Capitanio C., Guazzoni G., Rigatti P., Montorsi F. Vita-Salute University San Rafaele, Dept. of Urology, Milan, Italy Introduction & Objectives: The aim of this study was to evaluate the infuence of the percentage of positive cores on Gleason grade agreement between biopsy and radical prostatectomy (RP). Material & Methods: The study cohort included 2422 patients treated with radical prostatectomy (RP) for clinically localized prostate cancer at a single European institution between January 2002 and May 2008. Of these, 1974 (81.5%) had complete pre-operative clinical and biopsy data. Pathological evaluation was performed by three expert uro-pathologists. For the aim of this study four outcomes were considered: Gleason sum concordance (GSC) between biopsy and RP, biopsy Gleason sum downgrading (GSD) and upgrading (GSU) as well as biopsy Gleason sum signifcant upgrading (GSSU) defned as a shift from either biopsy Gleason sum 2-6 to 7 or higher, or biopsy Gleason sum 7 to 8-10 at RP. Univariable and multivariable analyses addressed the association between percentage of positive cores and the aforementioned outcomes after controlling for patient age at surgery, pre-operative PSA, clinical stage, primary and secondary biopsy Gleason score. Results: Mean age at surgery was 65.1 yrs (median: 65.8; range 41.4-82). Mean PSA at biopsy was 8.8 ng/ml (median 6.9 ng/ml; range: 0.3-50). Mean number of cores taken was 15.7 (median: 14; range 2-24 ). Mean number of positive cores was 6.5 (median 6; range 1-24). Mean percentage of positive cores was 43.6% (median: 35.7%; range 6-100%). Biopsy Gleason sum was ≤6 in 65.9% (1300/1974), 7 in 27% (532/1974) and ≥8 in 7.1% (142/1974) of patients, respectively. Pathological Gleason sum was ≤6 in 38.7% (764/1974), 7 in 50.5% (996/1974) and ≥8 in 10.8% (14/1974) of patients, respectively. The rates of GSC, GSD, GSU and GSSU were 45% (883/1974), 13% (266/1974), 42% (825/1974) and 35% (689/1974) respectively. At multivariable analysis, percentage of positive cores was a signifcant predictor of GSC (OR=0.45; p=0.008), GSD (OR=0.22; p=0.001), GSU (OR=6.6; p<0.001) and GSSU (OR=4.4; p<0.001; Table 1) after accounting for pre-operative predictors. conclusions: The percentage of positive cores represents a important signifcant predictor of Gleason sum agreement between biopsy and RP. Increasing percentage of positive cores is indeed associated with higher probability of Gleason score upgrading, signifcant upgrading and downgrading. Multivariate analysis GSC GSD GSU GSSU OR ; p value OR ; p value OR ; p value OR ; p value Age 1.002 ; 0.8 0.97 ; 0.06 1.01 ; 0.3 1.01; 0.002 PSA 0.97 ; 0.01 1.002 ; 0.9 1.03 ; 0.01 1.03 ; <0.001 DRE 1.19 ; 0.2 0.58 ; 0.01 1.09 ; 0.6 1.1 ; 0.09 BGS1 1.35 ; 0.05 2.6 ; <0.001 0.35 ; <0.001 0.75 ; 0.09 BGS2 2.47 ; <0.001 1.8 ; 0.001 0.13 ; <0.001 0.24 ; <0.001 PPC 0.45 ; 0.008 0.22 ; 0.001 6.3 ; <0.001 4.4 ; <0.001 617 cOULd HYpeRcHOLeSTeROLeMIa and HIGH BOdY MaSS Index Be a RISK FacTOR FOR pROSTaTe canceR? Ozari M., Toktas C., Tuncay O.L., Sınık Z., Turan T., Aybek Z., Eskicorapci S.Y. Pamukkale University, Dept. of Urology, Denizli, Turkey Introduction & Objectives: The relationship between prostate cancer and obesity had been debated in recent years. We planned a prospective study to detect the relation between high body mass index, hypercholesterolemia and prostate cancer. Material & Methods: 300 patients with abnormal rectal examination and/or PSA values>2,5 ng/ml included in this study. Body mass index (BMI), serum total cholesterol, LDL, VLDL, HDL values of all patients had been analyzed. All patients underwent 12-core biopsy. Patients were evaluated in four subgroups according to the BMI. (Group 1 body mass index <25, Group 2 body mass index 25,1-27,5, group 3 body mass index 27,6-30 and group 4 body mass index >30). Relationship between the cholesterol parameters and pathological results of abovementioned had been studied. Results: 32 % of the patients had been positive for prostate cancer. There was no statistical signifcant diference between mean BMI of prostate cancer and benign prostate hyperplasia groups. The rate of detecting prostate cancer in four groups were %33,%33, %26, and % 32, respectively and no statistically signifcance was found.(p>0,05) Also we did not fnd any relationship between serum total cholesterol, LDL, VLDL, HDL values and pathological results.(p>0,05)(Table 1) Besides mean total cholesterol, LDL, VLDL, HDL values were not diferent for prostate cancer and benign prostate hyperplasia groups. PROSTATE CANCER/ALL OF THE PATİENTS (%) P CHOLESTEROL<200mg/dl ≥ 200 61 /200(%30.5) 35 /100 (% 35) P=0.783 LDL <130 mg/dl ≥130 78 /250 (%31,2) 18 /50 (% 36) P=0.628 VLDL <32 mg/dl ≥32 67 /201 (%33) 29 /99 (%29.2) P=0.825 HDL <40 mg/dl ≥40 25 /82 (%30.4) 73 /218 (%33.4) P=0.653 conclusions: Body mass index and serum cholesterol parameters are not risk factors for prostate cancer and not helpful to predict prostate cancer 618 patients with biopsy gleason ≥ 8 prostate cancer: what aRe THe expecTaTIOnS aFTeR RadIcaL pROSTaTecTOMY Khauli R.B., Halalsheh O.M., Bulbul M., Wazzan W., Balaa J. American University of Beirut, Division of Urology, Beirut, Lebanon Introduction & Objectives: Patients with biopsy Gleason ≥ 8 have been traditionally considered as high risk patients, having poorer outcomes and higher PSA recurrence following Radical Prostatectomy (RP). Many of these patients have been referred for radiotherapy rather than primary RP. We evaluated the outcome of patients presenting with biopsy Gleason ≥ 8 who underwent RP with specifc attention to pathologic stage and overall PSA-free survival following RP. Material & Methods: 27 patients with biopsy Gleason ≥ 8 underwent RP from 1997 to 2007. PSA and clinical stage at presentation were prospectively recorded. Patients underwent additional staging using bone scan and CT scan. Pathologic staging was performed after inking the whole specimen with specifc attention to upstaging and upgrading or vice-versa, positive margins, seminal vesicle and lymph node involvement. Follow-up included PSA every 3 months for 2 years, followed by six-monthly. Patients with pT3b or higher were given adjuvant hormonal deprivation treatment ± radiotherapy. Mean follow-up was 1 to 7 years. Results: Preoperative patient characteristics and postoperative fndings are depicted in table. Mean PSA at presentation was 13.42ng/ml. Clinical T1c was seen in 3/27 (11%). Lymphadenectomy was performed in 23/27 patients and all revealed benign nodes. Preoperative Gleason was downgraded on fnal pathology in 11/27 (41%). The pathological stage distribution was pT2 in 13/27 (48%), and pT3 in 14/27 (52%), of whom 6 were pT3b (22%). Positive margin rate was 10/27 (37%) with 3/27 (11%) microscopic and 7/27 (26%) difuse involvement. Overall, 7/27 (26%) underwent adjuvant treatment consisting of radiation in 2/27 (8%), hormonal in 1/27 (4%) and combined therapy in 4/27 (14%). At follow-up, PSA recurrence (≥0.2ng/ml) was identifed in 6/27 (22%), all were after 1 year, and managed by hormonal ± radiation treatment. 2/27 progressed to metastatic disease and are receiving hormonal and chemotherapy. 5-year PSA-free survival was 59.9%. Age (years) Clinical Stage at Presentation PSA (ng/ml) Pathological Gleason (PG) Post- Prostatectomy Pathological Stage (up-staging) Mean = 64.7 T1 5/27 (18%) Median 7.6 Upgrading 3/27 (11%) 15/27 (55.6%) Range (56-73) T2a/b 14/27 (52%) Mean 13.42 Same Gleason 10/27 (37%) T2c 6/27 (22%) Range 2.13-70 Down-grading 14/27 (52%) T3 2/27 (8%) PG < 8à11/27 (41%) conclusions: These observations underscore the important role of RP for patients with biopsy Gleason ≥ 8. While half of this population was upstaged at fnal pathology necessitating adjuvant treatment, the other half remained organ-confned. The intermediate term results demonstrate a reasonable PSA-free survival and good disease control. Longer follow-up is needed to better assess the overall efcacy.