CONCLUSIONS: TPMB found significant cancer in 81.4% (48/ 59). It also identified the subgroups with very high risk features (positive PI and SVI). Positive TPMB is not influenced by prior negative TRUS biopsy. TPMB might be considered as the first biopsy approach, especially in higher risk patients with a positive family history or abnormal DRE. The performance of TPMB should be prospectively compared to mpMRI to determine which technique yields more accurate information. Source of Funding: None MP48-10 INCLUSION OF THE “EXTREME” ANTERIOR APICAL NEEDLE BIOPSIES IN THE STANDARD 12 CORE BIOPSY TEMPLATE AT THE INITIAL DETECTION OF PROSTATE CANCER Ayman S. Moussa*, Giza, Egypt; Ahmed El-Shafei, Cairo, Egypt; Ahmad Aref Al-Dessoukey, Ahmed Abdel-bary, Amr Masoud, Giza, Egypt; Amr Abd El-Hakium, Cairo, Egypt INTRODUCTION AND OBJECTIVES: Prostate cancer detec- tion efforts have focused on increasing the number of cores. An even more important factor may be their location. Laterally directed and apical cores have been associated with the highest cancer detection rate, especially the apical cores for men undergoing repeated biopsies. In this study, we describe our experience with adding extreme apical cores in men undergoing initial biopsy as a modification to the standard 12 core biopsy. METHODS: A prospective trial has been conducted from 9/2012 to 10/2013. A total of 320 consecutive men with increased PSA and/or abnormal DRE underwent initial TRUS-BX. All patients underwent a modified 12 cores biopsy scheme in which the 2 medial apical cores on both sides are replaced by 2 cores taken from the extreme anterior apex, (figure 1) defined as the site immedi- ately lateral to the junction of apex and urethra. Each core was marked individually for identification. Site-specific detection and tumor charac- teristics were reported. Multivariable logistic regression was used to assess the association between cancer and site of cores. RESULTS: Prostate cancer was detected in 69 patients (21.6%). The apical cores (2 on each side) achieved the highest cancer detection rate (71.6% of all cancers) and the 2 extreme anterior apical cores (one on each side) achieved the highest rate of unique cancer detection (p¼ 0.03). Multivariable logistic regression analysis shows that PSA, all the apical cores and specifically the extreme anterior apical cores were highly significance for cancer detection (P value: 0.03, <0.0001, <0.0001) respectively. CONCLUSIONS: In our experience, modifying the standard 12 core biopsy scheme by including the extreme apical cores increase prostate cancer detection on initial Transrectal ultrasound-guided bi- opsies and minimize the potential for misdiagnosis and need for repeat biopsy. Source of Funding: none MP48-11 PROSPECTIVE RANDOMIZED CONTROLLED STUDY TO ASSESS THE EFFECT OF PERINEAL REGION CLEANSING WITH POVIDONE IODINE BEFORE TRANSRECTAL NEEDLE BIOPSY OF THE PROSTATE ON INFECTIOUS COMPLICATIONS Younis Taher*, Haluk Ozen, Bulent Akdogan, Serhat Unal, Serkan Dogan, Ankara, Turkey INTRODUCTION AND OBJECTIVES: To analyze the effect of perineal region cleansing with povidone iodine (PI) before transrectal needle biopsy of the prostate on infectious complications. METHODS: From 01/07/2013 to 05/01/2014, 120 consecutive patients with a PSA > 2.5 ng/ml or abnormal digital rectal examination were prospectively randomized to perineal cleansing (60) with PI or no cleansing (60) before their first transrectal needle biopsy of the pros- tate. Patients in both groups received 3 gr fosfomycin po the day before and after the procedure and 1 gr amikacin iv infusion 30 mi- nutes before the procedure. The patients characteristics, comorbid- ities, PSA, fPSA, f/t PSA ratio, total prostate and transitional zone volume and thus PSA dansity (PSAD) and transitional zone PSA dansity (TZPSAD), previous history of antibiotic usage in the last three months, previous history of transrectal needle biopsy of the prostate, hematuria, hematospermia, rectal bleeding, the pathological results and the primary end point which was infectious compilications were evaluated in both groups. RESULTS: There was no difference in baseline evaluation between groups, except mean volume of the prostate was larger in PI group (63.9 vs 52.8 cc, p¼0.016). Infectious complications were observed in 4 patients (3,3%); 1 (1.7%) in PI group and 3 (5%) in control group (p¼0.309). Regarding the other parameters and path- ological results, there was no significant difference between two groups. CONCLUSIONS: Although there was a trend for reducing in- fectious complications in patients with perineal cleansing with PI before ultrasound guided transrectal needle biopsy; this difference has not reached significant level in this study. Further studies with larger num- ber of patients are needed to clarify the effect of perineal cleansing with PI. Source of Funding: none MP48-12 MULTIPARAMETRIC MRI INCREASES THE EFFICIENCY OF THE STANDARD 12-CORE TRUS-GUIDED REPEATED BIOPSIES Lucas Regis*, Pol Servian, Ana Celma, Ricardo Lopez, S. Roche, Jacques Planas, Jose Placer, Ines DeTorres, Juan Morote, Barcelona, Spain INTRODUCTION AND OBJECTIVES: Repeated prostatic bi- opsies (rPBs) are frequently performed due to the persistence of prostate cancer (PCa) suspicion, however the rate of detection is usu- ally low. Therefore, efforts to increase the efficiency of rPBs are being done. Multiparametric magnetic resonance image (mMRI) can detect suspicious areas and enables us to target biopsies through MRI or ul- trasounds by using MRI/US fusion systems. The objective of this study was to analyze if mMRI increases the efficiency of the standard 12-core TRUS-guided biopsy. METHODS: This was a prospective and blinded mMRI study, including 175 consecutive patients with median age (67y) and me- dian serum PSA (8.1 ng/mL) scheduled to rPB. Pelvic mMRI was performed the week before rPB by using a 1.5 Tesla Siemens de- vice. PI-RADS scoring was done by one experienced radiologist (SR), and mMRI classified as low suspicion (LS: PI-RADS 1-2), intermediate suspicion (IS: PI-RADS 3), and high suspicion (HS: PI-RADS 4-5). Univariate and multivariate analysis were done to analyze the association between mMRI and PCa as well as its predictive capacity to detect high-grade tumors (HG-PCa: primary Gleason grade 4-5). e598 THE JOURNAL OF UROLOGY â Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015