Post AUA Cancer de la Prostate

1. Post AUACancer de la Prostate Fred Saad

2. Late Breaking Abstracts • PCPT • RP from PCPT are insignificant cancers in 25% • RR reduction 30% if consider bias and if all men had a BX • IN RP specimens the RR cancers • 32% for Gleason 6 (p=.0001) • 28% for gleason >6 (p=.02) • 3 Papers conclude no added risk of HG cancer from finasteride • SWOG 8794 update • pT3 randomised to adj vs no adj rads • Metastasis free survival improved 26% (p<.031)

3. CONVERTING FROM OPEN TO ROBOTIC PROSTATECTOMY: INSTITUTIONAL IMPACT ON NUMBER OF PELVIC LYMPHNODES RETRIEVED DURING ROBOTIC−ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RALRP)Jennifer Yates *, Joseph Renzulli MD , Harry Iannotti MD , George E Haleblian MD and GyanPareek MD . RESULTS The mean number of lymph nodes obtained during robotic PLND was 3.2 and the mean number obtained by open PLND was 6.9 (p< 0.001). CONCLUSIONS: Robot−assisted laparoscopic PLND yielded fewer lymph nodes compared to open PLND at the time of radical prostatectomy for organ confined disease. In patients presenting with a high risk of lymph node involvement based on preoperative staging, open PLND yields a higher number of lymph nodes compared to robotic PLND and should be considered the gold standard.

4. PATHOLOGIC UPGRADING AND UPSTAGING WITH IMMEDIATE REPEAT BIOPSY FOR PATIENTS ELIGIBLE FORACTIVE SURVEILLANCERyan K Berglund MD *, Timothy A Masterson MD , Kinjal C Vora MD , Scott E Eggener MD , James A Eastham MD and Bertrand D Guillonneau MD . METHODS: A retrospective review of consecutive patients undergoing repeat biopsy within 3 months of a first positive biopsy from March 2002 until June 2007 was analyzed. Patients were considered eligible if they had a PSA < 10 ng/ml, clinical stage < T2b, Gleason pattern <4, <4 cores positive, and no single core with > 50% cancer involvement. RESULTS: 104 patients Of the repeat biopsies performed, 27/104 (26%) were negative, 58/104 (56%) had Gleason score = 6, 17/104 (16%) had Gleason score 7, one patient had Gleason score 9, 10/104 (10%) of patients had > 3 cores involved on repeat biopsy, 12/104 (12%) had > 50% involvement of at least one core. A total of 27/104 (26%) patients were upgraded or upstaged. CONCLUSIONS: Immediate repeat biopsy in patients with prostate cancer being considered for AS resulted in more than one quarter being upgraded or upstaged

5. PATHOLOGIC DISEASE PROGRESSION ON REPEAT TRANSRECTAL BIOPSY IN A CONTEMPORARY WATCHFULWAITING PROSTATE CANCER COHORTAndrew Feifer MD *, Mohammed F Al−Otaibi MD , Kanishka Sircar MD , Louis R Begin MD , Armen G Aprikian MD , WassimKassouf and Simon Tanguay . METHODS: In a prospective study, 186 men with prostate cancer were conservatively managed by active surveillance (AS). Of these, 92 men had at least one 12−core re−biopsy. followed every 3−6 months and were offered re−biopsy annually or if there were any changes on physical exam or PSA. Progression while on AS was defined as having one or more of the following: >cT2b, >2 positive cores, >50% of cancer in at least one core, or predominant Gleason 4 in re−biopsies. RESULTS: 92 patients underwent re−biopsy; 24/92 patients (26%) had pathologic progression, 32/92 (34.78%) had no change, 36/92 (39.12%) had improved pathology. Of the 36 patients with improved pathological findings, 72.3% had no cancer on re−biopsy. Patients demonstrated histological progression at 1st, 2nd, 3rd, 4th, and 5th repeat biopsy in 46%, 25%, 17%, 8% and 4% of the time respectively.

6. IMPROVED PREDICTION OF DISEASE RELAPSE AFTER RADICAL PROSTATECTOMY USING A PANEL OFPREOPERATIVE BLOOD−BASED BIOMARKERSShahrokh F Shariat MD *, Jochen Walz , Claus G Roehrborn , Francesco Montorsi , Claudio Jeldres , Fred Saad , Kevin M Slawin and Pierre I Karakiewicz . METHODS: 421 consecutive patients treated with radical prostatectomy and bilateral PLND Preoperative plasma levels of transforming growth factor−b1 (TGF−b1), interleukin−6 (IL−6), interleukin−6 soluble receptor (IL−6sR), vascular endothelial growth factor (VEGF), vascular cell adhesion molecule−1 (VCAM1), Endoglin, urokinase plasminogen activator (uPA) urokinase plasminogen inhibitor−1 (PAI−1), and urokinase plasminogen receptor (uPAR) were measured using commercially available enzyme immunoassays in Multivariable models were used to explore the gain in the predictive accuracy of the models. The accuracy was quantified by the c−index statistic and was validated with 200 bootstrap resamples. RESULTS: In standard multivariable analyses that adjusted for the effects PSA, biopsy Gleason sum, and clinical stage, TGF−b1 (p<0.001), IL−6sR (p<0.001), IL−6 (p<0.001), VCAM−1 (p<0.001), VEGF (p=0.008), Endoglin (p=0.002), and uPA (p<0.001) were associated with biochemical recurrence. The multivariable model containing standard clinical variables alone had an accuracy of 71.6%. The addition of TGF−b1, IL−6sR, IL−6, VCAM1, VEGF, Endoglin, and uPA increased the predictive accuracy by 15% to 86.6% (p<0.001) and demonstrated virtually perfect calibration.

7. LONG−TERM SURVIVAL PROBABILITY IN A COHORT OF OVER 20,000 IN MEN WITH PROSTATE CANCER TREATED CONSERVATIVELY OR WITH DEFINITIVE TREATMENT (RADIOTHERAPY OR RADICAL PROSTATECTOMY)Robert A Leung *, Jay K Jhaveri , Rajiv Yadav , Sandhya Rao , Terry Field , Edward H Wagner , Mani Menon , E Darracott Vaughanand Ashutosh K Tewari MD . The goal: report the long−term survival in men diagnosed with prostate cancer in a cohort of 23,811 men. METHODS: The HMO Cancer Research Network (CRN) consists of data systems of 12 health maintenance organizations nationwide. included: tumor characteristics, neo-adjuvant hormone therapy, age, mean follow−up time, treatment modality, co−morbidity score. RESULTS: 23,811 men diagnosed with prostate cancer between 1990 and 1998. mean follow−up time is 6.6 years (median 10.9 years). Overall death rate was 26.82% (n = 6,385) with a prostate cancer specific death rate of 6.06% (n =1,442) CONCLUSIONS: The results of this study have shown that compared with conservative management, both radiotherapy and Radical prostatectomy increase survival for men with localized prostate cancer.

8. IS DIABETES MELLITUS ASSOCIATED WITH POORLY DIFFERENTIATED PROSTATE CANCER (PCa)?Firas Abdollah *, Andrea Salonia , Andrea Gallina , Vincenzo Scattoni , Rayan Matloob , Patrizio Rigatti and Francesco Montorsi . METHODS: 1874 consecutive radical prostatectomy between February 1997 and July 2007. Six and a half percent (120/1874) of them were diabetic at the moment of PCa diagnosis. RESULTS: No significant differences between diabetic and non diabetic men were observed regarding age (66±6 vs 65±7 years; p=0.7), PSA level at diagnosis (9.5±9 vs 9.8±10 ng/ml; p=0.1), and pathological stage (pT2 67%, pT3 33%, pT4 0% vs pT2 71%, pT3 28%, pT4 1%). Significantly higher percentage of poorly differentiated PCa were found in diabetic patients (pGS <6 : 12%, pGS 6: 21%, pGS 7: 55%, pGS >7: 12% vs pGS <6 : 16%, pGS 6: 26%, pGS 7: 52%, pGS >7: 6%; p=0.02). Multivariate: significantly higher risk of having a poorly differentiated PCa in diabetic patients (OR: 2.4; P=0.05). the other parameters included in the multivariate analysis (age, total PSA, and pathological stage) were not significantly correlated to the presence or not of DM. CONCLUSIONS: Diabetic patients have a higher risk of having a poorly differentiated PCa at final pathology following radical prostatectomy than patients who are euglycemic.

9. HIGHER CHOLESTEROL INCREASES THE RISK OF BIOCHEMICAL FAILURE AFTER RADICAL PROSTATECTOMY:RESULTS FROM THE SEARCH DATABASE GROUPLionel L Banez MD *, Robert J Hamilton MD, MPH , William J Aronson MD , Martha K Terris MD , Joseph C Presti MD , Christopher J Kane , Christopher L Amling MD and Stephen J Freedland MD .. METHODS: 471 men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database who underwent radical prostatectomy from 1998 to 2007 and had available cholesterol, low−density lipoprotein (LDL) and high−density lipoprotein (HDL) levels and known statin medication use status prior to surgery. RESULTS: increased serum cholesterol (p=0.001) and increased serum LDL (p=0.007) increased the risk for biochemical recurrence after surgery. HDL was not associated with biochemical relapse (p=0.79). Men in the highest quartile of serum cholesterol (³ 217 mg/dl) had 2.5 times higher risk for biochemical relapse (HR 2.49, 95% CI 1.28 − 4.86, p=0.007) compared to men in the lowest quartile (<167 mg/dl). CONCLUSIONS: Suggest that hypercholesterolemia may promote prostate cancer progression.

10. EXTERNAL−BEAM RADIATION THERAPY INCREASES THE RATE OF SECONDARY MALIGNANCIES RELATIVE TORADICAL PROSTATECTOMY IN MEN WITH PROSTATE CANCERNaeem Bhojani MD *, Claudio Jeldres MD , Luigi F Da Pozzo MD , Monica Morgan MD , Shahrokh F Shariat MD , Paul Perrotte MD , NazarenoSuardi MD , Fred Saad MD , Francesco Montorsi MD and Pierre I Karakiewicz METHODS: The study population consisted of 10,333 men treated with radical prostatectomy (RP) (n=6196) or EBRT (n= 4137) between 1983 and 2004 without neo− or adjuvant hormonal therapy. The diagnosis of bladder, lung and colo−rectal cancer were established with the ICD−9 and surgery codes, (cystectomy, lobectomy or pneumectomy and colectomy with or without rectal resection). RESULTS: Overall, 92 (0.9%) cystectomies, 82 (0.8%) lung cancer surgeries and 228 (2.2%) surgeries for colo−rectal cancers were performed. In univariable analyses, the rate of cystectomies (log−rank p=0.002), of treatments for lung cancer (log−rank p<0.001) and for colo−rectal cancers (log−rank p<0.001) were higher in patients treated with EBRT relative to patients treated with RP. At multivariable analyses, after adjusting for age, baseline comorbidities and year of treatment EBRT predisposed to a 3.0−fold higher rate of cystectomy for bladder cancer (p=0.04), 1.8−fold higher rate of lung cancer resections (p=0.02) 1.7−fold higher rate of rectal cancer (p=0.02).

11. DIETARY LONG−CHAIN OMEGA−3 FATTY ACIDS, COX2 GENE POLYMORPHISM, AND AGGRESSIVE PROSTATE CANCERVincent Fradet MD *, Iona Cheng PhD , Graham Casey PhD and John S Witte PhD . METHODS: case−control study of aggressive prostate cancer of 1012 subjects prostate cancer presenting with one or more of the following clinical criteria: clinical T stage >T2b, initial PSA >10 ng/mL or biopsy Gleason score >6. Controls had no diagnosis of prostate cancer, a serum PSA <4 ng/mL, and were frequency matched to cases for age, institution and ethnicity. Assessed food intake by a validated questionnaire and calculated nutrient intake. RESULTS: Both EPA and DHA were associated with a dose−response reduction in prostate cancer risk (ps for trend £0.0001). The Odds Ratios (95% Confidence Intervals) comparing the highest quartile of fatty acid intake to the lowest equaled 0.44 (0.30 − 0.65) and 0.37 (0.25 − 0.55) for DHA and EPA, respectively. CONCLUSIONS: Intake of food containing the long−chain omega−3 fatty acids EPA and DHA is inversely associated with aggressive, clinically significant, prostate cancer. The potential protective effect of EPA appears to be stronger among men with the rs274557 COX2 variant. This might be expected because COX2 is a key enzyme involved in the metabolism of fatty acids.

12. SERUM TESTOSTERONE IS ASSOCIATED WITH AGGRESSIVE PROSTATE CANCER: RESULTS FROM THE BALTIMORE LONGITUDINAL STUDY OF AGINGPhillip M Pierorazio MD *, Luigi Ferrucci , Anna E Kettermann , E Jeffrey Metter and H Ballentine Carter MD . INTRODUCTION AND OBJECTIVE: Evaluated the relationship between testosterone and the development of high−risk prostate cancer. Prospectively evaluated serum androgen concentrations and the development of high risk prostate cancer. METHODS: Cohort was 729 male participants in the Baltimore Longitudinal Study of Aging who had sex steroid measurements prior to a diagnosis of prostate cancer, or last visit for those without prostate cancer (no cancer, n= 611; prostate cancer not high risk, n=83; prostate cancer high risk, n=35). High risk cancer was defined as death from prostate cancer, or >20 at diagnosis, or Gleason score >8. RESULTS: After adjusting for age and date of diagnosis, calculated free testosterone was significantly associated with high risk prostate cancer (RR=1.25; 95% CI=1.03 to1.51, p=0.022). CONCLUSIONS: Higher levels of calculated serum free testosterone are associated with an increased risk of aggressive prostate cancer.

13. OBESE MEN HAVE LARGER AND HIGHER−GRADE TUMORS: AN ANALYSIS OF THE DUKE PROSTATE CENTER DATABASENicholas J Fitzsimons MD *, Leon Sun MD, PhD , Judd W Moul MD , John F Madden MD and Stephen J Freedland METHODS: Retrospective analysis of 2,171 patients treated with radical prostatectomy Association between BMI and tumor volume and high−grade disease (Gleason 4+3 or greater) was assessed RESULTS: Increased BMI was significantly associated with younger age (p<0.001), black race (p<0.001), more recent year of surgery (p<0.001), positive surgical margins (p<0.001), higher−grade disease in the surgical specimen (p=0.03), and larger tumor volumes (p=0.003). Higher BMI was associated with increased tumor volume (p<0.001) and high−grade disease (p=0.001). Men with a BMI of 35 kg/m2 or greater had nearly 40% larger mean tumor volumes than normal weight men (5.1 vs. 3.7 cc). CONCLUSIONS: first study to show obese men have larger cancers and higher grade tumors at the time of RP

14. TESTOSTERONE (T) LEVEL CORRELATES WITH SURVIVAL IN PTS WITH ADVANCED PROSTATE CANCER (APC): THE LOWER IS REALLY THE BETTERMassimo Perachino MD * and Valerio Cavalli MD . METHODS: 162 consecutive pts with diagnosis of PC treated with ADT T and PSA were measured every 3 months age, stage, Gleason Score (GS), basal PSA, basal T, PSA nadir, time to PSA nadir, T after 6 m, T nadir and time to T nadir. Multivariate analysis was performed With a mean follow up of 52.3 ± 33.2 months, 97 pts are dead (59.9%) and 65 pts are alive (50.1%). Statistical analysis using Cox's model shows that serum T at 6 m correlates with pts survival (HR=1.92, p<.05). Death risk is directly correlated not only to GS (p<.01) and to basal PSA (p<.01), but also to 6 m serum T level (p=.0286). The lower the T level after 6 m, the longer the survival. pt with GS 7 and pretreatment PSA 50 ng/ml has 60% 5−yr probability of survival if 6m T is 10 ng/ml. 5−yr probability of survival decreases to 54.3% if 6m T is 40 ng/ml. CONCLUSIONS: correlation between T levels and survival. suggest to choose an LHRH analogue that allows to reach the lowest possible T value in the shortest time, and to strictly monitor T levels during LHRH therapy

15. CORRELATIONS BETWEEN N−TELOPEPTIDE OF TYPE I COLLAGEN RESPONSE AND ZOLEDRONIC ACID ONCLINICAL OUTCOMES IN PATIENTS WITH BONE METASTASES FROM PROSTATE CANCERFred Saad MD *, Richard Cook , Allan Lipton and Robert Coleman . METHODS: Data were obtained from patients with bone metastases secondary to HRPC who had urinary NTX assessments at baseline and month 3 (n = 314) Patients were stratified by baseline NTX (normal [N group], < 64 nmol/mmol creatinine; elevated [E group], ³ 64 nmol/mmol creatinine). All patients received standard anticancer therapies in addition to zoledronic acid. RESULTS: Baseline NTX was elevated in 193 (62%) patients (E group). NTX levels normalized within 3 months of zoledronic acid therapy in ~70% of the E group. NTX normalization was associated with a significant 59% decrease in relative risk of death (relative risk = 0.410; P < .0001) compared with patients whose NTX levels remained elevated. percentage decrease in NTX at 3 months correlated with a continuum of benefit, with the longest survival in patients whose NTX levels decreased ³ 75% (P < .0001 for comparison between percentage−reduction quartiles). CONCLUSIONS: NTX normalization correlated with survival benefits.

16. RESULTS OF A PROSPECTIVE PILOT CLINICAL TRIAL ADMINISTERING ACUPUNCTURE FOR HOT FLASHES INPATIENTS UNDERGOING HORMONAL THERAPY FOR PROSTATE CANCERJillian L Capodice *, Zhezhen Jin PhD , Brian A Stone MD , James M McKiernan MD , Carl A Olsson MD and Aaron E Katz MD . First prospective clinical trial testing the safety and efficacy of acupuncture in reducing hot flashes in advanced CaP patients undergoing hormonal therapy. METHODS: reporting >4 flashes/day (a standardized value on the Expanded Prostate Cancer Index (EPIC)−hormone questionnaire). patients received standardized full body acupuncture 1x/week (wk) for 14 wks. Patients were evaluated at 0, 7, 14 and a 14−wk follow−up (F/U) (28−wks). At 0 and 14 wks serum testosterone was measured. At the 0, 7, 14 and 28−wk evaluations EPIC and patient reported hot flash frequency were administered. Endpoints are number of flashes as determined by the EPIC and patient report, and testosterone levels. RESULTS: all patients were enrolled (n=16) and 14 completed the trial. no change in testosterone at baseline 11(ng/mL) (range 0−32) vs endpoint 18 (range 0−28) (p=0.237). No serious adverse events Analysis of patient reported frequency shows a significant reduction in the number of flashes at 7 (p<0.01), 14 (p<0.01) and 28 wk F/U (p<0.01) as compared to baseline

17. IMPACT OF PELVIC LYMPHADENECTOMY ON DISEASE−FREE SURVIVAL AFTER RADICAL PROSTATECTOMY: AMULTICENTER STUDYMichele Lodde MD *, Helene Hovington , Francois Harel MD , Michael J Harris MD , David P Wood MD , Michel Hugues Lebel MD , Louis Lacombe MD and Yves Fradet MD . METHODS: The databases of (RP) from three different Urological Departments were retrospectively analyzed. Center A performed only perinealprostatectomies (PP) with no PNLD in patients with PSA < 10. Center B performed a standard PNLD center C performed an extended PLND including internal and common iliac LN. RESULTS: The median of LN removed was 0, 6 and 14 and LN+ 0%, 1.2% and 6% respectively. the risk of PSAF was increased in patients with PP and no PLND (Group A) vs extended PLND (Group C) (HR=1.49; p=0.017) but not vs standard PLND (Group B). standard vs no PLND did not reduce the risk of PSAF extended PLND was associated with a risk reduction of 64% (HR=0.36; p<.0001). Standard PLND was associated with 2 times more risk of PSAF (HR 2.11 p<.0001) compared to extended PLND. Type of PLND was a stronger independent predictor than pStage, Gleason >7 and positive margin. CONCLUSIONS: The data suggest that the extent of PLND can reduce the risk of biochemical recurrence after RP.

18. EXTENDED PELVIC LYMPH NODE DISSECTION DOES NOT AFFECT RISK OF BIOCHEMICAL FAILURE AFTER RADICALPROSTATECTOMY: A 20−YEAR, SINGLE−INSTITUTION ANALYSISStefan T Samuelson *, ManishaDesai , Mitchell C Benson MD , James M McKiernan MD and Ketan K Badani MD . METHODS: 1052 men with negative LN on final pathology and complete data on the following parameters: 12 months of follow−up, a known number of nodes removed, preoperative prostate−specific antigen (PSA), biopsy Gleason score, clinical stage, pathological stage, and surgical margin status. met these criteria. The primary endpoint of the study was biochemical failure, defined as PSA >0.2 ng/mL. The number of LN removed was assessed as both a continuous and categorical variable (0−2, 3−5, 6−8, and 9+). RESULTS: The categorical LN breakdown was as follows: 0−2 nodes, n=69; 3−5 nodes, n=280; 6−8 nodes, n=255; 9 or more nodes, n=448. On univariate analysis, BCFR was significantly influenced by preoperative PSA (P<0.001), Gleason grade (p<0.001), and pathologic tumor stage (p=0.001). There was no significant difference found in BCFR among all lymph node categories. On multivariate analysis controlling for stage, grade, and preoperative PSA, there was no significant difference found CONCLUSIONS: role of EPLND during radical prostatectomy remains unclear.

19. CHARACTERISTICS OF PROSTATE CANCERS DETECTED AT LOW PSA VALUESJoshua J Meeks MD, PhD *, Stacy Loeb MD , Donghui Kan , Brian T Helfand MD, PhD , Norm D Smith MD , Christopher R Griffin and William J Catalona MD . METHODS: 934 radical retropubic prosatectomy (RRP) by one surgeon between 2003 and 2007. 78 had a preoperative PSA level <2.5 ng/ml. We evaluated the clinicopathological features of these men after stratification for DRE findings. RESULTS: Of the 78 men with a PSA <2.5 ng/ml, the digital rectal exam was abnormal in 51 men (65%) and normal in 27 men (35%). Prostate cancer was detected in the (TURP) specimen in 15% of the men with a normal DRE. In the subgroup with a normal DRE, 8.0% had biopsy Gleason score of >6, while 15.4% had final pathology grade of >6 on RP overall rate of upgrading was 8% in these men. mean tumor volume at the time of RRP was significantly higher in men with an abnormal DRE (p=0.017). trend toward a higher prostatectomy Gleason score in men with palpable disease (p=0.09); CONCLUSIONS: Despite low PSA, a significant proportion of men with PSA <2.5 ng/ml have aggressive pathology on biopsy and ultimately in the radical prostatectomy specimen.

21. LONG TERM OUTCOME OF PATIENTS WITH POSITIVE LYMPH NODES DURING RADICAL PROSTATECTOMY:SURVIVAL BENEFIT OF PATIENTS WITH COMPLETED VS. ABANDONED SURGERYThomas P Steuber MD *, FrederikeBeyer , Felix K H Chun , Sascha A Ahyai , Alexander Haese , Andreas Erbersdobler , HartwigHuland and Markus Graefen . METHODS: Between 1992 and 2000, 158 of 2591 patients treated with rP for clinically localized PCa were pNpos (6%). Follow−up information was available for 140 men. All patients received adjuvant or salvage hormonal therapy. RESULTS: Five and 7−year cpfs for pNpos patients was 71% and 65%, respectively; 5− and 7−year css was 86% and 76%, respectively.

22. HYPOFRACTIONATED EXTERNAL BEAM RADIATION THERAPY AND SINGLE FRACTION HDR−BRACHYTHERAPY:IMPROVING THE RESULTS IN THE TREATMENT OF INTERMEDIATE−RISK PROSTATE CANCERMarie Duclos MD *, Armen G Aprikian MD , FavioCury MD , Marc David MD , George Shenouda MD , Jordan Steinberg MD , Sergio Faria MD , Boris Bahoric MD , Horacio Patrocino PhD and Luis Souhami MD . METHODS: Since 2001, 111 patients with intermediate risk PC were treated with HDR−B plus H−EBRT, without ADT. The median age was 69 years. Radiotherapy consisted of a single HDR−B fraction of 10 Gy to the prostate surface followed by H−EBRT to a dose of 50 Gy in 20 fractions. The first 73 consecutive patients with minimum follow−up of 2 years were assessed for toxicity and disease control. Repeat prostate biopsies and PSA control (Phoenix definition), were used to assess local control. RESULTS: Median follow−up was 50.6 months. No patient presented acute grade III or higher gastro−intestinal or genito−urinary toxicities. Late rectal toxicity grade II was seen in 5 patients and grade III in one. Five patients presented intermittent gross hematuria, and one patient developed urinary incontinence. After a minimum follow−up of 2 years, 42 patients (57.5%) underwent a repeat prostate biopsy; the remaining either refused or were never offered the procedure. Negative biopsies were found in 39/42 patients (92.9%); among the 3 positive biopsies, only one patient has true biochemical failure, while the other two have stable serum PSA levels below 0.1 ng/dL. Overall, eight patients (10.9%) failed the treatment, 6 with metastatic disease and 2 with biochemical failure.

23. WHAT IS THE BEST TREATMENT FOR CLINICALLY LOCALIZED PROSTATE CANCER: RADICAL PROSTATECTOMY,BRACHYTHERAPY, OR EXTERNAL BEAM RADIATION THERAPY?Kimberly A Roehl *, Jessica M Duerscheidt , William J Catalona MD , Stacy Loeb and Brian K Suarez PhD . METHODS: evaluated 3565 patients diagnosed with prostate cancer until 2003 who were treated by radical prostatectomy, brachytherapy, or external beam radiation therapy. Kaplan−Meier 10−year PFS, OS and CSS rates.

24. TREATMENT OF LOCALIZED PROSTATE CANCER BY HIGH INTENSITY FOCUSED ULTRASOUND (HIFU); RESULTS OFTHE FIRST FRENCH PROSPECTIVE STUDY ON PATIENTS NOT PREVIOUSLY TREATED: MINIMUM OF FIVE YEARS OF FOLLOW−UPPierre Conort MD *, Pascal Rischmann MD, PhD , Henri Bensadoun MD, PhD , Daniel Chevallier MD , Christian Pfister MD, PhD, Christian Saussine MD, PhD , Guy Vallancien MD and Albert Gelet MD, PhD . METHODS: Ablatherm® (EDAP S.A., CE mark on 2000), from 25/01/01 to 25/01/02, 8 urological centers PSA<15 ng/mL, Score de Gleason (GS) <8, <50% of positive biopsies, volume prostate volume (PV) < 50 cc, stageT1b− c & T2. Data management and analysis were done by an independent institution (ITEC). RESULTS: 117 patients (68 T1, 49 T2) were included : mean age 69 ans (47−79), PSA 8,4 ± 3,4 ng/mL (1−15), 2 ± 1 positive biopsies from 8 ± 3, GS 6 ± 1 (2−7), PV 31 ± 10 cc (12−50). Sessions of HIFU: 179. Retreatment = 52%: With a mean FU of 62 months, 73 patients were treated by HIFU alone (retreatment 39%) with a mean PSA 1,9 ± 2,0 ng/mL (31< 1,0 et 63 < 4,0). With more than 5 years of FU, 55 patients (75% of those without adjuvant treatment) were considered as success. Initial PSA is not a pronostic factor, but PSA nadir after the first session seems to be related to success: 38 success from 42 patients with PSA nadir < 1,0 ng/mL. CONCLUSIONS: this first prospective study, > 5years of FU, has shown that HIFU (Ablatherm®) a retreatment rate of 39%, can successfully treat more than 50% of patient without any major side−effects; adjuvant treatment was required for 22% No disease related death was reported.

25. LONG−TERM SURVIVAL AFTER RADICAL PROSTATECTOMY FOR PATIENTS WITH HIGH RISK PROSTATE CANCER IN THE PSA ERAStephen A Boorjian MD *, R Jeffrey Karnes MD , Laureano J Rangel MS , Eric J Bergstralh PhD and Michael L Blute MD . METHODS: 7,591 consecutive patients who underwent RP without prior therapy at the Mayo Clinic between 1987−2003 to identify patients with high risk disease (PSA > 20 ng/mL, biopsy Gleason score 8−10, or clinical stage T2c). RESULTS: total of 1513 men underwent RP for high risk disease, with a median follow−up of 8.7 years. 858/1513 (56.7%) men were found to have organ−confined tumors at RP. Ten year cancer−specific survival (CSS) was 95%, with 90% of patients without local recurrence (LR) 55% free from biochemical recurrence (BCR, defined as a PSA > 0.4 ng/mL) (figure). On multivariate analysis, Gleason score on biopsy (HR 1.3, p=0.006) and at RP (HR1.4, p=0.006), pathological tumor stage (HR 1.8, p=0.04), positive lymph nodes (HR 2.3, p=0.02), and positive surgical margins (HR 2.1, p=0.008) predicted death from prostate cancer. Age, year of surgery, preoperative PSA, clinical stage, and the number of high risk features did not affect survival. Adjuvant hormonal therapy (n=356) decreased the risk of BCR (HR 0.36, p<0.0001), LR (HR 0.26, p<0.0001), and systemic progression (SP) (HR 0.49, p=0.006) but did not significantly impact the risk of CSS (HR 0.59, p=0.11) or (OS) (HR 0.87, p=0.39).

27. PROSTATE SPECIFIC ANTIGEN TESTING AMONG THE ELDERLY: WHEN TO STOP?H Ballentine Carter MD , Anna E Kettermann *, Luigi Ferrucci MD, PhD , Patricia Landis BS , Bruce J Trock and E Jeffrey MetterMD. INTRODUCTION AND OBJECTIVE: We determined the proportion of men who developed aggressive prostate cancer by PSA and age to evaluate the safety of discontinuing PSA testing among older men. METHODS: The probability of aggressive prostate cancer (death from prostate cancer) by PSA and age was determined from a Cohort participating in the Baltimore Longitudinal Study of Aging (National Institute on Aging). RESULTS: PSA of 3.0ng/ml and above at the age of 75−80 years had a probability of death from prostate cancer afterwards that continued to increase; no subject at the age of 75−80 years with a PSA below 3.0ng/ml died of prostate cancer afterwards (P<.001, Fisher's exact test). aggressive prostate cancer was defined as death from prostate cancer, or Gleason score 8 or above at diagnosis, or PSA 20ng/ml or above at diagnosis. CONCLUSIONS: Men who have a PSA level below 3ng/ml at age 75−80 years are unlikely to develop aggressive prostate cancer during their remaining life and for these men PSA testing might be safely discontinued.

28. IS PROSTATE CANCER AT YOUNG AGE BIOLOGICALLY MORE AGGRESSIVE THAN IN ELDERLY MEN?David Pfister *, Dina Sahi , David Thuer , Carsten Ohlmann , Udo Engelmann and Axel Heidenreich . INTRODUCTION AND OBJECTIVE: study to compare the clinical and oncological characteristics of PCA at young age < 55 years with a cohort of patients > 55 years. METHODS: 550 consecutive patients with PCA were retrospectively evaluated 108 (19.6%) patients were < 55 years (Group 1), 442 (80.4%) patients were > 55 years (Group 2). RESULTS: There were no significant differences between both groups with regard to clinical stage, number of positive Biopsies and preoperative PSA serum concentration. RP specimens revealed more locally advanced PCA in group 1 as compared to group 2: pT3b/4 PCA (p=0.05); positive lymph nodes were significantly more often diagnosed in men < 55 years (27.3% vs. 12.7%, p=0.005). Gleason Score 8−10 (30% vs. 19%, p<0.05) and positive urethral surgical margins (42% vs. 26%, p<0.05). The 5−year biochemical progression−free survival was significantly lower in the low age group (62% vs. 82%, p<0.007), the PCA − specific mortality was significantly higher in the low age group (18% vs. 6%, p<0.003).

29. DETECTION OF TMPRSS2−ERG FUSION TRANSCRIPTS AND PCA3 IN URINARY SEDIMENTS MAY IMPROVEDIAGNOSIS OF PROSTATE CANCERDaphneHessels *, Frank P Smit , Gerald W Verhaegh , J Alfred Witjes , Erik B Cornel and Jack A Schalken . METHODS: 78 men with prostate cancer−positive biopsies and 30 men with prostate cancer−negative biopsies were included in this study. After DRE, the first voided urine was collected and urinary sediments were obtained. We used semi−quantitative RT−PCR analysis followed by Southern−blot hybridization with a radiolabeled probe for the detection TMPRSS2−ERG fusion transcripts in these urinary sediments. A quantitative RT−PCR assay for PCA3 was used to determine the PCA3 score in the same sediments. RESULTS: TMPRSS2−ERG fusion transcripts were detected in the urine after DRE with a sensitivity of 37%. In this cohort of patients the PCA3−based assay had a sensitivity of 62%. When both markers were combined the sensitivity increased to 73%. In men with persistently elevated serum PSA levels and history of negative biopsies the positive predictive value of TMPRSS2−ERG fusion transcripts was 94%, suggesting that detection of TMPRSS2−ERG fusion transcripts could give a better indication which patients require repeat biopsies. CONCLUSIONS: combination of TMPRSS2−ERG and PCA3, improve the sensitivity for prostate cancer diagnosis.