Vol. 181, No. 4, Supplement, Wednesday, April 29, 2009780 THE JOURNAL OF UROLOGY®

RESULTS: The average patient age was 70 y (range=35-91y). 79.7% (51/64) were male and 20.3% (13/64) were female. 65.5% (47/64) of patients had a history of tobacco use. 46.9% (n=30) of patients with UPD were found to also have the diagnosis of a urothelial malignancy (transitional cell carcimona). Of these patients, with UPD and a urothelial malignancy diagnosis, 83.3 % had lower urinary tract lesions and 16.7% had upper urinary tract lesions. No correlation existed between laterality of UPD and the laterality of the urothelial malignancy.

CONCLUSIONS: Our sample showed the diagnosis of UPD was associated with urethelial malignancy to the same degree as previously reported (near 50%). However, until now, the association had been reported almost entirely in male veterans of United States wars. Though the mechanistic explanation still requires exploration, the diagnosis of UPD in all populations must be taken as a serious sign of potential synchronous or metachnonous malignancy.

Source of Funding: None

2150RISK FACTORS TO PREDICT POSITIVE SURGICAL MARGINS DURING TRUS-GUIDED LAPAROSCOPIC RADICAL PROSTATECTOMY

Kazumi Kamoi*, Osamu Ukimura, Kyoto, Japan; Georges-Pascal Haber, Andre Berger, Inderbir S Gill, Ricardo Brandina, Cleveland, OH

INTRODUCTION AND OBJECTIVE: Real-time transrectal ultrasound (TRUS) guidance has significantly decreased our incidence of positive surgical margins (PSM) during LRP, yet considerable number of patients still have PSM. Herein, we sought to identify risk factors to predict PSM in patients undergoing TRUS-guided LRP.

METHODS: TRUS measurements were documented during LRP in 215 consecutive patients with prostate cancer. TRUS findings and various clinical parameters were compared with pathological outcomes.

RESULTS: Twenty nine PSM (13%) occurred in 215 LRP specimens. Commonest locations of positive surgical margins were apical and postero-lateral aspects of the prostate (45% and 38%, respectively). Intra-operative TRUS demonstrated hypoechoic lesion (HEL) in 120 (56%) of the patients in those 60 (28%) were suspicious for ECE. Multivariate logistic regression analysis demonstrated that the appearance of HEL was the only significant variable to predict PSM. In patients with HEL, the chance of PSM was 23%, while only 1% without HEL (p <0.0001). In 61 patients with suspicion of extracapsular extension by TRUS, 14 (23%) unilateral and 16 (27%) bilateral dissection of neurovascular bundles were performed to avoid PSM and successfully achieved negative surgical margin in 43 (70%) of these high risk patients.

CONCLUSIONS: Negative ultrasound findings at LRP enable us to ensure the safe postero-lateral and apical dissection of the prostate. Since most of PSM arose in patients with abnormal findings on TRUS, site-specific wider excision at the high risk area of ECE should be considered to secure negative margins.

Univariate and multivariate analysis to predict positive surgical margins (n = 29)

Variables Univariatep value

Multivariatep value Odds ratio 95% CIs

Age 0.0783* 0.0967 0.95 0.89- 1.01

Body mass index 0.1659

Clinical stage (T2/T1) 0.0493* 0.1819 2.03 0.70- 5.59

PSA 0.0472* 0.0623 1.05 0.99-1.21

Gleason sum (>7, 7, <7) 0.3777

Nerve sparing (Bilateral/Uni/Non) 0.3827

Prostate volume 0.3836

Hypoechoic lesion (Yes/No) <0.0001* 0.0183 3.58 1.22- 16.8

Suspicion of ECE (Yes/No) <0.0001* 0.2134 1.35 0.84- 2.22

Tumor contact length <0.0001* 0.6447 1.01 0.94-1.09

Apical protrusion(Yes/No) 0.8537

*: Valuables with p value < 0.10 by univariate analysis are selected for multivariate variables

Source of Funding: None

215111C-ACETATE POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY FOR PRE-OPERATIVE LYMPH NODE STAGING IN PROSTATE CANCER

Mohammed Haseebuddin*, Farrokh Dehdashti, Barry A Siegel, Cary L Siegel, Keith C Fischer, Adam S Kibel, Gerald L Andriole, Tom R. Miller, Saint Louis, MO

INTRODUCTION AND OBJECTIVE: Positron emission tomography/computed tomography (PET/CT) is a promising modality to detect prostate cancer (PCa) in normal-sized lymph nodes (LNs). We prospectively investigated the efficacy of PET/CT with 11C-acetate for LN staging in patients with intermediate-risk (IR) and high-risk (HR) PCa.

METHODS: From October 2003 to August 2008, 155 men with biopsy-proven PCa with negative conventional CT (± pelvic MRI) and bone scintigraphy underwent 11C-acetate-PET/CT. Patients who had hormonal therapy prior to PET/CT (n=5), underwent hormonal therapy or radiation therapy (n = 55), or did not meet the risk criteria (n=1) were excluded. The remaining 94 patients, who had either LN biopsy or radical retropubic prostatectomy (RRP) with LN dissection (LND), were included. The IR subset was defined by Gleason Score (GS) 7 and PSA of 10-20 ng/mL or GS>=8 and PSA >10 ng/mL or any GS with PSA >20 ng/mL (n = 44). Each PET/CT study was reviewed by an experienced nuclear radiologist and a genitourinary radiologist independently and then together. Their consensus interpretation was used for the analysis blinded to the pathologic report. LN status was graded from 0 to 4, where 0 = definitely normal, and 4 = definitely abnormal. LNs graded as 2, 3, or 4 were considered PET positive.

RESULTS: Eighty-nine men underwent RRP with LND, 3 had only LND, 1 had LND and CT-guided biopsy of a positive LN and 1 had only CT-guided biopsy. The performance of PET/CT for detection of nodal metastasis is shown in the Table.

CONCLUSIONS: 11C-acetate-PET/CT has a relatively high sensitivity and specificity for diagnosing occult LN metastasis in patients with negative conventional preoperative studies. As such, 11C-acetate-PET/CT has the potential to improve staging in patients with intermediate-risk and high-risk prostate cancer.

Correlation of PET/CT and pathological results for LN metastasis

Positive Pathology

Negative Pathology Total

Intermediate Risk Positive PET/CT 5 8 13

Negative PET/CT 2 35 37

7 43 50

Sensitivity = 71.4 % (30.3% - 94.9%)*

Specificity = 81.4% (66.1% - 91.1%)

PPV = 38.6% (15.1% - 67.7%)NPV = 94.6 %

(80.5% - 99.1%)

High Risk Positive PET/CT 11 4 15

Negative PET/CT 6 23 29

17 27 44

Sensitivity = 64.7 % (38.6% - 84.8%)

Specificity = 85.2 % (65.4% - 95.1%)

PPV = 73.3% (44.8% -91.1%)NPV = 79.3 %

(59.7 % - 91.3 %)

*Values in parentheses are 95% confidence intervals

Source of Funding: NIH grant R01 CA101734