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Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008 THE JOURNAL OF UROLOGY ® 493 1442 PREDICTIVE VALUE OF BIOCHEMICAL RECURRENCE DEFINITIONS IN LOW DOSE RATE BRACHYTHERAPY PROSTATE CANCER PATIENTS Jochen Walz*, Naji Salem, Gwenaelle Gravis, Olivier Simonin, Gilles Karsenty, Franck Bladou. Marseille, France. INTRODUCTION AND OBJECTIVE: There is a controversy therapy after low dose rate (LDR) brachytherapy in a cohort with long- term follow-up. METHODS: From September 1998 to December 2006, consecutive PSA rises >0.5ng/ml and PSA nadir + 2ng/ml. The reference endpoint of the study was the need for secondary therapy after initial LDR brachytherapy, such as hormonal therapy or local salvage therapy. For predictive value (PPV), as well as the area under the receiver operating characteristics curve (ROC) were calculated. RESULTS: In the entire cohort, mean age was 64.6 years and mean PSA was 8.8 ng/ml. Clinical stage was T1c in 47.3%, T2a in 25.1%, T2b in 10.9%, T2c in 16.7% and biopsy Gleason sum was <6 in 90.6% and 7 in 9.4%. Mean follow-up was 2.8 years (range: 0.1-7) and during follow-up 43 patients (7.8%) needed secondary therapy for Pca recurrence. Overall, 3860 post treatment PSA levels were available. The actuarial survival probability without secondary therapy after LDR brachytherapy at 3 and 5 years were 98.3% and 84.5%, respectively. and ROC addressing the need of secondary therapy. the highest ROC in order to identify patients who might need secondary associated with the highest number false positive patients. BCR n= Sensitivity NPV PPV ROC 3 PSA rises 62 98.4% 56.5% 94.7% 81.4% 0.88 3 PSA rises >0.5ng/ml 38 97.3% 76.3% 98.2% 67.4% 0.83 2 PSA rises >0.5ng/ml 63 98.8% 58.7% 94.9% 86.0% 0.91 PSA nadir + 2ng/ml 73 99.4% 54.8% 93.5% 93.0% 0.93 Source of Funding: None 1443 IN-FIELD/ OUT-FIELD PROSTATE CANCER FOCI: MULTIFOCALITY AND CONSIDERATIONS FOR THE APPLICATION OF FOCAL PROSTATE THERAPY John F Ward*, Hiroyuki Nakanishi, Richard J Babaian, Patricia Troncoso. Houston, TX. INTRODUCTION AND OBJECTIVE: Sub-total prostate ablation with controlled energy devices (cryotherapy, high intensity a portion of the prostate gland is left viable following these procedures. eligibility criteria for focal prostate cancer therapy. METHODS: Records of 180 patients (1997 - 2006) with unilateral, multisite positive prostate biopsy cores (10-13 cores) who subsequently underwent radical prostatectomy were retrospectively reviewed. Clinical and biopsy features were correlated with the prostatectomy specimens assessed for the location and characteristics by comparing detailed prostate maps created from histologic sections to treatment plans commonly employed in focal prostate cancer therapy (ipsilateral “hemispheric” versus 3/4 “hockey stick” templates). RESULTS: A single biopsy core was positive in 60% of men (108/180), 40% having multiple (range 2-5) ipsilaterally positive cores. The median number of tumor foci within the prostate was 3 (range 1-8). Median total tumor volume and dominant tumor volume were 0.727 cc and 0.501 cc, respectively. 26% (47/180) of men had dominant tumors the unilaterally positive biopsy site in 66% (118/180). Bilateral disease (dominant and non-dominant tumor foci) was present in 83% (157/180) capture of all tumor foci from 17% to 47% (55% if a single core was disease when applying either hemispheric or hockey stick treatment 64% of specimens. CONCLUSIONS: Undetected multifocality of prostate cancer persists even using an extended, laterally directed biopsy scheme in the PSA era. Focal treatment plans, will leave untreated prostate cancer in the majority of men. However, these untreated tumors are remains unknown. Source of Funding: None 1444 TRANSRECTAL HIGH INTENSITY FOCUSED ULTRASOUND IN THE TREATMENT OF LOCALISED PROSTATE CANCER – THE FIRST UK SERIES Evangelos Zacharakis, Hashim U Ahmed*, Tim Dudderidge, Rebecca Scott, James Armitage, Rowland O Illing, Clare Allen, Mark Emberton. London, United Kingdom. INTRODUCTION AND OBJECTIVE: The use of HIFU in technology that offers the potential fewer side-effects and effective cancer control. Visually-directed HIFU for the conduct of therapy for the Sonablate®500 device allows the user to change energy levels per pulse based on real-time greyscale ultrasound feedback. METHODS: All 172 primary HIFU cases with presumed organ- st February 2005 and 15 th May 2007 were included. An analysis of side-effects, PSA kinetics and early cancer control was carried out. RESULTS: The mean age was 64.1 years (SD 8.3) with a mean follow-up of 346 days (SD 237, max 759). 27.8% (38/136), 37.5% (51/136) and 34.6% (47/136) were in the low, intermediate and high risk categories. 29% (50/172) were on 3 months casodex 50mg to 22% required an overnight stay. Urinary tract infection/dysuria syndrome occurred in 23.54% and urethral stricture in 36% overall. There was a compared to urethral catheter (44%) (p=0.001). Mild-moderate stress urinary incontinence occurred in 7.6% (13/172). PSA levels below 0.2ng/ ml for those who reached 3, 6, 9, 12, 18 and 24 months were achieved by 69.7% (108/155), 65% (78/120), 58% (60/103), 57.8% (48/83), 57% (36/63) and 60.9% (14/23), respectively. 83.2%, 78.3%, 80.58%, 78.31%, 74.6%, and 82.61% achieved <0.5ng.ml. 31 demonstrated a clinically concerning PSA level or a rising PSA and had biopsy. 13 had positive biopsies and 4 were treated by redo HIFU. 92.1%, 90.2% and 91.5% of patients had no evidence of disease in the low, intermediate and high cancer is a safe, day case procedure with toxicity that is lower than other radical treatments. Success of various modalities of localised prostate PSA kinetics using 0.2ng/ml and 0.5ng/ml to inform comparison with other studies. If the procedure is standardised, good early biochemical control can be achieved. Source of Funding: None

PREDICTIVE VALUE OF BIOCHEMICAL RECURRENCE DEFINITIONS IN LOW DOSE RATE BRACHYTHERAPY PROSTATE CANCER PATIENTS

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Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008 THE JOURNAL OF UROLOGY® 493

1442PREDICTIVE VALUE OF BIOCHEMICAL RECURRENCE DEFINITIONS IN LOW DOSE RATE BRACHYTHERAPY PROSTATE CANCER PATIENTSJochen Walz*, Naji Salem, Gwenaelle Gravis, Olivier Simonin, Gilles Karsenty, Franck Bladou. Marseille, France.

INTRODUCTION AND OBJECTIVE: There is a controversy

therapy after low dose rate (LDR) brachytherapy in a cohort with long-term follow-up.

METHODS: From September 1998 to December 2006,

consecutive PSA rises >0.5ng/ml and PSA nadir + 2ng/ml. The reference endpoint of the study was the need for secondary therapy after initial LDRbrachytherapy, such as hormonal therapy or local salvage therapy. For

predictive value (PPV), as well as the area under the receiver operating characteristics curve (ROC) were calculated.

RESULTS: In the entire cohort, mean age was 64.6 years and mean PSA was 8.8 ng/ml. Clinical stage was T1c in 47.3%, T2a in 25.1%, T2b in 10.9%, T2c in 16.7% and biopsy Gleason sum was <6 in 90.6% and 7 in 9.4%. Mean follow-up was 2.8 years (range: 0.1-7) and during follow-up 43 patients (7.8%) needed secondary therapy for Pca recurrence. Overall, 3860 post treatment PSA levels were available. The actuarial survival probability without secondary therapy after LDRbrachytherapy at 3 and 5 years were 98.3% and 84.5%, respectively.

and ROC addressing the need of secondary therapy.

the highest ROC in order to identify patients who might need secondary

associated with the highest number false positive patients.

BCR n= Sensitivity NPV PPV ROC3 PSA rises 62 98.4% 56.5% 94.7% 81.4% 0.883 PSA rises >0.5ng/ml 38 97.3% 76.3% 98.2% 67.4% 0.832 PSA rises >0.5ng/ml 63 98.8% 58.7% 94.9% 86.0% 0.91PSA nadir + 2ng/ml 73 99.4% 54.8% 93.5% 93.0% 0.93

Source of Funding: None

1443IN-FIELD/ OUT-FIELD PROSTATE CANCER FOCI: MULTIFOCALITY AND CONSIDERATIONS FOR THE APPLICATION OF FOCAL PROSTATE THERAPYJohn F Ward*, Hiroyuki Nakanishi, Richard J Babaian, Patricia Troncoso. Houston, TX.

INTRODUCTION AND OBJECTIVE: Sub-total prostate ablation with controlled energy devices (cryotherapy, high intensity

a portion of the prostate gland is left viable following these procedures.

eligibility criteria for focal prostate cancer therapy. METHODS: Records of 180 patients (1997 - 2006) with

unilateral, multisite positive prostate biopsy cores (10-13 cores) who subsequently underwent radical prostatectomy were retrospectively reviewed. Clinical and biopsy features were correlated with the prostatectomy specimens assessed for the location and characteristics

by comparing detailed prostate maps created from histologic sections to treatment plans commonly employed in focal prostate cancer therapy (ipsilateral “hemispheric” versus 3/4 “hockey stick” templates).

RESULTS: A single biopsy core was positive in 60% of men (108/180), 40% having multiple (range 2-5) ipsilaterally positive cores.

The median number of tumor foci within the prostate was 3 (range 1-8). Median total tumor volume and dominant tumor volume were 0.727 cc and 0.501 cc, respectively. 26% (47/180) of men had dominant tumors

the unilaterally positive biopsy site in 66% (118/180). Bilateral disease (dominant and non-dominant tumor foci) was present in 83% (157/180)

capture of all tumor foci from 17% to 47% (55% if a single core was

disease when applying either hemispheric or hockey stick treatment

64% of specimens. CONCLUSIONS: Undetected multifocality of prostate cancer

persists even using an extended, laterally directed biopsy scheme in the PSA era. Focal treatment plans, will leave untreated prostate cancer in the majority of men. However, these untreated tumors are

remains unknown.Source of Funding: None

1444TRANSRECTAL HIGH INTENSITY FOCUSED ULTRASOUND IN THE TREATMENT OF LOCALISED PROSTATE CANCER – THE FIRST UK SERIESEvangelos Zacharakis, Hashim U Ahmed*, Tim Dudderidge, Rebecca Scott, James Armitage, Rowland O Illing, Clare Allen, Mark Emberton. London, United Kingdom.

INTRODUCTION AND OBJECTIVE: The use of HIFU in

technology that offers the potential fewer side-effects and effective cancer control. Visually-directed HIFU for the conduct of therapy for the Sonablate®500 device allows the user to change energy levels per pulse based on real-time greyscale ultrasound feedback.

METHODS: All 172 primary HIFU cases with presumed organ-st February 2005 and 15th May 2007

were included. An analysis of side-effects, PSA kinetics and early cancer control was carried out.

RESULTS: The mean age was 64.1 years (SD 8.3) with a mean follow-up of 346 days (SD 237, max 759). 27.8% (38/136), 37.5% (51/136) and 34.6% (47/136) were in the low, intermediate and high risk categories. 29% (50/172) were on 3 months casodex 50mg to

22% required an overnight stay. Urinary tract infection/dysuria syndrome occurred in 23.54% and urethral stricture in 36% overall. There was a

compared to urethral catheter (44%) (p=0.001). Mild-moderate stress urinary incontinence occurred in 7.6% (13/172). PSA levels below 0.2ng/ml for those who reached 3, 6, 9, 12, 18 and 24 months were achieved by 69.7% (108/155), 65% (78/120), 58% (60/103), 57.8% (48/83), 57% (36/63) and 60.9% (14/23), respectively. 83.2%, 78.3%, 80.58%, 78.31%, 74.6%, and 82.61% achieved <0.5ng.ml. 31 demonstrated a clinically concerning PSA level or a rising PSA and had biopsy. 13 had positive biopsies and 4 were treated by redo HIFU. 92.1%, 90.2% and 91.5% of patients had no evidence of disease in the low, intermediate and high

cancer is a safe, day case procedure with toxicity that is lower than other radical treatments. Success of various modalities of localised prostate

PSA kinetics using 0.2ng/ml and 0.5ng/ml to inform comparison with other studies. If the procedure is standardised, good early biochemical control can be achieved.

Source of Funding: None