James Catto, UK. Giacomo Novara, Italy Jean-Nicolas Cornu, France. Alexander Kutikov, USA. Karim Fizazi, France. Leila Ayandi, UK

Transcription

1 EDITOR EMERITUS ( ) Claude Schulman, Belgium EDITOR EMERITUS ( ) Francesco Montorsi, Italy EDITOR-IN-CHIEF James Catto, UK Christian Gratzke, Germany Matthew Cooperberg, USA ASSOCIATE EDITORS Giacomo Novara, Italy Jean-Nicolas Cornu, France Shahrokh Shariat, Austria Anthony D Amico, USA SURGERY IN MOTION EDITOR Alexander Mottrie, Belgium DIGITAL MEDIA EDITOR Alexander Kutikov, USA MEDICAL ONCOLOGY EDITOR Karim Fizazi, France STATISTICAL EDITOR Andrew Vickers, USA NORTH AMERICAN EDITOR Stephen Freedland, USA EAU-EBU UPDATE SERIES EDITOR Oliver W. Hakenberg, Germany MANAGING EDITOR Cathy Pierce, USA EDITORIAL OFFICE ASSISTANT Leila Ayandi, UK COPY EDITOR Samantha Enslen Dragonfly Editorial, USA Peter Albers, Germany Peter Albertsen, USA Anders Bjartell, Sweden Michel Bolla, France Christopher Chapple, UK Noel Clarke, UK Firouz Daneshgari, USA James Eastham, USA Shin Egawa, Japan Scott Eggener, USA Mark Emberton, UK Matthew Galsky, USA Matthew Gettman, USA CONSULTING EDITORS Gianluca Giannarini, Switzerland Inderbir Gill, USA Markus Graefen, Germany Axel Heidenreich, Germany Brent Hollenbeck, USA Brant Inman, USA Pierre Karakiewicz, Canada Lou Kavoussi, USA Adam Kibel, USA Yair Lotan, USA Surena Matin, USA Kevin McVary, USA Mani Menon, USA Rodolfo Montironi, Italy J. Kellogg Parsons, USA Jens Rassweiler, Germany Claus Roehrborn, USA Dan Sjoberg, USA Arnulf Stenzl, Germany Andrew Stephenson, USA Christian Stief, Germany Tullio Sulser, Switzerland George Thalmann, Switzerland Houston Thompson, USA Christopher Wood, USA Michael Zelefsky, USA Alexandre Zlotta, Canada Official Journal of the Official Journal of Società Italiana di Urologia (SIU) EUROPEAN UROLOGY EDITORIAL OFFICE Academic Urology Unit, University of Sheffield The Medical School Beech Hill Road Sheffield S10 2RX, UK platinum@europeanurology.com Tel: ; Fax:

2 Firas Abdollah, Italy Hashim Ahmed, UK Karl-Erik Andersson, Sweden Apostolos Apostolidos, Greece Monish Aron, USA Riccardo Autorino, Italy Marko Babjuk, Czech Republic Alexander Bachmann, Switzerland Rafael Badalyan, Armenia Riccardo Bartoletti, Italy Patrick Bastian, Germany Ricarda Bauer, Germany Frank Becker, Germany Joaquim Bellmunt, Karim Bensalah, France Michael Blute, USA Steve Boorjian, USA Alberto Bossi, France Alberto Briganti, Italy Richard Bryan, UK Lukas Bubendorf, Switzerland Jeffrey Cadeddu, USA Steve Campbell, USA Abdullah Canda, Turkey Umberto Capitanio, Italy Peter Carroll, USA Rufus Cartwright, UK Andrea Cestari, Italy Joseph Chin, Canada Laurence Collette, Belgium Renzo Colombo, Italy Elisabetta Costantini, Italy Francisco Cruz, Portugal Guido Dalbagni, USA Rocco Damiano, Italy Jean de la Rosette, Netherlands Cosimo De Nunzio, Italy Theo de Reijke, Netherlands John Denstedt, Canada Roger Dmochowski, USA Christopher Eden, UK Jason Efstathiou, USA Behfar Ehdaie, USA Mark Emberton, UK EDITORIAL BOARD Bernard Escudier, France Vincenzo Ficarra, Italy Paolo Fornara, Germany Clare Fowler, UK Matthew Galsky, USA John Gearhart, USA Gianluca Giannarini, Switzerland Ofer Gofrit, Israel Christian Gozzi, Germany Stavros Gravas, Greece Francesco Greco, Germany Jürgen Gschwend, Germany Bertrand Guillonneau, USA Axel Haferkamp, Germany Harry Herr, USA Piet Hoebeke, Belgium Jacques Irani, France Hendrik Isbarn, Germany Kazuto Ito, Japan Ateş Kadioğlu, Turkey Jeffrey Karnes, USA Michael Kattan, USA Ziya Kirkali, Turkey Tobias Klatte, Germany Eric Klein, USA Pilar Laguna, Netherlands Massimo Lazzeri, Italy Eric Lechevallier, France Evangelos Liatsikos, Greece William Lowrance, USA Stephan Madersbacher, Austria Massimo Maffezzini, Italy Padraig Malone, UK Luis Martínez-Piñeiro, Spain Mani Menon, USA Martin Michel, Netherlands Andrea Minervini, Italy Nicolas Mottet, France Alexander Mottrie, Belgium Masaru Murai, Japan Richard Naspro, Italy Willem Oosterlinck, Belgium Anup Patel, UK Jehonathan Pinthus, Canada Guillaume Ploussard, France Francesco Porpiglia, Italy David Ralph, UK Oliver Reich, Germany Mesut Remzi, Austria Michael Rink, Germany Morgan Rouprêt, France Paul Russo, USA Kazutaka Saito, Japan Andrea Salonia, Italy Christian Saussine, France Vincenzo Scattoni, Italy Jack Schalken, Netherlands Thorsten Schlomm, Germany Michael Seitz, Germany Maurizio Serati, Italy Giuseppe Simone, Italy Guru Sonpavde, USA Cora Sternberg, Italy Jens-Uwe Stolzenburg, Germany Urs Studer, Switzerland Nazareno Suardi, Italy Samir Taneja, USA Derya Tilki, Germany Bertrand Tombal, Belgium Karim Touijer, USA Quoc-Dien Trinh, Canada Levent Türkeri, Turkey Roderick van den Bergh, Netherlands Theo van der Kwast, Canada Hendrik Van Poppel, Belgium Bas van Rhijn, Netherlands Yoram Vardi, Israel Jochen Walz, France Johannes Witjes, Netherlands Wim Witjes, Netherlands Jean-Jacques Wyndaele, Belgium Evanguelos Xylinas, France Ofer Yossepowitch, Israel Richard Zigeuner, Austria Amnon Zisman, Israel Official Journal of the Official Journal of Società Italiana di Urologia (SIU) EUROPEAN UROLOGY EDITORIAL OFFICE Academic Urology Unit, University of Sheffield The Medical School Beech Hill Road Sheffield S10 2RX, UK Tel: ; Fax:

3 EUROPEAN UROLOGY SUPPLEMENTS, VOL. 13, NO. 5, NOVEMBER 2014 CONTENTS 6th European Multidisciplinary Meeting on Urological Cancers (EMUC) and the 3rd Meeting of the EAU Section of Urological Imaging (ESUI), Lisbon, Portugal, November 2014 EUROPEAN UROLOGY SUPPLEMENTS Welcome... v Organisers... vii Sponsor Acknowledgement... vii Floorplan... ix General Information... x Continuing Medical Education Accreditations... xiii Symposia... xvi Thursday, 13 November... xvi Friday, 14 November..... xvi Saturday, 15 November... xvi Hands on Training (HOT) Courses... xvii Scientific Programme... xviii Thursday, 13 November... xviii The 3rd Meeting of the EAU Section of Urological Imaging (ESUI)... xviii EAU-ICUD consensus meeting on Medical Treatment of Urological Malignancies.... xx Friday, 14 November... xxi 6th European Multidisciplinary Meeting on Urological Cancers.... xxi Saturday, 15 November... xxiii 6th European Multidisciplinary Meeting on Urological Cancers.... xxiii Sunday, 16 November... xxv 6th European Multidisciplinary Meeting on Urological Cancers.... xxv YAU Autumn Meeting.... xxvi Abstracts EMUC Oral Presentations Prostate cancer Advanced prostate cancer Bladder cancer Renal cell carcinoma EMUC Unmoderated Poster Presentations Localised prostate cancer Prostate cancer Advanced prostate cancer Bladder cancer Renal cell carcinoma Testicular cancer Penile cancer Pathology

4 EUROPEAN UROLOGY SUPPLEMENTS, VOL. 13, NO. 5, NOVEMBER 2014 Late Breaking Localised prostate cancer ESUI Oral Presentations Imaging ESUI Unmoderated Poster Presentations Imaging Exhibition: Company Profiles About the Organisers About the European Society for Medical Oncology (ESMO) About the European Society for Radiotherapy and Oncology (ESTRO) About the European Association of Urology (EAU) About the EAU Section of Urological Imaging (ESUI) Indices Abstract Authors Abstracts sorted per Topic Faculty Lists... Inside back cover

5 Welcome to the 6th European Multidisciplinary Meeting on Urological Cancers (EMUC) and the 3rd EAU Section of Urological Imaging (ESUI) v We welcome all participants to the 6th European Multidisciplinary Meeting on Urological Cancers (EMUC) and the 3rd EAU Section of Urological Imaging (ESUI), an international meeting that highlights the gains and challenges in providing optimal treatment to onco-urology patients. With our goal to further examine the advances and prospects in onco-urology, we acknowledge the role of holding this event as an effective platform for experts to identify areas of collaboration and keep up with new developments. Thus, the EMUC has been organised annually since 2011, contributing to the wider efforts to integrate multidisciplinary care in the hospital setting. A multidisciplinary approach can only lead to a more refined understanding of urological malignancies, and the rapid changes in treatment strategies are best examined within the context of collaborative work. The EMUC also offers participants the opportunity to actively engage with cutting-edge science and for them to cast a critical eye on standard approaches in urology, medical oncology and radiology. This year two meetings will kick off EMUC s main programme. The EAU Section of Urological Imaging (ESUI) and the EAU-ICUD Consensus meeting on Medical Treatment of Urological Malignancies will both hold simultaneous full-day conferences. The 3rd ESUI meeting will focus on innovations and new tools in urological imaging, while the EAU-ICUD Consensus meeting aims to conduct in-depth assessments of new treatments in systemic urological malignancies. As in previous years, EMUC anchors the scientific programme on in-depth discussions across disciplines while emphasising the role of translational and basic science and the need for cancer experts to implement forward-looking management strategies in their daily practice. From state-of-the-art sessions, best abstract presentations to panel discussions and debates, participants will have various opportunities to look closely into problem cases and examine second and third-line options for optimal care. Welcome to Lisbon! Prof. Joaquim Bellmunt, Boston (US) ESMO Chair Prof. Philip Poortmans, Nijmegen (NL) ESTRO President Prof. Per-Anders Abrahamsson, Malmö (SE) EAU Secretary General

6 2014 European Association of Urology. Published by Elsevier B.V. This journal and the individual contributions contained in it are protected under copyright, and the following terms and conditions apply to their use in addition to the terms of any Creative Commons or other user license that has been applied by the publisher to an individual article: Photocopying Single photocopies of single articles may be made for personal use as allowed by national copyright laws. Permission is not required for photocopying of articles published under the CC BY license nor for photocopying for non-commercial purposes in accordance with any other user license applied by the publisher. Permission of the publisher and payment of a fee is required for all other photocopying, including multiple or systematic copying, copying for advertising or promotional purposes, resale, and all forms of document delivery. Special rates are available for educational institutions that wish to make photocopies for non-profit educational classroom use. Derivative Works Users may reproduce tables of contents or prepare lists of articles including abstracts for internal circulation within their institutions or companies. Other than for articles published under the CC BY license, permission of the publisher is required for resale or distribution outside the subscribing institution or company. For any subscribed articles or articles published under a CC BY-NC-ND license, permission of the publisher is required for all other derivative works, including compilations and translations. Storage or Usage Except as outlined above or as set out in the relevant user license, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the publisher. Permissions For information on how to seek permission visit or call: (+44) (UK) / (+1) (USA). Author rights Author(s) may have additional rights in their articles as set out in their agreement with the publisher (more information at Notice No responsibility is assumed by the publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. Although all advertising material is expected to conform to ethical (medical) standards, inclusion in this publication does not constitute a guarantee or endorsement of the quality or value of such product or of the claims made of it by its manufacturer. Advertising information: Advertising orders and enquiries can be sent to: USA, Canada and South America: Elsevier Inc., 360 Park Avenue South, New York, NY , USA; phone: (+1) (212) ; Europe and ROW: Advertising Sales: Elsevier Pharma Solutions, 32 Jamestown Road, London NW1 7BY, UK; phone: (+44) (0) ; fax: (+44) (0) ; elsevierpharma.uk@elsevier.com. Commercial Reprint Sales, Greg Davies, Elsevier Ltd.; phone: (+44) ; fax: (+44) ; gr.davies@elsevier.com. The paper used in this publication meets the requirements of ANSI/NISO Z (Permanence of Paper). Abstracted/indexed in: BIOBASE, EMBASE, Medical Documentation, Current Contents Clinical Medicine, Science Citation Index, Adis Clinical Trials Insight, SciVerse Scopus. Full text available on SciVerse ScienceDirect. Orders, claims, and journal enquiries: please contact the Elsevier Customer Service Department nearest you: St. Louis: Elsevier Customer Service Department, 3251 Riverport Lane, Maryland Heights, MO 63043, USA; phone: (800) [toll free within the USA]; (+1) (314) [outside the USA]; fax: (+1) (314) ; JournalsCustomerService-usa@elsevier.com Oxford: Elsevier Customer Service Department, The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, UK; phone: (+44) (1865) ; fax: (+44) (1865) ; JournalsCustomerServiceEMEA@elsevier.com Tokyo: Elsevier Customer Service Department, 4F Higashi-Azabu, 1-Chome Bldg, Higashi-Azabu, Minato-ku, Tokyo , Japan; phone: (+81) (3) ; fax: (+81) (3) ; JournalsCustomerServiceJapan@elsevier.com Singapore: Elsevier Customer Service Department, 3 Killiney Road, #08-01 Winsland House I, Singapore ; phone: (+65) ; fax: (+65) ; JournalsCustomerServiceAPAC@elsevier.com Printed by Henry Ling Ltd, Dorchester, Dorset, UK

7 Organisers vii EMUC Organising Steering Committee ESMO Prof. Joaquim Bellmunt, Boston (US) ESTRO Prof. Philip Poortmans, Nijmegen (NL) EAU Prof. Per-Anders Abrahamsson, Malmö (SE) EMUC Scientific Committee ESMO Prof. Alan Horwich, Sutton (GB) ESMO Prof. Vesa Kataja, Jyväskylä (FI) ESTRO Prof. Vincent Khoo, London (GB) ESTRO Prof. Marco van Vulpen, Utrecht (NL) EAU Prof. Hein van Poppel, Leuven (BE) EAU Dr. Alberto Briganti, Milan (IT) EORTC GUCG Prof. Bertrand Tombal, Brussels (BE) EUOG Prof. Susanne Osanto, Leiden (NL) ESUR Prof. Gertraud Heinz-Peer, Vienna (AT) ESP/ESUP Prof. Antonio Lopez-Beltran, Lisbon (PT) ESUI Dr. Jochen Walz, Marseille (FR) YAU Dr. Francesco Sanguedolce, London (GB) EMUC Congress Office Congress Consultants B.V. PO Box AA Arnhem The Netherlands T: +31 (0) F: +31 (0) ESUI Board ESUI Chairman ESUI Board ESUI Board ESUI Board ESUI Board ESUI Board ESUI Board Dr. Jochen Walz, Marseille (FR) Dr. Brendan Carey, Leeds (GB) Assoc. Prof. Manuel Xavier Ferreira Coelho, Lisbon (PT) Prof. Petrisor Aurelian Geavlete, Bucharest (RO) Prof. Tillmann Loch, Flensburg (DE) Prof. Carlo Trombetta, Trieste (IT) Prof. Dr. Hessel Wijkstra, Amsterdam (NL) Sponsor Acknowledgement The organisers respectfully acknowledge the following sponsors for providing unrestricted educational grants and services to the 6th European Multidisciplinary Meeting on Urological cancers Multidisciplinary consensus on the management of urological malignancies and the 3rd Meeting of the EAU Section of Urological Imaging (ESUI). Silver Sponsors Other Sponsors and Exhibitors ANALOGIC ULTRASOUND BAYER HEALTHCARE ELSEVIER EXINI GOOD HEALTH AGENCY (JOURNAL OF ONCOPATHOLOGY) JANSSEN PHARMACEUTICAL COMPANIES MERCK SHARP & DOHME MIMIC SIEMENS SPRINGER HEALTHCARE TAKEDA

8 webcasts Selected webcasts will be available shortly after the sessions European Association of Urology

9 Floorplan ix First Floor Auditorium VIII Auditorium VIII esc.7 Foyer F Room 1.15 Poster Area Poster Area Registration Area MAIN ENTRANCE Ground Floor Auditorium VI-VII Cloakroom Astellas Exhibition / Catering Area Bayer Healthcare Europa Uomo Foyer E Siemens Exini Analogic Ultrasound Elsevier ESMO ESTRO EAU Janssen Pharmaceutical Companies Good Health Agency Boardroom Room 0.08 Press Centre/ Speaker Service Centre Room 0.07 Prayer Room Room 0.06

10 x General Information About Lisbon The historical neighborhoods of central Lisbon are perfect for visitors to the Portuguese capital to experience for themselves. Their culture, the history, the architecture and the people are fundamental aspects of Lisbon s identity, and those who explore them will discover their own personal map. There are so many possibilities, don t let them get away. Lisboa is a historic capital, a potpourri of unusual character and charm, where 800 years of cultural influences mingle with modern trends and life styles creating spectacular contrasts. For more information see Abstracts and Posters The abstracts are included in this book. Abstracts and posters are available on-line from 13 November 2014 on and Accessibility Congress Venue EMUC and ESUI 2014 will take place at Lisbon Congress Centre which is easily accessible by public transport. It is 15 minutes by bus, tram and taxi from the airport. Address: Lisbon Congress Centre Praca das Indústrias Lisbon Portugal T: +351 (21) lisboacc@aip.pt From the airport, you can reach the city centre by taking the AeroBus shuttle service, which leaves every 20 minutes between 7 am and 9 pm and stops at many hotels until it reaches Cais do Sodré (metro station downtown Lisbon). Travel from Cais do Sodré (following busses and tram) to the Lisbon Congress Centre and leave at station name: R. Junqueira/Centro de Congressos). You can take Bus 732: Marquês Pombal or tram 15E: Algés/Praça da Figueira. Certificate of Attendance A Certificate of Attendance for EMUC and ESUI 2014 can be printed online as of Monday, 17 November on and You will need your barcode which is mentioned on your badge to print the Certificate of Attendance. Cloakroom/Luggage The cloakroom is located on level 0 in the exhibition area and is open during meeting hours. Please be sure to collect all personal belongings at the end of the day. Congress Bag Each delegate can collect a congress bag in the registration area. Disclosure links to Industry It is requested that all faculty disclose to the audience any links with the industry related to the topic of their lecture at the beginning of each presentation. A link can be: being a member of the advisory board or having a consulting agreement with a specific company. Emergency Information Emergency phone number for police, fire brigade and ambulance service is 112. In case of an emergency in the congress venue contact the security or the organisation immediately. Exhibition A technical exhibition will be held jointly with the meeting. See page 179 for more information on the exhibiting companies and the company profiles. Exhibition opening hours: Thursday, 13 November Friday, 14 November Saturday, 15 November Sunday, 16 November First Aid A First Aid unit is present on level 0 of Pavilion 1 at the congress venue. In case of an emergency contact a security guard or the organisation immediately.

11 GENERAL INFORMATION xi Insurance The organisers do not accept responsibility for any personal damage. Participants are strongly recommended to arrange their own personal insurance. Language All presentations during the meeting will be conducted in English. No translation will be provided. Lost and Found Found items should be returned to the registration desk. If you lose something, please report to this desk for assistance. Mobile Phones The sound and flashlight of mobile phones must be switched off during sessions. Press Journalists can obtain free registration to the meeting. All media operators must show their credentials (press card dated 2013/2014 and original assignment letter). Registration Area The registration area is located on the 1st floor. Registration opening hours: Wednesday, 12 November Thursday, 13 November Friday, 14 November Saturday, 15 November Sunday, 16 November Safety All bags may be subject to inspection. Security is present for your safety. Please take all personal effects with you when leaving the session rooms. Scientific Posters The scientific posters are on display from 13 to 16 November in the poster area on level 1. Members of the EMUC Scientific Committee will visit the EMUC poster area per topic to discuss the poster with the presenter according to the following schedule. It has been requested that one of the authors is present to answer questions during the following poster viewing hours: Friday, 14 November Topic: Prostate cancer: P001 P Topic: Prostate cancer: P024 P Topic: Prostate cancer: P070 P093 Saturday, 15 November Topic: Bladder cancer: P094 P Topic: Kidney cancer: P126 P146 Topics: Testicular, Penile & Pathology P147 P155 Sunday, 16 November General poster viewing times for those who are interested For those who present their poster on Friday you are kindly invited to attend the scientific programme the next day. The best posters will be announced the best poster at 09:10 hrs on Saturday, 15 November in the main auditorium. For those who present their poster on Saturday you are kindly invited to attend the scientific programme on Sunday. The best poster will be announced at hrs on Sunday,16 November in the main auditorium. Smoking Policy Smoking is prohibited inside the congress venue. Speaker Service Centre (SSC) All presentations should be handed in at the Speaker Service Centre located on level 0 (room 0.07) at least three hours prior to the start of the session. SSC opening hours: Wednesday, 12 November Thursday, 13 November Friday, 14 November Saturday, 15 November Sunday, 16 November Transportation Delegates can collect a complimentary transportation pass in the registration area. The transportation pass is valid during 4 days and can be used for unlimited travels in busses, subways and trams within the city of Lisbon during the meeting. Travel

12 xii GENERAL INFORMATION from Cais do Sodré (following busses and tram) to the Lisbon Congress Centre and leave at station name: R. Junqueira/Centro de Congressos). You can take Bus 732: Marquês Pombal or tram 15E: Algés/Praça da Figueira. Tourist Information Information on Lisbon can be found on In case of any questions please call directly the Lisbon Tourist Office: Webcasts All sessions during EMUC and ESUI 2014 in Lisbon will be broadcasted via and if the speaker has given his/her approval. Wifi Free wireless internet will be available in all areas and session rooms. Please search for the EMUC14 network and connect by entering the following: Username: EMUC14 Password: EMUC14

13 Continuing Medical Education Accreditation EMUC xiii The 6th European Multidisciplinary Meeting on Urological Cancers (EMUC) is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical specialists. The EACCME is an institution of the European Union of Medical Specialists (UEMS), The 6th European Multidisciplinary Meeting on Urological Cancers (EMUC) is designated for a maximum of (or for up to ) 15 hours of European external CME credits. Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. Through an agreement between the European Union of Medical Specialists and the American Medical Association, physicians may convert EACCME credits to an equivalent number of AMA PRA Category 1 Credits. Information on the process to convert EACCME credit to AMA credit can be found at Live educational activities, occurring outside of Canada, recognised by the UEMS-EACCME for ECMEC credits are deemed to be Accredited Group Learning Activities (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada. EACCME credits Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. The event has also been accredited with 12 ESMO-MORA category 1 credits. Continuing Medical Education Accreditation ESUI The 3rd Meeting of the EAU Section of Urological Imaging (6 CME points) is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical specialists. The EACCME is an institution of the European Union of Medical Specialists (UEMS), The meeting is designated for a maximum of 6 hours of European external CME credits. Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. Through an agreement between the European Union of Medical Specialists and the American Medical Association, physicians may convert EACCME credits to an equivalent number of AMA PRA Category 1 Credits. Information on the process to convert EACCME credit to AMA credit can be found at Live educational activities, occurring outside of Canada, recognised by the UEMS-EACCME for ECMEC credits are deemed to be Accredited Group Learning Activities (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada. EACCME credits Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. The EACCME credit system is based on 1 ECMEC per hour with a maximum of 3 ECMECs for half a day and 6 ECMECs for a full-day event.

14 MSD Oncology Copyright 2014 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA. All rights reserved. ONCO ONCO x280.indd 1 25/09/14 14:48

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16 xvi Symposia Thursday, 13 November Symposium Auditorium VIII The role of MRI in prostate cancer care Louise Dickinson, London (GB) SPONSORED BY SIEMENS Friday, 14 November Symposium Auditorium VI VII Continuous care for the advanced prostate cancer patient Welcome and introduction Maria De Santis, Vienna (AT) Androgen receptor signalling: Driving prostate cancer progression Theo de Reijke, Amsterdam (NL) Continued inhibition of the androgen receptor signalling pathway on progression to mcrpc Maria De Santis, Vienna (AT) Multidisciplinary approach to navigating treatment decisions for the advanced prostate cancer patient Patrick Bastian, Düsseldorf (DE) Summary and close SPONSORED BY ASTELLAS Symposium Auditorium VI VII Optimizing Survival in Advanced Prostate Cancer Welcome and introduction Cora Sternberg, Rome (IT) A closer look to prostate cancer heterogeneity Cora Sternberg, Rome (IT) Tailoring therapy in a booming mcrpc landscape Nicolas Mottet, Saint-Etienne (FR) CHAARTED results and its implications for the future Christopher Sweeney, Boston (US) Closing remarks Nicolas Mottet, Saint-Etienne (FR) SPONSORED BY SANOFI Saturday, 15 November Symposium Auditorium VI VII Redefining clinical practice in CRPC: insights into MDT treatment decision-making Welcome and introduction Peter Mulders, Nijmegen (NL) Optimizing the implementation of a novel radiopharmaceutical within the mcrpc treatment paradigm Sten Nilsson, Stockholm (SE) MDT insights from the clinic: treatment decision-making in the pre-chemotherapy setting Peter Mulders, Nijmegen (NL) MDT insights from the clinic: treatment decision-making in the post-chemotherapy setting Nicholas James, Birmingham (GB) Panel discussion: ensuring that patients are at the centre of MDT decision-making in mcrpc All Meeting close Peter Mulders, Nijmegen (NL) SPONSORED BY BAYER HEALTHCARE Interactive workshop Auditorium VIII A new way of bringing the evidence alive in metastatic CRPC! Alberto Bossi, Villejuif (FR) radiation oncology Maria De Santis, Vienna (AT) medical oncology Nicolas Mottet, Saint-Etienne (FR) urology Herman Stoevelaar, Lier (BE) methodology Introduction Best available evidence: a new way to find and apply it Case discussions using models, voting and survey results What if... scenarios: challenge the experts Take home messages ORGANISED BY ISSECAM-MIRRORS OF MEDICINE SUPPORTED BY AN EDUCATIONAL GRANT FROM JANSSEN

17 Hands on Training (HOT) Courses xvii Aims and Objectives The European School of Urology (ESU) and the EAU Robotic Urology Section (ERUS) offer an intensive hands-on training course. We will provide training using simulators. The main aims of this 90 minutes course are: Improving the participants control-skills and hand-eye-coordination, as well as an objective benchmarking of console performance and an introduction into standardised surgical steps in robot-assisted procedures. Therefore, each course is limited to the small number of 4 participants, to facilitate an optimal training setting with only 1 participant per tutor. Course coordinator: Tutors: H. Van Der Poel, Amsterdam (NL) M. Naudin, Mons (BE), J. Schraml, Ústí nad Labem (CZ) ROOM 1.15 Friday, 14 November Course 1: Course 2: Course 3: Course 4: ROOM 1.15 Saturday, 15 November Course 1: Course 2: Course 3: Course 4:

18 xviii Scientific Programme Thursday, 13 November 3rd Meeting of the EAU Section of Urological Imaging (ESUI) Room: Auditorium VIII Welcome J. Walz, Marseille (FR) News from the ESUI Results from the ESUI study multicentre Hi-TRE G. Salomon, Hamburg (DE) Results from the ESUI survey 2012 J. Walz, Marseille (FR) Results from the ESUI and EAU Guidelines Office joint committee T. Loch, Flensburg (DE) Imaging for urological surgery and real time tissue characterisation Moderators: G. Heinz-Peer, Saint Poelten (AT) C. Trombetta, Trieste (IT) M. Ritter, Mannheim (DE) Intraoperative ultrasound in urology C. Trombetta, Trieste (IT) Near-infrared fluorescence imaging in urology H. Van Der Poel, Amsterdam (NL) Image fusion and augmented reality in urology D. Teber, Heidelberg (DE) Dyna CT in urology M. Ritter, Mannheim (DE) ALA in prostate cancer G. Salomon, Hamburg (DE) Photodynamic diagnosis and narrow band imaging in bladder cancer B. Geavlete, Bucharest (RO) Confocal laser endomicroscopy in the bladder M. Bus, Amsterdam (NL) Coffee break and poster viewing Practical aspects of Image guided therapy of small renal masses: How to implement a renal focal therapy programme into your clinic Moderators: F. Cornelis, Bordeaux (FR) M.P. Laguna, Amsterdam (NL) S. Siracusano, Trieste (IT) Imaging standards for renal masses F. Cornelis, Bordeaux (FR) Who is part of the team in image guided therapy? R. Sanchez Salas, Paris (FR) What equipment do I need and what technique to choose? M.P. Laguna, Amsterdam (NL) How to select patients, how to follow-up and what results can be expected? S. Joniau, Leuven (BE) Discussion Lunch Joint session of EAU Section of Urological Imaging (ESUI) and the European Association of Nuclear Medicine (EANM) Moderators: M. Beheshti, Linz (AT) P. Geavlete, Bucarest (RO) N. Nicolai, Milan (IT)

19 SCIENTIFIC PROGRAMME xix Point and counterpoint in urological imaging: Is PET CT playing an indispensable role in the management of urological malignancies? Pro: M. Beheshti, Linz (AT) Con: J. Walz, Marseille (FR) PET-CT and future tracers in the management of urological malignancies: Prostate cancer G. Giovacchini, Milan (IT) PET-CT and future tracers in the management of urological malignancies: Kidney cancer M. Beheshti, Linz (AT) PET-CT and future tracers in the management of urological malignancies: Bladder cancer L. Mertens, Amsterdam (NL) PET-CT and future tracers in the management of urological malignancies: Testicular cancer N. Nicolai, Milan (IT) PET-CT and future tracers in the management of urological malignancies: Penile cancer B. Schlenker, Munich (DE) Discussion Poster session and best poster award Moderators: M. Ferreira Coelho, Lisbon (PT) D. Georgescu, Bucharest (RO) EO6 Preoperative lymph node staging of intermediate and high-risk prostate cancer using whole body integrated PET/MR with a 68Gallium-labelled ligand of prostate-specific membrane antigen T. Maurer, L. Pähr, M. Souvatzoglou, G. Weirich, H. Kübler, H-J. Wester, B. Haller, M. Schwaiger, J.E. Gschwend, M. Eiber (Munich, Germany) EO7 MRI use prior to prostate biopsy in a German tertiary care centre: A plea for standardization B. Beyer, H. Heinzer, A. Haese, M. Graefen, L. Budäus (Hamburg, Germany) EO8 Initial experience with PSMA-radioguided surgery in prostate cancer patients T. Maurer, G. Weirich, M. Weineisen, H-J. Wester, M. Schottelius, B. Frisch, A. Okur, H. Kübler, M. Schwaiger, J.E. Gschwend, M. Eiber (Munich, Germany) EO9 Contribution of the confocal microscopy in the exploration of the upper urinary tract tumors J-L. Bonnal, A. Rock, K. El Maadarani, R. Yakoubi, R. Bollens, B. Mauroy, P. Gosset (Lomme, France) Coffee break and poster viewing Advanced imaging for prostate cancer diagnosis and treatment: Is MRI the best imaging tool for prostate cancer management? Moderators: A. Villers, Lille (FR) G. Villeirs, Ghent (BE) J. Walz, Marseille (FR) Point and counterpoint in prostate cancer: Image guided therapy in prostate cancer will become a standard in prostate cancer management Pro: H.U. Ahmed, London (GB) Con: A. Briganti, Milan (IT) Multiparametric MRI: Standardisation and quality control L. Dickinson, London (GB) Multiparametric MRI: Detection of prostate cancer lesions B. Carey, Leeds (GB) Multiparametric MRI: Cancer grading and size estimation G. Villeirs, Ghent (BE) To fuse or not to fuse? Clinical value of image fusion techniques A. Villers, Lille (FR) ANNA/C-TRUS for prostate cancer: An update T. Loch, Flensburg (DE) Histoscanning for prostate cancer S. Javed, Guilford (GB)

20 xx SCIENTIFIC PROGRAMME Contrast enhanced ultrasound and dispersion quantification for prostate cancer H. Wijkstra, Amsterdam (NL) Real time elastography for prostate cancer: An update G. Salomon, Hamburg (DE) Shearwave elastography for prostate cancer J. Walz, Marseille (FR) Multiparametric ultrasound for prostate cancer M. Brock, Herne (DE) Summary and closure of the ESUI programme Symposium (see page xvi) Thursday, 13 November EAU-ICUD Medical Treatment of Urological Malignancies Room: Auditorium VI VII Introduction C. Evans, Sacramento (US) K. Fizazi, Villejuif (FR) C. Stief, Munich (DE) RCC: Targeted therapy 1st line B. Escudier, Villejuif (FR) C. Wood, Houston (US) Discussion RCC: Targeted therapy 2nd and 3rd line P. Lara, Sacramento (US) M. Staehler, Munich (DE) Discussion RCC: Immunotherapy, alternative approaches P. Mulders, Nijmegen (NL) A. Pantuck. Los Angeles (US) C. Sternberg, Rome (IT) Discussion Coffee break Testicular cancer: Medical Tx G. Daugaard, Copenhagen (DK) M. Jewett, Toronto (CA) Discussion Testicular cancer: Late effects of Tx S. Fosså, Oslo (NO) F-J. Zhou, Guangzhou (CN) Discussion UCC: Medical Tx M. De Santis, Vienna (AT) A. Pycha, Bolzano (IT) Discussion Lunch break PCA: Biology of androgen and castration resistence E. Mostaghel, Seattle (US) J. Schalken. Nijmegen (NL) Discussion PCA: Androgen deprivation and management of side effects C-X.Liu, Guangzhou (CN) M. Wirth, Dresden (DE)

21 SCIENTIFIC PROGRAMME xxi Discussion PCA: Androgen pathway targeted agents P. Febbo, Redwood City (US) M. Gleave, Vancouver (CA) W. Loidl, Linz (AT) Discussion Coffee break PCA: Vaccines, Immuno- and gene based Tx C. Drake, Baltimore (US) A. Stenzl, Tuebingen (DE) Discussion PCA: Cytotoxic chemotx and targeted agents A. Bjartell, Malmö (SE) M. De Santis, Vienna (AT) Discussion PCA: Isotope based Tx S. Fosså, Oslo (NO) D. Heinrich, Lørenskog (NO) Discussion Coffee break Conclusions and strategies C. Evans, Sacramento (US) K. Fizazi, Villejuif (FR) C. Stief, Munich (DE) Friday, 14 November 6th European Multidisciplinary meeting on Urological Cancers (EMUC) Room: Auditorium VI VII Welcome and Introduction ESMO J. Bellmunt, Boston (US) ESTRO P. Poortmans, Nijmegen (NL) EAU P-A. Abrahamsson, Malmö (SE) ESUR G. Heinz-Peer, Saint Poelten (AT) ESP/ESUP A. Lopez-Beltran, Lisbon (PT) Prostate cancer: Management of progressing disease Chairs: Urologist A. Bjartell, Malmö (SE) Urologist G. Giannarini, Udine (IT) Clinical oncologist V. Khoo, London (GB) Case presentation including voting Urologist G. Giannarini, Udine (IT) Optimising imaging for biochemical recurrence Radiologist J. Barentsz, Nijmegen (NL) Understanding the natural history of progressing PCa: Is treatment always needed? Urologist M. Gleave, Vancouver (CA) Intermittent hormonal therapy for the worse or the better? Medical oncologist M. Hussain, Michigan (US) Intermittent hormonal therapy for the better or the worse? Urologist P-A. Abrahamsson, Malmö (SE) Discussion Curative radiotherapy for local recurrence: When and to whom? Radiation oncologist M. Van Vulpen, Utrecht (NL)

22 xxii SCIENTIFIC PROGRAMME Curative surgery for local recurrence: When and to whom? Urologist S. Joniau, Leuven (BE) Optimal treatment sequencing for mcrpc: When is docetaxel (not) the first choice? Medical oncologist G. Attard, Sutton (GB) Discussion and conclusions from the chairmen Coffee break and poster viewing Best of journals: Medical oncology Chairs: Clinical oncologist A. Horwich, Sutton (GB) Medical oncologist S. Osanto, Leiden (NL) Debate: Is surveillance the standard of care for all stage 1 testicular cancers? Chairs: Oncologist G. Daugaard, Copenhagen (DK) Urologist M. Jewett, Toronto (CA) Pro Urologist N. Mottet, Saint Etienne (FR) Con Medical oncologist J. Oldenburg, Oslo (NO) Discussion and conclusions from the chairmen Translational research session: When science meets the clinic Chair: Medical oncologist C. Sternberg, Rome (IT) The role of checkpoint inhibitors in Uro-Oncology Medical oncologist J. Bellmunt, Boston (US) Lunch and poster viewing & symposium (see page xvi) General session: Kidney cancer Locally advanced Chairs: Urologist S. Brookman-May, Munich (DE) Oncologist T. Eisen, Cambridge (GB) Urologist P. Mulders, Nijmegen (NL) Do we need more than CT for staging and follow up? Radiologist G. Schneider, Homburg/Saar (DE) Defining the optimal extent of surgery: The role of lymph node dissection Urologist M. Blute, Boston (US) Genomics will determine the management of locally advanced RCC Medical oncologist J. Brugarolas, Dallas (US) Drugs in the pipeline for RCC Medical oncologist B. Escudier, Villejuif (FR) Discussion and conclusions from the chairmen Coffee break and poster viewing Bladder cancer Chairs: Medical oncologist J. Bellmunt, Boston (US) Urologist M. Brausi, Modena (IT) Radiation oncologist B. Jereczek-Fossa, Milan (IT) Imaging approaches in bladder cancer: Can we do better? Radiologist G. Heinz-Peer, Saint Poelten (AT) The role of minimally invasive radical cystectomy Urologist C.M. Annerstedt, Stockholm (SE) Bladder preserving strategies: When and how? Oncologist R. Huddart, Sutton (GB) Translational approach to the management of bladder cancer Urological researcher T. Orntoft, Aarhus (DK) Discussion and conclusions from the chairmen Symposium (see page xvi)

23 SCIENTIFIC PROGRAMME xxiii Saturday, 15 November 6th European Multidisciplinary meeting on Urological Cancers (EMUC) Room: Auditorium VI VII Oral presentations of the best abstracts Chairs: Urologist F. Chun, Hamburg (DE) Clinical oncologist V. Khoo, London (GB) Medical oncologist S. Osanto, Leiden (NL) O1 O2 O3 O4 O5 Chromosome X polysomy is associated with increased androgen receptor expression in epithelial cells and reduced expression in stromal cells in treatment-naive prostate cancer C. Van Praet, F. Poelaert, S. Verschuere, L. Libbrecht, M. Praet, S. Rottey, S. Van Belle, K. Decaestecker, T. Claeys, N. Lumen (Ghent, Belgium) Results of EORTC 22991: 3D-CRT/IMRT with or without 6-month androgen deprivation therapy in localized T1b-cT2aN0M0 prostate cancer (EORTC 22991) M. Bolla, P. Maingon, A. Van Den Bergh, C. Carrie, S. Villa, P. Kitsios, P. Poortmans, S. Sundar, E. Van Der Steen-Banasik, L. Collette, EORTC Radiation Oncology Group (Grenoble, Dijon, Lyon, France; Groningen, Tilburg, Arnhem, The Netherlands; Badalona, Spain; Nicosia, Cyprus; Nottingham, United Kingdom; Brussels, Belgium) Bone scan index as a biomarker to predict outcome in mcrpc patients on abiraterone acetate (Zytiga ) a multicenter study M. Reza, A. Bjartell, M. Ohlsson, R. Kaboteh, I. Frank, J.-E. Damber, L. Budäus, T. Eichenauer, P. Wollmer, L. Edenbrandt, E. Trägårdh (Malmö, Lund, Gothenburg, Sweden; Hamburg, Germany) The long term outcome of combined NBI-plasma vaporization approach in large NMIBT cases a prospective, randomized controlled comparison to the standard management B. Geavlete, R. Multescu, D. Georgescu, C. Moldoveanu, F. Stanescu, M. Jecu, P. Geavlete (Bucharest, Romania) Patients with metastatic papillary Renal Cell Carcinoma (RCC) who may benefit from sunitinib therapy (tx): Results from an international metastatic RCC database D. Keizman, M. Gottfried, N. Maimon, H. Hammers, M. Eisenberger, M. Carducci, V. Sinibaldi, V. Neiman, E. Rosenbaum, D. Sarid, E. Gez, A. Peer, A. Sella, W. Mermershtain, K. Rouvinov, R. Berger, J. Lee (Kefar-saba, Petach Tikva, Tel-Aviv, Haifa, Zerifin, Beer-Sheva, Tel-Hashomer, Israel; Baltimore, United States of America; Seoul, South Korea) Announcement best unmoderated posters Moderator: Radiation oncologist M. Van Vulpen, Utrecht (NL) Lecture: The role of stem cells across tumour types Chair: Medical oncologist J. Bellmunt, Boston (US) Speaker: Molecular genetician N. Maitland, York (GB) Parallel session Hands on Training (HOT): Prostate radiotherapy delineation contouring workshop Upon pre-registration only Chair: C. Salembier, Brussels (BE) Panellists: V. Khoo, London (GB) M. Van Vulpen, Utrecht (NL) Administrator: B. De Bari, Lausanne (CH) Kidney cancer: Management of small renal masses Chairs: Pathologist F. Algaba, Barcelona (ES) Urologist M. Blute, Boston (US) Urologist J. Walz, Marseille (FR) Case presentation including voting Urologist J. Walz, Marseille (FR) Role of imaging in predicting histology of small renal masses Radiologist H. Thoeny, Berne (CH) Role of percutaneous renal biopsy: Why, when and how Urologist A. Volpe, Novara (IT) Active surveillance is often applicable Urologist M. Jewett, Toronto (CA)

24 xxiv SCIENTIFIC PROGRAMME Role of focal treatments Urologist M. Laguna, Amsterdam (NL) Is there a role for stereotactic or other methods of external beam radiotherapy? Radiation oncologist G. De Meerleer, Ghent (BE) Discussion and conclusions from the chairmen Coffee break and poster viewing Best of journals: Surgery Urologist F. Greco, Halle Saale (DE) Urologist H. Van Poppel, Leuven (BE) Late breaking news Quality assessment in uro-oncology Chairs: Radiation oncologist M. Bolla, Grenoble (FR) Urologist A. Briganti, Milan (IT) Oncologist G. Daugaard, Copenhagen (DK) Surgery Urologist F. Chun, Hamburg (DE) Radiation therapy Radiation oncologist A. Bossi, Villejuif (FR) Medical treatment Medical oncologist C. Sweeney, Boston (US) Imaging Radiologist J. Futterer, Nijmegen (NL) Discussion and conclusions from the chairmen Lunch and poster viewing & symposium (see page xvi) Lecture: How to optimise screening in prostate cancer Epidemiologist s perspective Epidemiologist S. Carlsson, New York (US) Discussion led by: Urologist P-A. Abrahamsson, Malmö (SE) Prediction and prevention of treatment related toxicity in uro-oncology Chairs: Urologist W. Artibani, Verona (IT) Radiation oncologist D. Dearnaley, Sutton (GB) Medical oncologist S. Osanto, Leiden (NL) Surgery/minimal invasive/organ preserving Urologist P. Gontero, Turin (IT) Radiation therapy Radiation oncologist R. Valdagni, Milan (IT) Anticipative management of adverse effects in patients treated with systemic therapy Clinical oncologist V. Kataja, Jyväskylä (FI) Discussion and conclusions from the chairmen Coffee break and poster viewing Best of journals: Radiotherapy Radiation oncologist M. Van Vulpen, Utrecht (NL) Radiation oncologist P. Poortmans, Nijmegen (NL) Late breaking news An overview of the 2nd Conference on Active Surveillance for Low Risk Prostate Cancer, Amsterdam 2014 Urologist M. Roobol, Rotterdam (NL) Penile cancer Chairs: Urologist H. Van Poppel, Leuven (BE) Radiotherapist C. Haie-Meder, Villejuif (FR) HPV and penile cancer Pathologist M. Colecchia, Milan (IT)

25 SCIENTIFIC PROGRAMME xxv Imaging for staging and recurrence of penile cancer Urologist S. Minhas, London (GB) Lymph node management in penile cancer Urologist S. Horenblas, Amsterdam (NL) Discussion and conclusions from the chairmen Symposium (see page xvi) Sunday, 16 November 6th European Multidisciplinary meeting on Urological Cancers (EMUC) Room: Auditorium VI VII Immunotherapy in prostate cancer Chair: Urologist B. Tombal, Brussels (BE) Speaker: Medical oncologist K. Fizazi, Villejuif (FR) Announcement best unmoderated posters Moderator: Urologist H. Van Poppel, Leuven (BE) Coffee break and poster viewing The really high-risk prostate cancer Chairs: Urologist N. Clarke, Manchester (GB) Clinical oncologist V. Khoo, London (GB) Urologist M. Wirth, Dresden (DE) Case presentation including voting Radiation oncologist V. Khoo, London (GB) What is really high-risk prostate cancer? Role of biomarker and genetic assessment Urologist R. Karnes, Rochester (US) Is radiotherapy with hormone therapy still the gold standard? Urologist O. Yossepowitch, Petah Tikva (IL) Has radical prostatectomy proven to be the best primary treatment? Radiation oncologist A. Bossi, Villejuif (FR) Role of robotic assisted radical prostatectomy: A step forward? Urologist F. Montorsi, Milan (IT) Should primary cancer be treated in metastatic patients? Urologist B. Tombal, Brussels (BE) Discussion and conclusions from the chairmen Take home messages Radiologist G. Heinz-Peer, Saint Poelten (AT) Urologist A. Briganti, Milan (IT) Clinical oncologist V. Khoo, London (GB) Clinical oncologist V. Kataja, Jyväskylä (FI) Pathologist A. Lopez-Beltran, Lisbon (PT) Closing remarks Urologist P-A. Abrahamsson, Malmö (SE) Clinical oncologist V. Kataja, Jyväskylä (FI) Radiation oncologist P. Poortmans, Nijmegen (NL)

26 xxvi SCIENTIFIC PROGRAMME Sunday, 16 November YAU Autumn Meeting Room: Auditorium VIII YAUM opening F. Sanguedolce, London (GB) Working group presentations: Achievements, issues and feedback part Renal cancer S. Brookman-May, Munich (DE) Prostate cancer G. Giannarini, Udine (IT) Urothelial cancer E. Xylinas, Paris (FR) ESOU YAU: A strategic alliance ESOU: M. Brausi, Modena (IT) YAU: S. Brookman-May, Munich (DE) G. Giannarini, Udine (IT) E. Xylinas, Paris (FR) F. Sanguedolce, London (GB) Working group presentations: Achievements, issues and feedback part Men s health P. Verze, Naples (IT) Paediatric A.F. Spinoit, Ghent (BE) Female urology J.N Cornu, Paris (FR) BPH C. De Nunzio, Rome (IT) Endourology & Urolithiasis F. Sanguedolce, London (GB) A. Papatsoris, Athens (GR) Robotic N.M. Buffi, Milan (IT) Coffee break YAUM: What s going on and future perspectives F. Sanguedolce, London (GB) Farewell

27 #EAU15 MADRID March 2015 Sharing knowledge - Raising the level of urological care Register now for the early bird fee! 30th Anniversary Congress European Association of Urology

28 Join the European Association of Urology, become a member, get involved! The EAU is the voice of European urologists, a non-profit scientific organisation dedicated to serving their members and representing their professional interests! Learn about the many benefits of being a member of the European Association of Urology. Member discounts on EAU products and services Registration benefits for EAU meetings EAU ID Card for automatic registration of EU-ACME credit points Free subscriptions to: European Urology, the official scientific EAU journal (full access to journal website and all supplements) and The EAU Urology Updates EAU Newsletter: European Urology Today Historia Urologiae Europaeae EAU Guidelines Online access to the European Urology Video Journal The EAU has a number of membership categories catering to all professionals involved in the speciality of urology. We invite you to become a member today! Please go to

29 EUROPEAN UROLOGY SUPPLEMENTS 13 (2014) Abstracts Oral Presentations 3rd Meeting of the EAU Section of Urological Imaging (ESUI) Thursday, 13 November hrs EO6 EO9 Unmoderated Poster Presentations 3rd Meeting of the EAU Section of Urological Imaging (ESUI) Poster viewing times Thursday, 13 November hrs hrs hrs EP156 EP172 Oral Presentations 6th European Multidisciplinary Meeting on Urological Cancers (EMUC) Saturday, 15 November hrs O1 O5 Unmoderated Poster Presentations 6th European Multidisciplinary Meeting on Urological Cancers (EMUC) Poster viewing times Friday, 14 November Saturday, 15 November Sunday, 16 November hrs hrs hrs hrs hrs hrs hrs P001 P155 Disclaimer The statements and the opinions published in this abstract book are solely those of the individual abstract authors and not of the organisers. The abstracts have been printed as submitted. For the consistency of this publication only a standard language spelling check was made on all abstracts; it is the decision of the organisers not to edit the abstracts in order not to change any context /$ see front matter 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

30 104 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) EMUC Oral Presentations Prostate cancer O1 Chromosome X polysomy is associated with increased androgen receptor expression in epithelial cells and reduced expression in stromal cells in treatment-naive prostate cancer C. Van Praet 1, F. Poelaert 1, S. Verschuere 2, L. Libbrecht 2, M. Praet 2, S. Rottey 3, S. Van Belle 3, K. Decaestecker 1, T. Claeys 1, N. Lumen 1. 1 Ghent University Hospital, Dept. of Urology, Ghent, Belgium; 2 Ghent University Hospital, Dept. of Pathology, Ghent, Belgium; 3 Ghent University Hospital, Dept. of Medical Oncology, Ghent, Belgium Introduction & Objectives: Chromosome X polysomy represents an adverse pathological feature in prostate cancer (PC). Although the androgen receptor (AR) gene is located on chromosome X, little is known about the relationship between chromosome X polysomy and AR expression. Our objective was to analyze interaction between chromosome X (and AR gene) count and AR protein expression. Material & Methods: PC tissue samples were obtained from 72 treatment-naive PC patients. Samples were analysed with interphase fluorescence-in-situ-hybridization (FISH) using AR and X-centromere probes. Probe signals were counted in 100 non-overlapping nuclei. Malignant and adjacent benign epithelial as well as stromal cell AR expression was analyzed with immunohistochemistry and quantified using the Quick score. All observations were performed by 2 trained clinicians, blinded to each other s results. Chi-square test, Spearman correlation and non-parametric tests were used to detect associations with known prognostic factors (prostate-specific antigen, Gleason score, TNM status and risk group stratification: low-, intermediate-, high-, very-high-risk and metastatic PC). Results: Chromosome X polysomy in 10% cells was seen in 18 (25%) patients. Chromosome X polysomy is associated with increased AR expression in malignant epithelial cells, but decreased AR expression in peritumoral stromal cells. Chromosome X polysomy was more prevalent in metastatic patients (5/10) compared to non-metastatic patients (13/62, P=0.049). We also found an inverse linear relationship between stromal AR expression and more advanced PC Figure 1. Patients with stromal AR expression, stratified according to European Association of Urology prognostic risk group: low & intermediate risk (16/21), high & very high risk (24/35) and metastatic (4/10). risk group (P=0.037) with loss of stromal AR most prominent in metastatic PC (60%). Conclusions: Chromosome X polysomy is associated with increased AR expression in epithelial, but decreased AR expression in stromal cells, as well as with metastatic disease. Further research is required to validate these findings and identify potential therapeutic targets associated with disease progression. O2 Results of EORTC 22991: 3D-CRT/IMRT with or without 6-month androgen deprivation therapy in localized T1b-cT2aN0M0 prostate cancer (EORTC 22991) M. Bolla 1, P. Maingon 2, A. Van Den Bergh 3, C. Carrie 4, S. Villa 5, P. Kitsios 6, P. Poortmans 7, S. Sundar 8, E. Van Der Steen-Banasik 9, L. Collette 10, EORTC Radiation Oncology Group. 1 Centre Hospitalier Universitaire De Grenoble-La-Tronche, Dept. of Radiotherapy, Grenoble, France; 2 Centre Georges-Francois-Leclerc, Dept. of Radiotherapy, Dijon, France; 3 University Medical Center Groningen, Dept. of Radiotherapy, Groningen, The Netherlands; 4 Centre Leon Berard, Dept. of Radiotherapy, Lyon, France; 5 Hospital Universitari Germans Trías, Institut Català D Oncologia, Dept. of Radiotherapy, Badalona, Spain; 6 Bank of Cyprus Oncology Centre, Dept. of Radiotherapy, Nicosia, Cyprus; 7 Dr. Bernard Verbeeten Instituut, Dept. of Radiotherapy, Tilburg, The Netherlands; 8 Nottingham University Hospitals NHS Trust City Hospital, Dept. of Radiotherapy, Nottingham, United Kingdom; 9 Arnhem s Radiotherapeutisch Instituut, Dept. of Radiotherapy, Arnhem, The Netherlands; 10 European Organisation For Research and Treatment of Cancer Headquarters, Dept. of Statistics, Brussels, Belgium Introduction & Objectives: After primary irradiation, up to 30% patients with intermediate or high risk localized prostate cancer relapse biochemically within 5 years. This study evaluates the combination of 6 months of medical castration with primary irradiation. Material & Methods: 819 patients staged ct1b-c with PSA 10 ng/ml or Gleason 7 or ct2a (UICC TNM 1997) N0 M0 with PSA 50 ng/ml were randomized 1:1 between irradiation (RT) or irradiation and 2 injections of LH-RH analogue (gosereline acetate) with 1 month of antiandrogens. Randomization was performed centrally. Centers opted for one prostate irradiation dose among 70 Gy, 74 Gy or 78 Gy. Irradiation of pelvic nodes for patients who have at least 15% risk was left to the discretion of each institution. Biochemical progressionfree survival (BPFS primary endpoint) was counted from entry until PSA relapse (Phoenix criteria) or until clinical relapse (evidenced by imaging) or death of any cause if they occur without PSA relapse. The trial aimed for 80% power of detecting HR=0.714 by intention-to-treat analysis at the 2-sided 5% significance level with stratification for RT dose, which required 274 events (ClinicalTrials.gov NCT ). Results: Median patient age was 70y, 88% were WHO PS0, 74.8% classified intermediate risk and 24.8% high risk by D Amico classification. In the RT arm, 407/409 received RT, in the RT+HT, 403/410 received RT+HT and 3 RT only. Six patients refused treatment. After a median follow-up of 7.2 years, based on 319 events of BPFS (201 with RT vs 118 with RT+HT), BPFS was statistically significantly improved with RT+HT (HR=0.53, CI: , P<0.001) at all radiation doses (heterogeneity P>0.1) with an increase at 5 years from 69.3% to 82.5%. Clinical progression-free survival was also statistically significantly improved (205 events, HR=0.63, CI: , P=0.001, +7.9% at 5 years). Only 152 patients died so far of which 25 died of prostate cancer. Late genito-urinary toxicity was reported by 5.9% vs 3.6% of the patients, on RT+HT and RT, respectively (P=0.14), whereas 27.0% vs 19.4% reported severe impairment of sexual function (P=0.010). Conclusions: The addition of 6 months of medical castration to pri-

31 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) mary irradiation improves biochemical and clinical progression-free survival in intermediate and high risk localized T1b-cT2a N0M0 prostatic carcinoma. Advanced prostate cancer O3 Bone scan index as a biomarker to predict outcome in mcrpc patients on abiraterone acetate (Zytiga ) a multicenter study M. Reza 1, A. Bjartell 2, M. Ohlsson 3, R. Kaboteh 4, I. Frank 5, J-E. Damber 6, L. Budäus 7, T. Eichenauer 8, P. Wollmer 1, L. Edenbrandt 1, E. Trägårdh 1. 1 Skåne University Hospital, Dept. of Clinical Physiology and Nuclear Medicine, Malmö, Sweden; 2 Skåne University Hospital, Dept. of Urology, Malmö, Sweden; 3 Lund University, Dept. of Astronomy and Theoretical Physics, Lund, Sweden; 4 Sahlgrenska University Hospital, Dept. of Molecular and Clinical Medicine, Gothenburg, Sweden; 5 Sahlgrenska University Hospital, Dept. of Oncology, Gothenburg, Sweden; 6 Sahlgrenska University Hospital, Dept. of Urology, Gothenburg, Sweden; 7 Martini-Klinik, Prostate Cancer Center, Hamburg, Germany; 8 Hamburg University Hospital, Dept. of Urology, Hamburg, Germany Introduction & Objectives: Bone Scan Index (BSI) is a measurement that reflects the tumor burden in bone as a percent of the total skeletal mass calculated from bone scintigraphy. We recently showed BSI to be a prognostic imaging biomarker in patients with metastatic castration resistant prostate cancer (mcrpc). Abiraterone acetate (AA) is one of several new treatment options for this group of patients and it has showed to prolong survival in patients who had disease progression after chemotherapy. An objective biomarker that is associated with improvement in survival would be of value in the management of patients under AA treatment, for example in decisions to continue or change treatment. In this study we used an automated method for calculation of BSI to evaluate the predictive value of BSI as a biomarker of response in mcrpc patients on treatment with AA. Material & Methods: We retrospectively studied a total of 39 mcrpc patients who received AA for disease progression after chemotherapy. All these patients had undergone whole-body bone scintigraphy before and during AA treatment at our centers. Baseline and follow-up BSI data was obtained using the automated quantification software EXINI Bone BSI. Data on overall survival (OS), and prostatespecific antigen (PSA) levels in blood at the time of baseline and upon follow-up was collected from medical records. The association between changes in BSI and PSA from baseline to follow-up and survival Figure 1. Kaplan-Meier curves showing patient-survival probability. Stratification by BSI changes: High BSI difference represents an increase in BSI of 0.3 (n=21), and Low BSI difference represents changes in BSI of <0.3 (n=18) (p<0.001). was evaluated using Cox proportional-hazards regression models and Kaplan-Meier estimates of the survival function. Discrimination between prognostic variables was assessed using the concordance index (C-index). Results: Patients with an increase in BSI ( 0.3; n=21) had a 1 yearsurvival rate of 21% compared to patients with improvement or stable disease (BSI change <0.3; n=18) (80%) (p<0.001) (Figure 1). In a univariate Cox analysis BSI change from baseline to follow-up was significantly associated with OS (p=0.001 and C-index 0.73) while PSA change was not prognostic. Conclusions: Increase in BSI was significantly associated with reduced survival in mcrpc patients under AA treatment following disease progression in a post-chemotherapy setting. We conclude that BSI is a useful biomarker to evaluate response to therapy and that calculation of BSI could be a valuable tool in monitoring patients with mcrpc on second-line therapies. Bladder cancer O4 The long term outcome of combined NBI-plasma vaporization approach in large NMIBT cases a prospective, randomized controlled comparison to the standard management B. Geavlete, R. Multescu, D. Georgescu, C. Moldoveanu, F. Stanescu, M. Jecu, P. Geavlete. Saint John Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: A prospective, randomized, comparison between narrow band imaging (NBI) cystoscopy and bipolar plasma vaporization (BPV) versus standard white light cystoscopy (WLC) and monopolar transurethral resection of bladder tumors (TURBT) was performed, aiming to evaluate the long term recurrence rates specific to the 2 approaches in cases of large non-muscle invasive bladder tumors (NMIBT). Material & Methods: A total of 220 patients with at least one apparently (NMIBT) over 3 cm were included in the trial based on abdominal ultrasound, computer tomography and flexible WLC. In one arm, 110 patients underwent WLC, NBI cystoscopy and BPV, while cases in the second arm only benefited from WLC and TURBT. A single postoperative mitomycin-c instillation standard monopolar Re-TUR at 4 weeks and one year BCG immunotherapy were applied in all NMIBT cases. The follow-up protocol included ultrasound, urinary cytology and WLC, performed every 3 months for a period of 2 years and every 6 months in the 3rd and 4th year. Results: In the NBI-BPV series, the CIS (94.6% versus 67.6%), pta (93% versus 82.4%) and overall NMIBT (94.9% versus 84.3%) detection rates were significantly improved for NBI cystoscopy by comparison to WLC. NBI diagnosed significantly more cases of additional tumors (30.5% versus 9.5%) as well as extended tumoral margins in 10.5% of patients. The obturator nerve stimulation (3.2% versus 18.6%), bladder wall perforation (1.1% versus 7.2%), mean hemoglobin level drop (0.2 g/dl versus 0.9 g/dl) and postoperative bleeding (1.1% versus 6.2%) rates were significantly reduced for BPV when compared to TURBT. The catheterization period (47.2 versus 73.6 hours) and hospital stay (2.9 versus 4.1 days) were significantly shorter subsequent to BPV. The overall (6.3% versus 17.5%) and primary site (4.2% versus 13.4%) Re-TUR residual tumors rates were significantly lower for NBI-BPV patients. The 1 (7.9% versus 17.8%), 2 (11.5% versus 25.8%), 3 (16.3% versus 33.3%) and 4 (19.5% versus 37%) years NMIBT recurrence rates were significantly reduced in the NBI-BPV group when compared to the WLC-TURBT series. Conclusions: NBI cystoscopy displayed significantly improved diagnostic accuracy and BPV emphasized superior efficacy, reduced morbidity and faster postoperative recovery in large NMIBT cases. The

32 106 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) NBI-BPV technique provided a lower Re-TUR residual tumors rate as well as reduced 1, 2, 3 and 4 years recurrence rates by comparison to the standard approach. Acknowledgement: This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/S/137390/ Renal cell carcinoma O5 Patients with metastatic papillary Renal Cell Carcinoma (RCC) who may benefit from sunitinib therapy (tx): Results from an international metastatic RCC database D. Keizman 1, M. Gottfried 1, N. Maimon 1, H. Hammers 2, M. Eisenberger 2, M. Carducci 2, V. Sinibaldi 2, V. Neiman 3, E. Rosenbaum 3, D. Sarid 4,E.Gez 4, A. Peer 5, A. Sella 6, W. Mermershtain 7, K. Rouvinov 7, R. Berger 8,J.Lee 9. 1 Meir Medical Center, Dept. of Oncology, Kefar-saba, Israel; 2 Johns Hopkins Hospital, Dept. of Sidney Kimmel Comprehensive Cancer Center, Baltimore, United States of America; 3 Rabin Medical Center, Dept. of Oncology, Petach Tikva, Israel; 4 Tel Aviv Sourasky Medical Center, Dept. of Oncology, Tel-Aviv, Israel; 5 Rambam Medical Center, Dept. of Oncology, Haifa, Israel; 6 Asaf Harofe Medical Center, Dept. of Oncology, Zerifin, Israel; 7 Soroka Medical Center, Dept. of Oncology, Beer-Sheva, Israel; 8 Sheba Medical Center, Dept. of Oncology, Tel-Hashomer, Israel; 9 University of Ulsan College of Medicine, Asan Medical Center, Dept. of Oncology, Seoul, South Korea Introduction & Objectives: The VEGFR inhibitor sunitinib is a standard tx for metastatic clear cell RCC. Data on the activity of sunitinib in metastatic non clear cell RCC, is limited by small or heterogeneous (mixed histology or targeted therapies) studies, that revealed a lower antitumor activity than in patients with clear cell histology. We aimed to analyze the activity of sunitinib in a large international cohort of patients with metastatic papillary RCC, and to characterize patients who may benefit for this therapy. Material & Methods: Records from metastatic papillary RCC patients treated with sunitinib in 10 centers across 3 countries were retrospectively reviewed. Univariate and multivariate analyses of association between clinicopathologic factors and clinical outcome were performed using Cox regression. Results: Between 2004 and 2013, 74 patients (median age 60, 68% male) with metastatic papillary RCC were treated with sunitinib. 78% had a prior nephrectomy. HENG risk was good 11%, intermediate 56%, and poor 33%. 21% were active smokers, and 31% users of angiotensin system inhibitors. 24% and 41% had liver and bone metastases, respectively. 55% had a pre-treatment neutrophil to lymphocyte ratio (NLR) >3. 40% had dose reduction/treatment interruption. Sunitinib induced hypothyroidism and hypertension (HTN) occurred in 30% and 43%, respectively. 70% achieved a clinical benefit (partial response + stable disease), while 30% had disease progression within the first 3 months of therapy. Median progression free survival (PFS) and overall survival (OS) were 5 and 12 months, respectively. 27% had a PFS 1 year, and 26% survived 2 years. Factors associated with PFS were sunitinib induced HTN (HR 0.31, p=0.002), pre-treatment NLR >3 (HR 5.3, p=0.001), and active smoking (HR 2.5, p=0.01). Factors associated with OS were sunitinib induced hypothyroidism (HR 0.4, p=0.024), past nephrectomy (HR 0.41, p=0.02), pre-treatment NLR >3 (HR 2.25, p=0.036), and active smoking (HR 2.3, p=0.027). Conclusions: Clinicopathologic factors may be used to identify patients with metastatic papillary RCC who may benefit from sunitinib tx. A prolonged PFS and OS were noted in 26 27% of patients.

33 CLINICAL & TRANSLATIONAL MEETING PHYSICS BIENNIAL MEETING GEC - ESTRO - ISIORT MEETING April 2015 Barcelona, Spain PREVENT AND TARGET MEETING RTT MEETING Abstract submission deadline: 20 November 2014 Early registration: 15 December 2014 Late registration: 24 March 2015 Desk registration: as of 25 March Ad page EMUC programme book - 3rd ESTRO Forum.indd 1 10/09/14 09:42

34 108 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) EMUC Unmoderated Poster Presentations Localised prostate cancer P001 Side-effects and complications of transperineal prostate (TP) biopsies the first prospective evaluation using a validated patient reported outcome measures (PROM) tool L.M. Carmona Echeverria 1, I. Dimov 2, G. Gaziev 1, E. Serrao 1, J. Seidenader 2, T. Kuru 2, J. Frey 1, P. Acher 3, A. Doble 1, V. Gnanapragasam 1, G. Muir 4, B. Hadaschik 2, C. Kastner 1, Ginsburg Study Group for Cancer Diagnostics. 1 Addenbrooke s Hospital, Dept. of Urology, Cambridge, United Kingdom; 2 Heidelberg University Hospital, Dept. of Urology, Heidelberg, Germany; 3 Southend University Hospital, Dept. of Urology, Southedn, United Kingdom; 4 King s College Hospital, Dept. of Urology, London, United Kingdom Introduction & Objectives: Transrectal ultrasound guided biopsies of the prostate (TRUSP) are standard for detection of prostate cancer (CaP). Increasing sepsis rates have turned many urologists to using the TP approach with alleged higher detection rates and negligible infection rates. There is no published PROM data to assess side-effects and complications of TP biopsies. We aimed to prospectively assess their occurrence using a validated PROM tool. Material & Methods: Using the Probe PROM tool, validated for TRUSP biopsies as part of the ProtecT study, we collected data prospectively in four centres between February and November All patients undergoing TRUSP or TP biopsies were asked to complete the questionnaires immediately after the procedure and at follow up. Results: 655 patients were included in the study, of these 65% (429) of patients in total completed both questionnaires (228 for TRUS and 201 for TP biopsy). The side effect profile and demographics can be seen on Table 1. There was one confirmed case of sepsis in the TRUS group, and 4 patients had clot retention in the TP group (1.99%). More than twice the numbers of cores were taken for TP biopsies (12.17 vs 27.1), yet, subjective infection and urinary retention rates were measured significantly less in the TP group. Table 1. Demographics and side effects TRUS biopsy TP biopsy Difference (n=228) (n=201) TRUS TP Age (years) 66.7±8.1 (42 88) 63.9±7.9 (36 83) p=0.265 (ns) PSA (ng/ml) 13.5±16.3 (1 116) 11.2±8.4 ( ) p=0.000 (s) Prostate Volume (ml) 56.4±32.1 (7 211) 56.4±36.1 (6 210) p=0.496 (ns) Side effect profile at follow up Haematospermia 64.5% (n=147)* 63.2% (n=127)* Haematuria 71.5% (n=163) 74.6% (n=150) Haematochezia 30.7% (n=70) 10.0% (n=20) Acute urinary retention 7.5% (n=17) 5% (n=11) GP review post procedure 11.8% (n=33) 11.9% (n=24) Fever 12.7% (n=29) 6.5% ( n=13) Antibiotics by GP for suspected infection 9.2% (n=21) 9.0% (n=18) *Patients who had not had sexual activity were excluded. ns: not significant, s: significant. Conclusions: This study reports the first prospective PROM based assessment of side-effects and complications from TP biopsies. Despite accruring more biopsies TP appears to have a similar side effect profile to TRUS with fewer septic events and surprisingly lower urinary retention rate. P002 Transperineal prostate (TP) biopsies the first prospective evaluation of patient reported experience and effects on symptoms and life style L.M. Carmona Echeverria 1, I. Dimov 2, E. Serrao 1, J. Seidenader 2, J. Frey 1, P. Acher 3, A. Doble 1, V. Gnanapragasam 1, G. Muir 4, B. Hadaschik 2, C. Kastner 1, Ginsburg Study Group for Cancer Diagnostics. 1 Addenbrooke s Hospital, Dept. of Urology, Cambridge, United Kingdom; 2 Heidelberg University Hospital, Dept. of Urology, Heidelberg, Germany; 3 Southend University Hopsital, Dept. of Urology, Southend, United Kingdom; 4 King s College Hospital, Dept. of Urology, London, United Kingdom Introduction & Objectives: Many urologists are choosing the transperineal biopsy approach (TP) for detection of prostate cancer, with alleged higher detection and negligible infection rates compared to the transrectal approach (TRUSP). There is no published PROM data to assess patient reported experience and effects on symptoms. We aimed to prospectively assess their occurance using a validated PROM tool. Material & Methods: Using the PROBE PROM tool, validated for TRUSP biopsies as part of the ProtecT study, we collected data prospectively in four centres in All patients undergoing TRUSP or TP biopsies were asked to complete the questionnaires immediately after the procedure and at follow up. Results: 655 patients were included in the study, of these 429 of patients in total completed both questionnaires (228 for TRUS and 201 for TP biopsy). Outcomes and demographics are shown in Table 1. Twice the numbers of cores were taken for TP biopsies (12.27 vs 27.1), yet, there was no clinically significant difference in IPPS from before to after biopsy in both groups. However, there was significant change in IIEF score and sexual desire following both procedures, more so for TP. Pain was experienced in both groups in days after biopsy with only little impact on patients life. Table 1. Demograpics and Symptoms scores TRUS biopsy TP biopsy Difference (n=228) (n=201) TRUS TP Age (years) 66.7±8.1 (42 88) 63.9±7.9 (36 83) p= (ns) PSA (ng/ml) 13.5±16.3 (1 116) 11.2±8.4 ( ) p=0.000 (s) Prostate volume (ml) 56.4±32.1 (7 211) 56.4±36.1 (6 210) p=0.496 (ns) Symptom scores presented as the mean of the difference (follow up baseline) IPSS 0.61±5.35 (ns) 0.23±4.05 (ns) p=0.50 (ns) Quality of life 0.36±1.21 (ns) 0.08±1.22 (ns) p= 0.06 (ns) IIEF ±6.92 (s) 1.96±6.86 (s) p= Sexual desire (worse/much worse) since biopsy 14.5% (n=33) 28.3% (n=62) Pain Pain during period following biopsy 28.1% (n=64) 46.8% (n=94) Patients little or not affected by pain 76.5% (n=49) 91.4% (n=86) Patients that required painkiller prescription by GP 8.2% (n=18) 8.8% (n=20) Patients experience Patients describing procedure as uncomfortable 19.2% (n=42) 23.2% (n=53) Patients unhappy to have repeat biopsy 11% (n=25) 10% (22) Patients descrbing procedure as minor intervention 93.9% (n=214) 82.6% (n=181) ns: not significant, s: significant. Conclusions: This study reports the first prospective PROM-based assement of patients experience and effects on symptoms of TP biopsies Despite acuring more biopsies TP appears to have similar impact

35 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) to TRUSP. Patients should be warned of the effect of both techniques on sexual desire and erectile function. P004 Tumor size in MRI and percentage of cancer in biopsy are independent predictors of side-specific extracapsular extension or seminal vesicular invasion B.A. Dybowski 1, E.K. Bres-Niewada 1, T. Lorenc 2, A. Powała 3, T. Borkowski 1, F. Sawa 1, P. Radziszewski 1. 1 Medical University of Warsaw, Dept. of Urology, Warsaw, Poland; 2 Medical University of Warsaw, Dept. of Radiology, Warsaw, Poland; 3 Medical University of Warsaw, Dept. of Pathology, Warsaw, Poland Introduction & Objectives: Multiparametric magnetic resonance (MP-MRI) is considered the best method for imaging of prostate cancer. Preoperative staging is one of its potential applications. Information on the localization and extension of the tumor may influence decision which neurovascular bundle should be preserved. Extracapsular extension (ECE), however, is often difficult to identify on images. The aim of this study was to find if MP-MRI is useful in predicting side-specific prostate cancer ECE or seminal vesicular invasion (SVI). Material & Methods: A consecutive group of 49 patients with prostate cancer diagnosed in needle biopsy, who underwent MP- MRI followed by radical prostatectomy was included in the study. The following clinical parameters were investigated: digital rectal examination, PSA and TRUS results, Gleason score, percentage of cancer in biopsy, presence and size of suspicious lesions in MP-MRI. Variable values have been determined for the right and left side of each prostate. Logistic regression analysis was used to assess value of those variables for predicting side-specific ECE or SVI. Results: Mean age of 49 patients was 65. ECE or SVI was found in 25 patients (51%) and in 30 prostate sides (30.6%). Logistic regression analysis revealed two independent predictors of side-specific ECE or SVI: percentage of cancer in biopsy (odds ratio 2.0; 95% confidence interval ) and maximal diameter of the tumor in MP-MRI (odds ratio 2.2; 95% confidence interval ). The model consisting of presence of >15% cancer in biopsy OR >15mm lesion suggestive for neoplasm in MP-MRI was characterized by 80% sensitivity, 71% specificity, 56% positive predictive value and 89% negative predictive value. Conclusions: Size of the tumor detected by MP-MRI increases ability of biopsy results to predict side-specific ECE or SVI which may affect the decision making on preserving neurovascular bundles. P005 Diagnostic accuracy of prostate histoscanning N. Arumainayagam 1, M. Mikhail 1, A. Shamsuddin 1,D.Nir 2, M. Winkler 1. 1 Charing Cross Hospital, Imperial College NHS Trust, Dept. of Urology, London, United Kingdom; 2 Imperial College London, Dept. of Bioengineering, London, United Kingdom Introduction & Objectives: Prostate HistoScanning (PHS) is a novel ultrasound-based tissue characterisation application which has the potential to confirm or rule-out prostate cancer. We aimed to evaluate the accuracy of PHS using whole-mount radical prostatectomy specimens as the reference standard. Material & Methods: Between July 2010 and November 2011, 46 men (median age 63 years and median PSA 7.74 ug/l) scheduled to radical prostatectomy within our institution, underwent PHS following TRUS imaging just before surgery. PHS axial images were overlaid onto corresponding digital axial images of each radical prostatectomy specimen, permitting cognitive correlation of PHS lesions with actual tumours on prostatectomy. Accuracy values were calculated at the octant, quadrant, and hemi-gland level. In addition we compared the accuracy of PHS between anterior and posterior prostate. Results: Overall accuracy was better in the posterior prostate (0.72) compared to the anterior gland (0.51). Sensitivity was 0.92 in the posterior gland. Conclusions: When it comes to the posterior part of the gland, PHS shows promise as an ultrasound imaging bio-marker for predicting presence of prostate cancer. P006 Diagnostic MRI prostate pre-biopsy is associated with a false negative rate K. Wadhwa 1, E. Serrao 2, J. Frey 3, F. Gallagher 4,B.Koo 4, C. Kastner 3. 1 University of Cambridge, Dept. of Oncology, Cambridge, United Kingdom; 2 University of Cambridge, Dept. of Radiology, Cambridge, United Kingdom; 3 Addenbrookes Hospital, Dept. of Urology, Cambridge, United Kingdom; 4 Addenbrookes Hospital, Dept. of Radiology, Cambridge, United Kingdom Introduction & Objectives: MRI technology is revolutionizing how we diagnose and manage prostate cancer in the UK. With the advent of MRI-guided biopsy, one important caveat is that of false negative scans: That is when the MRI has reported no lesion but the patient subsequently is found to have a tumour by biopsy. This study aims to determine the rate and causes of false negative prostate MRI exams in our centre. Material & Methods: 148 prostate MRI scans (with T2WI, DWI and ADC maps) from a tertiary referral centre, conducted in patients with suspected prostatic cancer, prior to transrectal ultrasound (TRUS)- guided biopsy were retrospectively reviewed and compared with histological Gleason grade (June 2011 to May 2013). Scans were reported by 5 radiologists, followed by a second reader who drew a region of interest (ROI) around the lesions to be biopsied (target lesion) according to a prostate MRI map (Dickinson L et al. European urology 59, 2011). At prostatic biopsy, specimens were labeled according Table 1. Distribution of lesion location and MRI classification of the affected sectors. Number of significant cancers missed on MRI and their correspondent classification Lesion location (sectors) 1 6 3L 4L 5L 10/46 11/46 6/46 6/46 6/46 MRI analysis MRI report Target lesion True miss 10 7 Non-specific features No features of a focal lesion Miscalled zone 3 1 Difficult interpretation 2 2 Total (lesions): MRI analysis Significant cancer MRI report Target lesion True miss 8/10 5/7 Non-specific features 8/12 6/10 No features of a focal lesion 11/19 10/15 Miscalled zone 2/3 0/1 Difficult interpretation 1/2 ½ Total (lesions): 30 out of out of 35 Abstract P005 Table 1 Level of analysis Accuracy values (95% CIs) Sensitivity Specificity PPV NPV Accuracy Octant 0.57 ( ) 0.69 ( ) 0.75 ( ) 0.50 ( ) 0.61 ( ) Quadrant 0.62 ( ) 0.73 ( ) 0.89 ( ) 0.35 ( ) 0.64 ( ) Hemi 0.98 ( ) 0.40 ( ) 0.97 ( ) 0.50 ( ) 0.95 ( )

36 110 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) to histological mapping (Kuru T et al. BJU Int. 112, 2013). The histology and location of each positive biopsy was compared with the MRI report. Sectors where positive cores were found were characterized (Table 1). Results: False negative lesions were identified in 28 exams out of 148 (18.92%; 46 lesions). This number was reduced by the second reader to 25 exams (35 lesions). Most false negative lesions were located in sector 1 (10/46) Table 1. Conclusions: Double reading reduced false negative lesions by 23.91% but many of the false negative lesions (15/46) were not MRI visible despite double-reading. This might be due to volume of diseased tissue required in each voxel, for the lesion to be detected and subtleness of areas of abnormality. Anterior lesions were more likely to be missed than lesions elsewhere within the prostate, as has previously been shown (Arumainayagam, N. et al. Radiology 268, 2013). MRI is still associated with a significant false negative rate and further work is indicated to improve diagnostic accuracy. P007 Transperineal biopsy prostate cancer detection in first biopsy and post-negative TRUS biopsy settings: The victorian transperineal biopsy collaboration experience W.L. Ong 1, M. Weerakoon 2, S. Huang 1, E. Paul 3, N. Lawrentschuk 4, M. Frydenberg 4, D. Moon 2, D. Murphy 2, J. Grummet 1. 1 Alfred Health, Dept. of Urology, Melbourne, Australia; 2 Peter MacCallum Cancer Centre, Dept. of Urology, Melbourne, Australia; 3 Monash University, Dept. of Epidemiology and Preventive Medicine, Melbourne, Australia; 4 Epworth Health, Dept. of Urology, Melbourne, Australia Introduction & Objectives: To present the Victorian Transperineal Biopsy Collaboration (VTBC) experience in patients with no prior prostate cancer diagnosis, assessing the cancer detection rate, pathological outcomes and anatomical distribution of cancer within the prostate. Material & Methods: VTBC was established through partnership between urologists performing transperineal biopsies of the prostate (TPB) at three institutions in Melbourne. Consecutive patients who had TPB, as first biopsy or repeat biopsy following previous negative TRUS biopsy, between September 2009 and September 2013 in the VTBC database were included in this study. Data for each patient was collected based on the minimum dataset published by the Ginsburg Study Group. Univariate and multivariate analyses were performed to identify factors predictive of cancer detection on TPB. Results: 160 patients were included in the study, of these 57 patients had TPB as first biopsy while 103 had TPB as repeat biopsy after previous negative TRUS biopsies. The mean patient age at TPB was 62, with the repeat biopsy patients having higher median serum PSA level and larger prostate volumes. Cancer was detected in 53% of first biopsy patients and 36% of repeat biopsy patients, of which 87% and 81%, respectively, were clinically significant cancers, defined as Gleason score of 7 or higher, or more than 3 positive cores of Gleason 6. 75% of cancers detected in repeat biopsies involved the anterior region, while 25% were confined exclusively within the anterior region; a lower proportion of only 5% of cancer detected in first biopsies were confined exclusively within the anterior region. Age, serum PSA level and prostate volume were predictive of cancer detection in repeat biopsies, while only age was predictive of cancer detection in first biopsies. Conclusions: TPB is an alternative approach to TRUS biopsy of the prostate, offering a high rate of detection of clinically significant cancer. TPB provides excellent sampling of the anterior region of the prostate, which is often under-sampled using the TRUS approach, and should be considered an option for all men in whom a prostate biopsy is indicated. P008 Histoscanning in diagnosis of prostate cancer, results for implementation in transperineal biopsies O.I. Apolikhin 1, A.V. Sivkov 1, G.D. Efremov 2, N.G. Keshishev 3, A.V. Koryakin 4. 1 Moscow Institute of Urology, Dept. of Innovative Technologies, Moscow, Russia; 2 Moscow Institute of Urology, Dept. of Patomorphology, Moscow, Russia; 3 Moscow Institute of Urology, Dept. of Oncology, Moscow, Russia; 4 Moscow Institute of Urology, Moscow, Russia Introduction & Objectives: A transrectal ultrasound (TRUS) biopsy is mostly performed on the basis of risen PSA and is often blind tissue specimens are taken from standard zones. Biopsy under MRI control is technically and logistically complicated and expensive, while TRUS can t always differentiate the suspicious areas. Histoscanning is already a well known diagnostic appliance, claimed to be very effective, but published data on its effectiveness is controversial. Material & Methods: Histoscanning was performed to 31 patients scheduled to transperineal biopsy. All these patients already had one to six negative TRUS biopsies although they still had clinical suspicion of PCa (risen PSA, HPIN in 4 cores, suspicious TRUS or DRE findings). Age range was 51 75, with PSA values ng/ml. Prostate size range 22 67cc. Most of the patients (n-26) from this group received 5α-reductase inhibitors for more than half year. The gland was divided into 18 zones and cores were taken. Lesion found on Histoscanning was defined as suspicious if its volume exceeded 0.2cc. Results: In all of the patients we registered suspicious lesions, so they were defined as Histoscanning positive. Histopathology identified PCa in 13 out of 31 patients (41.9%), with Gleason score 6 8. In 11 patients (35.4%) we found HPIN. Comparing histology reports to Histoscanning mapping, in 8 PCa cases (61.5%) we found high correlation of this method with histopathological study on the location of tumor lesions and in 5 cases (38.5%) Histoscanning showed greater spread of lesions. Conclusions: Histoscanning is a promising method for more effective targeted biopsy of the prostate, showing better results than biopsies performed under regular TRUS control. Further research should be aimed on comparing this method with MRI and transperineal saturation biopsy, resulting in answer on the question whether we could reduce the number of cores not sacrificing cancer detection. Based on our data we cannot give this recommendation so far. P009 The Rotterdam prostate cancer risk calculator: Improved prediction with more relevant pre-biopsy information, now in the palm of your hand N. Azevedo 1, M.J. Roobol 2. 1 University of Beira Interior, Dept. of Health Sciences, Covilhã, Portugal; 2 Erasmus University Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands Introduction & Objectives: The Rotterdam prostate cancer risk calculator (RPCRC, has been developed to risk stratify potential candidates for a prostate biopsy. To improve the user-friendliness and accessibility the risk calculator has been transformed to a mobile application, available on the Apple App Store and Google Play Store, and translated in several languages. Here we assess the change in predictive capability when using more relevant pre biopsy information in the form of a decision tree incorporated into the app. Material & Methods: Analyses are based on the biopsy outcome of 3,600 men screened for the first time and 2,910 men with a previous PSA test/biopsy within ERSPC, section Rotterdam. Predictive capability of models within the RPCRC app (1: PSA alone, 2: PSA+DRE, 3: PSA+DRE+DRE assessed volume, 4: PSA+DRE+TRUS+volume) were assessed in terms of discrimination (C-statistic) for both predicting the probability of PC on biopsy and serious PC (defined as >T2B and/or Gleason 7).

37 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P010 PI-RADS and local staging (T) of Pca A. Guerra 1, A. Gaspar 1, J.A. Vilhena Ayres 2, K. Maers 2, M.F. Coelho 2, R. Formoso 2,V.Vaz 2, F.M. Mascarenhas 3, M. Pantaroto 4, R. Vieira 5, P. Oliveira 6. 1 Hospital Da Luz, Dept. of Radiology, Lisbon, Portugal; 2 Hospital Da Luz, Dept. of Urology, Lisbon, Portugal; 3 Hospital Da Luz, Dept. of Radiotherapy, Lisbon, Portugal; 4 Hospital Da Luz, Dept. of Oncology, Lisbon, Portugal; 5 Hospital Da Luz, Dept. of Molecular Medicine, Lisbon, Portugal; 6 Hospital Da Luz, Dept. of Pathology, Lisbon, Portugal Results: Applying model 1 to model 4 resulted in AUC s of from 0.69 respectively 0.79 for predicting PC and AUC s for predicting serious PC of 0.74 respectively Similar data for men with a previous PSA test/biopsy were 0.62 respectively 0.69 for predicting PC and 0.69 respectively 0.82 for predicting serious PC, confirming that including more relevant information increases predictive capability. Introduction & Objectives: To retrospectively compare accuracy of multiparametric magnetic resonance imaging (mp-mri) for local staging prostate adenocarcinoma (Pca). We compare the results of the mp-mri exams, that were classified according PI-RADS (Prostate Imaging Report and Data System) scale and compared with histologic findings as reference standard, of all patients who underwent Robotic assisted prostatectomy during 2013 year. Material & Methods: We analysed 36 patients who underwent robotic prostatectomy in our institution during the year of these patients did mp MRI before surgery in our institution. The MR imaging was performed with 3T unit (Verio, Siemens) with the adequate ESUR protocol and data interpretation according to PI-RADS score. All histologic findings (36 patients were compare with the MRI findings (21 patients) and pre surgical staging findings of the 15 patients who had no mp-mri. Results: The mp-mri results were: 83% of sensibility, 87% of specificity and 86% of accuracy for detecting extra-prostatic evolvement of the Pca. Only 29% of patients with MRI had locally advanced disease (T3a) in histology compared with 63% (T3a and T3b) of the patients who underwent surgery without previous mp-mri, in our institution. Conclusions: Mp-MRI is an accurate method to stage locally Pca. P011 Transrectal ultrasound-guided prostate biopsy is it reliable for prostate cancer staging? H. Martins Pires Coelho, P. Temido, A.F. Mota. Centro Hospitalar E Universitário De Coimbra, Dept. of Urology and Renal Transplantation, Coimbra, Portugal Conclusions: The Rotterdam risk calculators, based on the robust data from the ERSPC, section Rotterdam, were developed with the prime objective of helping to reduce unnecessary biopsies and the over-diagnosis of indolent prostate cancers. The new mobile app takes this one step further, providing doctors and patients with an increasingly powerful tool which is easy to use and always accessible and available in their language. Introduction & Objectives: Despite its shortcomings transrectal ultrasound-guided prostate biopsy remains the gold standard investigation for diagnosing prostate cancer. As new less invasive therapeutic options arise (active surveillance, focal therapy, nerve-sparing RRP) can we trust the biopsy results alone to accurately stage prostate cancer? Material & Methods: A retrospective study of the patients submitted to radical retropubic prostatectomy (RRP) in the period between January 1st and December 31 of 2013 was performed. The results of the pathological study and previous biopsy were compared regarding Grade, Gleason, side, % of invasion and pt stage. Statistical analysis was performed using IBM SPSS Statistics v.22 Results: 118 patients were submitted to RRP in this period. The average age was years [43 75]. PSA mean was [2 160]. Average time between biopsy and surgery was 3.36 months. The size of the prostate mean was 47 cc. The Gleason score at biopsy was mostly 3+3 (37.5%) and 3+4 (45%) while the Gleason score at pathology report was mostly 3+3 (10.8%) e 3+4 (74.2%). Spearman s correlation coefficient was (p<0.05). In the biopsy 25% were right side only, 22% left side and 53 bilateral while after surgery 95% were bilateral. Spearman s correlation coefficient was (p=0.61). Biopsy grade was most frequently 2 (66.1%) and 1 (32.1%) while after surgery grade was 2 (82%) and 1 (10.6%). Spearman s correlation coefficient was (p=0.05). There was also correlation between higher invasion percentages and higher pt stages. Spearman s correlation coefficient was (p<0.05). Prostates with size larger than 50cc had a lower correlation coefficient regarding side and gleason score. With

38 112 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) PSA higher than 10 ng/ml Gleason score correlation is higher but not grade or laterality. Conclusions: Although there is a high correlation coefficient regarding gleason score and histological grade ultrasound guided biopsy tends to underestimate the gleason and grade. A good correlation between percentage of invasion and pt stage exists. There was a weak correlation regarding laterality. Prostate biopsy is more accurate in patients with smaller prostate sizes and higher PSA values. Based on this series, ultrasound guided prostate biopsy alone is not a reliable method for staging prostate cancer, especially when proposing less invasive therapeutic modalities. P012 Relationship between baseline IPSS and genitourinary toxicity from prostate Stereotactic Body RadioTherapy (SBRT) A. Martos 1, A. Tree 2, N. Van As 2. 1 Hospital General De Albacete, Dept. of Radiotherapy Oncology, Albacete, Spain; 2 The Royal Marsden Hospital, Dept. of Radiotherapy Oncology, London, United Kingdom Introduction & Objectives: SBRT is an emerging therapy for patients with early stage prostate cancer and may reduce the dose to normal tissues whilst maximizing tumour coverage. Symptoms of acute genitourinay (GU) toxicity such as frequency ad dysuria are seen in around 30% of patients after SBRT. An increased IPSS is reported by the patients during the acute toxicty period. We analized different dosimetric parameters potentially related to urinary toxicity, to determine the influence of this, and try to define dosimetric criteria to minimize side effects. Material & Methods: 29 plans from patients with early stage prostate cancer treated with SBRT to a dose of 3625 cgy in 5 fractions were reviewed. We collected data of several dosimetric parameters, (D10cc bladder, D3cc bladder, V42Gy urethra, V40Gy urethra). Patients were not catheterized, the urethra was seen or extrapolated on the planning MRI. IPSS at baseline and every 2 weeks for 12 weeks after the commencement of the treatment had been recorded. We compared IPSS rise with baseline IPSS and IPSS rise and maximum with the different dosimetric parameters. Linear regression has been used. Results: Baseline IPSS is found to be correlated with IPSS rise after treatment (p=0.01). We compared the rise in IPSS with dosimetric parameters of Urethra V42 Gy and V 40 Gy and there was no correlation seen. We obtain the same results if we compare the relationship between maximum IPSS with V42 Gy and V40 Gy. Conclusions: Baseline IPSS is correlated with IPSS rise after treatment and could be used to identify those at higher risk of urinary toxicity in the acute phase. No dosimetric parameters have yet been identified which predict for acute GU toxicity. With larger number of patients it s posible to demonstrate higher urinary symptoms as higher as baseline IPSS. Improving IPSS before beginning treatment may be advisable in this cohort. P013 Rectal distension on prostate radiotherapy planning CT scan is not a negative prognostic factor in the modern era of image guided radiotherapy K. Johnson, C. Perry, R. Silverman, S. Sundar. Nottingham City Hospital, Dept. of Clinical Oncology, Nottingham, United Kingdom Introduction & Objectives: Rectal distension on a planning CT scan is considered to be a poor prognostic factor, mostly likely due to geographical misses caused by prostate movement. We tested the hypothesis that frequent imaging during modern radiotherapy and replanning CT scans would alleviate the risk caused by rectal distension. Material & Methods: The study included 172 patients whose rectal diameter, (AP and Lateral) was prospectively measured on the midplane of a radiotherapy planning CT scan. Patients were treated with 2 phase 3D conformal radiotherapy between the years 2006 and Patients whose rectal diameters were more than 4.5 cm had a repeat planning CT scan for phase 2. Post operative patients were treated with a single phase radiotherapy plan. Daily imaging with Theraview software was carried out during the first week of radiotherapy and if this was satisfactory weekly imaging was done throughout the subsequent course of radiotherapy. Patients electronic medical records were then reviewed up to March 2014 for evidence of biochemical PSA progression (defined as 3 consecutive rises in PSA). Results: In our cohort the median age was 69 years. 75.9% of the total cohort were in the high risk category (as per NICE criteria). The low risk group only contained 4 patients so was combined with the moderate risk group for further analysis. No patient had metastatic disease. The most frequent T stage was T3b (18.3%). The median gleason score was 7. Median PSA at presentation was ng/ml (range 2.4 to 467). Median rectal AP diameter was 3.80 cm (range cm) and median lateral diameter was 3.50 cm (range cm). The median total dose of radiotherapy was 70 Gy (range Gy). Median follow up was 72 months, in which 41 (26.1%) patients had a PSA progression. An independent T Test showed no significant affect of rectal diameter on PSA progression (AP (p=0.309); lateral (p=0.605)). Multivariate analysis showed no significant affect on PSA progression from rectal diameter (AP (p=0.449); Lateral (p=0.646)); age (p=0.600) or use of hormones (p=0.224). When patients were assessed for biochemical relapse no difference was observed in relapse rate for those with a distended rectum. Conclusions: Our mature long term follow up results indicate that rectal distension is not a negative prognostic factor in the era of image guided radiotherapy. P014 Salvage robotic prostatectomy after brachytherapy M. Fajardo Paneque, C.B. Congregado Ruiz, J.M. Conde Sánchez, C. Corchuelo Maillo, I. Osmán Sánchez, J.M. Pena Outeiriño, R.A. Medina López. Universitary Hospital Virgen Del Rocio, Dept. of Urology, Seville, Spain Introduction & Objectives: Salvage radical prostatectomy has become a feasible option for patients with biochemical relapse after low-dose rate brachytherapy for localized prostate cancer. The aim of this study is to review our serie of salvage radical prostatectomies after low-dose rate brachytherapy with curative intent, in patients with low risk localized prostate carcinoma, and to compare oncologic outcomes, functional and surgical complications between open salvage radical prostatectomy (SRP) and robotic-assisted laparoscopic prostatectomy (sralp). Material & Methods: Descriptive and comparative study of 15 patients who underwent salvage radical prostatectomy between December 2009 and May Recurrence was confirmed by biopsy. Metastatic disease was discard prior to surgery. 8 patients underwent SRP and 7 patients sralp. We analyzed clinical and oncologic parameters at diagnosis and at relapse, peri-operative complications, hospital stay and functional data, and pathologic characteristics. Results: Median follow-up: months in SRP, 11 months in sralp. Both groups were homogeneous in clinical stage, PSA and Gleason at diagnosis and at relapse. Peri-operative considerations and complications are described in Table 1. Table 1 Lymphad- Length Complications Anastomotic Anastomotic enectomy of stay Clavien I II Clavien III leak stricture (days) SRP (n=8) 2 (25%) 5 3 (37.5%) 1 (12.5%) 3 (37.5%) 1 (12.5%) sralp (n=7) 4 (57.1%) 4 2 (28.5%) 0 2 (33.3%) 0 Table 2 provides pathologic characteristics. None PSA recurrence has been detected. There has been no exitus in this cohort until date. Functional data (urinary continence and sexual function) showed no differences in both groups (Table 3).

39 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Abstract P014 Table 2 Persistence disease: PSA 0.1 ng/ml ptstage Gleason score Pathologic node Positive surgical margin Seminal vesicle Extra-capsular extension and adjuvant hormonal therapy status (p=0.01) invasion (p=0.04) SRP (n=8) 1 (12.5%) 7T2c 5 (3+3) N+1 1 (12.5%) 0 1 (12.5%) 1T3a 2 (3+4) N 1 1 (4+5) Nx6 sralp (n=7) 3 (42.9%) 2T2c 1 (3+3) N+0 6 (85.7%) 2 (33.3%) 5 (71.4%) 3T3a 2 (3+4) N 4 2T3b 3 (4+3) Nx3 1 (4+4) Table 3 Mild UI: Moderate UI: Severe UI: ED potent ED impotent 0 1 ppd 2 3 ppd >3 ppd with PDE5Is with PDE5Is SRP (n=8) 2 (25%) 1 (12.5%) 5 (62.5%) 4 (50%) 2 (25%) sralp (n=7) 3 (42.9%) 0 3 (42.9%) 1 (14.3%) 4 (57.1%) UI: urinary incontinence; ppd: pad per day; ED: erectile dysfunction; PDE5Is: Phosphodiesterase 5 inhibitors. Conclusions: We observed a higher percentage of locally advanced disease in robotic surgery patients, associated with an increase in positive surgical margins in this group (p=0.01).a trend to a greater rate of complications was seen in open surgery. P015 Prostate hypofractionated stereotactic ablative body radiotherapy: Disease control and quality of life at 6 years G. Beltramo, A. Bergantin, A.S. Martinotti, C. Vite, F. Ria, M. Invernizzi, L.C. Bianchi. Centro Diagnostico Italiano, Dept. of Cyberknife, Milan, Italy Introduction & Objectives: Hypofractionated Stereotactic Radiotherapy may yield disease control for prostate cancer without increasing treatment toxicity. We tested Cyberknife Stereotactic Radiotherapy Treatment in men with prostate cancer. Material & Methods: From July 2007 through September 2012 a retrospective analysis was carried out on 139 consecutive patients with a median age of 76 years (range 60 86) years, mean prostate volume of 64.7 cc (range ), and clinically localized prostate cancer. The majority of patients 73 (53%) were low risk, 40 pts (29%) were intermediate risk and 26 pts (19%) were high risk using the NCCN criteria. Pre-treatment PSAs ranged from 1.75 to ng.ml (median 7.6 ng.ml). Among the entire study cohort 11 of 26 high risks received Androgen Deprivation Therapy (ADT). The course of radiotherapy consisted of 3800 cgy over four fraction given daily. Results: Acute urinary symptoms (frequency, disurya, urgency, hesitancy) were common with 51% of patients (71 pts) experiencing grade I-II RTOG toxicity. No patients experienced RTOG grade 3 acute urinary toxicity. In 22% of patients (31 pts) RTOG late grade I-II urinary toxicity was observed, in 5 patients (4%) RTOG late grade 3 urinary toxicity was recorded. No RTOG grade 3 acute and late rectal toxicity was observed. Six patients (5%), one with prior Turp, experienced incontinence. PSA decline after Cyberknife stereotactic radiotherapy gradually fell to an overall median of 0.20 ng/ml, at 30 months. The actuarial median follow up is 40 months (range months). The six years actuarial psa relapse free survival rate is 96.1% (CI: 94.3%-97.9%) with 100% for low risk, 89.3% for intermediate risk and 96.2% for high risk respectively. No added benefit of Androgen Deprivation Therapy (ADT) was observed for high risk group. To date 5 patients failed biochemically. One intermediate risk patient revealed local relapse 30 months after Cyberknife treatment. Two patients developed bone metastases, one died, in 2 patient we observed lymph node dissemination. All patients are alive except for twelve that died of unrelated causes. Conclusions: Cyberknife Stereotactic Radiotherapy produces excellent biochemical control rates at up to 6 years with mild toxicity and minimal impact on quality of life. PSA relapse free survival rates after Cyberkife radiotherapy compare very favourably with other radiation modalities and strongly suggest durability of our results. P016 Switching from conventional laparoscopic to robot-assisted laparoscopic prostatectomy in a single surgeon setting. Is it worth it? A. Verbrugghe 1,D.Ost 2, K. Maes 2. 1 UZ Leuven, Dept. of Urology, Leuven, Belgium; 2 AZ Sint-Blasius Dendermonde, Dept. of Urology, Dendermonde, Belgium Introduction & Objectives: To compare perioperative, oncological and functional outcomes of laparoscopic radical prostatectomy (LRP) versus robot-assisted laparoscopic prostatectomy (RARP) in a single institution. Material & Methods: We retrospectively reviewed three groups in a single institution, single surgeon setting, each consisting of 50 patients. The first group consisted of the first 50 LRPs out of in total 193, which were performed between April 2001 and February The last 50 LRPs are denominated as the second group (April September 2008). The third group consisted of the first 50 RARPs, performed from March 2009 till May Patients were preoperatively characterized by BMI, age, PSA, prostate size and gleason score. Postoperative evaluation was performed at 3, 6, 9, 12, 18 and 24 months and annually thereafter. Intra- and peri-operatively we studied hospital stay, catheterisation time, operative time, transfusion rate, the number of performed lymphadenectomy and presence of nerve sparing surgery. We analysed functional (continence rate, potency rate) and oncological (surgical margins) outcomes. Results: There was no difference in patient characteristics. There was a reduction in the mean operative time from 259 minutes in the first LRP group to 219 in the RARP group (p=0.001).hospital stay was reduced from 10.6 days in the first LRP group to 8.8 days in the RARP group (p=0.007). Bladder catheterization also reduced from 8 days in the first LRP group to 6.3 days in the in the RARP group (p=0.04). There was no difference in the overall number of complications. Overall continence rate at the last consultation was respectively 64%, 78% and 78% for the first LRP, second LRP and RARP group (p>0.05). Continence rates remain stable even for pt3 tumours especially in the RARP group (first LRP group:64%, second LRP group:75%, RARP group:83%) (p>0.05). Superior potency rates were seen in the RARP group compared to the second LRP group, respectively 60% versus 35% (p=0.02). No difference was seen in the potency rates in the unilateral nerve sparing group, 33% potency in the second LRP group and 36% in the RARP group. Statistically significant higher potency rates were seen in the RARP group concerning bilateral nerve sparing surgery (p=0.06).there was no difference in overall positive surgical margins, 24% for the first LRP group, 18% for the second LRP group and 20% for the RARP group (p>0.05). There were less positive surgical margins in the RARP group (33%) in comparison to the first LRP group (64%), concerning pt3 tumours (p=0.004). Conclusions: Shifting from LRP to RARP for localised prostate cancer results in comparable overall continence rates (78%) and positive surgical margins (20%), but shorter operative time (219 min), less positive surgical margins for pt3 tumours (33%) and superior potency rates (60%).Limitations of the study are the retrospective character,

40 114 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) the absence of validated questionnaires and the relatively short follow up of the RARP group. P017 Patient decision-making prior to radical prostatectomy: What is and is not involved and the role of the urologist C. Öbek 1, C. Dogan 1, H. Gultekin 1, S. Erdogan 2, H. Ozkara 1, Z. Talat 1, A. Erozenci 1, V. Yalcin 1. 1 Cerrahpasa School Medicine, Dept. of Urology, Istanbul, Turkey; 2 Cerrahpasa School Medicine, Dept. of Public and Occupational Health, Istanbul, Turkey Introduction & Objectives: It is essential to ensure that men have access to balanced information before choosing a particular therapy for localized prostate cancer to allow for maximum patient satisfaction. We assessed the decision-making process prior to surgery with emphasis on patient perspectives and enquired whether patients were satisfied with their physician s approach during this tough period and the outcomes of surgery. Material & Methods: Telephone interview was conducted with 162 consecutive patients who underwent radical prostatectomy with a diagnosis of clinical T1-3 prostate cancer. A database was established and analyzed on pre and post-operative patient variables and interview results. Results: Of 145 patients evaluated, 23% were unaware of cancer diagnosis. Radiation and active surveillance was presented as alternative options to 39 and 14%, respectively. Difficulty during decision was reported by 18%. Decision for surgery was made by the urologist 42%, patient 30% and shared 28%. Patients definition of effective treatment was preservation of quality of life 32%, extension of lifetime 29% and a combination of both 38%. Patient perception was that information provided by their urologist was not sufficient/satisfactory in 15%, side effects were not discussed at all in 18%; 39% wished side effects were illuminated in more detail. In efforts to increase their level of awareness, 47% did research from various sources, while 41% sought opinion from others. Wife impacted on decision in 60% of married patients. Importantly, 16% regretted having undergone surgery and regret was significantly more common when the patient was not involved in the decision process. Conclusions: Urologists should be mindful of the prospects of prostate cancer patients in their community and devote more effort to fulfill their expectations. There seems to be room for improvement on topics such as moving from paternalism to more shared-decision making and informing patients in more detail on management alternatives along with side effects and complications. P018 To what extent urologists embrace active surveillance for low risk localized prostate cancer at an academic center? C. Öbek 1, C. Dogan 1, H. Gultekin 1, S. Erdogan 2, H. Ozkara 1, Z. Talat 1, A. Erozenci 1, V. Yalcin 1. 1 Cerrahpasa School of Medicine, Dept. of Urology, Istanbul, Turkey; 2 Cerrahpasa School of Medicine, Dept. of Public and Occupational Health, Istanbul, Turkey Introduction & Objectives: EAU, AUA and NCCN guidelines suggest that active surveillance is a viable management option which should be offered to patients diagnosed with low risk localized prostate cancer (LRPC). We reviewed data on patients who were diagnosed with LRPC and underwent radical prostatectomy. We assessed whether they recalled being offered active surveillance as an option. Material & Methods: All patients who underwent radical prostatectomy with a diagnosis of localized prostate cancer between April 2009 and September 2013 were contacted by telephone by a neurologist (same person) who was not involved in the patients management. He asked each patient the same set of questions. A database was established on pre and post-operative variables and responses to telephone interview. LRPC was defined as ct1-2a, Gleason score 6, PSA 10, 3 cores positive for cancer and 50% core involvement. LRPC patients were analyzed regarding having been offered active surveillance as an option during the process of decision for management. Results: A total of 162 surgeries were performed; 17 were excluded from analysis (unable to reach 8, Alzheimer 1, pre-op urethral catheter 4, renal transplant nominee 1, very recent surgery 2, deceased with colon cancer 1). Of the remaining 145, 36 fulfilled LRPC criteria. Mean age was 60.5 years, PSA 5.4 ng/ml, and time after surgery 14.1 months. Seven (19%) patients recalled having been offered active surveillance as an option. Regret for having undergone surgery was reported by 14%. An additional 5% reported ambivalent feelings on regret about their decision for surgery. Conclusions: These results suggest that urologists do not appear to have readily embraced active surveillance as a management option for patients with low risk localized prostate cancer. These results reflect the practice at a university hospital in Istanbul and may not necessarily be generalized. P019 Multi-variable models predicting specific patient-reported acute urinary symptoms after radiotherapy for prostate cancer: Ad interim results of a cohort study C. Cozzarini 1, T. Rancati 2, V. Carillo 3, F. Civardi 2, E. Garibaldi 4, P. Franco 5, B. Avuzzi 6, C. Degli Esposti 7, G. Girelli 8, C. Iotti 9, F. Palorini 3, V. Vavassori 10, R. Valdagni 11, C. Fiorino 3. 1 San Raffaele Scientific Institute, Dept. of Radiotherapy, Milan, Italy; 2 Fondazione IRCCS Istituto Nazionale Dei Tumori, Prostate Cancer Program, Milan, Italy; 3 San Raffaele Scientific Institute, Dept. of Medical Physics, Milan, Italy; 4 IRCCS Candiolo, Dept. of Radiotherapy, Candiolo, Italy; 5 Ospedale Regionale U. Parini-AUSL Valle D Aosta, Dept. of Radiotherapy, Aosta, Italy; 6 Fondazione IRCCS Istituto Nazionale Dei Tumori, Dept. of Radiotherapy, Milan, Italy; 7 Ospedale Bellaria, Dept. of Radiotherapy, Bologna, Italy; 8 Ospedale ASL9, Dept. of Radiotherapy, Ivrea, Italy; 9 Arcispedale S. M. Nuova, Dept. of Radiotherapy, Reggio Emilia, Italy; 10 Cliniche Gavazzeni-Humanitas, Dept. of Radiotherapy, Bergamo, Italy; 11 Fondazione IRCCS Istituto Nazionale Dei Tumori, Radiotherapy and Prostate Cancer Program, Milan, Italy Introduction & Objectives: A multi-centric cohort study started in 2010 with the goal of developing predictive models of genito-urinary (GU) toxicity and of erectile dysfunction after high dose radiotherapy for prostate cancer. The aim of this ad-interim analysis was to assess correlations between clinical/dosimetric risk factors and acute urinary symptoms as measured by the International Prostate Symptom Score (IPSS). Material & Methods: IPSS was prospectively filled in before and at the end of radiotherapy; relying on previous studies, absolute (cm 2 ) weekly bladder dose-surface histograms (DSHw) were chosen as dosimetric descriptors. Relevant clinical factors were prospectively collected including concomitant morbidities/drugs, androgen deprivation (AD), previous abdominal surgery, smoking, alcohol, age and BMI. Backward feature selection based on prediction optimization (minimization of residual) was used to select variables to be included in seven logistic models predictive of symptoms corresponding to each of the IPSS questions: moderate-severe symptoms (scores 4) were considered as end-points. Results: Complete data of 262 patients (120 treated with conventional fractionation (1.8Gy/fr, median:78gy) and 142 with hypofractionation ( Gy/fr, 71.4Gy, HYPO)) were available. Smoking was a predictor for feeling of incomplete emptying (OR=6.20), frequency (OR=2.94), intermittency (OR=2.71), urgency (OR=2.81) and straining (OR=2.37); AD and use of anti-hypertensive drugs were risk factors for intermittency (OR=4.3) and weak stream (OR=1.95) respectively. The baseline score (ranging between 0 and 5) was a major predictor for all symptoms apart intermittency (ORs= ). DSHw parameters were correlated to an increased risk of frequency, intermittency, urgency and nocturia. Models showed moderate-high discriminative power (AUC: ) and were sufficiently robust

41 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Abstract P019 Figure 1 (boostrap-based optimism: 2 6%). Dose-response relationships as a function of clinical risk factors is shown in figure. Main results were confirmed even when excluding patients with severe baseline symptoms; the impact of DSHw was stronger for HYPO. Conclusions: Smoking and other clinical and dosimetry factors predict for specific moderate-severe acute urinary symptoms; baseline condition heavily modulated the risk in 6 out of 7 end-points. P020 The effect of the bladder take down on vesicourethral anastomosis and urinary incontinence in patients with localized prostate cancer K.K. Park, S.D. Kim, Y.J. Kim, J.S. Huh. Jeju National University Hospital, Dept. of Urology, Jeju-Si, South Korea Introduction & Objectives: Postoperative urinary incontinence after robot assisted radical prostatectomy (RALP) is one of the most bothersome complication, that affects to patient s daily life. Time to recovery from postoperative urinary incontinence is important in patients satisfaction. We evaluate the effect of degree of bladder takedown on urethrovesical anastomosis and continence. Material & Methods: We prospectively analyzed 60 patients who underwent robot assisted laparoscopic prostatectomy for prostate cancer at our instititute from March 2013 to August Patients were randomly assigned into two groups, Group I, 30 patients underwent deperitonization of lateral of bladder above the level of vas until exposing the both vas, the group II was done below it and cutting the vas. We compared the anastomosis time and postop continence. Defining continence as patients being pad free, continence at 1, 3, and 6 month were checked. Results: There were no significant differences in age, body mass index, membranous urethral length, prostate volume, results of neurovascular bundle saving and between urethrovesical anastomosis leaking between both groups. Anastomosis time were mean 25.5 min (16 35min) in group I and 23.4 min ( min) in group II (P=0.654). Cumulative number of patients, who recovered from incontinence at postoperative 1, 3, and 6 months in group I, were 9 (30%), 14 (46.6%) and 22 (73.3%), respectively. In group II, cumulative number of patients were 10 (33.3%), 16 (53.3%) and 21 (70%), respectively. There was no difference in time to recovery of urinary incontinence between two groups. Conclusions: more wide deperiotonization of bladder lateral attachment would not meaningful affect the result of urethra-vesical anastomosis and continence in RLRP. P021 Rectal diameter on staging scan can predict risk of requiring rescan at radiotherapy planning for radical radiotherapy to the prostate: Test and confirmatory datasets C.J. Thompson 1, A. Lewis 2, A.A. Cree 1, J. Stratford 1, A. Choudhury 1, P.A. Elliott 1. 1 The Christie NHS Foundation Trust, Dept. of Clinical Oncology, Manchester, United Kingdom; 2 Central Manchester University Hospitals NHS Foundation Trust, Dept. of Medicine, Manchester, United Kingdom Introduction & Objectives: Patients with large anterior posterior rectal diameter (RD) at the time of CT planning scan (RTP) for prostate radiotherapy may exhibit more variability in rectal size and prostate position during treatment, potentially changing dose received by the rectum and prostate. At this centre patients with a RD of >4 cmat mid prostate at RTP undergo rescan after dietary advice/laxative intervention. We have previously reported a dataset examining the relationship between RD on staging imaging and RTP. Here we report results from a confirmatory study.

42 116 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Material & Methods: 89 consecutive patients who had RTP scan between September 2011 and April 2012 and had undergone cross sectional radiological staging within 6 months of RTP were identified. RD at mid prostate was measured on staging scan and initial RTP. Correlation between these measurements was assessed and sensitivity, specificity and positive predictive value (PPV) calculated for a RD of >4 cm and >3.5 cm at staging scan to predict a RD of >4 cm at RTP. This confirmatory dataset was compared with the test dataset. Results: 29 patients had a RD of >4cm and 41 >3.5cm at staging. At RTP 39 patients had a RD >4cm, indicating the need for intervention and rescan. Mean RD at staging scan was 4.10 cm (range cm) and at RTP was 3.99 cm (range cm), consistent with our previous study. We demonstrated a weak correlation between RD at staging and RTP with a correlation coefficient of 0.35, slightly lower than the value of 0.55 in our initial study. Sensitivity, specificity and PPV results from both studies are shown in Table 1. Table 1. Rectal diameter (RD) at staging CT scan and radiotherapy planning scan (RTP) RTP RD >4cm RTP RD >4cm Confirmatory study Initial study Staging RD >3.5cm: Sensitivity 72% 78% Specificity 74% 64% PPV 68% 59% Staging RD >4cm: Sensitivity 56% 62% Specificity 86% 82% PPV 76% 70% Conclusions: This data confirms that using a criteria of RD>3.5 cm on staging scan would have clinical utility, correctly identifying 72% of patients who would go on to require rescan due to a RD of >4cmat RTP and might therefore benefit from intervention. As the intervention triggered does not have a significant detriment to the patients and is of low cost, the PPV (68%) would be clinically acceptable. The relatively weak correlation between RD at these two time points may in part be due to dynamic rectal filling. Other data published looking at RD at planning and on treatment, published by Stille et al, suggests that in fact RD at RTP does not reliably predict RD during treatment, supporting this conclusion. We therefore plan further studies to assess the impact of RD at RTP on RD and prostate position during treatment and whether intervention to reduce RD reduces variability in RD during treatment. P022 Comparison of short term oncological and functional outcomes between open and robotic-assisted radical prostatectomy for localized postate cancer in the victorian prostate cancer registry W.L. Ong 1, S. Evans 2, D. Murphy 3, P. Kearns 4, J.L. Millar 2. 1 Alfred Health, Dept. of Urology, Melbourne, Australia; 2 Monash University, Dept. of Epidemiology and Preventive Medicine, Melbourne, Australia; 3 Peter MacCallum Cancer Centre, Dept. of Urology, Melbourne, Australia; 4 Barwon Health, Dept. of Urology, Geelong, Australia Introduction & Objectives: We aimed to compare the short-term oncological and functional outcomes between prostate cancer patients treated with open (ORP) and robotic-assisted (RARP) radical prostatectomy in a population-based study. Material & Methods: We studied consented registered men in the population-based Victorian Prostate Cancer Registry (PCR). The oncological outcomes of interest were the positive surgical margin (PSM) and biochemical recurrence (BCR) rate, defined as any post-operative serum PSA >0.2ng/mL. The functional outcomes of interest were the urinary and sexual function, assessed using the bother items adapted from the Expanded Prostate Cancer Index Composite (EPIC) at 12-month after diagnosis. Weighted propensity score method was used to adjust for differences in characteristics between ORP and RARP patients, including age at diagnosis, serum PSA level, biopsy Gleason score, clinical stage, hospital type (public/private and rural/metropolitan), year of surgery and surgeon volume. Logistic regression was used to analyse the PSM. Cox proportional hazard regressions were used to estimate the effect of ORP/RARP on BCR. For sexual and urinary function, ordered logistic regressions were used, treating each level of bother as ordinal category. All models also employed the robust standard errors, to allow for patient clustering by surgeons. Results: Between January 2009 and June 2012, 1211 (54%) patients who had ORP and 1022 (46%) patients who had RARP as their primary treatment within 12-month of diagnosis were included in the study. ORP and RARP patients had a median follow-up of 11.6 months and 7.7 months respectively. There was a significantly higher proportion of NCCN low risk prostate cancer among RARP patients (28%) compared to ORP patients (23%) (P<0.01). In the propensity score adjusted analyses, RARP patients had lower PSM rate (OR=0.46; 95% CI = ). There was also a lower risk of BCR among RARP patients (HR=0.75; 95% CI = ) after adjusting for pathological stage and PSM. 60% of ORP patients and 59% of RARP patients reported moderate-big sexual bother at 12-month, whereas 14% of ORP patients and 11% of RARP patients reported moderatebig urinary bother at 12-month. In multivariate analyses, there is a non-statistically significant trend towards lower sexual and urinary bother among RARP patients compared ORP patients. Conclusions: Our large population-based comparative study on ORP and RARP showed that RARP patients had lower risk features compared to ORP patients. Despite adjustment with propensity score technique, RARP patients had significantly better short-term oncological outcomes. There were no significant differences in the functional outcomes. P023 Correlation between planning scan rectal diameter and long term control in prostate cancer J.M. Mcgrane 1, R. Srinivasan 2, D.J. Sheehan 2, R. Powell 2, I.F. Fraser 2. 1 Royal Cornwall Hospital, Dept. of Oncology, Truro, United Kingdom; 2 Royal Devon & Exeter Hospital, Dept. of Oncology, Exeter, United Kingdom Introduction & Objectives: Pronounced rectal distension during radiotherapy for prostate cancer is associated with inter-fraction prostate motion during a radiotherapy treatment course. This motion can increase the chance of radiotherapy geographical miss during treatment causing decreased planning target volume coverage which reduces rates of biochemical and local control. Aims: We looked at rate of biochemical relapse free survival (BRFS) after radical radiotherapy for prostate adenocarcinoma and what factor seemed most associated with biochemical relapse. The factors assessed were maximum rectal diameter on radiotherapy planning scan or presenting prostate cancer risk stratification group. Material & Methods: 3 months of consecutive patients who received radical prostate radiotherapy from July 2010 were retrospectively assessed at the Royal Devon and Exeter Hospital. Biochemical relapse was defined in 2 ways; i) The Phoenix definition of PSA nadir +2 mg/ml or ii) the ASTRO definition of 3 consecutive PSA rises. The patient s maximal rectal diameter at any point of the planning target volume (PTV) was recorded as well as the Gleason grade, PSA, T-stage to assess prostate cancer risk startification group (see table below). Whether the patient had adjuvant hormone treatment with LHRH analogues was also recorded. Results: 33 patients were identified. 1 patient was ineligible due to discovery of symptomatic bone metastases during radiotherapy and another patient was ineligible as they had positive lymph nodes Table 1 PSA Gleason grade T-stage Low <10 & 6 T1-T2a Intermediate or 7 T2b High 20+ or 8 10 T2c+

43 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Abstract P023 Table 2 Patient Adjuvant LHRHa duration Phoenix failure Time to bf Phoenix ASTRO failure Time to bfastro Risk group Rectal diameter (months) (months) (cm) 1 12 Yes 30 Yes 18 High Yes 42 Yes 24 High No Na Yes 19 High na No Na Yes 19 Intermediate 3.52* 5 na No Na Yes 12 Intermediate 5.0 *PSA has returned to normal without treatment likely PSA bouce effect. treated, 1 further patient was lost to follow-up (n=30). The maximum rectal diameter range was cm (5.2cm median). No patients were in the low risk category, 15 patients were in the intermediate group and 15 patients were in the high risk group. PSA range was (median PSA 15.8 mg/ml). Biochemical failure group2 patients met the Phoenix bf criteria and 5 patients met the ASTRO bf criteria. Median rectal diameter for the bf group was 5.3 cm. Biochemical relapse free (BRF) group: 25 (83%) patients have no evidence of biochemical relapse. 12 high risk and 13 intermediate risk patients. 15 of which had adjuvant hormones ranging between 12 and 36 months as tolerated. Rectal diameter ranged from 3.0 to 8.0 cm (median 5.2 cm) Conclusions: There was no significant difference between the rectal diameters in the bf and the BRF group. The patients risk stratification seems to play a more dominant effect in bf allowing for the small number of patients in this series. In the era of image guided radiotherapy correcting for rectal ditension we propose that gleason grade, PSA and T-stage will have a much stonger impact on rates of bf than rectal distension. P024 Late rectal toxicity after RT for prostate cancer: Case of patients with moderate/severe basal symptoms G. Fellin 1, T. Rancati 2, V. Vavassori 3, C. Fiorino 4, R. Valdagni 5. 1 Ospedale Santa Chiara, Dept. of Radiotherapy, Trento, Italy; 2 Fondazione IRCCS Istituto Nazionale Dei Tumori, Prostate Cancer Program, Milan, Italy; 3 Cliniche Humanitas-Gavazzeni, Dept. of Radiotherapy, Bergamo, Italy; 4 San Raffaele Scientific Institute, Dept. of Medical Physics, Milan, Italy; 5 Fondazione IRCCS Istituto Nazionale Dei Tumori, Prostate Cancer Program and Radiotherapy, Milan, Italy Introduction & Objectives: To evaluate long term late rectal bleeding and late fecal incontinence after high-dose RT for prostate cancer in a population of patients with moderate/severe gastrointestinal (GI) symptoms before RT. Material & Methods: A prospective multicentre observational study was previously conducted with the aim of finding clinical/dosimetry predictors of late rectal toxicity. Late toxicity was evaluated with a self-reported questionnaire filled in by the patients before RT and at different times up to 7 years after RT. The delivered doses ranged between 70 and 80 Gy ( Gy/fr). Individual information on comorbidity, previous abdominal surgery, use of drugs and rectal DVHs was available. Predictive models for toxicity were previously developed for the population with no/mild basal GI symptoms. We here consider the subpopulation of patients with moderate/severe basal GI symptoms and the evolution of rectal morbidity in this group. Results: 1132 patients were enrolled in the trial, 81/1132 (7%) had moderate/severe basal GI symptoms (including high stool frequency, diarrhoea, tenesmus, rectal pain, rectal bleeding and fecal incontinence). 48/81 patients have data at 3 year follow-up, while 29/81 have 7 year follow-up information. In particular 10/81 patients exhibited severe basal fecal incontinence (use of pads) and 5/81 reported daily rectal bleeding before RT. 8/10 patients with severe fecal incontinence at RT beginning still had this complain one month after RT end, while at 3 year follow-up nobody in this group had moderate/severe incontinence, with only one patient exhibiting chronic grade 1 incontinence at 7 year follow-up. 2/5 patients complaining with severe rectal bleeding at RT beginning still had daily bleeding one month after RT end. At 3 year follow-up no grade 2 3 bleeding was registered in this subgroup and at 7 year follow-up no rectal bleeding at all was scored. The rates of grade 2 3 bleeding and incontinence in this population (48 patients having 3 year follow-up) are 6.3% and 2%, respectively. These rates are very similar to those that were registered for the population having no/mild symptoms at the basal level (7% and 3% for bleeding and incontinence, respectively). Due to the very low number of events, it was not possible to look for clinical/dosimetric predictors of late toxicity in this particular cohort. Conclusions: The availability of a large prospectively followed cohort of patients gave us the almost unique possibility to focus on the evolution of rectal toxicity after RT for prostate cancer for patients exhibiting moderate/severe GI symptoms before RT. The results suggest that severe fecal incontinence and bleeding registered at RT beginning had a transient nature which was not exacerbated by RT dose. The 3 year incidence of late rectal bleeding and fecal incontinence in this particular cohort was very similar to that reported for the cohort of patients with no/mild basal GI symptoms (i.e. 6% and 2%, respectively). P025 Predictors of upgrading/upsizing in low-risk prostate cancer patients on active surveillance: Validation of a model T. Rancati 1, M.F. Alvisi 1, N. Nicolai 2, G. Conti 3, M. Gallucci 4, G. Martorana 5, M. Tanello 6, R. Sanseverino 7, C. Bangma 8, R. Valdagni 9. 1 Fondazione IRCCS Istituto Nazionale Dei Tumori, Programma Prostata, Milan, Italy; 2 Fondazione IRCCS Istituto Nazionale Dei Tumori, Dept. of Urology, Milan, Italy; 3 Ospedale Sant Anna, Dept. of Urology, Como, Italy; 4 Istituto Regina Elena, Dept. of Urology, Roma, Italy; 5 Policlinico Sant Orsola Malpighi, Dept. of Urology, Bologna, Italy; 6 Ospedale Civile, Dept. of Urology, Desenzano, Italy; 7 Ospedale Umberto I, Dept. of Urology, Nocera Inferiore, Italy; 8 Erasmus MC University Medical Centre Rotterdam, Dept. of Urology, Rotterdam, The Netherlands; 9 Fondazione IRCCS Istituto Nazionale Dei Tumori, Dept. of Urology, Milan, Italy Introduction & Objectives: Prostate biopsy findings at diagnosis and during follow-up are essential criteria in active Surveillance (AS). In a previous work (Nicolai et al. Eur Urol Suppl 2013) upgrading (UPG) and upsizing (UPS) at 1-year rebiopsy resulted to be independent outcomes with different, and sometimes opposite, risk factors. In that frame a combined model was also proposed to predict the probability of dropping out of AS starting from the separate probabilities of UPG and UPS. The aim of the present work is to validate the combined model in an independent population. Material & Methods: The PRIAS-Siuro-ITA population was considered for external validation. Model for UPG considered: age (continuous variable, risk factor, OR=1.06), PSA density (continuous variable, OR=1.02) and prostate volume (>60cc, OR=0.2). The model for UPS included: age (continuous variable, protective factor OR=0.97), >5% core length containing cancer (5%core, OR=2.8), >1 positive cores at diagnosis (OR=1.6). Using the two separate models for UPG and UPS, the new combined model (OUT) for PCa reclassification after 1 year AS is given by P(OUT) = 1 {[1 P(UPG)] (1 P(UPS)]} (AUC=0.63). Performance on the independent population was evaluated through AUC and calibration.

44 118 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Results: 183 patients were included in the validation, 29/183 UPG and 15/183 UPS were registered. In the validation population, risk factors for UPG and UPS were confirmed, with Odds Ratios very similar to those of the original model (Figure 1a and b), with the only exception of prostate volume >60 cc and maximum core involvement which here have OR=0.6 and OR=1.04, respectively. AUC was 0.62 (combined model) fairly the same as in the development population. Calibration was satisfactory (Figure 1c). P026 Correlation between urinary continence and nerve sparing quality after radical retropubic prostatectomy V. Atduev, D.S. Ledyaev, Y.O. Lyubarskaya. Nizhny Novgorod State Medical Academy, Dept. of Urology, Nizhny Novgorod, Russia Introduction & Objectives: Radical retropubic prostatectomy (RRP) remains one of the standard methods of treatment for localized prostate cancer (PC). Urinary incontinence (UI) as a complication of RRP significantly impairs the quality of life in long-term postoperative outcome. The aim of our study was to assess the urinary continence function in patients after nerve-sparing RRP and in patients after totally removing of neuro-vascular bundles (NVB). Material & Methods: A total of 119 patients after RRP were examined retrospectively. The mean age in groups was 61.04±0.58. All operations were done by one surgeon. All patients were continent before operation. Patients witch had either neoadjuvant or adjuvant therapies were excluded from the investigation. In all cases in postoperative period pelvic floor exercises were recommended and done. The median of further follow-up in all groups was 36 months (p=0.936). We had 3 groups of patients: patients with bilateral NVB sparing were included in Group 1, Group 2 consists of patients with one side NVB sparing. Patients in which NVB were totally removed were included in Group 3 (control group). To assess results PAD-test and International Consultation on Incontinence Questionnaire-Short Form (ICIQ- SF) were used. Statistic results were analyzed by Kruscal-Wallis test, Mann-Whitney U-test with significance at the 0.05 and bivariate correlation with significance at the 0.01 level (SPSS Statistics 16). Results: The ICIQ-SF score in patients after any type of nerve-sparing prostatectomy was lower than in patients which underwent totally removing of NVB (p<0.05). Pads per day amount was significantly high after non-nerve-sparing RRP than in patients after bilateral sparing of NVB (p<0.05). Though we did not find any significantly differences in groups with unilateral (Group 1) or bilateral (Group 2) nerve sparing operations (PAD-test and ICIQ-SF p>0.05). The study results are shown in the table below: Questionnaire Groups Mann-Whitney U-test, p=0.05 ICIQ-SF score Group 1 Group PAD test Group 1 Group ICIQ-SF score Group 2 Group PAD test Group 2 Group ICIQ-SF score Group 1 Group PAD test Group 1 Group Negative correlation between ICIQ-SF score and nerve sparing quality (Spearman s rho = 0.293, p=0.01), and negative correlation between nerve sparing quality and pads per day amount (Spearman s rho = 0.282, p=0.02) were revealed. Conclusions: Nerve-sparing surgery for the PC significantly decreases the risk of urinary incontinence in patients after RRP. Figure 1 Conclusions: One-year biopsy is the main reason of withdrawal from active surveillance protocols due to increase of cancer volume (upsizing) and/or increase of grade (upgrading). External independent validation confirmed that factors predicting UPG vs UPS are different, leading to consider these events as clinically separate ones. P027 Is the EAU guideline for active surveillance in low-risk prostate cancer suitable for Asian men? K.T. Chong, D. Yong, T.W. Tan, S.J. Chia. Tan Tock Seng Hospital, Dept. of Urology, Singapore, Singapore Introduction & Objectives: Singapore has a multiracial cosmopolitan patient profile with descendents from China, India, Europe and Malay ancestry. We compared the pathological upgrading and upstaging after radical prostatectomy for low-risk prostate cancer who had met the criteria for active surveillance based on European Association of Urology (EAU), National Comprehensive Cancer Network (NCCN) and Singapore Urological Association (SUA) clinical guidelines. Material & Methods: Men treated with radical prostatectomy at a single tertiary institution in Singapore were analysed retrospectively from 2000 to Clinico-pathological factors were assessed based

45 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) on active surveillance protocol from NCCN and EAU guidelines. This is also compared with the SUA guidelines, which has similar criteria to EAU but has an additional requirement of prostate-specific antigen density (PSAD) of less than 0.15 ng/ml. Factors for pathological upgrading and upstaging were evaluated. Results: Out of a total of 317 radical prostatectomies, 11% (n=35), 23% (n=73) and 7.9% (n=25) of patients met the EAU, NCCN and SUA criteria for active surveillance in low-risk prostate cancer respectively. Of the 35 men suitable for active surveillance by EAU guidelines, 28.6% (n=10) were upgraded on final pathology to Gleason score of 7 or more, and 8.6% (n=3) were upstaged to pt3 or higher. For the 73 patients who met the NCCN criteria, 37% (n=27) and 9.6% (n=7) were upgrading and upstaged respectively. When the SUA guidelines was applied on 25 men, 24% (n=6) and 12% (n=3) were upgrading and upstaged respectively. Conclusions: In our Asian study, current EAU guidelines for active surveillance in low-risk prostate cancer provided the lowest upstaging risk, and SUA guidelines gave the lowest upgrading risk. Hagendorn, CH). The Wilcoxon signed rank test was used for comparison of the measured parameters between the plans with and without PS. Results: The mean PTV (prostate+sv) volumes (±SD) without and with PS were not statistically different: 138 (±22) cc & 134 (±25) cc, respectively, (p=0.225). PTV coverage was good in all plans, with >99% of the PTV receiving 95% of the prescribed dose and coverage was similar between no PS and PS plans (p=0.104). Rectal volumes without and with PS were significantly different; mean rectal volume without PS 74.6 (±29)cc and 98.9 (±22)cc with PS, respectively, p= Table 1 shows the differences in dosimetric parameters between the treatment plans without and with PS. A significant reduction in anal canal parameters was seen with the use of PS (V40-V65). Figure 1 shows a statistical reduction in mean rectal surface doses using PS (p=0.001). P028 The effect of ProSpare, a rectal obturator on anorectal doses in prostate radiotherapy J.R. Murray 1, S. Gulliford 2, E.J. Alexander 3, H. Mcnair 4, D.P. Dearnaley 1. 1 The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Dept. of Radiotherapy and Imaging, London, United Kingdom; 2 The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Joint Department of Physics, London, United Kingdom; 3 The Royal Marsden NHS Foundation Trust, Dept. of Radiotherapy and Imaging, Sutton, United Kingdom; 4 The Royal Marsden NHS Foundation Trust, Radiotherapy, Sutton, United Kingdom Introduction & Objectives: ProSpare (PS) is a single use, selfinsertable endorectal device, which is made of Empera resin and has ball-bearings in the wall along with venting holes. In addition to being a daily image-guidance tool, we investigated the effect of PS on anorectal dosimetry in prostate radiotherapy. Material & Methods: Twenty-one patients with localized prostate cancer are to be recruited and randomized to receive prostate radiotherapy with PS either in the 1st or 2nd half of their treatment. For each patient two planning CT scans were acquired, one without and one with PS and dose distributions generated. Planning target volumes and organs at risk were delineated by a single physician as described in the CHHiP trial (CRUK/06/016, ISRCTN: ) and patients were treated with a forward planned multi-segment technique to a total dose of 74Gy in 37 fractions. We report the dosimetric data from the first five patients. Dose-volume histograms were created and dose surface histograms generated (VODCA MSS GmBH, Table 1. Mean (±SD) dose volume histogram parameters for rectum and anal canal without and with ProSpare* No ProSpare ProSpare p-value Rectum D mean (Gy) 39.5 (±3.6) 38.7 (±5.6) D min (Gy) 3.5 (±0.2) 2.8 (±0.7) D max (Gy) 74.8 (±0.7) 74.8 (±0.3) V 30 (%) (±10) 61.3 (±15) V 40 (%) 44.7 (±10) 41.6 (±14) V 50 (%) 35.6 (±9) 32.9 (±13) V 60 (%) 21.7 (±6) 20.5 (±9) V 65 (%) 12.3 (±3) 11.8 (±6) V 70 (%) 5.4 (±1) 5.1 (±2) 0.5 Anal canal D mean (Gy) 34.3 (±7.5) 28.9 (±7.1) D min (Gy) 4.2 (±1.5) 3.7 (±1.0) D max (Gy) 73.4 (±1.7) 72.4 (±2.3) V 30 (%) 50.7 (±16) 36.3 (±21) V 40 (%) 34 (±13) 17.8 (±13) V 50 (%) 25.7 (±12) 12.2 (±10) V 60 (%) 17.6 (±10) 7.5 (±8) V 65 (%) 11.5 (±7.8) 5.04 (±6) V 70 (%) 5.3 (±4.1) 2 (±3) *Bold entries indicate significant differences. Figure 1. Average dose surface histograms without and with ProSpare. The vertical bars show the standard deviation of the distribution. The p value shows a significnt difference in mean rectal dose without and with ProSpare. Conclusions: ProSpare resulted in a reduction in dose to the anal canal and rectum, which may have an impact on acute and late GI toxicity; continued dosimetric evaluation of PS is warranted. P029 The impact of family history on selecting candidates for active surveillance for prostate cancer R. Garcia, R. Silva, A. Nunes, T. Oliveira, H. Correia, T. Lopes. Hospital De Santa Maria, Dept. of Urology, Lisbon, Portugal Introduction & Objectives: Current data suggest that many men with localized Prostate Cancer (PCa) will not actually benefit from definitive treatment. Active Surveillance (AS) with the intent for curative treatment is being increasingly utilized. We seek to compare Radical Prostatectomy (RP) pathological findings between men who have at least one first-line relative with PCa history and men with negative family history, who met criteria for AS. Material & Methods: We queried our institutional database for pathologic data on RP specimens from 2009 to Eligibility criteria for AS included: Gleason 3+3 disease in no more than three positive cores with no single core having more than 50% tumor involvement, PSA <10 and clinical stage <T2a. Results: We identified 98 men from 452 RP specimens who met eligibility criteria for AS, of which 26 had at least one first-line relative with PCa history (26.5%). These men had a higher risk of positive margins (27% vs. 15.2%), seminal vesicle invasion (3.8% vs. 1.4%) and biochemical recurrence (23.2% vs. 16.6%) compared to those with negative family history. Conclusions: Men who have at least one first-line relative with PCa had a slightly higher risk of positive margins, seminal vesicle invasion and biochemical recurrence, compared to men with negative family history. Men with family history of PCa who are appropriate candi-

46 120 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) dates and seek active surveillance may harbor more aggressive disease, and should be counseled appropriately. P030 Effect of neoadjuvant hormonal treatments on cancer specific survival of high-risk prostate cancer patients L. Tosco 1, P. Bastian 2, A. Briganti 3, F.K. Chun 4, P. Gontero 5, C.Y. Hsu 6, R.J. Karnes 7, G. Marchioro 8, R. Sanchez Salas 9, M. Spahn 10, B. Tombal 11, H. Van Der Poel 12, H. Van Poppel 1, S. Joniau 1. 1 University Hospitals of Leuven, Dept. of Urology, development and regeneration, Leuven, Belgium; 2 Ludwig Maximilians Universität, Dept. of Urology, Munich, Germany; 3 VitaSalute San Raffaele Hospital, Dept. of Urology, Milano, Italy; 4 University Medical Center Hamburg Eppendorf, Dept. of Urology, Hamburg, Germany; 5 University of Turin, Dept. of Urology, Torino, Italy; 6 Puli Christian Hospital, Dept. of Medical Education and Research, Puli, Taiwan; 7 Mayo Clinic, Dept. of Urology, Rochester, United States of America; 8 University of Piemonte Orientale, Dept. of Urology, Novara, Italy; 9 Institut Mutualiste Montsouris, Dept. of Urology, Paris, France; 10 University Hospital Bern, Dept. of Urology, Bern, Switzerland; 11 Cliniques Universitaires Saint Luc, Dept. of Urology, Brussels, Belgium; 12 Netherlands Cancer Institute, Dept. of Urology, Amsterdam, The Netherlands Introduction & Objectives: Neoadjuvant hormonal treatments (NHT) have not demonstrated, in randomized clinical trials, to improve overall survival of patients with prostate cancer but there is a lack of information about the effect on cancer specific survival. This study aims to explore the effect of NHT for high-risk prostate cancer patients in a contemporary large retrospective series. Materials & Methods: 5876 patients affected by high-risk prostate cancer (PSA >20 ng/ml and/or clinical stage ct3 4 and/or biopsy Gleason score; biopsy Gleason Score = 8 10) were treated primarily by radical prostatectomy (RP) + pelvic lymph node dissection (PLND) with a multimodal approach based on institutional indications. Exclusion criteria: missing data, patients treated before 1994, PSA >100 ng/ml and a number of lymph node removed inferior to 10. NHT was registered simply as a binary variable and there were not data available on the typology of treatment. Chi-square test and unpaired t- test were used for comparisons respectively about proportions and continuous variables. Kaplan-Meier with log-rank test was used to evaluate cancer specific survival between groups and Cox proportional hazard models to perform multivariate analysis. Significance level was set at α=0.05. Results: 902 patients were treated by RP+PLND between 1994 and 2011 in multi-institutional tertiary centers. Median age was 66 years (range: 39 78) and median follow up was 21 months (range: 0 188). 114 were treated with NHT prior to surgery and 788 underwent immediately RP+PLND with an overall median number of nodes Figure 1 removed of 14 (range: 10 62) At the end of follow up 31 patients died of prostate cancer. Preoperative clinico-pathological features did not demonstrate statistically significant differences in terms of PSA, biopsy Gleason score and ct stage. Kaplan Meier with log-rank test did not evidence any statistically significant difference between the two treatment groups in terms of CSS (p=0.4) (Fig. 1). NHT was not an independent predictor of prostate-cancer related death at multivariate analysis (Table 1). Table 1. Multivariate analysis Covariates HR p 95% CI ipsa (continuous) bgs 8vs< < ct 3vs< Neo yes vs no Conclusions: High-risk prostate cancer patients treated by classical NHT+RP+PLND did not demonstrate to have different CSS compared to surgery alone in current series. P031 Validation of a comprehensive summary metric for radiation dosimetry in prostate cancer patients M. Reis Ferreira 1, S.L. Gulliford 1, K. Thomas 2, H. Mcnair 2, L. Truelove 3, D.P. Dearnaley 1. 1 Institute of Cancer Research, Dept. of Radiotherapy and Imaging, London, United Kingdom; 2 Royal Marsden Hospital, Dept. of Statistics, London, United Kingdom; 3 Royal Marsden Hospital, Bob Champion Unit, London, United Kingdom Introduction & Objectives: Radiation proctopathy is an important side-effect in patients undergoing intensity-modulated radiotherapy (IMRT) for prostate cancer. The risk of this problem is assessed before treatment by evaluating dose-volume histograms (DVH), which provide a visual summary of radiation dose distribution. Retrospectively, this data can be combined with clinical data to assess the correlation between radiation dose and toxicity. In this study, we sought to validate the area under the curve (AUC) as a summary measure of DVH. Radiation bleeding (RTOG scale) was chosen for analysis as a thoroughly studied endpoint for radiation proctopathy. Materials & Methods: Data were available for 219 patients treated from 2001 to 2012 in a single institution study of IMRT to the prostate and pelvis (70 to 76 Gy in 2 Gy fractions to the prostate and seminal vesicles and 50 to 60 Gy to the pelvic lymph nodes). Minimum followup was 24 months. A summary of the dose distribution to the rectum was available for all patients. This included the volume (cc) of rectum and the volume receiving 50Gy (V50), 60Gy (V60), 65Gy (V65), 70 Gy (V70) and 75Gy (V75) which were all constrained by the study protocol. As an alternative we consider a comprehensive summary metric which describes the dose distribution to the rectum over the same dose range. AUCs were calculated using the trapezoid method (Figure 1; lower limit 50Gy; upper limit 75 Gy) and the correlation between AUCs and individual dose-volume data points was explored. Finally, the significance of AUCs and individual dose-volume data points was assessed between two groups: patients with < grade 2 rectal bleeding (no toxicity group) and grade 2 rectal bleeding (toxicity group). Results see Figure 1: Individual trapeze-shaped areas (A1, A2, A3 and A4) were calculated and then summed to obtain AUC from the rectal DVH (AUC = A1 + A2 + A3 + A4). AUCs were strongly positively correlated with V50 (ρ=0.73), V60 (ρ=0.95), and V65 (ρ=0.87), moderately correlated with V70 (ρ=0.41) and not correlated with V75 (ρ=0.02). V50 was significantly higher in the toxicity group (p<0.001). V60, V65, V70 and V75 were not found to be significantly different between both groups (p>0.05). Rectal AUCs were also found to be significantly higher in the toxicity group (p=0.04). Conclusions: The statistically significant association between AUC and grade 2 rectal bleeding is in keeping with previous results. It was expected that more of the individual dose volume variables

47 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P034 Predictive value of surgical margins for biochemical progression three years after RARP: Location, length and focality E.R.P. Collette 1, M. Kliffen 2,M.Gan 1, R.P. Engel 1, D. Van Den Ouden 1, D.C.D. De Lange 1, O.S. Klaver 1. 1 Maasstad Hospital, Dept. of Urology, Rotterdam, The Netherlands; 2 Maasstad Hospital, Dept. of Pathology, Rotterdam, The Netherlands Figure 1 would have been statistically significant. As such, the AUC approach was shown to be a good summary measure of rectal DVH. Future work will explore the use of a comprehensive metric for other endpoints related to bowel toxicity. Using a summary metric has the potential to account for dosimetry in order to assess other variables that may be involved in the gastrointestinal toxicity pathway. P033 Retrospective study of gene prolaris (myriad genetics) signature in prostate biopsy from 29 patients with low and intermediate risk adenocarcinoma F. Clar 1, L. Bernet 2, L. Morell 3, A. Monserrat 4, J. Lopez 1, V. Gonzalvo 4, A. Benedicto 1, A. Polo 4, R. Cano 3. 1 Hospital De La Ribera, Dept. of Urology, Alzira, Spain; 2 Hospital Lluis Alcanyis, Dept. of Pathology, Xativa, Spain; 3 Hospital De La Ribera, Dept. of Pathology, Alzira, Spain; 4 Hospital Lluis Alcanyis, Dept. of Urology, Xativa, Spain Introduction & Objectives: Prostate cancer is the most common malignancy diagnosed in Western countries and the second leading cause of cancer death among men. Many prostate cancers, however, do not progress to a clinically meaningful stage even in the absence of treatment. Molecular testing of tumor samples to guide treatment decisions is of increasing importance. The Cell cycle progression score (CCP) (Prolaris, Myriad Genetic Laboratories) is a RNA-based marker which improved the prediction of prostate cancer aggressiveness. To assess the relationship between Cell Cycle Proliferation test (CCP)- Prolaris with clinicopathologic variables currently used in the diagnosis and prognosis and related to aggressiveness, biochemical relapse and overall survival. Material & Methods: Correlation study between gene expression signatures and diagnostic clinical criteria (digital rectal examination, PSAtotal,PSAfree/total,PSAdensity) and pathological (Gleason grade) in 29 patients diagnosed of low or intermediate risk prostate adenocarcinoma by transrectal biopsy. All patients were followed between 24 and 142 months. Statistical analysis has been performed using SPSS version 21. The CCP (Prolaris ) test was determinatedby Myriad Genetics Results: In 5 of 29 patients (17.24%) the material was insufficient for determination of genetic test. We don t find any statistical signification differences between the classical criteria for prognosis of prostatic cancer and the Genetic signature. In our series a result test (Prolaris ) value of < 1 shows a tendency for the patients to have an evolution free of disease (p=0.07). Conclusions: The CCP (Prolaris ) test behaves as an independent prognostic factor. Although we are unable to demonstrate a statistically significant relationship with the disease progression, we think is due to the small sample size, because of there is a clear trend towards significance. Introduction & Objectives: Various prognostic variables for biochemical progression (BCR) after robot assisted radical prostatectomy (RARP) are known. Less well known is the predictive value of characteristics of surgical margins, like location, length and focality. Material & Methods: Prospective registration and retrospective analysis. From January 2009 until March patients underwent RARP in our hospital because of clinical localized prostate carcinoma. The procedures were performed by one surgeon. All patients were analyzed at exact 36 months of follow-up. The variables ptumorstadium, pgleason score and surgical margins were evaluated. Positive surgical margins were analyzed; location (apex vs. other), length (short 0.1mm-3.0mm vs. long >3.0mm) and focality (unifocal vs. multifocal). Definition of limited surgical margin is 0.1mm-3.0mm AND unifocal, definition of extensive surgical margin is >3.0mm OR multifocal. The end variable BCR is defined as PSA >0.2 ng/ml. Results: Within 36 months BCR occurred in 115/420 (27%) of pts. Three years BCR outcomes are listed in the table. In univariable analysis no significant difference was seen regarding location and presentation of BCR; apex 20/40 (50%) pts vs. other 17/38 (45%) pts (p=0.64). We did see a significant difference regarding length; short 5/27 (19%) pts vs. long 32/51 (63%) pts (p<0.001). Also focality showed a significant difference; unifocal 21/54 (39%) pts vs. multifocal 16/24 (67%) pts (p=0.02). There was a significant difference seen between limited surgical margin 5/25 (20%) pts vs. extensive surgical margin 32/53 (60%) pts (p=0.001). In multivariable logistic regression analysis there was corrected for chronological order of surgery, initial PSA, prostate volume, BMI, age, pgleason score and ptumor-stadium. With negative surgical margins as reference, a limited surgical margin appeared as no predictor for BCR (p=0.39) and an extensive surgical margin appeared as a strong significant predictor for BCR (p=0.02; OR 2.385; 95% CI ). Table 1. Proportion of pts with BCR three years after RARP Post-RALP Biochemical Recurrence Risk Table after 36 months follow-up Pathological Pathological Surgical margin Surgical margin Surgical margin Gleason score tumor-stadium negative limited extensive pgl3+3 pt2ab 5% (2/41) N.A. 0% (0/1) pt2c 7% (6/88) 0% (0/7) 25% (1/4) pt3a 20% (2/10) N.A. 33% (1/3) pt3b 0% (0/1) N.A. N.A. pg3+4 pt2ab 13% (2/16) N.A. N.A. pt2c 20% (15/76) 14% (1/7) 33% (2/6) pt3a 21% (3/14) 33% (1/3) 29% (2/7) pt3b 33% (3/9) 0% (0/1) 0% (0/1) pgl4+3 pt2ab 57% (4/7) N.A. 0% (0/1) pt2c 20% (3/15) 0% (0/1) 100% (1/1) pt3a 27% (3/11) 50% (1/2) 100% (3/3) pt3b 75% (3/4) N.A. 100% (4/4) pgl pt2ab 50% (2/4) 0% (0/1) 0% (0/1) pt2c 61% (11/18) N.A. 67% (4/6) pt3a 50% (4/8) N.A. 80% (4/5) pt3b 75% (15/20) 67% (2/3) 100% (10/10) Total 23% (78/342) 20% (5/25) 60% (32/53) Conclusions: Three years after surgery 73% of pts is free of biochemical recurrence, despite of the first 150 pts concerning the oncological learning curve of the surgeon (previously presented) with 41% (174/420) of pts presenting pt3a and/or pgl7b. After correction for seven prognostic variables, a limited surgical margin appeared as no predictor for BCR and an extensive surgical margin appeared as a strong significant predictor for BCR. When counselling on salvage therapy, one might take this into account.

48 122 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P035 Outcome prognostic factors in prostate cancer patients after surgical treatment K.M. Nyushko, B.Y. Alekseev, A.S. Kalpinskiy, A.A. Krasheninnikov, M.P. Golovaschenko, L.V. Moskvina, A.D. Kaprin. P.A. Herzen Moscow Oncological Research Institute, Dept. of Urology, Moscow, Russia Introduction & Objectives: Results of surgical treatment of prostate cancer (PC) patients (pts) depend on preoperative and postoperative prognostic factors. Biochemical recurrence (BR) is observed in 15 44% of PC pts after radical prostatectomy (RPE) and could manifest by local recurrence (LR) or distant disease progression (DP). The aim of the study was to evaluate prognostic factors of LR and DP; and influence of these factors on local disease control failure rate (LCF) and radiological progression-free survival (R-PFS). Material & Methods: Retrospective analysis of database of 1357 PC pts, undergone RPE and pelvic lymph node dissection (PLND) since 1998 till 2013 in single institution was performed. Exactly established follow-up survival status and outcomes were assessed in 854 (63%) pts. Mean PSA level was 14.4±12.5 ng/ml; mean percentage of positive biopsy cores (PBC) was 47.6±29.8%. Clinical stage was T1b- T2c in 1057 (77.9%), T3a-T3b in 300 (22.1%). Biopsy Gleason score 6 was verified in 776 (57.2%) pts, 7 in 413 (30.4%) and 8 10 in 89 (6.6%); not assessed in 79 (5.8%) pts. Low risk PC was verified in 267 (19.7%) pts, intermediate risk in 534 (39.4%) pts and high risk in 556 (40.9%) pts. Mean number of LN removed was 19±10 (4 64). LN metastases were verified in 214 (15.8%). Biochemical recurrence was assessed as elevation of PSA>0.2 ng/ml on three consecutive measurements. Radiological DP was assessed using bone scintigraphy, CT or MRI. Results: Median follow up time was 34.7±27 months (3 168 months). During this period BR was observed in 292 (34.2%) pts. Histologicaly proven LR was confirmed in 27 (3.2%) pts; radiological DP in 32 (3.7%) pts. Cumulative 5-year biochemical progression-free survival (PFS) rate was 51.2±2.7%; 5-year LCF rate was 92.8±1.7%; and 5-year R-PFS was 92.5±1.9%. In univariate analysis significant predictors of LR were percentage of PBC (R=0.08, p=0.03), preoperative PSA level (R=0.07, p=0.04), risk group (R=0.1, p=0.006), morphological stage (R=0.12, p=0.002) and presence of positive surgical margin (PSM) (R=0.12, p<0.001). Significant predictors of DP were percentage of PBC (R=0.22, p<0.001), preoperative PSA level (R=0.12, p=0.001), risk group (R=0.13, p<0.001), morphological stage (R=0.2, p<0.001), presence and number of LN metastases (R=0.2, p<0.001) and morphological Gleason score (R=0.11, p=0.004). There was a reverse correlation of number of LN removed and probability of DP (R=- 0.08, p=0.03). In Cox regression analysis significant predictors of LR were percentage of PBC (p=0.04) and presence of PSM (p=0.005). Predictors of DP in Cox analysis were percentage of PBC (p<0.001), morphological stage (p=0.007), presence of LN metastases (p<0.001) and morphological Gleason score (p=0.05). Conclusions: PBC, preoperative PSA level and risk group were the most important preoperative predictor for both LR and DP in our study. Most important postoperative predictors were PSM for LR and morphological stage, Gleason score and presence of LN metastases for DP. The extent of PLND could be also associated with long-term oncologic results. P036 Role of prostate specific density as prognostic factor in relapsed prostate cancer after robotic radical prostatectomy C. Corchuelo-Maillo, M. Fajardo-Paneque, J.M. Conde Sánchez, C.B. Congregado Ruiz, I. Osman-García, J.M. Pena Outeiriño, S. Marmol-Navarro, R.A. Medina López. Virgen Del Rocio Hospital, Dept. of Urology, Seville, Spain Introduction & Objectives: The high incidence of prostate cancer in recent years has led to an increasing interest in finding out what factors determine the prognosis of the disease. There are multiple studies demonstrating the application of PSA density (DPSA) in the diagnosis of prostate cancer, but there are just a few published literature about its use as a predictor of recurrence. The aim of the present work is to determine if the DPSA can be considered as a predictor of progression in patients undergoing robot-assisted radical prostatectomy (RARP). Material & Methods: We present a retrospective analysis of a serie of 150 patients with localized low-risk prostate cancer, from a total of 158, operated by PRAR from 2007 to We compare DPSA of the 112 patients who have not progressed with 38 patients DPSA who have done it, and their relation to pre and postoperative variables. Results: The median age is 61 years old. The PSA at diagnosis of patients who have not progressed is 6.29 mg/dl, in comparison with 6.43 in those who have done it. We found a direct correlation between PSA at diagnosis and DPSA (p<0.001), but there is no evidence of differences between patients who have not progressed and who have had a recurrence. There is no statistically significant difference comparing the DPSA of both groups (0.17 and 0.19mg/dl/cc respectively). The predominant Gleason grade pre and post-intervention (6, 3+3), and the local stage of the surgical specimen (pt2c, 59%) show no relationship with the DPSA in any of the groups studied. We have found a significant correlation between the presence of understaging (23%) and DPSA (p<0.001), with no differences between patients who have not relapsed and who have done it. There is no statistically significant relationship between PSA density and the presence of positive surgical margin (16%), PSA nadir (0mg/dl), the median time to progression (45 months) and the presence of metastasis (1.3%). Conclusions: The presence of elevated PSA at diagnosis is associated with high densities of PSA. A high PSA density increases the chances of finding more local stage of disease. P038 Volumetric surveillance of low risk prostate cancer with prostate histoscanning M. Mikhail 1, N. Arumainayagam 1, A. Shamsuddin 1,D.Nir 2, M. Winkler 1. 1 Charing Cross Hospital, Imperial College NHS Trust, Dept. of Urology, London, United Kingdom; 2 Imperial College, Dept. of Bioengineering, London, United Kingdom Introduction & Objectives: Prostate HistoScanning (PHS) is an ultrasound-based tissue characterisation technology that shows promise in prediction of prostate cancer. It may have a role in active surveillance if tumour volumes can be reliably characterised in repeated scans. We aimed to determine if serial PHS could track changes in tumour volume and location, and if this correlated with PSA and PSA density (PSAD) and tumour reclassification on repeat biopsy. Material & Methods: From June 2010 and March 2014, 26 men on an active surveillance protocol for Gleason 6 prostate cancer underwent at least 2 serial PHS, along with DRE, PSA and PSAD measurement. Template mapping biopsies were performed after one year of active surveillance. Repeat PHS measured tumour volume (TV) and the change in volume between measurements was calculated. This was compared to change in PSA and PSAD and stage change on repeat biopsy. Results: Median time between the two PHS was 310 days (range ). Median initial tumour volume at PHS was 0.5ml, which was equal to the median at the second scan. The range of change in tumour volume was between a reduction of 0.37ml and an increase of 0.52ml. There was also only a small median rise in PSAD of 0.01 ( ). Gleason grade was reclassified to 3+4 in 4 cases, with 3 of these cases revealing an increase in PHS TV of 0.06ml, 0.12 and 0.13ml. Conclusions: PHS appears to consistently identify tumour volume and quantify changes through serial scanning. A static tumour volume is mirrored in static serial PSAD measurements. More studies are

49 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) needed to determine if PHS tumour volumetry could in some cases be used to safely avoid protocol driven repeat prostate biopsy. P039 Oncologic difference between capital and regional tertiary referral hospital in patients with prostatectomy K.K. Park, S.D. Kim, Y.J. Kim, J.S. Huh. Jeju National University Hospital, Dept. of Urology, Jeju-Si, South Korea Introduction & Objectives: Many research reported that increased mortality and aggressiveness of prostate cancer in rural area. Because of decreased accessibility and inequal distribution of medical property. When the problem of accessibility and distribution of medical property were resolved, what happen in rural area? Therefore we compared the oncologic outcome differences of patients with underwent prostatectomy in tertiary referral university hospital between capital and rural area. Material & Methods: From May 2012 to April 2014, total 112 patient in urban hospital and 32 patients in regional hospital were retrospectively enrolled in this study. All patients underwent Robotic Assisted Laparoscopic Prostatectomy to treat their prostate cancer and lived for more than 10 years in their region. We defined biochemical failure as any PSA 0.2. Results: Patients age and pre biopsy prostate specific antigen (PSA) and gleason sum and postoperative prostate cancer staging were not significant different between two groups. Mean follow-up was 11.9 months in rural, months in urban. Patients lived in rural area trend to visit a hospital with more higher PSA (15.27±22.86 ng/ml) than urban (11.06±11.21 ng/ml). Accordingly, patients who lived in rural area trend to had a more aggressive feature of prostate cancer. However, there was not difference on early oncology outcome. Early biochemical recurrence rate was superior to the urban hospital (p=0.0221, log-rank test). Table 1 Urban Rural p Number of patients Age (years old) 63.83± ± pre bx PSA (ng/ml) 11.06± ± Prostatectomy findings Gleason sum (3+4) >7(3+4) Staging T T3a 39 8 BCR (%) 26% 15% Mean f/u (months) ( ) (3.0 24) P040 Long term outcome of positive surgical margins patients with adverse pathological parameters following radical prostatectomy treated with immediate adjuvant hormonal and radiotherapy M. Shahait 1, Z. Farahat 2, M. Bulbul 1. 1 American University of Beirut, Medical Center Surgery, Beirut, Lebanon; 2 American University of Beirut, Medical Center, Beirut, Lebanon Introduction & Objectives: Hormonal therapy (HT) prior to radiation (RT) is the standard treatment in high risk patients with localized prostate cancer (intact prostate). Patients with positive surgical margins and any of the adverse parameters following radical prostatectomy (RP) (extra prostatic extension (EPE), seminal vesicle involvement (SVI) and high grade Gleason) planned for adjuvant radiation were considered to receive concomitant hormonal therapy. We report our long term experience in this subset of patients. Material & Methods: Between June 1998 and May 2012, patients with positive surgical margins and adverse parameters following RP committed to receive adjuvant radiation therapy based on pathologic examination were given immediate HT (LHRH analogues) after the first postoperative follow-up. RT was delivered at approximately 3 months following surgery to allow for surgical healing. The rationale behind immediate HT is to suppress residual disease in the prostatic bed prior to initiation of RT along with benefiting from its radio-sensitizing property. HT was continued for a total of 6 months, enough to complete RT. One patient was lost for follow-up. Results: 26 patients were identified with a median age of 62 years (51 73). Mean PSA level was 12.3 ng/ml (4 37). The clinical stage at presentation was: T1c=13/26 (50%); T2: 12/26 (46%); T3: 1/26 (3.5%). Seminal vesicle was involved in 9 patients (34%), extra prostatic extension was found in 4 patients (15.8%), and Gleason score >8 in 6 patients. All patients had undetectable PSA at time of radiation. At median follow up of 67 months (3 166) biochemical recurrence occurred in 5 of the 25 patients (20%). Median time to fail was 31 months (5 124 months). Of those five only one developed lymph node metastasis 9 years after surgery. Eighty percent of the patients were disease free at median follow-up of 67 months. The adverse events from 6 months of HT were minimal. Three patients who declined LHRH analogues were treated with anti-androgen alone. Conclusions: Our results are in line with previous reports on the benefit of concomitant HT & RT for high risk patients. Lessons learned from the benefit of HT along with RT in patients with high risk localized and locally advanced prostate cancer encouraged us to use this regimen in patients with positive surgical margins and adverse parameters following radical prostatectomy (RP). Short term HT infers an improved outcome along with radiation therapy in those patients. Randomized clinical trials are needed to compare the outcome of RT alone versus RT & HT. P041 Five years results of interstitial radiation therapy in the treatment of prostate cancer: Toxicity and dosimetry analysis O.I. Apolikhin 1, A.V. Sivkov 1, V.N. Oshepkov 1, D.A. Roshin 1, A.V. Koryakin 2. 1 Moscow Institute of Urology, Innovative Technologies, Moscow, Russia; 2 Moscow Institute of Urology, Moscow, Russia Figure 1 Conclusions: Patients underwent prostatectomy in rural tertiary hospital had less early biochemical recurrence rate than urban hospital. Early and proper treatment would augment the prostate cancer mortality in urban area. We believed that long term followed up study were need to confirm the results. Introduction & Objectives: Early detection of biochemical recurrence after brachytherapy is often difficult, due to the individual characteristics of the post-operative PSA dynamics. To assess the quality of implantation experts propose to perform PDA (postimplant dosimetric analysis), but the data published does not conclusively confirm the dose-response correlation. Material & Methods: We analyzed the 5 years biochemical diseasefree survival (bdfs), and toxicity profile depending on the calculated postimplant dose in a single center with more than 10 years experience. The research was focused on 117 patients who met the following criteria: Disease stage T1-T2c, low or intermediate risk of disease

50 124 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) progression (criteria d Amico), with follow-up of 5 years or more, who underwent PDA after implantation. According to the results of PDA patients were divided into two comparable groups, first group with prostate D90 >140 Gy, the second sources used 125 I, with the summary dose of Gy. Results: The mean preoperative PSA level was 7.3±2.6 ng/ml and 7.9±2.4 ng/ml for the firstand second groups, respectively. Average age in the group 1 was 67.6±1.7 years, in group ±1.8 years. Mean prostate volume 34.1±4.1 cm 3 and 33.5±4.7 cm 3 in the first and second groups respectively. A 5 years bdfs in the first group was achieved in 96.4% with ct1, and 82.9% with ct2. In the second group in 85.2% and 71.9% respectively. bdfs in patients who received radiation dose of D90 >140 Gy was significantly higher than in the group of patients with a dose of which was registered in 58.6% patients in group 1 and in 25 (42.4%) of group 2. Other complications are shown in the table. Symptom Group 1 (D90 >140 Gy) Group 2 (D90 <140 Gy) p n % n % Dysuria p<0.05 Hematuria p>0.05 Proctitis p<0.05 Urethritis p<0.05 Prostatitis p>0.05 Urinary retention p>0.05 Incontinence p>0.05 Conclusions: The low-dose radiation therapy with 125 I sources is an effective radical treatment of localized prostate cancer in low- and intermediate-risk. PDA plays a great role in the prognosis of treatment results, in statistically comparable groups there is dose response relationship. Biochemical control is better in patients with higher D90, although the frequency of complications in these patients is also significant higher. P042 Late toxicity in patients treated with salvage radical radiotherapy following primary High-Intensity Focal Ultrasound (HIFU) for localized prostate cancer R. Davda 1, S. Patel 1, M. Maru 2, N. McCartan 3, C. Moore 3, H. Ahmed 3, M. Emberton 3, M. Mitra 1, H.A. Payne 1, RR Davda. 1 University College London Hospitals NHS Foundation Trust, Dept. of Oncology, London, United Kingdom; 2 University College London Hospitals NHS Foundation Trust, Dept. of Urology, London, United Kingdom; 3 University College London, Dept. of Surgery and Interventional Science, London, United Kingdom Introduction & Objectives: In primary treatment of localised prostate cancer, minimally invasive ablative therapies such as HIFU aim to achieve cancer control whilst offering a potentially favourable toxicity profile. However, 18% of patients treated with HIFU require salvage therapy. There is a paucity of data reporting toxicity in patients treated with salvage radiotherapy in this setting. We report on late GU and GI toxicity in patients treated with primary HIFU and salvage radical radiotherapy plus hormone therapy. Material & Methods: A cohort of 10 such patients who received radiotherapy at our centre was identified and RTOG and IPSS data reported. Results: 5/10 received 1 HIFU treatment; 5/10 received 2 HIFU treatments. HIFU treatment received: focal 2/15; hemi-gland: 3/15; whole gland:10/15. Median interval from last HIFU treatment to commencing radiotherapy: 22 months (range 16 67) Median age at time of radiotherapy 69.5 years (range 54 84) All patients had biopsy proven recurrent prostate cancer with median PSA 4.2 ng/ml (range ) All patients received 74 Gy including 1 patient with quiescent Crohn s disease; 1 with conformal EBRT in a multiphase technique and 9 with IMRT. All patients received neoadjuvant and adjuvant androgen deprivation therapy according to risk. Late radiation toxicity was reported at median follow-up of 20 months (range 6 47) and was as follows: RTOG late GI Grade 0: 9/10 Grade 1: 1/10 IPSS 0: 1/10 1: 0/10 2: 1/10 3: 1/10 4: 3/10 5: 1/10 6: 1/10 7: 1/10 8: 0/10 9: 1/10 IPSS quality of life 0: 1/10 1: 4/10 2: 4/10 3: 1/10 No patient has experienced biochemical progression to date. Conclusions: Late GI and urinary toxicity is acceptable in this cohort of men treated with primary HIFU and salvage radiotherapy. These results suggest such patients may be safely treated to a standard dose of 74 Gy. However outcomes for a greater number of patients treated with minimally invasive therapies followed by salvage radiotherapy are required. Additionally, late effects on erectile function require reporting. P043 Matched pair study to assess the quality of life and toxicity in patients with carcinoma of the prostate undergoing external beam radiotherapy plus high dose rate brachytherapy boost compared with patients receiving conformal external beam radiotherapy alone A. Lydon 1, L. Welsh 1, L. Merry 2, D. Ingham 2, R. Taylor 3. 1 South Devon NHS Healthcare Trust, Dept. of Oncology, Torquay, United Kingdom; 2 Royal Devon and Exeter NHS Foundation Trust, Dept. of Oncology, Exeter, United Kingdom; 3 University of Exeter, Dept. of Medical School, Exeter, United Kingdom Introduction & Objectives: The study was designed to evaluate the Quality of Life (QoL) and the acute toxicity experienced by patients receiving Conformal External Beam Radiotherapy (EBRT) plus High Dose Rate Brachytherapy (HDR) compared to a matched cohort of patients receiving Conformal EBRT (CRT) alone, from baseline to 2 years post treatment. Material & Methods: Any patient with high risk disease planned for either CRT or HDR, at the 2 participating centres, was approached to participate in the study. Patients were matched for age, stage, Gleason Score, PSA and comorbidities including diabetes. The study was powered to detect a 20% change in acute toxicity and matching on a 1:1 basis 97 patients per treatment group were recruited into the study. Patients were assessed for QoL and toxicity at baseline, post treatment, month 1, 3, 6 and year 1 and 2. Patients completed the EORTC C-30 and PR25, IPSS and R-FAS scales and toxicity was assessed using the CTC V3.0 and Lent Som scale. All patients had at least 3 months of neo adjuvant androgen deprivation therapy with the majority remaining on this for the duration of the study. CRT Group Patients were CT planned and treated using a 3D conformal technique to 74Gy in 37 fractions to the prostate and seminal vesicles. HDR Group Under GA and using transrectal ultrasound guidance, catheters were implanted in prostate and seminal vesicles. Patients were CT planned for both fractions, and received 15Gy in 2 fractions over 24 hours, followed by CRT, 46Gy in 23 fractions to prostate and seminal vesicles. Results: Overall the adjusted regression analysis showed no statistical differences (at the 0.01 level of significance) between either HDR or CRT at any time point for QoL or toxicity. Urinary and bowel side effects peaked at end of treatment, as reported by the patients QoL, for both groups and returned back to or close to baseline levels by the first follow up time point, 1 month post treatment. The difference in IPSS scores (P=0.014) favoured the HDR group. At 3 months incidence of acute GI and GU toxicity was low, with 1 incidence of grade 2 proctitis and 6 incidences of grade 2 bowel frequency in the CRT group and only 1 incidence of grade 3 bowel frequency in the HDR group. 1 HDR patient experienced grade 3 hesitancy and decreased stream. Urinary frequency (max Grade 1) was seen in 27 CRT patients and 19 HDR patients. At 2 years, GU toxicity was rare, with a maximum of grade 3 reflecting the low incidence of urethral stricture at 3% (3 patients) and 1% (1 patient), in the HDR and CRT groups respectively, with no statistical difference (P=0.829) observed. There was only 1 incidence of late grade 3 GI toxicity with 1 CRT patient presenting with grade 3 rectal bleeding at 24 months.

51 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Conclusions: Increasing the dose of radiotherapy to the prostate using an HDR boost does not compromise QoL. When compared with CRT there is no difference in urinary or bowel toxicity up to 2 years post treatment. Other studies have suggested improved effectiveness [1]. In our treatment centres HDR is now a standard form of dose escalation to treat prostate cancer. Reference [1] Hoskin PJ, et al Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer. Radiother Oncol 2012;103: P044 Factors related with urinary incontinence grade after radical prostatectomy B.Y. Padilla Fernandez 1, Á.J. Virseda Rodríguez 2, B.J. Pereira 3, H. Coelho 4, M. Montesino Semper 5, C. Müller Arteaga 6, J.L. Álvarez-Ossorio Fernández 7, F. Migliorini 8, M.B. García Cenador 9, P. Antúnez Plaza 10, J.M. Silva Abuín 11, A. Lorenzo Gómez 9, M.T. Santos Antunes 9, J.A. Mirón Canelo 12, M.F. Lorenzo Gómez 9, IBSAL (Salamanca Institute for Biomedical Research). 1 University Hospital of the Canary Island, Dept. of Urology, San Cristóbal De La Laguna, Spain; 2 University Hospital of Salamanca, Dept. of Urology, Salamanca, Spain; 3 University Hospital of Pêro Da Covilhã, Dept. of Urology, Covilhã, Portugal; 4 Centro Hospitalar E Universitário De Coimbra, Dept. of Urology, Coimbra, Portugal; 5 University Hospital Virgen Del Camino, Dept. of Urology, Pamplona, Spain; 6 University Hospital of Ourense, Dept. of Urology, Ourense, Spain; 7 University Hospital Puerta Del Mar, Dept. of Urology, Cádiz, Spain; 8 Azienda Ospedaliera Universitaria Integrata, Dept. of Urology, Verona, Italy; 9 University of Salamanca, Dept. of Surgery, Salamanca, Spain; 10 University Hospital of Salamanca, Dept. of Pathology, Salamanca, Spain; 11 San Pedro Hospital, Dept. of Urology, Logroño, Spain; 12 University of Salamanca, Dept. of Preventive Medicine and Public Health, Salamanca, Spain Introduction & Objectives: The most feared after-effect of radical prostatectomy is urinary incontinence (UI). Its evaluation is more precise when considering the quantity in grams of urine per day, but an exhaustive follow-up protocol is required. We analysed the prevalence of post-surgical UI, technical and pathological variations and UI severity in a multicentric study. Material & Methods: Retrospective multicentric study of a sample of 265 patients who underwent radical prostatectomy between March 2009 and March 2013 in seven hospitals (2 level-four hospitals and 5 tertiary hospitals). Variables: Age, PSA, presurgical LUTS, BMI, technique [laparoscopic (LP), open retropubic (OP), robot-assisted (RobP)], ptnm, post-surgical Gleason score, margins complications, UI prevalence and grade. Patients were classified according to IU severity assessed by the pad test Mild: <100 g/24 hours (LUI); Moderate: g/24 hours (MUI): Severe: >400 g/24 hours (SUI) Results: Average age years (45 72). Level-four hospitals: RobP 12.50%, OP 45%, LP 42.50%. Tertiary hospitals: OP 63.82%, LP 37.17%. Post-surgical UI was present in 40%: 57 LUI (53.65%), 34 MUI (31.70%), 15 SUI (14.63%). Greater age (p=0.0032), higher PSA (p=0.0018), more complication in immediate and deferred postoperative period (p=0.0026) and higher ptnm (p=0.0019) were found in group SUI. No differences were found when comparing technique, time keeping the urethral catheter, prostate volume, Gleason score, affected margins, complementary radio- or hormone-therapy (Comp). Table 1 shows the variables distribution in incontinent patients. Table 1. Value and distribution of variables in patients with UI Group PSA pt2a % pt2b % pt2c % pt3a % pt3b % Comp % LUI MUI SUI p Conclusions: Higher ptnm stage and local complications related with the surgery have a greater association with more sever UI than affected margins or prostate volume. Wider studies are needed to confirm these results. Prostate cancer P045 The quality of nerve-sparing during radical prostatectomy affects sexual function and urinary continence recovery S. Collingwood 1, Y.S. Kwon 2, A. Hobbs 3, M. Katsigeorgis 4, R. Mcbride 5, M. Leapman 1, D. Samadi 4. 1 Icahn School of Medicine at Mount Sinai, Dept. of Urology, New York, United States of America; 2 Mercer University School of Medicine, Dept. of Urology, Macon, United States of America; 3 University of California San Francisco, Dept. of Helen Diller Family Comprehensive Cancer Center, San Francisco, United States of America; 4 North Shore LIJ Lenox Hill Hospital, Dept. of Urology, New York, United States of America; 5 Icahn School of Medicine at Mount Sinai, Dept. of Pathology, New York, United States of America Introduction & Objectives: Regain of continence and sexual function after radical prostatectomy depends on the quality of cavernous nerve preservation. We investigated the factors associated with the quality of nerve sparing (NS) and the resultant effect on sexual and urinary function following robot-assisted laparoscopic prostatectomy (RALP). Material & Methods: The study included 2,542 men who underwent RALP from March 2010 to August NS was characterized as unilateral (left/right), bilateral (BNS) or non-sparing (NNS). Multivariate regression models were constructed to assess the significance of BNS on recovery of continence and erectile function. Regression models were designed to identify variables that impact the quality of nerve sparing. Results: Of the 2,542 patients participating in this study, 2,460 were preoperatively continent, meeting inclusion criteria. Of those patients included the study, 2255 (91%), 61 (2%), 62 (3%) and 82 (4%) underwent BNS, left and right NVB sparing and NNS, respectively. Patients who underwent BNS were significantly younger, had higher rates of preoperative continence and had a lower BMI (all p<0.05) compared to the other degrees of nerve sparing. There was no significant difference in cardiovascular risk factors among nerve sparing groups. The mean time to regain continence was shortest with BNS (4.7 months), and mean time to regain potency was shortest with left NVB sparing (4.1 months), though they did not reach statistical significance. Age, BMI, D Amico risk and margin status were associated with BNS sparing versus NNS. Table 1. Quality of nerve sparing impacts on disease free survival Overall Bilateral NS Unilateral NS Non-nerve sparing p value (n=2542) (n=2314) (n=133) (n=95) Disease-free survival 0 Year 2295 (100%) 1963 (100%) 116 (100%) 87 (100%) < Year 1271 (95.5%) 1073 (96.8%) 66 (84.9%) 48 (80.7%) 3 Years 458 (88.9%) 373 (90.8%) 22 (70.4%) 19 (73.9%) 5 Years 96 (83%) 65 (86.7%) 3 (70.4%) 4 (53.9%) Conclusions: The quality of NVB sparing impacts the time to recovery of sexual function and urinary continence following RALP. Patients treated with BNS recover full continence the fastest. Cardiovascular risk factors were not associated with quality of nerve sparing.

52 126 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P046 The modulating effects of benign prostate hyperplasia medications on upgrading predictors Y.S. Kwon 1, R. Mcbride 2, M. Leapman 3, M. Katsigeorgis 4, S. Collingwood 3, A. Hobbs 5, D. Samadi 4. 1 Mercer University School of Medicine, Dept. of Urology, Macon, United States of America; 2 Icahn School of Medicine at Mount Sinai, Dept. of Pathology, New York, United States of America; 3 Icahn School of Medicine at Mount Sinai, Dept. of Urology, New York, United States of America; 4 North Shore LIJ Lenox Hill Hospital, Dept. of Urology, New York, United States of America; 5 University of California San Francisco, Dept. of Helen Diller Family Comprehensive Cancer Center, New York, United States of America Introduction & Objectives: The role of 5-alpha reductase inhibitors (5-ARI) as chemopreventive agents for prostate cancer has been extensively studied and is still the subject of considerable controversy. We investigated whether the use of 5-ARIs and alpha blockers affect known clinical predictors of Gleason score upgrading. Material & Methods: We performed a retrospective study on 998 patients with complete records treated with robot-assisted laparoscopic prostatectomy (RALP) for clinically localized biopsy Gleason score 6 prostate cancer. Chi squared and t-tests were used to compare characteristics of those who upgraded and those who stayed concordant. Both the logarithm of PSA concentration and prostate size were compared on the basis of the medication history of 5-ARI and alpha blockers in 1) the cohort of biopsy Gleason 6, 2) patients with BPH history, and 3) patients whose prostate sizes fall in the top quartile. We compared known clinical and pathologic characteristics associated with upgrading in regression models with and without these drugs. Results: The use of alpha blockers, but not 5-ARI, was positively associated with bigger prostates in all three study cohorts (p=0.004, p<0.0001, p<0.0001) while the association between the use of 5-ARI and prostate size or log-transformed PSA was not significant. Upgrading was associated with older age (OR 1.037, 95% CI ), higher BMI (OR CI ), higher log PSA (OR 6.905, CI ), less total number of cores (OR 0.963, CI ), higher number of positive cores (OR 1.205, CI ), higher maximum % tumor at any core (OR 1.022, CI ), and smaller prostate size (OR 0.975, CI ). Neither medication was a significant predictor of upgrading. Minimal changes were observed in the odds ratios of the clinically significant predictors when incorporated in the logistic model. Conclusions: Although alpha blockers were positively associated with bigger prostate sizes, the modulating effects of alpha blockers and 5-ARI on common predictors of Gleason score upgrading were not significant. P047 Castration promotes radiosensitivity by direct regulation of DNA repair in prostate cancer F. Al-Ubaidi 1, N. Schultz 1, H. Hamberg 2, T. Granfors 3, T. Helleday 1. 1 Karolinska Institute, Dept. of Medical Biochemistry and Biophysics, Stockholm, Sweden; 2 Västmanland Hospital Västerås, Dept. of Pathology, Västerås, Sweden; 3 Västmanland Hospital Västerås, Dept. of Urology, Västerås, Sweden Introduction & Objectives: Neoadjuvant castration promotes radiosensitivity in prostate cancer, yet the mechanism is still not well defined. We hypothesized that neoadjuvant castration by GnRH analogue impairs DNA repair of double-strand breaks (DSBs) mediated by classical non-homologous end joining (NHEJ), and hence enhanced radiosensitivity. Material & Methods: Forty-eight patients with clinically localized or locally advanced prostate cancer, eligible for curative radiotherapy (RT), were enrolled and divided in two arms. Patients in arm 1 received neoadjuvant GnRH analogue leupropelin followed by external beam radiotherapy (EBRT) to 78 Gy to the prostate. On the contrary, patients in arm 2 received first 2 Gy/fraction for 5 days followed by neoadjuvant GnRH analogue and then EBRT to a total of 82 Gy. Before treatment, prostatic needle core biopsy specimens were taken. In arm 1, a second round of prostatic needle core biopsy specimens were taken before EBRT, eight weeks after administration of neoadjuvant GnRH analogue and a third round of prostatic needle core biopsy specimens about three hours after the fifth dose EBRT. In arm 2, a second round of prostatic needle core biopsy specimens were taken about three hours after the fifth dose EBRT, before hormone treatment was started, and a third round of prostatic needle core biopsy specimens took place after eight weeks of neoadjuvant GnRH analogue administration. The levels of Ku70, DNA-dependent protein kinase catalytic subunit (DNA-PKcs) and androgen receptor (AR) were determined by immunofluorescence in verified cancer tissue. Results: In arm 1, we found a significant decrease in nuclear AR (p<0.001, p<0.001), nuclear Ku70 protein (p<0.001, p<0.001) and DNA-PKcs protein (p=0.01, p=0.004) after castration, respectively, after combined castration and radiotherapy. In arm 2, we saw no decrease in nuclear AR (p=0.5) after radiotherapy alone, but an increase of nuclear Ku70 protein (p=0.01), and DNA PKcs protein in cell nuclei (p=0.01). The changes in AR expression correlated significantly with changes in Ku70 and DNA-PKcs after castration, suggesting that AR activity regulates the levels of these proteins in prostate cancer tissue. Conclusions: We show for the first time in vivo material that AR activity is directly involved in DNA repair. Ku70 and DNA-PKcs are essential proteins for NHEJ repair of DSBs. Since downregulation of these proteins impairs NHEJ mediated DNA repair machinery, proves our studies that neoadjuvant castration improve radiosensitivity in prostate cancer cells. P048 Correlation between the levels of metastases-related serum markers and the presence of circulating tumor cells in breast and prostate cancer patients M. Jančíková 1, V. Mikulová 1,O.Čapoun 2, V. Soukup 2, P. Tesarova 3, H. Honová 3, T. Zima 1. 1 General Teaching Hospital, Dept. of Medical Biochemistry and Laboratory Diagnostics, Prague, Czech Republic; 2 General Teaching Hospital, Dept. of Urology, Prague, Czech Republic; 3 General Teaching Hospital, Dept. of Oncology, Prague, Czech Republic Introduction & Objectives: Circulating tumor cells (CTCs) represent one of the most promising metastatic markers. The mechanism which enables CTCs to escape from the primary site into blood and to form metastases is closely related to the matrix metalloproteinses (MMPs). MMPs are enzymes which are able to degrade extracellular matrix. For this reason they are an important factor of tumor growth and spread. Together with vascular endothelial growth factor (VEGF) they also enable the growth of new vessels in the tumor. We are studying the correlation between the serum levels of MMP2, MMP9 and VEGF and the presence of circulating tumor cells (CTCs) in the patients with advanced breast (BC) and prostate cancer (PC). We would like to evaluate the results of this research with regard to the clinical outcomes of the patients. We would like to clarify whether there are any differences for breast and prostate cancer patients. The results should pave the way for the introduction of new metastatic markers into clinical practice. Material & Methods: We collected 5 ml of whole blood for CTC isolation and 3 ml of serum from each patient. The samples from PC patients were collected before and after docetaxel therapy. The levels of MMP2, MMP9 and VEGF in serum samples were measured by Quantikine ELISA (R&D systems). We used immunomagnetic separation followed by multiplex PCR (Adnagen) for the determination of the presence of CTCs. We evaluated the results according to the manufacturer s instruction as positive/borderline/negative. Results: So far we have evaluated the results from 16 patients with PC

53 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) and 25 patients with BC. Most of the patients with PC were CTC positive. These patients had elevated levels of MMP9 (238±71 ng/ml) and VEGF (209±161 pg/ml). The highest level of MMP2 (266±68 ng/ml) was in the CTC borderline group. On the other hand the majority of BC patients were CTC negative. These patients had elevated level of MMP9 (332±228 ng/ml). CTC positive patients had elevated levels of MMP2 (346±64 ng/ml) and VEGF (464±294 pg/ml). Conclusions: Our preliminary results may be influenced by the small numbers of patients but they indicate a possible correlation between the presence of CTCs and the serum marker levels of metastatic process. The levels of serum markers are higher in breast cancer patients despite the fact that most of them are CTC negative. An important goal is to increase the number of patients for statistical evaluation. We will continue collecting the results and we will evaluate the clinical outcome of the patients as well. This work was supported by grants SVV , GAUK and IGA MZ NT P049 Assessment of association between genetic variant in hsa-mir-146a gene and prostate cancer risk in Serbian population Z. Nikolic 1, D. Savic Pavicevic 1, N. Vucic 1, V. Vukotic 2, S. Tomovic 3, S. Cerovic 4, N. Filipovic 2, S. Romac 1, G. Brajuskovic 1. 1 Faculty of Biology, University of Belgrade, Dept. of Biochemistry and Molecular Biology, Belgrade, Serbia; 2 Clinical Centre Dr Dragiša Mišović, Dept. of Urology, Belgrade, Serbia; 3 Urological Center Urologija Vuk, Dept. of Urology, Belgrade, Serbia; 4 Military Medical Academy, Dept. of Pathology, Belgrade, Serbia Introduction & Objectives: Prostate cancer (PCa) is the most common cancer and the third leading cause of cancer-related deaths among males in developed countries. In Serbian population, data for the period suggest increasing trend of newly diagnosed PCa cases and PCa-related mortality. Alarming PCa statistics has led to focusing research efforts on discovering molecular mechanisms underlying its onset and progression. Several lines of evidence implicated non-coding RNA (ncrna) in malignant transformation process. A SNP located in has-mir-146a has been analyzed for association with various cancers, including PCa. Two previous studies have provided inconsistent results regarding association between SNP (rs ) in hsa-mir-146a gene and PCa risk. The possible association between rs and PCa onset or progression to the more aggressive form has not been assessed in a population of European descent. Material & Methods: In this study, 286 samples of peripheral blood were obtained from the patients with PCa and 271 samples from patients with benign prostatic hyperplasia (BPH). 199 volunteers derived from general population who gave samples of buccal swabs comprised the control group. For individuals diagnosed with PCa clinicopathological characteristics including serum prostate-specific antigen level at diagnosis, Gleason score (GS) and clinical stage were determined. Genotyping of rs was performed using Taqman SNP Genotyping Assay. Analysis of SNP association was done using PLINK and SNPStats software. Results: The comparison of genotype frequencies in PCa patients and controls yielded no evidence of association between rs and the risk of PCa. Eventhough rs showed no association with PCa risk, heterozygous genotype was found to be associated with higher GS, as well as with the presence of distant metastases. The analysis of association between rs and the serum PSA level at diagnosis has shown statistically significant difference in genotype distribution among subgroups of patients with high (PSA>20 ng/ml) and low PSA (PSAGC = 2.22, 95% CI ; ORCC = 0.47, 95% CI ). When comparing genotype distributions among PCa and BPH patients, no statistically significant difference was found. Nevertheless, for log-additive model of inheritance, statistical trend of significance (0.05<p<0.1) was reached in this comparison (P=0.076). Conclusions: Our results obtained in Serbian population significantly differ from previously reported from Chinese Han and North Indian population. This study provided evidence of association between rs and PCa aggressiveness in Serbian population. P050 Cxcr4 inhibition reduces bone metastases by affecting tumour growth and tumorigenic potential in prostate cancer preclinical models C. Festuccia 1, G.L. Gravina 2, A. Mancini 2, L. Scarsella 2, A. Jitariuc 2, A. Colapietro 2, L. Ventura 3, E. Ricevuto 4. 1 University of L Aquila, Dept. of Applied Clinical Sciences and Biotechnology, L Aquila, Italy; 2 University of L Aquila, Dept. of Applied Clinical Sciences and Biotehnology, L Aquila, Italy; 3 San Salvatore Hospital, Dept. of Pathology, L Aquila, Italy; 4 University of L Aquila, Dept. of Applied Clinical Sciences and Biotechnolgy, L Aquila, Italy Introduction & Objectives: The majority of prostate cancer (PCa) patient morbidity can be attributed to bone metastatic events, which poses a significant clinical obstacle. Therefore, a better understanding of this phenomenon is imperative and might help to develop novel therapeutic strategies. Material & Methods: In this report, we analyzed the expression of CXCR4 in human tissues from prostate cancers, and tested in vitro and in vivo the capabilities of two CXCR4 receptor antagonists, Plerixafor and CTE9908, in order to interfere with bone metastasis of prostate cancer cells. We used two experimental in vivo models which resemble sub-clinically and clinically evident bone metastases. Results: We observed that bone-derived PCa cells express higher CXCR4 levels than other PCa cell lines; this was also the case in human PCa samples. SDF-1 induced tumor cell migration and invasion, as well as MMP-9, MMP-2 and upa expression, which were reduced by Plerixafor. Plerixafor reduced PCa cell proliferation and was more effective when PCa were co-cultured with stromal cells, possibly due to the high levels of SDF-1a expressed by stromal cells. Plerixafor and CTCE-9908 delayed tumor growth, reduced angiogenesis and bone lesions, increased survival rates, and changed the bone microenvironment. The incidence of X-ray detectable bone lesions was reduced from 80% (8/10) in controls to 40% (4/10) and 50% (5/10) following Plerixafor and CTE9908 treatment, respectively. Bone-associated tumor growth and associated bone erosion were efficiently decreased in Plerixafor- and CTE9908-treated animals with respect to controls. Kaplan-Meier probability plots showed significantly improved overall survival after Plerixafor and CTE9908 treatment. The reduced intra-osseous growth of PC3 tumor cells after intratibial injection, as a result of Plerixafor and CTE9908 treatment, correlated with decreased osteolysis and serum levels of both mtrap and type I collagen fragments (CTX), respectively. The anti-metastatic potential of Plerixafor correlated with decreased secretion of proteolytic enzymes (MMP-9, MMP-2 and upa) and reduced migratory and invasive capacities in vitro. Conclusions: In summary, our report provides novel information on the potential activity of CXCR4 inhibitors on the formation and progression of prostate cancer bone metastases and supports this treatment as a useful approach in men with advanced PCa with established metastatic disease or at high risk of bone lesions.

54 128 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P051 Lipid methabolism as therapeutic target for prostate cancer C. Festuccia 1, G.L. Gravina 1, A. Mancini 1, E. Di Cesare 1, R. Kirk 2, S. Hughes 2, R. Gibson 2, L-Y. Lian 3, E. Ricevuto 4, A. Carnell 5. 1 University of L Aquila (Italy), Dept. of Applied Clinical and Biotechnological Sciences, L Aquila, Italy; 2 University of Liverpool, Dept. of Chemistry, Robert Robinson Laboratories, L Aquila, Italy; 3 University of Liverpol, Dept. of Institute of Integrative Biology, L Aquila, Italy; 4 University of L Aquila (Italy), Dept. of Applied Clinical Sciences and Biotechnolgy, L Aquila, Italy; 5 University of Liverpol, Dept. of Chemistry, Robert Robinson Laboratories, L Aquila, Italy Introduction & Objectives: One of the most conserved features of all cancers is a profound reprogramming of cellular metabolism, favoring biosynthetic processes and limiting catalytic processes. Cancer cells synthesize de novo large amounts of fatty acids and cholesterol, irrespective of the circulating lipid levels and benefit from this increased lipid synthesis, in terms of growth advantage, self-survival and drug resistance. Fatty acid synthase (FASN) and Alfa-methyl-acyl-CoA racemase (AMACR) are overexpressed in PCa. FASN is a key metabolic enzyme that catalyses the synthesis of palmitate from the condensation of malonyl-coa and acetyl-coa de novo and plays a central role in energy homeostasis, by converting excess carbon intake into fatty acids for storage. The biological role of AMACR in cancer is complex, linking lipid metabolism with nuclear receptor (e.g. FXR and PPAR) activity and expression of enzymes such as cyclooxygenase-2 (COX- 2). Increased fatty acid synthesis and the use of branched fatty acids may play an important role in the development and progression of PCa. Inhibitors of FASN and AMACR show antitumor effects, making lipid metabolisma promising therapeutic target. Material & Methods: In vitro effects of Orlistat (FASN inhibitor) and Trifluoroibuprofen (TFIP) were verified by using three non-tumor prostate epithelial cell lines and a series of 8 PCa cell lines and 6 cell derivatives whereas in vivo experiments were performed in PC3 and 22rv1 xenografts grown in male Cd1 nude mice and treated with 50 mg/kg/day TFIP administered by oral gavage and 240 mg/kg/day orlistat administered by intraperitoneal (i.p.). Results: AMACR and FASN enzymes were expressed in PCa cells lines and their expression was much stronger in androgenindependent compared to androgen-dependent cells. FASN inhibition induced a G2/M cell cycle arrest associated with early autophagy and followed by a late apoptosis. This agent also reduced growth factor-dependent Akt/mTOR pathways through down-modulation of Her2 and c-met signaling. AMACR inhibition induced: (1) downmodulation of AMACR expression; (2) suppression of the survival Akt/mTOR signaling pathway and (3) down-modulation of cyclin D1 and survivin with G2/M arrest and apoptosis. TFIP and orlistat possessed high antitumor effects in PCa cell models. Conclusions: AMACR and FASM are good pharmacological targets for treatment of PCa, and TFIP and orlistat are suitable anticancer compounds to be administered by orally. P052 Immunostimulatory effect of Propionibacterium acnes type I and type II on prostate epithelial cells K. Zochowska, S. Davidsson, O. Andrén, J. Carlsson. University Hospital of Örebro, Dept. of Urology, Örebro, Sweden Introduction & Objectives: Prostate cancer is the second most frequently diagnosed cancer and it was the sixth leading cause of cancer death in males worldwide during There are several risk factors already identified such as age, genetic predispositions and ethnicity and a few more has been suggested. Chronic inflammation is one of them since it has been commonly observed upon histological examinations of prostate glands from radical prostatectomies of cancer patients. It is suggested that a primary infection of Propionibacterium acnes type II could contribute to chronic inflammation and, more speculatively, affect prostate carcinogenesis. P. acnes type II have been the most prevalent bacteria cultured from prostate tissue obtained from men with prostate cancer. P. acnes type I on the other hand is predominantly associated with moderate and severe acne. Recent studies show that micrornas can act as regulators of chronic inflammation. MicroRNAs are small noncoding RNA molecules with an impact on protein coding genes which regulate several biological functions for instance chronic inflammation. In prostate cancer, microrna 146a has been identified to be deregulated. This mirna down-regulates inflammatory process and its lack can lead to an unregulated reaction to inflammatory stimuli, chronic inflammation and growth of cancer. MiR-155 is another mirna which has been described as an inflammatory mirna, acting through stimulation of pro-inflammatory cytokines. So far, no studies have been able to find any deregulation of mir-155 in prostate cancer. The aim with this study was to investigate the inflammatory response of prostate cells to infection of P. acnes type I and type II, by measuring the expression of micrornas 146a and 155. The hypothesis was that cell lines infected with P. acnes will give an inflammatory response, with increased levels of both mir-146a and mir-155. Material & Methods: The normal prostate epithelial cell-line PNT1A was infected with 10 MOI (Multiplicity Of Infection) of P. acnes type I or type II for 4, 12 and 24 hours before cells were harvested. Total RNA, including small RNAs, was extracted using the mirvana mirna isolation kit (Life Technologies). RNA was converted into cdna (Taq- Man microrna reverse transcription kit) and the cdna was subsequently used in a qpcr, using mirna-specific primers for mir-146a and mir-155. Results: Cells infected with P. acnes type I or type II had a higher expression of mir-146a four hours post-infection compared to untreated control, although twelve and twenty-four hours postinfection with P. acnes, this increase had disappeared. Low levels of mir-155 could be detected in all samples although cells infected with P. acnes type I or type II showed a decreased expression of mir-155 compared to untreated control samples at all time points. Conclusions: The results indicate that P. acnes even at low multiplicity of infection have the ability to affect the inflammatory response in normal prostate epithelial cells. P053 The concordance of histological examination of prostate biopsies: Discrepancy in Gleason score and D Amico prognostic risk classification and the impact on treatment decisions H.H.M. Al-Itejawi 1, J.A. Nieuwenhuijzen 1, L. Rozendaal 2, R.J.A. Van Moorselaar 1, A.N. Vis 1. 1 VU University Medical Center, Dept. of Urology, Amsterdam, The Netherlands; 2 VU University Medical Center, Dept. of Pathology, Amsterdam, The Netherlands Introduction & Objectives: The histological examination of prostate biopsies by pathologists is a difficult skill of art. The aim of the present study was to determine the concordance of histological examination of prostate biopsies between general pathologists and a reference uro-pathologist by strictly applying the International Society of Urological Pathology 2005 recommendations. Secondly, we aimed to assess whether pathology review by a reference uro-pathologist leads to different treatment and diagnostics recommendations. Material & Methods: In a series of 277 men, referred for radical prostatectomy following prostate biopsies between January 2010 and May 2014, the pathology report of general pathologists was compared to that of a reference uro-pathologist. The correlation of Gleason score and D Amico prognostic risk group was measured using kappa-statistic. The Gleason score, assessment of tumor volume, site of tumor and number of cores with cancer were compared. We assessed if review of the prostate biopsy by the uro-pathologist would have altered treatment and diagnostics recommendations according to pre-defined algorithms. Results: Overall concordance for Gleason score was 70.0%, with up-

55 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) grading in 23.5% and downgrading in 6.5% of cases (kappa 0.57; p<0.0005). Upgrading in risk group after review by the reference uro-pathologist occurred in 14.8%, whereas 2.9% of cases shifted to a lower prognostic risk group. In pathology reports of general pathologists, tumor volume in mm and percentage was not reported in 81.6% and 54.5% of cases, respectively. In 43.3% cases neither mm nor percentage were mentioned. In 3.2% of the original pathology reports the number of cores positive for cancer was not reported correctly. The obsolete WHO-classification of good, intermediate, or poorly differentiated carcinoma was erroneously used in 32.5% of cases in addition to the Gleason score. Overall, in 28.5% of patients diagnostic assessment and/or treatment recommendations (e.g. indication for extended lymph node dissection or bone scintigraphy) was altered after pathological review. Conclusions: In this series of patients, the pathology report of the prostate biopsy of referring pathologists was not always in accordance with the recommendations on grading and terminology of the ISUP By pathological review of diagnostic prostate biopsies, a substantial change in Gleason score and prognostic risk group was observed, whereas in more than a quarter of cases the diagnostic assessment or treatment advice was altered. P054 Diagnostics of local recurrence of prostate cancer after radical prostatectomy: Native endorectal MRI and endorectal DCE-MRI Y. Alyaev 1, S. Ternovoy 2, E. Bezrukov 1, S. Morozov 2, G. Martirosyan 1, E. Lachinov 1. 1 First Moscow State Medical University of I. M. Sechenov, Research Institute of Uronephrology and Human Reproductive Health, Moscow, Russia; 2 First Moscow State Medical University of I. M. Sechenov, Chair of Radiological Diagnostics and Radiotherapy, Moscow, Russia Introduction & Objectives: The aims of this study were to evaluate the sensitivity and specificity of endorectal MRI with dynamic contrast enhancement in relation to detecting local recurrence of prostate cancer and also to determine the diagnostic capability of local recurrence detection in patients after radical prostatectomy. Material & Methods: We analyzed 48 patients who had undergone radical prostatectomy for prostate cancer during the period of Recurrence of prostate cancer in 27 patients was suspected based on progressive increasing of the PSA level higher than 0.2 ng/ml. The endorectal MRI with dynamic contrast enhancement with gadolinium was performed before transrectal biopsy. The results obtained from combined MRI were qualified as the recurrence if biopsy results were positive. Results: We analyzed the data obtained from 48 patients. Among them 27 patients were suspected to have a recurrence of prostate cancer with average PSA level of 1.6 ( ) ng/ml, and 21 patients with no evidence of the recurrence of the disease with average PSA level of lower than 0.2 ng/ml. After gadolinium injection in 25 of 27 patients with increased PSA level (92%) rapid and early signal enhancement occurs. In 21 patients with no evidence of the recurrence of the disease gadolinium accumulation was not revealed by dynamic MRI. The overall sensitivity and specificity of dynamic MRI (with rectal coil, the field density of which was 1.5 T, sensitivity was 93.4% (76 98%) and specificity was 100% (84 100%)) were higher than the capacity of the native MRI, in which sensitivity is 48% (28 69%) and specificity is 52% (30 74%). Diagnostic accuracy of dynamic MRI was 94% (78 98%) in comparison with 50% of native MRI. The most typical local recurrence was diagnosed in the vesico-urethral anastomosis (56%), in seminal vesicles (36%) and in iliac lymphatic nodes (8%). Recurrence of the disease in 24 cases was proven morphologically, and in other cases the outcome was measured upon decreasing of the PSA level after performed Hi-Fu therapy (n=3). Conclusions: Endorectal MRI with dynamic contrast enhancement showed a high sensitivity and specificity in detecting local recurrence of prostate cancer after radical prostatectomy. P055 Changes in prostate-specific antigen levels are not associated with changes in circulating tumour cells levels during chemotherapy in castration-resistant prostate cancer O. Čapoun 1,M.Jančíková 2, V. Mikulová 2, H. Honová 3, K. Kološtová 4, T. Zima 2, T. Hanuš 1. 1 General Teaching Hospital, 1st Faculty of Medicine, Charles University, Dept. of Urology, Prague; 2 General Teaching Hospital, 1st Faculty of Medicine, Charles University, Dept. of Medical Biochemistry and Laboratory Diagnostics, Prague; 3 General Teaching Hospital, 1st Faculty of Medicine, Charles University, Dept. of Oncology, Prague; 4 3rd Faculty of Medicine, Charles University, Dept. of Tumour Biology, Prague, Czech Republic Introduction & Objectives: The aim of the study is to identify an association of the serum prostate-specific antigen (spsa) and circulating tumour cells (CTC) levels and their changes during chemotherapy in patients with castration-resistant prostate cancer (CRPC). Material & Methods: Peripheral blood from patients with metastatic CRPC is taken before beginning of docetaxel therapy and after the fourth cycle of chemotherapy (CTX). Isolation of CTC from peripheral blood is done by using an immunomagnetic separation. Reverse transcription and multiplex-pcr were performed after lysis of CTC and the expression of tumour-associated antigens (PSA, PSMA and EGFR) was quantified. Samples were reported verbally as either positive, borderline or negative based on the absolute values (ng/μl) of the transcripts. Values of the levels of spsa and the three CTC transcripts were compared with each other before and in the course of CTX. Changes in the verbally reported group of CTC detection as well as correlation between the change of spsa and CTC levels during CTX were evaluated. The Spearman coefficient was used to assess the correlation of the parameters. Results: A total of 34 patients were included in the analysis with both samples taken in 28 of them. Median age was 73 years (56 84), mean spsa level before and after CTX was 206 and 113ng/ml, respectively. Before CTX only 4 out of 34 patients were considered CTC negative, whereas during the CTX the CTC negativity was confirmed in 13 out of 28 cases. Before CTX, positive detection of fragments of antigens for PSA, PSMA and EGFR was confirmed in 28, 20 and 3 patients, respectively, and after CTX in 14, 4 and 3 case, respectively. The spsa level before CTX was associated with the level of fragments for PSA (p=0.0020) and PSMA (p=0.0147). During CTX the association was seen in all antigens. However neither a change in spsa level nor a change in positive vs. negative CTC statement have correlated with a change of any of the tested antigens. Conclusions: The best association was seen between the spsa level and the level of gene fragment for PSA in CTC. Half of the initially CTC positive patients will become CTC negative during chemotherapy, however the change in CTC detection will not correlate with the change of the spsa level. The work was supported by Internal Grant Agency of the Ministry of Health of the Czech Republic no. NT P056 HDR brachytherapy for prostate cancer T. Lo, I. Iftimia, P. Cronin. Lahey Medical Center, Dept. of Radiation Oncology, Burlington, United States of America Introduction & Objectives: In our Institution, patients with clinically localized intermediate risk or high risk prostate cancer were generally offered our tri-modality therapy protocol, consisting of androgen deprivation, high dose rate (HDR) brachytherapy and external beam radiation therapy. We have been practicing HDR brachytherapy for prostate cancer since 1997 and we have treated over 400 patients to-date. This is a retrospect review of the techniques and outcome in this cohort of patients and we also did a preliminary comparison of our two different HDR regimens used over the years. Material & Methods: Between 1997 and March of 2011, we treated

56 130 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) all our patients with a single brachytherapy procedure and delivered a nominal dose of 18 Gy given in 3 fractions over 24 hours. (Group 1) All these patients needed to be hospitalized overnight. Since April, 2011, every HDR brachytherapy case was treated as daysurgery on an outpatient basis with a single fraction of 13 Gy. (Group 2) We are using the GammaMed Plus unit with BrachyVision software for dosimetry planning and treatment delivery. All patients in both groups received external beam therapy after the HDR procedure and a total dose of 45 to 50 Gy over a period of 5 weeks was delivered using contemporary technique. Hormone therapy was given for a minimum of 6 months starting about 2 to 3 months prior to HDR brachytherapy. Results: The median follow-up of our Group 1 patients was 60 months and the follow-up of our Group 2 patients remains too short for analysis. Thus far all our 25 Group 2 patients are doing well without apparent treatment failure or complications. There were a total of 405 patients in Group 1 and the outcome was favorable considering all had intermediate or high risk disease. Biochemical control was achieved in 340 patients (84%) Seventeen (17) patients died from metastatic or recurrent disease, and 65 other patients died from unrelated causes without evidence of prostate cancer. At present, 15 patients are alive with metastatic disease and 23 patients demonstrated biochemical failure without clinical evidence of local or distant disease. The most significant treatment related complication was urethral stricture which occurred in 23 patients (6%). However, only 3 patients ended up requiring urinary diversion. Conclusions: HDR Brachytherapy is effective in the treatment of clinically localized intermediate or high risk prostate cancer. Single dose HDR is appealing because of patient convenience and hospital savings. Most significantly it eliminates the risk of inter-fraction displacement of brachytherapy catheters. The results are encouraging, but further follow-up will be necessary. P057 PROSPER: A phase 3 study of enzalutamide in non-metastatic (M0) castration-resistant prostate cancer (CRPC) patients A. Heidenreich 1, C. Sternberg 2, K. Fizazi 3, F. Saad 4, N.D. Shore 5, M. Hirmand 6, F. Perabo 7, Z. Khondker 6, K. Modelska 6, M. Hussain 8. 1 University Hospital Aachen, Dept. of Urology, Aachen, Germany; 2 San Camillo and Forlanini Hospitals, Dept. of Oncology, Rome, Italy; 3 Institut Gustave Roussy, Dept. of Urology, Villejuif, France; 4 University of Montreal, Dept. of Urology, Montreal, Canada; 5 Carolina Urologic Research Center, -, Myrtle Beach, United States of America; 6 Medivation Inc, -, San Francisco, United States of America; 7 Astellas Pharma Global, -, Northbrook, United States of America; 8 University of Michigan, Dept. of Oncology, Ann Arbor, United States of America Introduction & Objectives: Prostate cancer growth is dependent on androgen receptor (AR) signaling. There is no standard of care for patients with M0 CRPC and most patients will eventually develop metastatic disease despite ongoing androgen deprivation therapy (ADT). In a recent study, patients with a PSA >8 ng/ml or PSA doubling time of <10 months had a median time to bone metastasis of only 2 years (Smith et al. Lancet 2012; 379: 39 46). Enzalutamide is an oral AR inhibitor that targets multiple steps in the AR signaling pathway. In two large Phase 3 studies (Scher et al. N Engl J Med. 2012; 367: , Beer et al. N Engl J Med epub ahead of print) enzalutamide was shown to prolong overall survival and radiographic progression-free survival in patients with metastatic CRPC. The objective of the PROSPER trial is to evaluate the efficacy and safety of enzalutamide in M0 CRPC patients. Material & Methods: PROSPER is a randomized, double-blind, placebo-controlled, Phase 3 study (NCT ) initiated in December 2013, and involving more than 200 sites in the United States, Canada, Europe, South America and the Asia Pacific region. Eligibility criteria include: asymptomatic M0 CRPC; PSA doubling time 10 months; screening PSA 2 ng/ml; and adequate hematologic, hepatic, and renal function. Approximately 1560 patients will have continued ADT and will be randomized 2:1 to enzalutamide 160 mg/day or placebo. Patients will be stratified by PSA doubling time (<6 vs 6 10 months) and baseline use of bone-targeting agent (yes vs no). The primary endpoint is metastasis-free survival based on central independent review of whole-body radionuclide bone scans for bone disease assessment and CT or MRI scans for soft tissue disease assessment. Imaging will be undertaken at screening and every 16 weeks post randomization until radiographic progression. The study has 90% power to detect a target hazard ratio of 0.75 based on a 2-sided logrank test at an overall significance level of Secondary endpoints include: overall survival; time to pain progression; time to opiate use for prostate cancer pain; time to first use of cytotoxic chemotherapy; time to first use of new antineoplastic therapy; time to PSA progression; PSA response; and quality of life as assessed by FACT-P, EQ-5D- 5L and QLQ-PR25. P058 Relationship between tumour burden in the transrectal biopsy and positive margins in radical prostatectomy B.Y. Padilla Fernandez 1, Á.J. Virseda Rodríguez 2, L.S. Valverde Martínez 2, B.J. Pereira 3, H. Coelho 4, M. Montesino Semper 5, C. Müller Arteaga 6, J.L. Álvarez-Ossorio Fernández 7, F. Migliorini 8, M.T. Santos Antunes 9, A. Lorenzo Gómez 9, M.B. García Cenador 9, P. Antúnez Plaza 10, M.F. Lorenzo Gómez 9, IBSAL (Salamanca Institute for Biomedical Research). 1 University Hospital of The Canary Islands, Dept. of Urology, San Cristóbal De La Laguna, Spain; 2 University Hospital of Salamanca, Dept. of Urology, Salamanca, Spain; 3 University Hospital of Pêro Da Covilhã, Dept. of Urology, Covilhã, Portugal; 4 Centro Hospitalar E Universitário De Coimbra, Dept. of Urology, Coimbra, Portugal; 5 University Hospital Virgen Del Camino, Dept. of Urology, Pamplona, Spain; 6 University Hospital of Ourense, Dept. of Urology, Ourense, Spain; 7 University Hospital Puerta Del Mar, Dept. of Urology, Cádiz, Spain; 8 Azienda Ospedaliera Universitaria Integrata, Dept. of Urology, Verona, Italy; 9 University of Salamanca, Dept. of Surgery, Salamanca, Spain; 10 University Hospital of Salamanca, Dept. of Pathology, Salamanca, Spain Introduction & Objectives: Prostate cancer s treatment is becoming increasingly complex, with several treatment options which have a similar oncologic efficacy but different secondary effects. PSA, Gleason score and clinical TNM are the tools to define local-confined cancer with surgical indication. We performed a multicentric study which analyzed the relationship between the tumor burden considering the proportion of affection in the biopsy cores and the presence of positive margins in the surgical specimen. Material & Methods: Retrospective, multicentric study of a sample of 265 patients who underwent RP between March-2009 and March-2013 in seven hospitals (2 level-four hospitals and 5 tertiaryhospitals). Variables: Age, PSA, TNM and Gleason score before (preq) and after surgery (postq), prostate s volume, number of positive biopsy cores and proportion of affection, affected surgical margins, type of prostatectomy [laparoscopic (LP), open retropubic (OP), robot-assisted (RobP)]. Results: Average age years (45 72). Level four hospitals: RobP 12.5%, OP 45%, LP 42.5%. Tertiary hospitals: OP 63.82%, LP 37.17%. PSA preq 8.73 ng/ml (SD 4.23). Volume 41.02cc (SD 18.48). Positive biopsy cores 33.20% (SD22.59). Gleason: preq 6.40 (SD 0.69), postq 6.72 (SD 0.71), p= PSA postq ng/ml (SD 0.139). Positive correlation was found between the percentage of positive biopsy cores and the Gleason preq and postq. Affected surgical margins: 27%. There were found more positive biopsy cores in specimens with affected margins, without significant differences (p=0.3966). There was no difference in the Gleason preq when comparing specimens with positive and negative margins (p=0.2197). PSA preq was greater in positive margins (10.06 ng/ml SD 5.00) than in negative (8.05 ng/ml SD 2.63) (p=0.0246).

57 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Conclusions: Positive correlation was found between the tumour burden considering the proportion of affection in the biopsy cores and the Gleason preq and postq. There were 27% of affected surgical margins in the whole sample. When affected margins were found, there were more positive biopsy cores, but the difference was not significant. Further wider studies may clarify the clinical importance and the prognostic significance of the tumour burden considering the proportion of affection in the biopsy cores. P059 Efficacy and safety of cabazitaxel plus prednisolone chemotherapy for metastatic castration-resistant prostatic carcinoma: Data on Korean patients obtained by the cabazitaxel compassionate use program J.L. Lee 1, S.H. Park 2, S-J. Koh 3, S.H. Lee 4, Y.J. Kim 5, Y.J. Choi 6,J.Lee 7, H.Y. Lim 2. 1 Asan Medical Center, University of Ulsan College of Medicine, Dept. of Oncology, Seoul, South Korea; 2 Samsung Medical Center, Sungkyunkwan University School of Medicine, Dept. of Hematology-Oncology, Seoul, South Korea; 3 Ulsan University Hospital, University of Ulsan College of Meidicine, Dept. of Hematology-Oncology, Ulsan, South Korea; 4 Seoul National University Hospital, Dept. of Internal Medicine, Seoul, South Korea; 5 Seoul National University Bundang Hospital, Dept. of Hematology and Medical Oncology, Seongnam, South Korea; 6 Korea University Anam Hospital, Dept. of Hematology and Oncology, Seoul, South Korea; 7 Sanofi-Aventis Korea, Medical Department, Seoul, South Korea Introduction & Objectives: To report the efficacy and safety of using cabazitaxel plus prednisolone chemotherapy to treat Korean patients with metastatic castration-resistant prostate cancer (mcrpc) following docetaxel therapy. Material & Methods: This cohort study enrolled 26 mcrpc patients. Treatment consisted of 25 mg/m 2 cabazitaxel that was intravenously administered every 3 weeks, in addition to twice-daily 5 mg prednisolone. Results: The median patient age was 67 years (range = 53 82), median ECOG performance status was 1 (range = 0 2), Gleason score was 8 in 25 patients (96%), and median serum PSA was 95.3 ng/ml (IQR = ). A total of 180 treatment cycles were administered, and a median of 5 cycles were administered per patient (range = 1 23). A PSA response was observed in 32% of evaluable patients. Tumor response was evaluated in 8 patients, and 3 and 4 patients achieved partial response and stable disease, respectively. Over a median follow-up duration of 23.4 months (95% CI = ), median time to treatment failure was 4.2 months (95% CI = ) and median time to progression was 8.5 months (95% CI = ). Median overall survival was 16.5 months (95% CI = ). Grade 3 or worse febrile neutropenia developed in 8 patients (31%) and neutropenic infection in 4 patients (15%). Conclusions: Cabazitaxel plus prednisolone chemotherapy can be used to treat Korean mcrpc patients. Prophylactic growth factor support should be considered for patients at high risk of neutropenic fever or infection. P060 Enzalutamide monotherapy in patients with hormone-naive prostate cancer: 1-year extended follow-up of a Phase 2 study M. Borre 1, M.R. Smith 2, P. Rathenborg 3, P. Werbrouck 4,H.Van Poppel 5, A. Heidenreich 6, P. Iversen 7, J. Braeckman 8, J. Heracek 9, E. Baskin-Bey 10, T. Ouatas 10, F. Perabo 11, D. Phung 10, B. Baron 10, M. Hirmand 12, B. Tombal Aarhus University Hospital, Dept. of Urology, Aarhus, Denmark; 2 Massachusetts General Hospital, Cancer Center, Boston, United States of America; 3 Herlev University Hospital, Dept. of Urology, Herlev, Denmark; 4 AZ Groeninge Kortrijk, Dept. of Urology, Kortrijk, Belgium; 5 UZ Leuven, Dept. of Urology, Leuven, Belgium; 6 RWTH University Aachen, Klinik und Poliklinik für Urologie, Aachen, Germany; 7 University of Copenhagen, Rigshospitalet, Copenhagen, Denmark; 8 UZ Brussel, Dept. of Urology, Brussels, Belgium; 9 Univerzita Karlova V Praze, Dept. of Urology, Prague, Czech Republic; 10 Astellas Pharma, Dept. of Global Development, Leiden, The Netherlands; 11 Astellas Pharma, Dept. of Global Development, Northbrook, United States of America; 12 Medivation, Inc, San Francisco, United States of America; 13 Cliniques Universitaires Saint-Luc, Dept. of Urology, Brussels, Belgium Introduction & Objectives: The efficacy and safety of enzalutamide monotherapy was assessed in men with any-stage hormone-naive prostate cancer eligible for androgen-deprivation therapy (ADT). The primary endpoint of prostate specific antigen (PSA) response rate ( 80% PSA decrease between baseline and week 25) was 92.5% (Tombal B et al, Lancet Oncol 2014). The median (range) maximum PSA decline from baseline to week 25 was 99.6% ( 100 to 86.5). 1-year extended follow-up data are presented. Material & Methods: In an open-label, single-arm, Phase 2 study (NCT ), men 18 years of age with histologically confirmed prostate cancer requiring ADT, with non-castrate testosterone ( 8 nmol/l), PSA 2 ng/ml at screening, and a life expectancy 12 months, received 160 mg enzalutamide once daily until disease progression or unacceptable toxicity occurred. Other endpoints included changes in hormone levels, metabolic parameters, bone mineral density (BMD), safety and quality of life (QoL). Results: 67 men were enrolled. Median (range) age was 73 years (48 to 86); 38.8% had metastases; 35.8% and 23.9% had undergone prior prostatectomy and radiotherapy, respectively. 54 men completed the 1-year treatment visit. The PSA response rate ( 80% PSA decrease from baseline) in men completing 1-year s treatment was 100% (54 out of 54) and 53 men (98.1%) had a PSA decrease 90% from baseline. The median (range) maximum decline in PSA was 100% ( 100 to 86.5) from baseline to 1 year. Luteinising hormone and testosterone were increased from baseline by 215.2% and 101.7%, respectively. Mean changes from baseline for fasting metabolic variables were: +5.0% total cholesterol, +8.9% triglycerides, ±3.5% HbA1c and +19.7% insulin resistance. Total body BMD was maintained ( 0.3% from baseline). The most frequently reported treatment-emergent adverse events (AEs) were gynaecomastia (47.8%) and fatigue (38.8%). Seven non-drug-related serious AEs were reported. QoL scores at 1 year demonstrate maintenance of global health status and a decrease in sexual activity and sexual functioning. Conclusions: Extended follow-up of hormone-naive patients demonstrated sustained PSA reductions up to 1 year of enzalutamide monotherapy. Endocrine changes, metabolic changes and AEs were consistent with potent androgen receptor-inhibition, and similar to results reported at 25 weeks. Results beyond 1 year may also be available for presentation. P061 Cancer in urology is there an App for that? A systematic review N. Azevedo 1, E. Carrasquinho 2, E. Cardoso De Oliveira 2, V. Cavadas 3, L. Osório 3, A. Fraga 3, M.J. Roobol 4, M. Castelo-Branco 1. 1 University of Beira Interior, Dept. of Health Sciences, Covilhã, Portugal; 2 Espírito Santo Hospital Évora, Dept. of Urology, Évora, Portugal; 3 Porto Hospital Centre, Dept. of Urology, Porto, Portugal; 4 Erasmus University Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands Introduction & Objectives: Currently smartphones are almost ubiquitous in our society and represent a popular method of accessing information. Mobile apps are increasingly playing a role in healthcare, with over 100,000 medical apps available on Apple s App and Google s Play Store. This comprehensive research reviews and compares urological cancer-specific apps in these platforms. Material & Methods: The researchers conducted a systematic search, between May and June 2014, on Apple s App and Google s Play Store, for urology-related and cancer-specific apps in English. Apps related

58 132 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) with cancer, but which were not specific for urological cancer, were not included in this study. Each of the selected apps was reviewed by three graders to unanimously determine their price, type of developer (individual or company), target audience (health care professional or general population) and type of cancer. Results: We found 139 ios applications designed for urology, of which 19% were cancer specific, and 128 Android urological applications, 12% of which were cancer specific. All variables were compared between Android and ios apps using Chi-square goodness-offit test for the numbers of apps and Fisher exact testing (for nominal variables). There was no statistically significant difference between the number of urological cancer apps in both stores (p=0.086). Moreover, Fisher test shows that there was no statistically significant differences between Android and ios in app price (paid or free, p=0.129), type of developer (p=0.566) and target audience (p=0.507). From a total of 34 urological cancer specific apps, 21% were available in both stores, 56% were exclusively on Apple s App Store and 24% on Google s Play Store. The majority were free (56%), developed by companies (65%) and designed for the general population (59%). Most were prostate cancer specific (74%); 9% were for general urological cancers, 9% for testicular, 6% for bladder and 3% for renal cell cancer. There were no apps specific for upper urinary tract, urethral or penile cancer. Conclusions: To our knowledge, this is the first study that completely reviews and compares mobile apps designed for urological cancer. There are some apps available exclusively in a specific platform, which could represent the difference in review policy (all ios apps have to be approved by Apple; Android apps are mostly unregulated). We can conclude that urological cancer specific apps represent less than a quarter of all urology related apps, with no statistically significant differences between the two most popular mobile platforms. In addition, the total number of available urological cancer specific apps is much lower than that of breast cancer (total = 238, Android = 138, ios = 100). With the foreseeable growth of the mhealth app market, expected to reach a value of more than USD 26bn in 2017, we look forward to an increase in the quantity and quality of available medical apps. P062 Full functional length urethral sphincter preservation during open radical prostatectomy will it improve the continence rate? R.K. Shimpi. Uro-Andrology Clinic, Dept. of Urology, Pune, India Introduction & Objectives: The full length of the urethral sphincter is the key for urinary continence after Radical Prostatectomy. As demonstrated by various studies, the Intra-Prostatic Urethra between the apex and verumontanum is an important part of the urethral sphincter complex. My modified technique is aimed at preserving the muscular part of the Intra-Prostatic Urethra in low volume disease. Material & Methods: 98 patients within the age group of treated between 2000 and 2011 were analyzed. 23 patients with low volume disease were chosen for Full Functional Length Urethral Preservation (FFLU) while 75 had non-fflu. Continence rate was assessed at 1 month and 3 months after the catheter removal. The proximal urethral tissue was sent for frozen section. Results: The continence rate at one month after the catheter removal was defined as no pad at all or one protective pad was used 79.9% with FFLU and that with non-fflu was 68.2%. After 3 months, the continence rate rose to 96.7% and 80.4% respectively. The other factors considered in the study are age, PT stage, prostatectomy Gleason score. The positive surgical margin rate was 1.6% with FFLU while the one with non-fflu was 2.2% Conclusions: The improved Urinary Continence Rate achieved by doing this technique shows that this simple manoeuvre of Full Functional Length Urethral Preservation (FFLU) in low volume disease should be attempted wherever possible. Advanced prostate cancer P063 Staging of biochemical recurrent prostate cancer after radical prostatectomy using 68Gallium-labelled ligand of prostate-specific membrane antigen PET/CT and PET/MRI T. Maurer, V. Beck, A.J. Beer, M. Souvatzoglou, K. Holzapfel, H. Kübler, J.E. Gschwend, H-J. Wester, B. Haller, M. Schwaiger, M. Eiber. Klinikum rechts der Isar der Technischen Universität München, Dept. of Urology, Munich, Germany Introduction & Objectives: Staging of recurrent prostate cancer after curative intended radical prostatectomy (RPE) remains challenging especially at low PSA values. Recently, Glu-NH-CO-NH-Lys- (Ahx)-[ 68 Ga(HBED-CC)] as a novel 68 Gallium-labelled ligand of the prostate-specific membrane antigen ( 68 Ga-HBED-PSMA) has been developed. PSMA shows a selective and marked expression on the cell surface of prostate cancer cells. Thus, the aim of this study was to investigate the detection rate of 68 Ga-HBED-PSMA PET/CT and PET/MRimaging in patients with biochemical recurrence of prostate cancer after RPE. Material & Methods: This retrospective analysis included 332 patients with a median PSA-level of 1.7 ng/ml (range ng/ml). After injection of 122±17 MBq 68 Ga-HBED-PSMA contrastenhanced PET/CT or fully-diagnostic PET/MR including multiparametric prostate MR was performed in 256 patients and 76 patients, respectively. Images were reviewed by one nuclear medicine physician and one radiologist in consensus. Findings were rated as suspicious or highly suggestive for recurrent prostate cancer. Results: For PET/CT and PET/MR detection rates for PSA-values 2 ng/ml, were 96.1% (122/127) and 95.5% (21/22), for PSA-values 1 2 ng/ml 94.4% (67/71) and 81.3% (13/16), for PSA-values ng/ml 71.4% (25/35) and 75.0% (9/12) and for PSA-value ng/ml 56.5% (13/23) and 50.0% (13/26), respectively. Especially in cases with low PSA-values the diagnostic certainty was substantially higher in PET/MR compared to PET/CT: for PSA-values ng/ml 38.5% vs. 69.2% of positive findings on PET/CT vs. PET/MR were rated as highly suggestive for prostate cancer recurrence. Conclusions: 68 Ga-HBED-PSMA PET-imaging shows higher detection rates for patients with recurrent prostate cancer than reported for other tracers especially at low PSA-values and most likely will replace other tracers like 18 F-FDG or choline derivatives in clinical practice. As salvage therapy is most effective at low PSA-levels, early detection of cancerous foci by 68 Ga-HBED-PSMA PET-imaging might improve oncological results. PET/MR might be advantageous in patients with PSA <1 ng/ml as multiparametric MR provides additional information, thus increasing the diagnostic certainty. P064 To prospectively compare F18-Choline PET/CT and axial skeleton MRI for the detection of bone metastases in patients with biochemically recurrent prostate cancer (PCa) P. Ost 1, W. Huysse 2, L. Delrue 2, K. Decaestecker 3, G. De Meerleer 1, F. De Vos 4, V. Fonteyne 1, B. Lambert 5. 1 Universitair Ziekenhuis Gent, Dept. of Radiotherapy, Ghent, Belgium; 2 Universitair Ziekenhuis Gent, Dept. of Radiology, Ghent, Belgium; 3 Universitair Ziekenhuis Gent, Dept. of Urology, Ghent, Belgium; 4 Universiteit Gent, Dept. of Radiopharmacy, Ghent, Belgium; 5 Universitair Ziekenhuis Gent, Dept. of Nuclear Medicine, Ghent, Belgium Introduction & Objectives: To compare F18-Choline PET-CT and axial skeleton MRI (AS-MRI) in detecting bone metastases in hormonenaïve prostate cancer (PCa) patients with a biochemical recurrence following curative treatment. Material & Methods: PCa patients with a biochemical relapse follow-

59 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) ing local PCa treatment radical prostatectomy and/or external beam radiotherapy). Patients with hormonal therapy or testosterone values below 50 ng/ml were excluded. Patients consented to participate in this prospective study. F18-Choline PET/CT was performed 45 m following injection of 3 4 MBq/kg F18-methylcholine. Patients were scanned from the base of skull to the proximal thighs. All PET/CT scans were co-reported by 2 senior staff members of nuclear medicine and radiology (BL, LD). AS-MRI included the entire spine and pelvis, and all scans were read by an experienced musculoskeletal radiologist (WH). Readers were initially blinded from other scan results. Panel review of initial and follow-up imaging findings, with all available baseline and follow-up clinical and biologic data were used as the best valuable comparator to define metastatic status. A lesion-based analysis was conducted. Patients with >5 lesions were classified as a single lesion termed diffuse We only considered lesions that were within the joint field of view of both imaging modalities. The sensitivity and specificity of these approaches were compared using the McNemar test, with P<0.05 considered statistically significant. Results: Sixty-one consecutive patients underwent both AS-MRI and PET/CT on average 3 days apart. On the basis of the BVC, 29 patients presented with 88 bone metastases. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI were estimated to be 97%, 92%, 85% and 92%. For F18-Choline PET/CT, sensitivity, specificity, PPV and NPV were 93%, 98%, 96% and 97%. Both sensitivity and specificity were comparable (p=0.22 an 1 respectively). In one patient, diffuse lesions were suspected on MRI, but follow-up imaging could only confirm the suspect nature in 2 lesions. Hence, the exact number of false positive MRI lesions could not be correctly be accounted for in the present lesion based analysis. Conclusions: Both F18-Choline and MRI perform comparable in the assessment of bone metastases in asymptomatic PCa patients with a biochemically relapse. P065 Size and extension of lymph node metastases in prostate cancer patients: Implications for radiological imaging based on 6804 lymph nodes B. Beyer 1, C. Meyer 1, T. Eichenauer 1, T. Steuber 1, G. Salomon 1, U. Michl 1, T. Schlomm 1, H. Huland 1, S. Steurer 2, G. Sauter 2, H. Heinzer 1, M. Graefen 1, L. Budäus 1. 1 Martini-Clinic, Prostate Cancer Center, Dept. of University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 2 University Medical Center Hamburg-Eppendorf, Dept. of Pathology, Hamburg, Germany Introduction & Objectives: Vigorous efforts and technical advance helped improving radiological lymph node staging in prostate cancer patients. Reliable detection of lymph node metastasis is reported for 8 mm in round nodes and 10 mm in ovally shaped nodes. Even with particle enhanced imaging techniques, lymph node metastases are detected only down to a diameter of approximately 5 mm. Aim of our study was to assess the size of lymph node metastases (LNM) in prostate cancer patients. Material & Methods: Between 4/2012 and 9/2013, positive lymph nodes were detected in 317 patients after radical prostatectomy (RP). The size (mm) of LNMs was analyzed after pathological work up. In case of multiple LNM, final analyses were restricted to the diameter of the largest metastasis. Results: The analyses of 317 patients resulted in the overall detection of 6804 lymph nodes; harboring 799 lymph node metastases. Mean, median (range) PSA was 19.8 ng/ml; ng/ml ( ng/ml). Mean, median (range) age was 64.9; 65 (61 70) years. Immunochemistry for verification of LNM diagnosis was necessary in 83 (26%) patients. Mean, Median (range) LNM size was 5.94 mm; 3 mm ( mm). LNM 10 mm, 8 mm and 5 mm were recorded in 69 (21.7%), 84 (26.5%) and 121 (38.2%) of all patients, respectively.a LNM smaller than 5 mm was found in 196 (61.8%) patients. Micrometastases ( 2 mm) were detected in 119 (37.5%) patients. Interestingly, even in 22/119 (18.5%) of pt2 tumors, the presence of micrometastases was recorded. Conclusions: Our results demonstrate that 62% (196/317) of all patients in our cohort harbor LNMs smaller than the theoretical threshold of 5 mm. Moreover, even in pt2 tumors micrometastases are prevalent in almost 20% of patients. Therefore, standardized pelvic lymph node dissection still remains the best way for staging and potential cure. P066 An indirect comparisons analysis of novel treatment strategies for castration-resistant prostate cancer L.M. Lee 1, E. Donath 1, W. Samra 1, S. Peles 2. 1 University of Miami, Dept. of Internal Medicine, Atlantis, United States of America; 2 University of Miami, Dept. of Hematology and Oncology, Atlantis, United States of America Introduction & Objectives: A large number of patients with advanced prostate cancer develop castration-resistant disease after initial treatment with androgen-deprivation therapy. Docetaxel in combination with prednisone has been the standard first-line chemotherapy for years, however recently the treatment landscape has been dramatically altered. In the past three years, five additional therapies (enzalutamide, radium-223, abiraterone, cabazitaxel, sipuleucel- T) with varied mechanisms of action have become available for the treatment of castration-resistant prostate cancer. Nevertheless, there is very little data available on any meaningful comparisons between these treatments (as past trials have employed either placebo or estramustine as the comparator group). The purpose of this research is to therefore perform an indirect comparisons analysis among these 6 classes of drugs. Material & Methods: Studies were extracted from a computerized literature search of MEDLINE and EMBASE of all relevant randomized controlled trials (RCTs). Twelve RCTs involving 8416 patients were identified. There were primarily three outcomes of interest: overall survival, progression-free survival and response rate. For each outcome, a fixed-effect meta-analysis was employed to compare each class of drugs to placebo. A mixed-treatment comparison analysis was then used to compare each of these classes to one another indirectly. Calculation of the probability that each treatment is best was implemented using the Bayesian Markov chain Monte Carlo method. Results: In terms of overall survival, although all drugs offered a statistically significant mortality benefit when compared directly to their controls, there was no statistically significant benefit in favor of any of the six approved therapies when indirectly compared to each other. By ranking probability, radium-223 has a 36% chance of being the agent most likely to offer the greatest mortality benefit followed closely behind by enzalutamide s 31% probability. Docetaxel has a 47% chance of being the agent least likely to offer a survival benefit. A wide degree of heterogeneity existed among the studies in how they defined disease response and disease progression and it was deemed inappropriate to consolidate these studies for the purpose of evaluating those outcomes. Conclusions: Although none of the six approved agents for castration-resistant prostate cancer offers indirect evidence of statistically significant superiority, there is a trend towards increased survival benefit from both radium-223 and enzalutamide in comparison to the other approved agents. There are a wide variety of limitations to pursuing this analysis the purpose is not necessarily to alter clinical decision-making but rather to support efforts to directly compare these drugs to one another to help determine superiority. Additional subgroup analyses are also required to identify which patients may be best suited for the varied therapeutic options.

60 134 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P067 Role of stereotactic body radiotherapy (SBRT) in the management of oligometastatic prostate carcinoma UK experience I.S. Bhattacharya, R. Hughes, P. Ostler, P. Hoskin. Mount Vernon Cancer Centre, Dept. of Oncology, London, United Kingdom Introduction & Objectives: Oligometastatic (OM) prostate cancer is defined as three or fewer sites of isolated metastatic disease. SBRT of OM disease has shown promising local control rates (80%) with minimal toxicity. SBRT is likely to delay the initiation of long term androgen deprivation and systemic therapy, and may affect overall survival in between 20 and 40% of patients [1]. The aim of this study is to identify local control and overall survival (OS) of patients receiving SBRT for OM prostate cancer. Material & Methods: Data was collected for patients receiving SBRT between September 2012-March 2014 including demographic details, SBRT date, date of local/distant progression, toxicity and date of death. Results: 9 patients received SBRT for OM prostate cancer. Median age was 67, range years at time of SBRT. SBRT sites included bone (4), pelvic lymph nodes (3), para-aortic nodes (2). Median follow-up was 13.8 months and range months. To date local control is 100%. Five (56%) patients have no evidence of disease. For the 4 (44%) patients that developed distant disease progression, the median time from SBRT to distant disease progression was 14.0 months, range months. 3 patients died from distant disease progression at 15.7, 20.5 and 23.0 months from SBRT. There was no grade 3 or 4 toxicity. 1 patients required ADT initiation 15.1 months from SBRT. 3 patients were on ADT prior to SBRT. 5 patients did not require ADT. Conclusions: Despite relatively limited follow up, our series confirms excellent local control with SBRT. SBRT may alter the outcome for men with OM prostate cancer and delay initiation of androgen deprivation and systemic therapies. Randomised control data is required to support SBRT in OM prostate cancer and the CORE trial is currently in discussion. Reference [1] Tree AC, Khoo VS, Eeles RA et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol Jan;14(1):e P068 Bipolar plasma vaporization in prostate cancer related urinary retention a palliative modality of maintaining long term spontaneous voiding B. Geavlete, C. Moldoveanu, F. Stanescu, M. Jecu, C. Ene, C. Bulai, L. Adou, P. Geavlete. Saint John Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: A prospective analysis evaluated the efficiency, safety and long term postoperative results of the bipolar plasma vaporization (BPV) in prostate cancer (PCa) cases associating complete urinary retention. Material & Methods: A series of 60 patients diagnosed with locally advanced or metastatic PCa and complete urinary retention requiring catheter indwelling underwent BPV aiming to restore spontaneous voiding. A total of 51 patients completed the 2 years evaluation protocol consisting of International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum flow rate (Qmax) and post-voiding residual urinary volume (PVR), measured at 1, 3, 6, 12, 18 and 24 months after the initial surgery. Results: BPV was successfully performed in all cases with satisfactory efficiency (mean operation time 41.7 minutes). BPV was characterized by reduced perioperative morbidity (capsular perforation 3.3%; hemoglobin level drop 0.9 g/dl; significant hematuria 8.3%; early irritative symptoms 16.7%). A fast postoperative recovery process was described in this group (mean catheterization period 1.8 days; mean hospital stay 2.2 days). No blood transfusions or early re-interventions were required. At the 1 to 24 months check-ups, satisfactory values were determined in terms of IPSS ( ), Qmax ( ml/s), QoL ( ) and PVR (25 39 ml). These parameters emphasized a stable evolution throughout the entire followup period, as 86.3% of the followed patients maintained spontaneous voiding. Conclusions: The present trial confirmed the plasma vaporization as a reliable therapeutic approach in PCa cases associating complete urinary retention. The technique displayed good surgical efficacy, low periopearative morbidity and short convalescence period. Satisfactory urodynamic and symptom score parameters were described during the 2 years follow-up protocol. P069 Low-dose prednisolone in first-line docetaxel for patients with metastatic castration-resistant prostate cancer. Is there a clinical benefit? P. Kongsted 1, I.M. Svane 2, G. Daugaard 3, H. Lindberg 4, L. Sengeløv 4. 1 Center For Cancer Immune Therapy, Herlev Hospital, University of Copenhagen, Dept. of Oncology and Hematology, Copenhagen, Denmark; 2 Center For Cancer Immune Therapy, Herlev Hospital, University of Copenhagen, Dept. of Oncology and of Hematology, Copenhagen, Denmark; 3 Rigshospitalet, University of Copenhagen, Dept. of Oncology, Copenhagen, Denmark; 4 Herlev Hospital, University of Copenhagen, Dept. of Oncology, Copenhagen, Denmark Introduction & Objectives: Suppression of adrenal androgen biosynthesis and inflammatory pain are some of the mechanisms thought to be responsible for the beneficial effects of low-dose glucocorticoids administered in mcrpc. Low dose prednisone has been a part of the systemic treatment in mcprc in combination with chemotherapy and randomized studies have shown improved survival with the combination of docetaxel and prednisone. In this retrospective study we investigate whether co-administration of low dose glucocorticoids has clinical benefits. Material & Methods: Records from 358 patients with mcrpc treated consecutively with either docetaxel 75 mg/m 2 /q3 weeks (n=107) (Rigshospitalet) or docetaxel and prednisolone (P) 10 mg daily (n=236) (Herlev Hospital) given as first-line chemotherapy were reviewed. Treatment was initiated between 2007 and Fifteen patients treated with glucocorticoids at initiation of docetaxel at Rigshospitalet were excluded from the analysis. Age, Gleason scores at diagnosis, pre-docetaxel treatments, ECOG performance status (PS) and levels of prostate specific antigen (PSA) at initiation of docetaxel were registered. Common Terminology Criteria for Adverse Events version 4.0 was used to register any grade of peripheral edema, grade 2 sensory neuropathy and grade 3 4 non-hematological toxicity. Dose reductions, use of pegfilgrastim and post docetaxel treatments were also registered. Background clinical data, toxicity, dose reductions, number of treatment cycles and admissions were analyzed by the Chi-squared- or Mann-Whittney U test. Progression free survival (PFS) and overall survival (OS) were calculated using the Kaplan- Meier model and differences were analyzed with the Log-Rank test and Cox regression model. Results: Overall, the group of patients treated with docetaxel and P had a poorer PS, with more patients being registered as PS 2 (25.5% vs 3.7%, p<0.001). More patients treated with docetaxel and P had a sum of Gleason scores 8 (73.9% vs 62.0%, p=0.038) and the median levels of PSA before initiating docetaxel were also higher in this group (295 ng/ml vs 187 ng/ml, p<0.001). Patients treated with docetaxel alone had a higher incidence of peripheral edema (33% vs 15%, p<0.001) and grade 3 non-hematological toxicity (55.1% vs 43.2%, p=0.04), respectively, compared to patients treated with docetaxel + P. Patients treated with docetaxel only also had a higher median number of admissions (p=0.019), mainly due to a higher incidence of febrile neutropenia (25.2% vs 10.2%, p<0.001). P did not influence PFS (p=0.87) or OS when adjusting for age, sum of Gleason scores and PS (p=0.73). There was no significant difference between the two groups regard-

61 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) ing the median number of treatment cycles, dose reductions, use of pegfilgrastim, deaths due to febrile neutropenia or post-docetaxel treatments (abiraterone, cabazitaxel, enzalutamide). Conclusions: Co-administration of low dose P reduced the incidence of peripheral edema, grade 3 non-hematological toxicity and the risk of being admitted due to febrile neutropenia during treatment with docetaxel. Adjusted survival analysis did not indicate that P affected prognosis. P070 Oncological outcomes of radical prostatectomy for high-risk prostate cancer E. Sokolov, E. Veliev, O. Loran, A. Bogdanov, A. Metelev, A. Tomilov, E. Ivkin. Russian Medical Academy of Postgraduate Education, Dept. of Urology and Surgical Andrology, Moscow, Russia Introduction & Objectives: Several recent studies have demonstrated that the patients with the high-risk (HR) prostate cancer (PC) can receive a significant benefit from the radical prostatectomy (RP). Aim of this study was to analyze the long-term biochemical recurrence-free survival (BCRFS) and prostate cancer-specific survival (PCSS) in patients with HR PC treated with open retropubic RP according to the number of HR-factors and results of pathological evaluation [specimen-confined (SC) vs non-specimen-confined (NSC) PC]. Material & Methods: Between 1997 and 2012, 776 patients with HR PC (clinical stage T2c and/or biopsy Gleason score 8 10 and/or prostate-specific antigen >20 ng/ml) underwent RP at our hospital. The study comprised 446 patients who were followed up for >12 months, had all preoperative and postoperative information available and received no neoadjuvant androgen deprivation therapy. SC disease was defined as pt2-3r0n0 PC. The Kaplan-Meier method with long-rank test was used to evaluate BCRFS and PCSS rates. Results: Median follow-up time was 50 months (IQR: 31 74); 320 patients (71.8%) had one HR-factor, 109 (24.4%) two HR-factors and 17 (3.8%) three HR-factors. SC PC was found in 308 (69%) patients. Overall BCRFS at 5 and 10 years was 65% and 62%, the overall PCSS at 10 and 15 years was 92.6% and 82.6%. In SC and NSC groups 5-year BCRFS was 79.6% and 32.7% (p<0.001); 10-year PCSS was 100% and 78.6% (p<0.001). Presence of >1 HR-factor was a significant predictor of biochemical recurrence (HR 2.916; p<0.001). For patients with 1, 2 and 3 HR-factors 5-year BCRFS was 76.7%, 39% and 35.3%; 10-year PCSS 97.8%, 85.4% and 64.2% respectively. Conclusions: RP can result in high long-term BCRFS in selected patients with HR-PC. SC disease (radical operation) provides highest BCRFS and PCSS after RP. Presence of >1 HR-factor results in less favorable oncological outcomes. Substratification of HR-patients and individual risk-assessment are essential. P071 Experience of a nurse led abiraterone clinic I.S. Bhattacharya, A. Samani, M. Swinton, L. Miles, R. Alonzi, P. Ostler, P. Hoskin. Mount Vernon Cancer Centre, Dept. of Oncology, London, United Kingdom Introduction & Objectives: Rising numbers of castrate resistant prostate cancer patients are receiving abiraterone requiring monthly monitoring visits for response and toxicity. A nurse-led clinic for these patients has been established with physician review every 3 months or sooner if there is evidence of progression or toxicity. Material & Methods: Retrospective audit of patients attending over 6 months based on patient notes and chemotherapy online prescribing system. Response was defined as immediate if there was reduction in PSA values 4 weeks after abiraterone initiation. Late response was defined by stable or rising PSA values 4 weeks after abiraterone initiation, followed by a reduction. Progression was defined by a 25% increase over baseline/nadir, with minimum PSA increase of 5 ng/ml) [1]. Results: 44 patients were included. Median age 76 years (range years). 37 (84%) patients were docetaxel naive and 7 (16%) were post docetaxel. Median follow-up was 8.2 months (range months). 32 (73%) patients had an immediate response, 5 (11%) patients had a delayed response and 7 (16%) patients did not respond. Median time to response was 2.6 months (range months) in those with a delayed response. Median time to PSA progression was 5.9 months (range months) in those with an immediate and delayed response who progressed. In those patients with PSA progression; 17 patients had imaging of whom 13 had radiological disease progression (defined as new metastatic disease), 2 had stable disease and 2 had no detectable radiological disease progression. 5 patients died of disease progression.2 patients required temporary cessation of abiraterone due to liver toxicity and dizziness respectively. 5 patients required antihypertensive medication. Conclusions: As abiraterone use, particularly in the pre-chemotherapy setting increases, there are rising demands on workload. The nurse led clinic provides a dedicated service for patients receiving abiraterone whilst maintaining continuity of care as well as a pathway for clinician review when required. The significant incidence of toxicity and relatively short duration of response in many patients demonstrates the need for close clinical surveillance which can be effectively undertaken in a nurse led clinic with physician support. Reference [1] Ryan CJ, Smith MR, de Bono JS et al; COU-AA-302 Investigators. Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med Jan 10;368(2): P072 Activity and clinical outcomes of New Agents (NAs) administered as third or fourth line after the failure of docetaxel (DOC) and another NA in metastatic Castration-Resistant Prostate Cancer (mcrpc) patients. Final results of an Italian multicentre retrospective study O. Caffo 1, U. De Giorgi 2, L. Fratino 3, D. Alesini 4, U. Basso 5, G. Facchini 6, D. Gasparro 7, C. Ortega 8, M. Tucci 9, F. Verderame 10, E. Campadelli 11,G.LoRe 12, G. Procopio 13, R. Sabbatini 14, M. Donini 15, F. Morelli 16, D. Sartori 17, P. Zucali 18, V. Conteduca 2, F. Maines 1, E. Galligioni 1. 1 Santa Chiara Hospital, Dept. of Medical Oncology, Trento, Italy; 2 Istituto Scientifico Romagnolo Per Lo Studio E La Cura Dei Tumori (IRST) IRCCS, Dept. of Medical Oncology, Meldola, Italy; 3 National Cancer Institute, Dept. of Medical Oncology, Aviano, Italy; 4 La Sapienza, University of Rome, Dept. of Radiological, Oncological and Anatomopathological Sciences, Rome, Italy; 5 Istituto Oncologico Veneto IOV IRCCS, Dept. of Medical Oncology Unit 1, Padua, Italy; 6 Instituto Nazionale Tumori Fomdazione G. Pascale IRCCS, Dept. of Medical Oncology, Department of Uro-Gynaecological Oncology, Naples, Italy; 7 General Hospital, Dept. of Medical Oncology, Parma, Italy; 8 Institute For Cancer Research and Treatment, Dept. of Medical Oncology, Candiolo, Italy; 9 University of Torino, San Luigi Hospital, Dept. of Medical Oncology, Turin, Italy; 10 Villa Sofia Cervello Hospital, Dept. of Medical Oncology, Palermo, Italy; 11 General Hospital, Dept. of Medical Oncology, Lugo Di Romagna, Italy; 12 Santa Maria Degli Angeli Hospital, Dept. of Medical Oncology, Pordenone, Italy; 13 Fondazione Istituto Nazionale Tumori, Dept. of Medical Oncology, Milan, Italy; 14 University of Modena, Dept. of Medical Oncology, Modena, Italy; 15 General Hospital, Dept. of Medical Oncology, Cremona, Italy; 16 Casa Sollievo Della Sofferenza, Dept. of Medical Oncology, San Giovanni Rotondo, Italy; 17 General Hospital, Dept. of Medical Oncology, Mirano, Italy; 18 Istituto Clinico Humanitas, Dept. of Medical Oncology and Haematology, Rozzano, Italy Introduction & Objectives: The availability of the NAs abiraterone acetate (AA), cabazitaxel (CAB) and enzalutamide (ENZ), which are active in patients with (mcrpc) who progress after DOC, has led to the possibility of using them sequentially in the hope of obtaining a cumulative survival benefit, although this is not supported by clinical

62 136 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) trial data. We report final results (preliminary data reported at ASCO 2014) from a large cohort of patients who received a NA as 3rd-line after the failure of docetaxel and another NA. Material & Methods: All NAs were available in Italy through a compassionate use program (CUP), or after the regulatory authorities approval (only CABA in 2012 and AA in 2013). We retrospectively reviewed the clinical records of patients who had received at least two NAs after the failure of DOC, and recorded their pre-na history of prostate cancer, their NA treatment history and outcomes, and their post-na history. A prognostic score (ProS) was obtained by weighting the factors predicting progression-free survival (PFS) and overall survival (OS). Results: We identified a consecutive series of 260 mcrpc pts who received NAs as 2nd and 3rd line after DOC, but 38 also as 4th line. The table summarizes the clinical outcomes. Table 1 Third-line (260 patients) Fourth-line (38 patients) brr orr PFS OS brr orr PFS OS All patients 24% 13% % 8% 5 5 AA 24% 15% % 9% 5 4 CAB 28% 14% % 17% 4 7 ENZ 20% 10% % 0% 5 5 No significant differences were observed according to the sequence used. According to ProS outcomes we identified three categories: pts with ProS 0 3 with low probability of benefitting from 3rd line treatment (median PFS and OS, 3 and 6 mos), pts with ProS 4 8 with good probability of benefitting (median PFS and OS, 5 and 11 mos), and pts with a ProS 9 with the highest probability of benefitting (median PFS and OS, 14 mos and NYR). Conclusions: Despite its retrospective nature, the present study suggested that the clinical outcome of 3rd-line NAs is similar regardless of the previous NA therapy, that some factors can help to identify patients. P073 HIFU in multimodal treatment of high-risk prostate cancer: 5-years single center experience V.A. Solovov 1, M.O. Vozdvizhenskiy 2, D.V. Fesenko 2, Y.S. Matysh 2, R.Z. Khametov 2. 1 Samara Regional Oncology Center, Dept. of Urology, Samara, Russia; 2 Samara Regional Oncology Center, Dept. of Surgery, Samara, Russia Introduction & Objectives: Patients with high-risk prostate cancer undergoing radical prostatectomy, external beam radiation therapy combined with androgen deprivation therapy (ADT) or ADT alone. HIFU showed effective method for localized prostate cancer. Here we explored the effectiveness of the HIFU combined with ADT for patients with high risk prostate cancer. Material & Methods: In a retrospective analysis were included 208 patients with high risk PCa (Gleason score 8 10, stage T3N0M0, PSA >20) who received treatment in The mean age was 68.2±5.9 years. Median follow-up after treatment was 58 (50 72) months. After treatment the level of PSA was determined, MRI and prostate biopsy were performed in the case of PSA growth. All patients received neoadjuvant ADT during 3 6 months, and adjuvant hormonal therapy was performed in 101 (48.5%) patients within 6 24 months intermittently. Adjuvant hormonal therapy was administered if the nadir PSA was more than 1 ng/ml or there was an increase in PSA level after treatment. 107 (51.4%) patients received no additional treatment after ultrasonic ablation. Results: After 12 and 60 months of follow-up median PSA was 0.5 and 3.8 ng/ml, respectively. To assess the biochemical recurrence, we used Stuttgart s criterion (PSA nadir ng/ml). Biochemical recurrence within five years occurred in 114 (54.8%) patients, which was mainly attributable to the generalization of process and implemented a manifestation of bone metastases and regional lymph nodes, which required additional external beam radiation therapy, hormone therapy. In 10 (4.8%) patients local recurrence were occurred and required repeated HIFU procedure. 5-year overall survival rate was 73.8%, disease free survival rate was 64.1%. Conclusions: Our results showed that HIFU is effective in multimodal treatment of patients with high-risk prostate cancer. P074 Salvage Stereotactic Body Radiation Therapy (SBRT) for prostate cancer local recurrence after radical prostatectomy G. Bolzicco 1, M.S. Favretto 1, E. Scremin 2, A. Casetta 1, G. Abatangelo 2, F. Nigro 2, C. Tambone 2, P. Ferrarese 2, C. Baiocchi 1, A. Tasca 2. 1 San Bortolo Hospital, Dept. of Radiation Oncology, Vicenza, Italy; 2 San Bortolo Hospital, Dept. of Urology, Vicenza, Italy Introduction & Objectives: Radiotherapy may cure patient s disease recurrence after radical prostatectomy (RP), we evaluated the safety and efficacy of CyberKnife-Stereotactic Body Radiation Therapy (CK- SBRT) in measurable local recurrence of prostate cancer (PCa). Material & Methods: From February 2011 to December 2013 twelve patients (Pts) with local recurrence after RP have been treated with CK-SBRT. Clinical characteristics at first diagnosis was: T2-Gleason 6 in 4 patients, T2-Gleason 7 in 5 patients and T3-Gleason 7 in 3 patients. Recurrence was made by biopsy in 3 Pts and by PET- Cholina and MRI in 9, none patient had metastatic disease. The median age was 69 years (54 82 years). In all Pts four gold seeds were implanted in the surgical prostate bed through an ultrasound-guided trans-perineal pre-loaded needle; one week later a CT scan and a MRI T1-T2 sequence was performed for the clinical target volume delineation and treatment planning. The mean recurrence volume was 3.39 cc., the prescription dose Gy in 3 5 daily fraction. None patient received androgen-deprivation therapy (ADT) and the failure was identified at the first rise PSA. Results: Over a median follow-up of 17.5 months (6 40 months) one patient had Grade 1 acute genitourinary (GU) toxicity, 3 acute Grade 1 rectal toxicity and one late Grade 1 GU toxicity (urgency). Biochemical response was observed in all Pts with a medium PSA of 0.46 ng/ml at six months (before CK-SBRT was 2.81 ng/ml). At the time of analysis all Pts are alive. One distant relapse (lymph node) occurred 24 months after salvage radiotherapy (pt2c, Gleason score 4+4, PSA pre- CK-SBRT 3.3 ng/ml). Conclusions: The CyberKnife-SBRT treatment in measurable recurrent PCa after RP is feasible with a low morbidity. Furthermore provides a favorable biochemical response with a high local control allowing not to do or to delay ADT. A longer follow-up and a larger series are necessary to better evaluate effectiveness and optimal patient selection criteria. P075 Is neoadjuvant docetaxel chemotherapy and androgen blockage before curative treatment feasible in locally advanced high-risk prostate cancer? B. Çıtamak 1, B. Akdoğan 1, M. Altan 1, E. Mammadov 1, G. Özyiğit 2, H. Özen 1. 1 Hacettepe University School of Medicine, Dept. of Urology, Ankara, Turkey; 2 Hacettepe University School of Medicine, Dept. of Radiation Oncology, Ankara, Turkey Introduction & Objectives: To evaluate the efficacy of neoadjuvant hormone±docetaxel chemotherapy before radical prostatectomy (RP) or radiotherapy (RT) in locally advanced prostate cancer. Material & Methods: Data of 16 patients with locally advanced prostate cancer who received neoadjuvant chemo-hormonal therapy from 2005 to 2014 was retrospectively reviewed. All patients had positive lymph nodes detected on pre-treatment imaging. All patients received 75 mg/m 2 three weekly docetaxel chemotherapy and luteinizing hormone-releasing hormone (LHRH) agonist. Seven patients were underwent RP/extended pelvic lymph node dissection

63 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) (LND) and nine patients were underwent curative RT in a mean of 3.5 months after chemotherapy in a non-randomized approach. Results: Mean age and PSA levels at presentation were 57.5±1.3 years and 44.6±16.7 ng/ml, respectively. Mean age, PSA at diagnosis, cycle of chemotherapy, mean PSA after chemotherapy were not different in RP or RT arm (p=0.232, 0.179, 0.861, 0.445; respectively). None of the patients in RP arm had pathological complete response. Of seven patients in RP arm, mean number of lymph nodes dissected was 13±1.7. Metastatic lymph nodes and surgical margin positivity were detected in 2 (28.6%) patients pathologically. Three patients in RT arm and one in RP arm were died by disease progression. Mean recurrence-free survival for patients in RP arm and RT arm was 37±3.5 and 43.4±8.3 months, respectively (p=0.646). No grade 3 or 4 toxicity was detected due to chemotherapy. Though the surgery was technically demanding, no major complications were detected and all patients in RP were continent at last visit. Conclusions: Although retrospective, our study shows that; neoadjuvant chemo-hormonal therapy before curative intervention is an effective and reasonable option in high risk locally advanced prostate cancer. More patients with longer follow-up are needed to confirm the efficacy better. P076 Stereotactic body radiation therapy in the treatment of oligometastatic prostate cancer G. Beltramo 1, V. Matei 2, A. Bergantin 1, A.S. Martinotti 1, C. Vite 1, F. Ria 1, M. Invernizzi 1, L.C. Bianchi 1. 1 Centro Diagnostico Italiano, Dept. of Cyberknife, Milan, Italy; 2 European Institute of Oncology, Dept. of Urology, Milan, Italy Introduction & Objectives: Patients with metastasized prostate cancer after primary treatment are generally considered palliative and Androgen Deprivation is considered the current standard therapy. Oligometastatic patients often have a long survival time, and non invasive low-toxicity approaches could be of great value to this large patient population. We investigated the role of Salvage Stereotactic Radiotherapy for patients with limited prostate cancer metastases to defer the initiation of palliative Androgen Deprivation Therapy (ADT). Material & Methods: Between March 2009 and march 2013 a cohort of 30 patients with up to 3 synchronous lymph node prostate metastases staged with [ 11 C]-choline positron emission tomography (47 lesions with a median volume of cc, range ), following biochemical recurrence after local curative treatment were treated with Cyberknife Stereotactic Body Radiotherapy. The mean age of patients population was 68 years (range 55 84). Cyberknife prescription doses were cgy delivered in 3 consecutive fractions of cgy. In 14 lesions (37%) Cyberknife Stereotactic Radiotherapy Treatment (SBRT) was performed as reirradiation (the recurrent lesion was situated in the preaviously irradiated volume). Clinical progression was defined as the detection of local progression or distant disease at reassessment. In case of an oligometastatic recurrence outside the previous Stereotactic Body Irradiated field, a re-treatment was performed. Androgen Deprivation (ADT) was initiated if more than 3 metastases were detected during follow up even when patients were still asymptomatic. Results: The Cyberknife treatment was well tolerated without any acute or late toxicity at all. There were no in field recurrence, resulting in a local control of 100%. Eleven and 3 patients, respectively required a second and third salvage treatment for metacronous metastatic disease. The median time to clinical progression was 14 months (range 3 54). After a median follow up of 33 months (range 13 73) 16 patients started with ADT because of polymetastatic disease resulting in an ADT-FS of 80% at 1 year and 65% at 2 years. The median time Androgen deprivation therapy (ADT) was deferred resulted of 26 months (range 4 56). Conclusions: The recent evidence of the potential toxic nature of Androgen Deprivation Therapy (ADT) suggest that effective local therapy might reduce the burden of systemic therapies usually given to patients with metastatic prostate cancer. Cyberknife salvage Hypofractionation Stereotactic Body radiotherapy is a safe and effective treatment option in patients with lymph node prostate metastases and could defer initiation of palliative Androgen Deprivation Therapy. P077 Characteristics and outcome of octogenarian versus young patients (pts) with metastatic Castrate Resistant Prostate Cancer (mcrpc), treated with ketoconazole M. Mishaeli 1, V. Sinibaldi 2, M. Gottfried 1, N. Maimon 1, A. Peer 3, A. Neumann 3, A. Sella 4, S. Kovel 4, M. Carducci 2, M. Eisenberger 2, D. Keizman 1. 1 Meir Medical Center, Dept. of Oncology, Kfar Saba, Israel; 2 Johns Hopkins Hospital, Dept. of Sidney Kimmel Comprehensive Cancer Center, Baltimore, United States of America; 3 Rambam Medical Center, Dept. of Oncology, Haifa, Israel; 4 Asaf Harofe Medical Center, Dept. of Oncology, Zerifin, Israel Introduction & Objectives: Standard treatment options for pts with mcrpc include docetaxel based chemotherapy, abiraterone, and radium 223. Octogenarian pts (aged 80) are often considered to be unfit for chemotherapy. However, recommendations for their management is limited by the paucity of clinical trials data in this population. In countries where abiraterone in the pre-chemotherapy setting has not been approved yet, or for pts who can t afford it, the CYP 17 inhibitor ketoconazole is used as an alternative advanced hormonal tx. We aimed to study baseline characteristics and outcome of octogenarian vs young (aged 60) pts with mcrpc treated with ketoconazole. Material & Methods: We performed an international multicenter retrospective study of pts with mcrpc, who were treated with ketoconazole at 4 centers across 2 different countries. We compared baseline characteristics and outcome of octogenarian versus young pts. The effect of very old age on PSA response, progression free survival (PFS) and overall survival (OS), was tested with adjustment of other known confounding risk factors using a chi-square test and partial likelihood test from cox model. Results: Between 2004 and 2013, 35 octogenarian (median age 83) and 33 young (median age 57) mcrpc were treated with ketoconazole. The groups were balanced regarding the following baseline clinicopathologic characteristics: extent of disease (limited-axial skeleton and/or nodal versus extensive- appendicular skeleton and/or visceral), combined gleason score, pre-treatment risk category (Keizman, Oncologist 2012; based on pre-tx neutrophil to lymphocyte ratio/psadt, and prior response to ADT), pain intensity, ECOG performance status, alkaline phosphatase level, hemoglobin level, PSA level. In octogenarian versus young, PSA response ( 50% decline from baseline) was 40% vs 61% (OR 3.5, p=0.04), median PFS 7 vs 8 months (HR 1.69, p=0.194), and median OS 31 vs 41 months (HR 4.49, p=0.034). Conclusions: In very old vs young mcrpc patients treated with ketoconazole, PSA response was lower and overall survival shorter. Baseline clinicopathologic characteristics and PFS were not significantly different between the groups.

64 138 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P078 Further characterization of the effects on sequential treatment of docetaxel before or after radium-223 dichloride therapy in Castration-Resistant Prostate Cancer (CRPC) patients with symptomatic bone metastases included in the phase 3 ALSYMPCA trial B. Mellado 1, O. Sartor 2, N.J. Vogelzang 3, P. Hoskin 4, S. Nilsson 5, R.E. Coleman 6, C. Parker 7, M. Wahba 8, I. Haugen 9, N.D. Shore Hospital Clinic, Dept. of Medical Oncology, Barcelona, Spain; 2 Tulane Cancer Center, Depts. of Medicine and Urology, New Orleans, Louisiana, United States of America; 3 Comprehensive Cancer Centers of Nevada, Dept. of Medical Oncology, Las Vegas, Nevada, United States of America; 4 Mount Vernon Hospital Cancer Centre, Dept. of Clinical Oncology, Northwood, United Kingdom; 5 Karolinska University Hospital, Dept. of Oncology, Stockholm, Sweden; 6 Weston Park Hospital, Dept. of Oncology, Sheffield, United Kingdom; 7 The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Dept. of Clinical Oncology, Sutton, United Kingdom; 8 Bayer HealthCare, Dept. of US Medical Affairs, Whippany, New Jersey, United States of America; 9 Algeta ASA (Bayer), Dept. of Clinical Research, Oslo, Norway; 10 Carolina Urologic Research Center, Dept. of Urologic Oncology, Myrtle Beach, South Carolina, United States of America Introduction & Objectives: In ALSYMPCA, radium-223 dichloride (Ra-223), a first-in-class alpha-emitting pharmaceutical, significantly prolonged overall survival (OS) (hazard ratio [HR]=0.70) and time to first symptomatic skeletal event (SSE) (HR=0.66) versus placebo (pbo) in CRPC patients (pts) with symptomatic bone metastases (mets). Among 921 randomized pts, 526 (57%) had prior docetaxel (D+) and 395 (43%) had no prior docetaxel (D ). Pt characteristics and Ra-223 safety for ALSYMPCA docetaxel subgroups are presented. Material & Methods: ALSYMPCA pts had progressive, symptomatic CRPC with 2 bone mets, had no known visceral mets, and had D+ or were unfit for docetaxel, declined docetaxel, or docetaxel was unavailable (D ). Pts were randomized 2:1 to 6 injections of Ra-223 (50 kbq/kg IV) q4wk or matching pbo. Baseline characteristics between subgroups were compared. OS and SSE data were analyzed using a log-rank test. A post hoc safety analysis of pts who received chemotherapy after Ra-223 (n=93) or pbo (n=54) was performed. Results: Baseline characteristics were similar between subgroups. Median OS was significantly prolonged with Ra-223 versus pbo, regardless of docetaxel use (D+, HR=0.70; D, H=0.69). Ra-223 reduced risk of SSEs versus pbo, regardless of docetaxel use (D+, HR=0.62; D, HR=0.74). Frequencies of grade 3 or 4 hematologic and nonhematologic adverse events (AEs) were low. Among Ra-223 pts, D pts, versus D+ pts, had lower rates of grade 3 or 4 anemia (11% vs 14%), neutropenia (1% vs 3%), and thrombocytopenia (3% vs 9%) (Table). In a post hoc analysis of 147 pts who received chemotherapy after study drug (of whom 66/93 Ra-223 and 39/54 pbo pts received docetaxel), no major safety concerns were identified and incidences of grade 3 or Table 1. No. (%) of patients with hematologic grade 3/4 AEs* No docetaxel prior Docetaxel prior Chemotherapy after to enrollment to enrollment study drug treatment Ra-223 Pbo Ra-223 Pbo Ra-223 Pbo n=253 n=130 n=347 n=171 n=93 n=54 Anemia 27 (11) 15 (12) 50 (14) 24 (14) 7 (8) 5 (9) Neutropenia 2 (1) 1 (1) 11 (3) 1 (1) 1 (1) 1 (2) Thrombocytopenia 7 (3) 1 (1) 31 (9) 5 (3) 3 (3) 0 *Safety population. 4 anemia and neutropenia were similar between Ra-223 and pbo pts; 3 Ra-223 pts had thrombocytopenia (Table 1). Conclusions: Ra-223 significantly prolonged OS with a favorable safety profile in CRPC pts with symptomatic bone mets, regardless of docetaxel use. D+ pts had higher rates of grade 3 or 4 hematologic AEs with Ra-223. The incidence of selected hematologic AEs remained low in pts receiving chemotherapy after Ra-223. Ra-223 is an option for pts with CRPC and symptomatic bone mets, regardless of prior docetaxel use. P079 Effectiveness of somatostatin analogues depending on chromogranin-a level in patients with castration resistant prostate cancer A. Sivkov 1, N. Keshishev 2, E. Rabinovitch 2, G. Efremov 3, G. Kovchenko 2, D. Roshin 4, Grigory Alexander Kovchenko. 1 Scientific Research Institute of Urology, Deputy Director, Moscow, Russia; 2 Scientific Research Institute of Urology, Dept. of Innovation, Moscow, Russia; 3 Scientific Research Institute of Urology, Dept. of Pathology, Moscow, Russia; 4 Scientific Research Institute of Urology, Dept. of Oncology, Moscow, Russia Introduction & Objectives: Castration Resistant Prostate Cancer (CRPC) develops within months after surgical or medicament castration, in 5 20% of cases the tumor is initially resistant to hormonal therapy. According to different authors in 71 85% of CRPC patients neuroendocrine differentiation (NED) of prostate is revealed. In our study we defined increasing chromogranin-a (CgA) serum level in 34% CRPC patients. For these cases administration of somatostatin analogues is pathogenetically justified. The aim of our study is to investigate the effectiveness and safety of combination therapy (somatostatin analogues + dexamethasone) in CRPC patients with chemical (GnRH analogues) or surgical castration. Material & Methods: The study included 56 men with CRPC. Locally advanced PC (T3-4N0M0) was diagnosed in 8 (14%) patients, metastatic (T3-4N0-1M1) in 48 (86%). 41 patients ran a 2-months treatment, 18 of them 6-months treatment. Patients were divided in 2 groups. The group I included 16 patients with elevated level of chromogranin A (CgA 3 nmol/l), the II 25 patients with normal CgA level. Combination therapy included octreotide depo mg once every 28 days with dexamethasone in a dose of 4 mg per day for one month. Further on dexamethasone was administered in a dose of 2 mg per day for 2 weeks, after which the dose was reduced to 1 mg per day (maintenance dose). GnRH analogues were also prescribed to all patients with CRPC, except patients with prior surgical castration. Each time 28 days prior to injection all patients were CgA and PSA tested. Results: After 2 months in group I 5 (31%) patients had a PSA reduction 50% to the ongoing combination therapy, 8 (50%) had a PSA reduction <50% and 3 (19%) no response. In group II, PSA reduction 50% was detected in 5 (20%) patients, PSA reduction <50% was also detected in 5 (20%) patients, no response in 15 (60%). Difference between the number of respondents to treatment in group I compared to group II is significant (p<0.05). After 6 months we treated 6 patients from group I and 12 patients from group II, due to study continuation and PSA progression. In 6 months 4 (67%) patients from group I had PSA reduction 50%, 2 (33%) patients PSA reduction <50%, no failure response. In group II PSA reduction 50% was detected in 4 (33%) patients, PSA reduction <50% was detected in 3 (25%) patients, no failure response in 5 (42%) patients (Table 1). In group I in Abstract P079 Table 1. Effectiveness of octreotide-depo in patients with normal and elevated CgA level Groups Patients CgA level Number of respondents Number of respondents 2/6 months (nmol/l) to treatment in 2 months (PSA) to treatment in 6 months (PSA) PSA 50% PSA <50% Failure to respond PSA 50% PSA <50% Failure to respond I 16/ (31%) 8 (50%) 3 (19%) 4 (67%) 2 (33%) 0 II 25/ (20%) 5 (20%) 15 (60%) 4 (33%) 3 (25%) 5 (42%)

65 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) months CgA reduction was detected in 13 patients (81%), in group II only in 56% of patients. Conclusions: Conclusions. CRPC combination therapy (octreotidedepo + dexamethasone) reduces PSA level or stabilises it in 81% of patients with elevated CgA after 2 months treatment. Achieved treatment effectiveness may last up to 6 months. Positive effectiveness in patients with normal serum CgA may be caused by direct antiprolipherative somatostatin analogues impact. These results need further more general long-term clinical trials. This work was initiated and fulfilled by it s authors without any sponsorship. P080 Analysis of survival in patients with CRPCm treated with Abiraterone. Duration of clinical and radiological response after biochemical progression P. Beardo Villar 1, C. Baena Villamarín 1, M.J. Ledó Cepero 2, L. Gambra Arregui 3, J. Soto Villalba 2, M. Soto Delgado 1, J. Rosety Rodriguez 2, A. Juárez Soto 1, R. Llarena Ibarguren 3, J.L. Alvarez Ossorio 2. 1 Jerez University Hospital, Dept. of Urology, Jerez De La Frontera (Cádiz), Spain; 2 Puerta Del Mar University Hospital, Dept. of Urology, Cádiz, Spain; 3 Cruces University Hospital, Dept. of Urology, Bilbao, Spain Introduction & Objectives: The emergence of new drugs change the treatment paradigm of castration resistant prostate cancer (CRPC) making a longer natural history and creating new future expectations. Abiraterone acetate is one of these new treatments, but due to limited clinical experience, we still unknow the patient profile of who will benefit most from its use or the suitable time to change treatment. Material & Methods: 52 patients with CRPCm treated with abiraterone in 3 national hospitals were included in the analysis. We evaluated retrospectively progression quantified in three different settings: clinical, biochemical and radiological. Cinical evaluation based in scales of analgesia, pain and ECOG performance status; baseline, at a month and every 2 months of abiraterone treatment. Biochemichal (PSA levels) and radiological progression were based in Prostate Cancer Clinical Trials Working Group 2 (PCWG2). The univariate stadistical analysis is based on t Student and the log rank test. Results: 38.5% of progression, PFS 10±0.9 months. At the moment of analysis 35.4% of patients have died of metastatic CPRC. OS 15.6 monhts (95% CI, ). For the total patient cohort treated with abiraterone (pre-chemotherapy 65.3% and post-chemotherapy 34.7%), clinical progression is the first progression event in all of baseline symtomatic patients (63.5%, including oligosymptomatic patients). Patients with clinical response to treatment (81.8%) have higher PFS, 9.6 m than those with no clinical improve, 2.3 months (95% CI; 1.8 to 2.9 vs 7 to 12.2 months; p= ); and higher OS [95% CI; 13.3 months (10.7 to 15.8) front 4.3 months (2.5 to 6.2); p<0.001]. None of the patients without clinical response have radiological or biochemical one (PSA reduction >50%). Patients with clinical and biochemical response (59.3%) have higher PFS than initially symptomatic ones who underwent clinical improve, but not biochemical, [95% CI; 9.6 months (7 to 12.2) front 5.9 months (3.8 to 8) of PFS; p<0.01)]. Nevertheless, there are not statistically significative differences in OS in both groups[95% CI; 13.3 months ( ) front 11.8 months ( ) OS; p=0.4]. In all cases in which a decrease of PSA (80.8% of patients) biochemical progression precedes radiological progression. In the group with a PSA decline of <50% (30.8% of patients), biochemical progression occurs 2.1±0.5 months before radiological progression and 2.5±0.6 months in patients (50% of patients) with a PSA decline of 50% (p=0.58). Biochemical progression also precedes radiological both in the group receiving abiraterone acetate in prechemotherapy (2.4±0.6 months) and in the post-chemotherapy group (2±0.5 months) (p=0.62). Conclusions: In symptomatic patients in whom no clinical response is obtained, no biochemical or radiological response is obtained with abiraterone acetate treatment. In symptomatic patients with clinical response, PSA decline 50% during treatment with abiraterone acetate is associated with increased PFS but not higher OS. There is a high proportion of patients that may continue in stabilizing the radiological and clinical disease despite PSA progression and therefore a priori should continue in treatment but we ignore the effect that continued treatment may have on the overall survival of these patients. P081 Efficacy of metronomic chemotherapy in metastatic castration resistant prostate cancer Y. Jeong 1, J.L. Lee 2,D.You 3, I.G. Jeong 3, B. Hong 3, J.H. Hong 3, H. Ahn 3. 1 Asan Medical Center, University of Ulsan College of Medicine, Dept. of Medicine, Seoul, South Korea; 2 Asan Medical Center, University of Ulsan College of Medicine, Dept. of Oncology, Seoul, South Korea; 3 Asan Medical Center, University of Ulsan College of Medicine, Dept. of Urology, Seoul, South Korea Introduction & Objectives: The purpose of this study was to report the efficacy and safety of oral metronomic chemotherapy in patients with metastatic castration resistant prostate cancer (mcrpc). Material & Methods: From January-2011 to February-2013, the metronomic chemotherapy was administered to sixty patients with mcrpc. The metronomic chemotherapy consisted of oral cyclophosphamide (50 mg daily), dexamethasone (1 mg daily), and celecoxib (200 mg twice daily). Treatment was continued until disease progression or intolerance. Treatment emergent adverse effects (AEs) and efficacy on serum prostate-specific antigen (PSA) decrease, RECIST response, and symptomatic responses were retrospectively reviewed. The primary endpoint was PSA response (per PCWG 1.0) rate and time to PSA progression (per PCWG 2.0). Results: Among 60 patients, 49 patients were evaluable. 27 of 49 patients had previous exposure to docetaxel. The median age was 71 years (range, 49 88) and median ECOG performance status was 1 (range, 0 2). Gleason score was 8 or more in 41 patients (84%), and median baseline serum PSA was 32.1 ng/ml (range, ). The median treatment duration was 5.7 months (95% CI: ). The PSA response rate was 39% and median time to PSA progression (TTPSA) was 5.2 months (95% CI: ). The median composite progression free survival (PFS) was 3.8 months (95% CI: ) and median overall survival (OS) was 13.3 months (95% CI: months). There were no significant differences in the TTPSA and PFS between prevs. post-docetaxel group. The median TTPSA 5.5 months (95% CI: ) in pre-docetaxel group vs. 4.9 months (95% CI: ) in postdocetaxel group (P=0.591). Clinically significant treatment emergent AEs occurred only in 7 patients (12%, anemia in 2, thrombocytopenia in 3, leukopenia in 1, nausea/vomiting in 2, asthenia in 1, and edema in 2). Conclusions: The metronomic chemotherapy was safe, well tolerated, and showed promising clinical efficacy in mcrpc. It could be a viable option in pre-docetaxel and post-docetaxel setting. P082 Long-term treatment of prostate cancer patients with LHRHa leuprorelin acetate efficacy data from a German non-interventional study M. Wirth 1, L. Manka 2, P. Hammerer 2. 1 University Hospital Carl Gustav Carus Dresden, Dept. of Urology, Dresden, Germany; 2 Academic Hospital Braunschweig, Dept. of Urology, Braunschweig, Germany Introduction & Objectives: LHRH analogs (LHRHa) are standard of care in the treatment of advanced and metastatic prostate cancer. The most widely prescribed LHRHa leuprorelin acetate is in clinical use more than 20 years. This study investigates the efficacy of long term treatment with depot formulations (1, 3, and 6 months) of leuprorelin acetate in microcapsules in advanced prostate cancer patients for >10 years.

66 140 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Material & Methods: The design was an observational, retrospective study of efficacy/safety carried out by 30 office-based urologists in Germany in 647 patients. Data were collected retrospectively for the time period from 1992 to Results: In the treatment group response rate according to EORTC criteria was 94.4% after 6 months of LHRHa treatment and remained above 90% for 10 years of treatment. PSA levels fell from 8.09 ng/ml (median, IR [ ]) to 0.40 ng/ml (IR [ ]) after 6 months. PSA levels are >90% declined compared to baseline at all time-points. Testosterone levels were at baseline 3.97 ng/ml (median, IR [ ]), dropped to castration level (<0.5 ng/ml) within 6 months and were suppressed 0.20 ng/ml (median) at all time points until 13 years of LHRHa treatment. Conclusions: More than 90% of the observed patients showed response (EORTC criteria) for >10 years of treatment. Median testosterone level was suppressed considerably below castration level, PSA declined subsequently and remained low for all time points of observation up to 13 years. Thus, leuprorelin acetate in microcapsules is an effective long term treatment for patients with advanced prostate cancer. P083 Analysis of geometric shifts for determination of proper margin in prostate cancer patients treated with SIB-IMRT using endorectal ballooning and daily enema for prostate immobilization S. Jeong, J.H. Lee, M.J. Chung, S.W. Lee, D.G. Kang, S.H. Kim. St. Vincent Hospital, The Catholic Univ. of Korea, College of Medicine, Dept. of Radiation Oncology, Suwon, South Korea Introduction & Objectives: The aim of this study was to evaluate geometric shifts of daily patient setup and determine the effective target margins in prostate cancer patients in treating radiotherapy, especially when applying intensity modulated-simultaneous boost technique. Material & Methods: From 2011 to 2013, total 1050 set of pretreatment MVCT scans, acquired from 35 prostate cancer patients who were treated with Helical Tomotherapy were reviewed. Patients who treated prostate only were excluded and all patients evaluated were treated both pelvic lymphatics and prostate/prostate op bed using SIB technique. Daily geometric shifts data of patient setup in Right-to-left (X), Anterior-to-posterior (Y), Superior-to-inferior (Z), and Angle of collimator (roll) were collected and fraction-to-fraction Systemic error ( ) and Random error (δ) were evaluated. The recommended planning target margin to cover setup variation is calculated using the equation: margin = δ. Daily endorectal balloon insertion and pre-treatment enema were performed to minimize prostate mobility in conjunction with bladder emptying. Because radiotherapy was intended to deliver prostate or prostatectomy bed simultaneously with pelvic lymphatics, initial auto-registration of daily MVCT to initial planning CT was performed in bone-matched session and followed by manual registration to adjust internal organ movement. Results: The radiotherapy was delivered to prostate with radical aim upto 70.5 Gy in 30 fx and to prostatectomy bed with adjuvant or salvage aim upto 63 Gy in 30 fx. 48 Gy of radiation dose delived to pelvic lymphatics. All patients were diagnosed ct2/3 and intermediate to high risk group prostate cancer. The mean geometric shifts in Rightto-left (X), Anterior-to-posterior (Y), Superior-to-inferior (Z), and Angle of collimator (roll) were 4.61mm, 3.10mm, 2.60mm and 1.33 in all patients. Evaluated mean Systemic error ( ) and Random error (δ) of all patients were 1.93mm (x), 1.57mm (y), 1.83mm (z), 0.68 (roll) and 2.12mm (x), 1.62mm (y), 1.42mm (z), 0.58 (roll). The calculated recommended planning target margins were 5.35 (x), 4.28 (y), 4.66 (z). There were no severe acute and late normal organ toxicity over grade 3, like rectal bleeding during and after treatment follow up. Conclusions: The patients who need to deliver radiation to pelvic lymphatics as well as prostate or prostate bed, should consider relative position, movement and distance of prostate or rectum with entire pelvis setup. When limitation of interfraction intrapelvic organ, using daily MVCT geometric shifts data can be convenient and effective way to evaluate and determine proper target margin. P084 Delayed hormonal therapy could be an option in selected patients with lymph node metastases after surgical treatment K.M. Nyushko 1, B.Y. Alekseev 1, A.A. Krasheninnikov 1, A.S. Kalpinskiy 1, N.V. Vorobyev 1, M.P. Golovaschenko 1, L.V. Moskvina 2, A.D. Kaprin 3. 1 P.A. Herzen Moscow Oncological Research Institute, Dept. of Urology, Moscow, Russia; 2 P.A. Herzen Moscow Oncological Research Institute, Dept. of Pathology, Moscow, Russia; 3 P.A. Herzen Moscow Oncological Research Institute, Head of Institution, Moscow, Russia Introduction & Objectives: Lymph node invasion (LNI) is a poor prognostic factor in prostate cancer (PC) patients (pts) undergone radical prostatectomy (RPE) and pelvic lymph node dissection (PLND) and often require immediate adjuvant hormonal therapy (ADT). The question if ADT could be delayed is controversial. The aim of the study was to assess biochemical progression-free survival (BPFS) in different prognostic subgroups of LN positive PC pts. Material & Methods: Retrospective analysis of 1430 PC pts undergone RPE and PLND since 1998 till 2014 was done. LN metastases were verified in 229 (16%). Mean PSA level was 23.8±23.3 ng/ml; mean percentage of positive biopsy cores (PPBC) was 76.4±27.7%. Clinical stage was T1b-T2c in 111 (48.5%), T3a-T3b in 118 (51.5%). Biopsy Gleason score 6 was verified in 57 (24.9%) pts; 7 (3+4) in 58 (25.3%); 7 (4+3) in 68 (29.7%) and 8 10 in 37 (16.2%); not assessed in 9 (3.9%) pts. Low risk PC was verified in 5 (2.2%) pts, intermediate risk in 44 (19.2%) pts and high risk in 180 (78.6%) pts. Biochemical recurrence (BR) was assessed as elevation of PSA>0.2 ng/ml on three consecutive measurements. Pts with immediate ADT after the operation were excluded. Results: Mean number of LN removed was 23±9 (2 53). Mean follow up time was 29.6±24.9 months (3 125 months). BR was observed in 91 (39.7%) pts. 3-year biochemical progression-free survival (BPFS) was 21.1±4.6%. 3-year BPFS in subgroup of pts undergone extended vs. standard PLND was 27.9±6.8% and 15.3±5.6%, respectively (p=0.02); in pts with 2 positive LN vs. >2 positive LN it was 33.1±6.9% and 6.8±4.3%, respectively (p=0.0002); in pts with positive LN density <15% vs. 15% was 30.3±6.4% and 7.3±4.7% (p=0.001) and in pts with presence of metastatic LN extra capsular extension (LN ECE) vs. absence of LN ECE it was 9.2±5.2% and 31.8±8.2%, respectively (p=0.003). In pts with LN metastases only in 1 anatomical region vs. in 2 regions 3-year BPFS was 33.2±7.1% and 9.4±4.8%, respectively (p=0.008). Conclusions: In LN positive pts underwent RPE and extended PLND with 2 positive LN, LN density <15%, absence of LN ECE and only 1 anatomical region involved delayed ADT could be an option. P085 Salvage pelvic lymph node dissection in prostate cancer: Surgical and oncological outcome T. Claeys 1, C. Van Praet 1, K. Decaestecker 1,P.Ost 2, V. Fonteyne 2, G. De Meerleer 2, P. De Visschere 3, G. Villeirs 3, N. Lumen 1. 1 Universitair Ziekenhuis Gent, Dept. of Urology, Ghent, Belgium; 2 Universitair Ziekenhuis Gent, Dept. of Radiation Oncology, Ghent, Belgium; 3 Universitair Ziekenhuis Gent, Dept. of Radiology, Ghent, Belgium Introduction & Objectives: To evaluate morbidity and oncological outcome of salvage pelvic lymph node dissection (PLND) in patients with prostate-specific antigen (PSA) rise after local curative treatment for prostate cancer.

67 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Material & Methods: We retrospectively analyzed records of 17 patients undergoing salvage PLND from 2009 to Indications for PLND were treatment of oligometastatic disease (0.2ng/ml. Nonresponders did not show a drop in PSA. Biochemical recurrence after cbr was defined as an increase in PSA >0.2 ng/ml on 2 consecutive measurements. After ibr 2 consecutive PSA rises were considered as biochemical progression. A new metastatic site on postoperative imaging was defined as clinical progression (CP). Palliative androgen deprivation therapy (ADT) was initiated if >3 metastases were detected or if patients became symptomatic. Kaplan-Meier statistics were applied to determine PSA progression-, CP- and ADT-free survival (FS). Results: Two laparoscopic interventions were converted to open surgery because of extensive adhesions. Grade 1, 2, 3a and 3b complications were seen in 6 (33.3%), 1 (5.5%), 1 (5.5%) and 2 (11%) patients respectively. Median follow-up time was 21 months (range 1 60). Among 13 patients treated for oligometastatic disease, all with histopathological LN involvement, 8 (62%) had a postoperative PSA decline including 2 patients (15%) that showed cbr. Median PSA progression-fs was 2.8 months. Seven patients (54%) showed CP: 1 solely to pelvic LNs outside PLND template, 1 to pelvic LNs within PLND template and to the bone, 3 to retroperitoneal LNs, 1 to the bone and 1 to the spongious body. Median CP-FS was 12 months. Four (31%) and 1 (8%) patients were treated with 1 and 2 additional oligometastasis-directed therapies respectively. Three patients (23%) started palliative ADT, resulting in a 2 year ADT-FS rate of 60%. disease characteristics were predictive for the median duration of the first cycle off-treatment period. Materials & Methods: 191 men with prostate cancer (all stages) with a baseline prostate specific antigen (PSA) >4 ng/ml or a PSA doubling time 4 ng/ml were estimated using the Weibull model with 3 disease classifiers: PSA at baseline, prostate cancer stage and Gleason score. Results: The model with all 3 disease factors showed that Gleason score (4 ng/ml (p=0.934). The estimated median times using a reduced model with PSA and prostate cancer stage at baseline are shown in the figure. Baseline PSA was highly predictive (p<0.0001) of the time to PSA >4 ng/ml with the lowest PSA group ( 4 ng/ml) having the longest off-treatment period. The relative delay in failure time (time to PSA >4ng/mL) for the baseline PSA 4 versus PSA >20 ng/ml subgroups was 3.96 (95% confidence interval [CI]: 2.69; 5.83), p 4 ng/ml (95% CI) of (717; 1255) days compared to (184; 312) days for the same group of patients with a baseline PSA >20 ng/ml. Prostate cancer stage/previous therapy also influenced (P=0.0555) the time to PSA >4 ng/ml with longer times for patients previously treated with curative intent or with localised disease compared to those with locally advanced or metastatic prostate cancer. Figure 1 Conclusions: Patients with lower PSA ( 4 ng/ml) levels at baseline, or patients with less extensive disease have longer median offtreatment periods after receiving IAD therapy with degarelix. Median time (days) to PSA >4 ng/ml using baseline PSA and prostate cancer stages as factors. Figure 1. PSA changes within 40 days post-surgery. Conclusions: Salvage PLND is feasible, both open and minimally invasive, but postoperative complication rate is rather high as compared to primary PLND series. Although only a limited number of patients has a durable response, as part of an oligometastic treatment regime it can defer palliative ADT. P086 Disease characteristics influencing the duration of the off-treatment period during intermittent androgen deprivation therapy with degarelix in prostate cancer P-A. Abrahamsson 1, P. Albers 2, J. Morote Robles 3, A. Malmberg 4, A.N. Neijber 5, L. Boccon-Gibod 6. 1 Skåne University Hospital, Dept. of Urology, Malmö, Sweden; 2 Heinrich-Heine Universitätsklinikum, Dept. of Urology, Düsseldorf, Germany; 3 Vall d Hebron University Hospital, Dept. of Urology, Barcelona, Spain; 4 Ferring Pharmaceuticals A/S, Dept. of Global Biometrics, Malmö, Sweden; 5 Ferring Pharmaceuticals A/S, Dept. of Urology, Copenhagen, Denmark; 6 Hôpital Bichat Claude Bernard, Dept. of Urology, Paris, France Introduction & Objectives: Intermittent (IAD) therapy is commonly used in prostate cancer. The objective of this analysis of trial data of IAD therapy with degarelix in prostate cancer was to establish how P087 Body mass index as predictive and prognostic factor for chemotherapy for metastatic prostate cancer patients E. Nowara, J. Huszno. Centrum Onkologii Instytut Gliwice Branch, Dept. of Oncology and Experimental Chemotherapy, Gliwice, Poland Introduction & Objectives: Polish society has become more and more overweigh during last decades. Cancer patients are increasingly overweight or obese. The aim of this study was to estimate whether Body Mass Index (BMI) affects the docetaxel chemotherapy response and survival for metastatic prostate cancer (MPC) patients (pts). Material & Methods: This retrospective study was conducted in Clinical and Experimental Oncology Department, MSC Memorial Cancer Center and Institute of Oncology in Gliwice Poland (COI). All pts were diagnosed, treated and followed up in COI. Patients medical records were reviewed according to national law regulation. The analysis included 81 consecutive MPC patients treated with docetaxel during The median age at diagnosis was 63 years (range 41 81). 38% of pts had history of alcohol abuse or smoking. 44% had comorbid conditions, the most frequent was hypertension and diabetes, 36 and 14% respectively. 17% of pts had BMI in normal range (<25), 50% were overweight ( ) and 33% were obese (>30). 21% of pts had radical prostatectomy and 43% had radical radiotherapy. The remaining pts had palliative treatment due to primary dissemination. All of pts had hormonotherapy. The median hormonotherapy time

68 142 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) before chemotherapy was 30 months (range 2 168). According to castration-resistance MPC all of the pts docetaxel based chemotherapy. Second line chemotherapy received 26% of pts. Response for chemotherapy was assessed according to RECIST 1.0. Statistical analysis was performed using STATISTICA 7 Stat Soft. The qualitative variables are presented as the percentage of their occurrence in both groups and evaluated with χ2with applicable Yates correction. Cox proportional hazards regression models was used for estimate potential prognostic factors on survival. Results: The median overall survival (OS) was 6 years. The 2, 5 and 10-year OS was 93%, 65% and 28% respectively. The most frequent metastatic site was: bones, distant lymph nodes and lungs, 73%, 53% and 12% respectively. Median survival time with metastases was 2 years. Pts with multiorgan metastases lived shorter, 1.9 vs 2.2 months, p=0.04. Overall survival for pts who underwent radical surgery was longer in comparison to pts without surgery, p=0.21. Pts who underwent radical radiotherapy lived significantly longer in comparison to pts without radiotherapy, p= History of alcohol abuse or smoking had negative impact on OS, 36% vs 68%, p=0.05. Median chemotherapy cycles was 6 (range 1012). None of the pts had complete response. Partial Response (PR), Stagnation Disease (SD) and Progressive Disease (PD) as the best response was observed in 18, 35 and 47% of pts respectively. Pts with history of alcohol abuse or smoking had more frequently chemotherapy failure, p= Pts older than 60 years significantly more often achieved PR than younger ones (53% vs 18%), p=0.03. Overweight and obese pts had significantly more often PD than pts with normal BMI, p= Overweight and obese pts lived nonsignificantly shorter than pts with normal BMI, p=0.28. Conclusions: BMI may be a predictive factor for docetaxel chemotherapy due to MPC and prognostic factor for OS. The results of this study has many limitations mostly due to small group of pts and retrospective character. This analysis is scheduled to be performed later in the project. Table 2 70 years >70 years Total n % n % n % Primary tumor (T), N=1290 1a 8 1% b 56 7% % c % % % 2a % % % 2b % % % 2c % % % % % 3a % % % 3b % % % % % % x Regional lymph nodes (N), N= % % x Distance metastasis (M), N= % 1a 1b % % % 1c 6 0.7% 4 0.8% % x 8 1% 1 0.2% 9 0.7% P088 Prostate cancer in area without screening A. Scavuzzo 1, N. Reynoso Noveron 2, Z.A. Santana Rios 2, M.A. Jimenez Rios 2. 1 Instituto Nacional De Cancerologia, Dept. of Urology, Mexico City, Mexico; 2 Instituto Nacional De Cancerologia, Dept. of Epidemiology, Mexico City, Mexico Introduction & Objectives: The effect of prostate-specific antigen (PSA) screening on prostate cancer (PCa) mortality remains debated, despite evidence from randomized trials. We described what happen in a population where there is no the use of PSA systematic or opportunist screening. Material & Methods: We recollected all new PCa cases diagnosed between 2004 and 2013 in cancer public hospital of Mexico City. The 2009 TNM staging system and the D Amico classification was used. Disease specific survival for patients with metastasis was calculated using the Kaplan Meier method. Results: A total of 1290 new cases of histologically confirmed PCa were diagnosed. The median age was 67 years (range 42 91). Some 146 (11.3%) patients had a familial history of PCa. The distribution of the cases with regard to histopathological variables and clinical characteristics at PCa diagnosis is given in Table 1 and 2. Table 1 n % Abnormal DRE Total Gleason Lost Figure 1 Distribution according to PSA level showed that 18% of the cases had a level of PSA 10 ng/ml and 60% >10 ng/ml (Fig. 1). Distribution of PSA when bone metastases occurred is showed in Table 3. Distribution according to risk groups shows of 4.4% patients were low risk, 14.9% intermediate risk and 80.7% high risk (Table 4). Treatment according to risk was resumed in Table 5. The disease specific survival is similar for patients with 70 years during first 18 months; adjusted for age risk to died is 7 times greater for metastasis vs no (Figs. 2, 3) Conclusions: Prostate cancer is observed in a reference Mexican cancer institution in patients with advanced clinical stages, high risk and Table 3 70 years >70 years Total n % n % n % PSA bone metastases occurred (N=323) <4 ng/ml % 4 10 ng/ml % ng/ml % >20 ng/ ml % Table 4 D Amico classification 70 years > 70 years Total Died n % n % n % n % Low risk % % % 0 Intermediate risk % % High risk % %

69 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Table 5 Low risk Intermediate risk High risk None Prostatectomy 22 (17%) 82 (63.5%) 25 (19.30%) Hormonotherapy 25 (2.4%) 106 (10.17%) 911 (87.43%) Radiation therapy 24 (7.23%) 104 (31.3%) 204 (61.45%) Chemotherapy 0 1 (0.94%) 105 (99.6%) The table above shows that the ED method reference value of 3.0 nmol/l corresponds to the DAKO value of 28 U/L (not to the DAKO value of 18 U/L, indicated by the producing company). Applying coordinated reference DAKO CgA values we have managed to get CgA values close to those obtained with ED testing method. Conclusions: Officially claimed high CgA reference value for DAKO is not exactly correct and leads to hyperdiagnostics in NED of prostate cancer. This may explains controversy in the literature on CgA blood elevation frequency in PC patients. Mathematically corrected max CgA level according to DAKO test method data is 28 U/L. Displayed DAKO/ED data relation is a good way to correct PC NED diagnostic and refine initial DAKO method research results. This work was initiated and fulfilled by it s authors without any sponsorship. P090 Time to prostate specific antigen nadir as a prognostic factor in metastatic castration-resistant prostate cancer under docetaxel Figure 2 Figure 3 with elevated PSA (>20). The mortality no drop in for patients with advanced disease in the PSA era. P089 Comparison of chromogranin-a levels determined by different test systems in patients with prostate diseases A. Sivkov 1, N. Keshishev 2, M. Krivenko 2, G. Kovchenko 2, L. Nikonova 2. 1 Scientific Research Institute of Urology, Deputy Director, Moscow, Russia; 2 Scientific Research Institute of Urology, Dept. of Innovation, Moscow, Russia Introduction & Objectives: Chromogranin-A (CgA) is the most popular marker for neuroendocrine tumors. CgA demonstrates acceptable diagnostic value in neuroendocrine differentiation (NED) of prostate cancer (PC). At the same time there are conflicting data reported in the literature on NED detection frequency in PC patients, based on blood serum CgA level, which may be the result of variability of testing methods. There are two widely used blood serum CgA detection methods: DAKO (Denmark) and Euro-Diagnostica (Sweden). According to the producing companies data, CgA reference values are: for Euro-Diagnostica (ED) 0 3 nmol/l, for DAKO 2 18 U/L. However, during our previous studies we had a problem with interpreting CgA values defined by different testing methods, which resulted in diagnostic errors. That is why the main purpose of this work is to compare CgA values, defined by using DAKO and ED testing methods in various prostate diseases. Material & Methods: The data of 84 prostate disease patients and 29 healthy volunteers were analyzed. CgA level for all patients was defined using both DAKO and ED testing methods in the same blood sample. Results: Prevalence of the number of patients (10 40%) with elevated CgA level has been found with DAKO testing method, compared to ED testing method. Linear regression analysis revealed functional link and defined equations for DAKO and ED CgA values coordination. Table 1. Number of patients with elevated CgA level tested by DAKO and Euro Diagnostica test systems Disease N Regulated reference values Coordinate ED: 3 nmol/l DAKO: 18U/L reference value DAKO: 28 U/L Control group Benign prostatic hyperplasia Chronicprostatitis Low grade PIN High grade PIN Localized PC Locally advanced PC Castrate-resistant PC A. Freire Coelho 1, A. Capela 1, C. Fernandes 1, R. Gomes 1,C.Rey 1, I. Augusto 1, F. Cruz 2, M. Damasceno 1, S. Meireles 1. 1 Hospital S. João, Dept. of Medical Oncology, Porto, Portugal; 2 Hospital S. João, Dept. of Urology, Porto, Portugal Introduction & Objectives: Docetaxel is the standard systemic treatment in metastatic castration-resistant prostate cancer (mcrpc). Yet, there s no consensus about the optimal chemotherapy (ChT) duration in patient responders and their follow-up. Since new treatment options for progression after docetaxel are increasing, it s important to determine prognostic factors which can identify patients in high risk of progression. The aim of our study was to identify these factors, especially if associated with PSA kinetics. Material & Methods: Retrospective analysis of clinical-pathological features of mcrpc patients with 50% reduction of their PSA level under docetaxel (21/21 days) between November 2003 and PSA nadir was defined as the lowest PSA level achieved during docetaxel. Survival analysis was made by Kaplan-Meier method. Log-rank test and Cox regression were used for univariate and multivariate analysis, respectively. Results: Ninety-one patients were analyzed with median age of 66 years-old [48, 82] and a median follow-up of 13 months [3, 30]. At diagnosis, the median PSA level was ng/ml [ ] with a 4.4% of patients with PSA 7. At start of docetaxel, 89% of patients had an ECOG PS 1 and the median PSA baseline was ng/ml [0.59, ]. The median number of cycles of docetaxel was 10 [2, 15], 51.6% of patients completed 10 cycles and dose reduction happened in 17.6%. The median PSA nadir was ng/ml [0.03, ] and median time to nadir PSA (TTN) was 20 weeks [5, 44]. The mortality rate was 53.8% and there was a loss of follow-up in 23.5% of cases. Progression free survival (PFS) at 2 years was of 23.1% and overall survival (OS) at 5 years was 44.1%. In the univariate analysis, PSA level at diagnosis (p=0.034), docetaxel dose reduction (p<0.0001) and TTN (p=0.001) were prognostic factors for PFS. PSA level at diagnosis (p<0.0001), ECOG PS (p=0.022), alkaline phosphatase level at start of ChT (p=0.005), docetaxel dose reduction (p=0.002) and TTN (p=0.003) presented as prognostic factors for the OS. In the multivariate analysis, TTN 20 weeks (p=0.003, HR 0.494, IC 95%: ) and absence of docetaxel dose reduction (p=0.001, HR 0.321, IC 95%: ) remained as positive prognostic factors of PFS. PSA <10 ng/ml (p=0.043, HR 0.863, IC 95%: ), absence of docetaxel dose reduction (p=0.031, HR 0.415, IC 95%: ) and TTN 20 weeks (p=0.027, HR 0.461, IC 95%: ) stayed as positive prognostic factors in OS. Conclusions: According to our results we can say that TTN 20 weeks from the initiation of docetaxel was an independent positive prognostic factor for PFS and OS. Thus, TTN could be considered to identify mcrpc patients at greater risk for progression after docetaxel. The association of shorter TTN with worst survival outcomes isn t clear; possible explanations are that a faster initial response to ChT may

70 144 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) echo a more aggressive disease. Also the fast removal of ChTsensitive cells could promote the growth of ChTresistant ones. Our study is restrospective with a relative small number of patients and further prospective data is needed. P091 Analysis of predictive factors of response and survival in castration-resistant prostate cancer treated with abiraterone acetate P. Beardo Villar 1, C. Baena Villamarín 1, L. Gambra Arregui 2, M.J. Ledó Cepero 3, J. Soto Villalba 3, M. Soto Delgado 1, J. Rosety Rodriguez 3, A. Juárez Soto 1, J.L. Alvarez Ossorio 3, R. Llarena Ibarguren 2. 1 Jerez University Hospital, Dept. of Urology, Jerez De La Frontera (Cádiz), Spain; 2 Cruces University Hospital, Dept. of Urology, Bilbao, Spain; 3 Puerta Del Mar University Hospital, Dept. of Urology, Cádiz, Spain Introduction & Objectives: In metastatic CPRC there may be potential biomarkers that inform on prognosis, determine the selection of the correct treatment (predictive value) and influence on survival. Material & Methods: Retrospective multi-institutional study of 52 CPRCm patients treated with abiraterone in 3 national hospitals. We evaluate various factors such as previous treatment, clinical and analytical baseline variables. The univariate stadistical analysis is based on log rank test. Results: Mean follow up treatment of 10±0.9 months. Abiraterone pre-chemotherapy 65.3%, pos-chemotherapy 34.7%. Global OS 15.6 monhts (95% CI, ), and cancer specific survival 16.6 months (95% CI, ). At the moment of analysis 35.4% of patients have died of metastatic CPRC, and 7.7% patients die from causes unrelated to the CPRC. The variables identified in the statistical analysis as predictors of response to treatment: ECOG PS. The median progression-free survival (PFS) in ECOG 0 1 (70.7%) is 11.5 months and 5.1 months in ECOG 2 3 (95% CI; 9.4 to 13.5 vs 2.8 to 7.5 months; p<0.0001). OS ECOG 0 1 is 17.8 months and 8.5 months in ECOG 2 3 (95% CI; vs ; p<0.001). Clinical baseline. Asymptomatic/oligosymptomatic (76.7%) PFS 13 months and 6.4 months in syntomatic patients (95% CI, 10.6 to 15.4 vs 4.7 to 8 months; p<0.0001). OS in baseline asymptomatic/oigosymptomatic is 19.2 months and in symptomatic patients 10.9 months (95% CI; vs months; p<0.01). VAS pretreatment 50% reduction on abiraterone treatment (95% CI; 11 to 16.1 vs 4.8 to 8.5 months; p<0.0001). No statistical difference is observed to OS [13.4 months (95% CI; 9.5 to 17.2 months) in PSA reduction 50%, and 15.5 months (95% CI; 13 to 18.3 months); p=0.052). Previous ketoconazole (25%), visceral metastases (15.4%), response to the previous hormone treatment <12 months (17%) and the anormals baseline levels of analytical variables analyzed (PSA, testosterone, hemoglobine, phosphatase alcaline, LDH and protein C reactive) were not associated with lower PFS or OS. Conclusions: Predictors of response to treatment were predominantly clinical. Good baseline performance status and asymptmatic patients, include lower score analgesic and visual analog scale (VAS), have a higher PFS and OS with abiraterone therapy for metastatic CRPC. PSA reduction levels >50% is a predictor factor of PFS, but not OS. In the near future the research lines and molecular markers will be a prognostic value. P F-FACBC compared with 11 C-choline PET/CT in patients with biochemical relapse after radical prostatectomy: A prospective study in 79 patients R. Schiavina 1, C. Nanni 2, E. Brunocilla 1, C.V. Pultrone 1, L. Zanoni 2, M. Borghesi 1, G. Passaretti 1, V. Vagnoni 1, G. Martorana 1, S. Fanti 2. 1 S.Orsola-Malpighi Hospital, University of Bologna, Dept. of Urology, Bologna, Italy; 2 S.Orsola-Malpighi Hospital, University of Bologna, Dept. of Nuclear Medicine, Bologna, Italy Introduction & Objectives: Approximately 40% of patients managed with radical treatment for localized prostate cancer (PCa) will develop biochemical relapse. Recently, a synthetic L-leucine analogue, anti-1-amino-3-18 F-fluorocyclobutane-1-carboxylic acid (anti-3-18 F-FACBC) has been proposed as a promising radiopharmaceutical agent to detect PCa recurrences, alternative to 11 C-choline. The aim of our study was to compare the detection rate (DR) of 18 F- FACBC PET/CT in comparison with 11 C-choline PET/CT in the evaluation of disease recurrence of PCa after radical treatment. Material & Methods: 79 patients treated with radical prostatectomy for prostate cancer and presenting with rising PSA levels (at least 2 consecutive PSA values of >0.2 ng/ml) were consecutively and prospectively enrolled. All the patients were free from androgen deprivation therapy at the time of the scans for at least 3 months. All the patients underwent 11 C-choline PET/CT and 18 F-FACBC PET/CT within one week. The results of the two imaging techniques were compared in terms of detection rate on a patient basis and lesion basis. Furthermore, a more detailed analysis regarding local, lymphnode, and bone relapse was performed. Results: At the time of PET scan, mean age was 69 years and mean serum PSA value was 3.2 ng/ml (SD 3.7). No adverse reactions to 18 F- FACBC were recorded. In patient-based analyses, 11 C-choline PET/CT was positive in 23 patients and negative in 56 (DR 29.1%) and 18 F- FACBC PET/CT was positive in 30 patients and negative in 49 (DR 37.9%). There was a statistical significant difference in terms of number of positive scans between 18 F-FACBC and 11 C-choline (Fisher s exact test p<0.001). All lesions that were positive using 11 C-choline were positive using anti-3-18 F-FACBC PET/CT but with the latter radiotracer 18 additional tumors were identified. On a lesion basis, (11)C-choline detected 38 lesions (15 bone, 12 lymph node, 11 local relapse), and anti-3-18 F-FACBC detected 56 lesions (15 bone, 29 lymph node, 12 local relapse). The TBR of anti-3-18 F-FACBC was greater than that of (11)C-choline in almost all lesions, confirming a better image quality and contrast. Conclusions: In our experimental condition 18 F-FACBC provides a statistically better performance in terms of lesion DR compared to 11 C-choline. These good results might be because of a favorable uptake mechanism of anti-3-18 F-FACBC. Furthermore, the distribution of the anti-3-18 F-FACBC in the body is favorable because the uptake in the kidney is negligible and the uptake in the bone marrow is mild and diffuse. A further advantage in terms of patient management derives from the longer half-life of 18 F compared with 11 C. With this radiotracer, more patients per single synthesis are studied and an on-site cyclotron is not required. More studies are required to evaluate the clinical significance in terms of sensitivity, specificity and accuracy. P093 Impact of palliative care clinic referrals on symptom burden of patients with genitourinary cancer: A retrospective longitudinal cohort study at Roswell Park Cancer Institute N. Gupta. Roswell Park Cancer Institute, Dept. of Medicine, Buffalo, United States of America Introduction & Objectives: Many cancer patients with genitourinary (GU) cancer suffer from uncontrolled symptoms. We assessed the impact of specialist palliative care clinic (PCC) referrals on symptoma-

71 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) tology of patients seen in our institute s GU medical oncology clinic (GUMOC). Material & Methods: 239 consecutive patients were collected from a retrospective review of GUMOC records in Roswell Park Cancer Institute from 12/1/2013 to 2/28/2014. Patients were divided into 2 arms- Arm A: GUMOC patients referred to PCC; Arm B: GUMOC patients not referred to PCC. 37 additional eligible patients were collected from review of PCC records over 9/1/2013 to 2/28/2014. Total 276 patients were divided into Arm A (n=49), and Arm B (n=227 patients). Data for baseline symptom score and 4-week follow up symptom scores were collected. Chi square test and T-test were used for statistical analyses. Results: Among all types of cancer, prostate cancer was the most frequent (53%), followed by renal cancer (25%), bladder cancer (14%), testicular cancer (7%), and penile cancer (1%). Baseline symptoms, ECOG status (2 3) and cancer stage (locally advanced or stage 4) were more advanced in the Arm A vs. Arm B (p=0.02, p<0.01, p<0.01 respectively). On comparing the symptom score change from baseline to 4-week follow-up, significant improvement occurred in Arm A (vs. Arm B) in pain, nausea, depression, anxiety, drowsiness, anorexia, well-being, dyspnea, and mean score (P<0.01 for all). Conclusions: GU cancer patients who are referred to PCC from medical oncology clinic have significant decrease in distressing symptoms. Standardized tools including disease severity and symptom intensity should be developed to guide PCC referrals. Routine use of these tools may help selecting patients who will benefit the most from PCC referral. Introduction & Objectives: Accumulating evidence from basic research indicates involvement of androgen receptor (AR) signals in bladder cancer (BC) development and suggests androgen deprivation therapy (ADT) as a new treatment option for BC. However, clinical effect of ADT on BC recurrence remains unclear. Prostate cancer (PC) patients are widely treated with ADT especially in Japan and several% of them experience concomitant BC. We aimed to investigate ADT effect on BC recurrence in patients with double primary cancer of PC and BC. Material & Methods: We conducted a multicenter retrospective cohort study in men with double primary bladder and prostate cancers diagnosed from 1991 to Recurrence-free survival (RFS) and cumulative recurrence for bladder cancer were compared between groups with (n=86) versus without (n=76) ADT for prostate cancer. Bladder cancer P094 The impact of androgen deprivation therapy on bladder cancer recurrence: Retrospective analysis K. Izumi 1, T. Masataka 2, H. Miyamoto 3, M. Sato 2, S. Morita 4, K. Noguchi 5, Y. Kubota 1, H. Uemura 1. 1 Yokohama City University Graduate School of Medicine, Dept. of Urology, Yokohama, Japan; 2 Yokohama City University Medical Center, Dept. of Biostatistics and Epidemiology, Yokohama, Japan; 3 Johns Hopkins University School of Medicine, Dept. of Pathology, Baltimore, United States of America; 4 Kyoto University School of Public Health, Dept. of Epidemiology and Healthcare Research, Kyoto, Japan; 5 Yokohama City University Medical Center, Dept. of Urology, Yokohama, Japan Figure 1 Results: Patients with ADT were older and had higher PSA levels or Gleason score prostate cancer than those without ADT. ADT patients had a significantly lower risk of bladder cancer recurrence (5-year actuarial RFS: 76% vs. 40%, p<0.001), and smaller number of cumulative recurrence (5-year cumulative recurrence: 0.44 vs. 1.54; p<0.001) compared with the control group. Multivariate analysis revealed ADT as an independent prognosticator (HR=0.240; 95% CI= ; p<0.001) for BC recurrence. Conclusions: This is first clinical evidence showing that ADT prevents bladder cancer recurrence. These results strongly suggest the efficacy and feasibility of ADT in patients with bladder cancer. Abstract P094 Table 1

72 146 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P095 The potential clinical relevance of serum soluble HER-2/neu level in urinary bladder carcinoma Y. Dinçer 1,Ş. Himmetoğlu 2, M.B. Tuna 3, E.E. Koç 1, S. Ataus 3. 1 Cerrahpaşa Medical Faculty, Dept. of Biochemistry, Istanbul, Turkey; 2 Biruni University, Dept. of Nutrition and Dietetics, Istanbul, Turkey; 3 Cerrahpaşa Medical Faculty, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: Early detection of disease is a crucial factor for increased survival rate in patients with urinary bladder cancer (UBCa). Despite all developments in this area, the options for diagnosis and detection of recurrences remain inadequate. In order to detect UBCa at early stage, new markers are needed. Certain growth factors in serum have been shown to have predictive/prognostic potential. Predictive potentials of soluble HER-2/neu (sher-2/neu), insulin like growth factor 1 (IGF-1) and epidermal growth factor (EGF) in patients with UBCa were examined in the present study. Material & Methods: A total of 37 patients with urinary bladder cancer and 27 age-matched healty volunteers were included by the study. Blood samples were collected just before the surgical operation and serum levels of sher-2/neu, IGF-1 and EGF were measured by ELISA. Results: In the UBCa group, serum level of sher-2/neu was found to be increased, serum level of IGF1 was found to be decreased in comparison to those in the control group. No significant difference was determined between the patient and control groups for serum level of EGF. All patients have high grade tumor and three of patients have distant metastases. There was no association between local invasion, tumor size, metastasis and serum sher/neu, IGF-1, EGF levels. The predictive performance of serum sher-2/neu level was evaluated by ROC curve generated by using sher-2/neu values obtained from 37 UBCa patients and 27 controls. We found ( ) within 95% confidence interval [CI] for sher-2/neu from the area under the curve (P=0.000). Using the cut off value of 4.7 ng/ml of serum sher- 2/neu, 100% sensitivity, 78% specifity, 86% positive predictive value, 100% negative predictive value and 90.6% accuracy were obtained. Conclusions: Serum sher-2/neu is a useful predictive marker for UBCa but IGF-1 and EGF have not such a potential. P096 Optimization of bladder hyperthermia treatment for non-muscle invasive bladder cancer using loco-regional heating, 3D thermometry and hyperthermia treatment planning G. Schooneveldt 1, E.D. Geijsen 1, P.J. Zum Vörde Size Vörding 1, E.R. Cordeiro 2, M.C.C.M. Hulshof 1, T.M. De Reijke 2, J. Crezee 1. 1 Academisch Medisch Centrum, Dept. of Radiotherapy, Amsterdam, The Netherlands; 2 Academisch Medisch Centrum, Dept. of Urology, Amsterdam, The Netherlands Introduction & Objectives: Hyperthermia (HT) is an adjuvant therapy that synergizes with chemotherapy treatments by locoregionally heating the tumour area to C. Loco-regional HT combined with intravesical instillation of Mitomycin C (MMC) is a promising candidate for the treatment of intermediate risk nonmuscle invasive bladder cancer (NMIBC) as it is potentially both more effective and less toxic than the current standard treatment with Bacillus Calmette-Guérin (BCG) immunotherapy. A good clinical effect combined with low toxicity requires a well-controlled temperature dose, as treatment outcome is strongly temperature dependent. Therefore, clinically effective loco-regional HT delivery requires adequate thermal dosimetry; thus, optimal thermometry methods and detailed thermophysical models are needed to accurately monitor, calculate and predict the temperature distribution throughout the bladder wall. The present intraluminal temperature measurement methods are inadequate. This study s purpose is to optimize the temperature distribution during loco-regional bladder HT treatment using three dimensional (3D) steering of the power deposition. This necessitates high resolution HT Treatment Planning (HTTP), which requires additional computational methods to be added to the current HTTP system, and improved 3D temperature data. Material & Methods: A novel multi-sensor probe was developed to monitor the bladder wall temperature distribution and the reliability of this probe was tested in porcine bladders placed in a tissue equivalent phantom for different bladder sizes. The phantom set-up has been numerically simulated using the OpenFOAM toolkit. Results: The probe was found to give accurate and representative values for the actual bladder wall temperature. Bladder wall temperatures may differ from lumen temperatures by up to 2 degrees centigrade. This is supported by the numerical simulations. The temperature of the bladder wall is much closer to the temperature around the bladder than to the temperature at the centre of the bladder. Figure 1 Conclusions: Successful 3D temperature reconstruction will provide more accurate information on the bladder wall temperature in comparison with intraluminally measured temperatures. Our combination of improved temperature data and more detailed and more accurate HTTP will allow for optimized equipment settings resulting in higher tumour temperatures and therefore better clinical results. Treatment of NMIBC with thus optimized loco-regional HT and MMC is expected to result in a 20% decrease in recurrences and/or progression compared with BCG, without the toxicity associated with the latter. Better local control can prevent more aggressive therapies (e.g. cystectomy, external beam radiotherapy). P097 Boosted tree in predicting advanced bladder cancer M. Stojadinovic 1, R. Prelevic 2, D. Milovanovic 3. 1 Clinical Center Kragujevac, Dept. of Urology, Kragujevac, Serbia; 2 Military Medical Academy, Dept. of Urology, Belgrade, Serbia; 3 Clinical Centre Kragujevac, Dept. of Clinical Pharmacology, Kragujevac, Serbia Introduction & Objectives: The major deficiency of clinical bladder cancer (BC) staging are the lack of accuracy. Consequently, clinical prediction has evolved from physician judgment alone to prediction models. Boosted regression has emerged as one of the most powerful methods for predicting data mining. The aim of the study was to develop and compare the predictive accuracy of boosted tree (BT) method with logistic regression (LR) for predicting advanced BC. Material & Methods: In a single-centre retrospective cohort study design, data of 183 patients with BC undergoing radical cystectomy (RC) were analyzed: demographic, initial transurethral resection, hy-

73 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) dronephrosis, abdominal and pelvic computed tomography (CT) and presence of advanced pathological stage on final pathology. BT analysis was conducted with same predictor variables. Advanced BC was defined as pt3 4 tumour or presence of lymph node metastases after pathological review. Various measures for the assessment of risk prediction models were determined, such as: predictive ability, accuracy, the area under the receiver operating characteristic curve [AUC]), calibration, and clinical utility using decision curve analysis. Results: Overall, 134 (73.2%) patients had advanced BC. The most decisive variables at the moment of classifications were nodal enlargement on CT, presence of hydronephrosis and size of dominant tumour. AUC for the models showing to have good discriminatory ability ( ), and in pairwise comparison of ROC curves difference between areas LR and boosted tree (2.2%) was almost significant (P=0.058). The best sensitivity was observed in the LR model with significant differences, although with the worst specificity. The LR model were well calibrated, however, BT model did not show satisfactory calibration. The Brier s scores were similar (ranged ). LR model leads to the higher net benefit compared with BT model. Conclusions: We compared the accuracy of the BT risk stratification tool with LR for predicting advanced BC. Both models show similar performance quality, but LR outperforms the BT model when decision curve analysis is used as benchmarks. However, before recommending its use in clinical practice, a larger and more complete database may be used to further clarify the differences between the BT and LR models in terms of prediction of the advanced BC. P098 Value of urinary flow cytometry in studying asymptomatic microhematuria A. Jimenez-Pacheco 1, M. Roldan-López 2, A.J. López-Luque 1, M. Verdú-Martínez 1, A. Jimenez-Pacheco 3. 1 Santa Ana Hospital, Dept. of Urology, Granada, Spain; 2 Santa Ana Hospital, Dept. of Emergency, Granada, Spain; 3 Virgen De La Nieves University Hospital, Dept. of Rehabilitation, Granada, Spain Introduction & Objectives: Asymptomatic microhematuria (AMH) is defined as three or more red blood cells per high powered field in a urine sample collected properly in the absence of an obvious benign cause. Urine test strip is a basic diagnostic instrument used in our daily clinical practice, which aims to detect some pathological changes. However, a dipstick positive urine does not define AMH (as yeasts, haemoglobin, and other cell types can be counted as RBCs), and the assessment should be based solely on the results of a microscopic examination of urinary sediment. Currently, there are other mechanisms to detect anomalies in the urine of patients such as flow cytometry, which is an analytical method that allows rapid measurement of certain physical and chemical properties of suspended particles or cells that produce a shape signal characteristics by interfering with a single light source. The aim of this study is to analyze the value of urinary flow cytometry in the study of the AMH. Material & Methods: We selected 21 patients older than 35 years diagnosed with AMH in our service. The variables studied were: sex, age, snuff consumption, personal history, exploration, development time and number of red blood cells in urine dipstick measured (hem/μl) and by flow cytometry (U/μl). All patients were first carried out a strip of urine. When detected in the blood count in the strip is greater than or equal to 50 hem/μl, flow cytometry automatically performed, considering the normal range between 0 and 16.5 U/μl. In turn, all patients were performed in consultation kidney and bladder ultrasound and urine cytology was requested. Subsequently, cystoscopy and UroTAC was requested following the recommendations of the published literature. Results: 54.1% were male and 45.9% female. The mean age was 53.9 years. 11 patients were active smokers (range of cigarettes/ day), 3 are former smokers and 7 non-smokers. 33.3% were hypertensive, and only one patient was taking antiplatelet agents. The examination was unremarkable in all patients. The median time to progression of 20 months. The number of RBCs detected by urine dipstick is between 50 and 250 hem/μl, with a median of 150 hem/μl. By flow cytometry, the number of red blood cells ranged from 7 to 403 U/μl, with a median of 31 U/μl. Ultrasound and cytology was negative in all cases. In 2 patients was detected in UroTAC microlithiasis, being cystoscopy negative in 100% of cases. Conclusions: Currently studying the AMH remains complicated, as it is not clear how many positive samples are needed before starting the study. Furthermore, the percentage of neoplasms detected in these patients is low, being less than 3% in most cases. Given the mechanization of laboratory services, there is growing tendency to use new techniques. In this study, we observed as flow cytometry, it can become a quick and effective diagnostic option of AMH. Studies of sensitivity/specificity are necessary to comparing urinary flow cytometry screening against erythrocytes by microscopy. P099 The role of narrow band imaging and photodynamic diagnostic cystoscopies among patients with newly diagnosed bladder cancer I. Pulin, M. Kutluev. Medical center Medservis, Dept. of Urology, Salavat, Russia Introduction & Objectives: According to WHO s datas bladder cancer (BC) takes place in 3 4% of all malignant lesions. Basic method of diagnosis is a white light cystoscopy. Innovative method is Narrow Band Imaging (NBI) cystoscopy. Usage of photodynamic enhancement during TURB allows to achieve complete tumor resection. To evaluate usage of videofibrocystoscopy with NBI and PDD cystoscopy in primary BC diagnosis. Material & Methods: We analyzed retrospectively 194 NBIcystoscopy (performed due to suspicion of BC) and 52 PDD TURB made thereafter. Cystoscopy was performed with videocystoscope Olympus CYF-4A in two modes: white-light and NBI. In case of tumor suspicion there was made a TURB under photodynamic control (PDD, Karl Storz). Results: During NBI-cystoscopy there were detected 52 cases with suspicious of BC (20.1%). Histological findings after PDD TURB proved BC in 39 cases (Table 1). Table 1. T-stage in BC cases Stage Total pt1 pt2 pt3 pt4 Absolute quantity Relative quantity (%) False positive results were proved in 12 cases (23.1%), false negative results in 1 case (1.9%). The results achieved throughout research point at the higher specificity and sensitivity of NBI/PDD cystoscopy compared to white light cystoscopy (Table 2). Table 2. Comparison of cystoscopy specificity and sensitivity Modes Sensitivity, % Specificity, % White light PDD NBI Conclusions: 1) white light cystoscopy in comparison with NBI and PDD cystoscopy does not show sufficient diagnostic value in bladder cancer. 2) the combination of NBI and PDD cystoscopy (both methods have different physical essences of visualization effect) inevitably brings to elevation of common specificity in bladder cancer detection.

74 148 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P100 Comparative study of conventional markers of bladder cancer: Preliminary results O.I. Apolikhin 1, A. Sivkov 2, D. Roshin 3, D. Perepechin 3, Y. Loshilov 3, L. Nikonova 3. 1 Federal State Budget Research Institute of Urology, Dept. of Innovative, Moscow, Russia; 2 Federal State Budget Research Institute of Urology, Deputy Director, Moscow, Russia; 3 Federal State Budget Research Institute of Urology, Dept. of Oncology, Moscow, Russia Introduction & Objectives: We performed a comparative analysis of four conventional markers of bladder cancer test systems (UBC, BTA, NMP-22, CYFRA 21-1) with ultrasonic diagnostics and urine cytology. Material & Methods: 45 patients with urothelial bladder cancer (BC) T1NxM0 were prospectively included in the study. Primary BC was observed in 15 patients and recurrent tumor in 30. The control group consisted of 30 patients with chronic inflammation of the urothelium. These patients underwent urine cytology, ultrasound diagnostics (UD) and NMP-22, UBC, BTA, CYFRA 21-1 testing (total 210 tests completed). UBC and BTA were determined by means of two test systems: express one and standard laboratory IFA. The definitive diagnosis was based on cystoscopy and histological examination after biopsy or transurethral resection of the bladder. All patients were examined according to the scheme recommended by the EAU Guidelines. Results: The main results are presented in table below. Test Cancer group Chronic inflammation group sensitivity specificity false-positive results UBC 62.2% 57.8% 80% UBC (express) 64.4% 57.8% 66.6% BTA 68.9% 55.6% 96.7% BTA (TRAK) 73.3% 57.8% 90% NMP % 68.9% 30% CYFRA % 84.4% Cytology 21.4% 84.4% 0% Ultrasound 91.1% 86.7% 0% Conclusions: None of the tests showed sufficient specificity and sensitivity. These limitations do not allow to replace cystoscopy by laboratory diagnosis. UD showed the best sensitivity and specificity. Urine cytology also demonstrated high specificity of all tests. BTA has the best sensitivity and comparable specificity among the three urine tests. In our opinion combination of UD and BTA is appropriate and has potential to avoid unnecessary cystoscopy during follow-up. In difficult cases, survey plan will include cytology and cystoscopy with biopsy. Inflammatory changes of the urothelium affect the high frequency of false- positive results among all urine tests. This work was initiated and fulfilled by its authors without any sponsorship. P101 BetaIGH3 in urine as biomarker for high grade bladder cancer diagnostics K. Lang 1, S. Robens 1, K. Braun 2, F. Sommerer 3, T. Behrens 1, J. Noldus 2, A. Tannapfel 3, K-H. Jöckel 4, R. Erbel 5, T. Brüning 1, H.U. Käfferlein 1. 1 Ruhr University Bochum, Dept. of Prevention and Occupational Medicine of the German social accident insurance, Bochum, Germany; 2 Marien Hospital Herne, University Hospital Ruhr University Bochum, Dept. of Urology, Bochum, Germany; 3 Ruhr University Bochum, Dept. of Pathology, Bochum, Germany; 4 University Hospital Essen, Dept. of Medical Informatics, Biometry and Epidemiology, Essen, Germany; 5 University Hospital Essen, University Duisburg-Essen, Dept. of Cardiology, West German Heart Centre, Essen, Germany Introduction & Objectives: The non-invasive detection of bladder cancer (BC) and the identification of patients with a high risk for cancer progression remains a challenge in BC diagnostics. Here we present the identification of soluble betaigh3 in urine as a sensitive and specific biomarker of high grade BC. Material & Methods: Urine samples from patients with primary BC and population controls were collected. Differential protein expression analysis in urine was carried out by antibody arrays. Results were verified in an additional set of urine samples obtained from 63 BC patients and 95 population controls using ELISA. Additionally, urine samples from 28 patients with acute inflammation of the bladder (urological hospital controls) were analysed to further verify the usefulness of betaigh3 for BC diagnosis and molecular characterization. Results: After identification of betaigh3 using antibody arrays, subsequent verification by ELISAs showed that urinary betaigh3 was found to be significantly higher in patients with primary bladder cancer (median pg/mg creatinine) in comparison to population controls (median 76.8pg/mg creatinine) and urological hospital controls (median 339.6pg/mg creatinine; p 0.001). Thereby, we found a notable difference of betaigh3 values between low and high grade BC with increased median levels in high grade tumours (549.7pg/mg vs pg/mg). Additional analysis (receiver operating characteristic curves) showed an increased sensitivity and specificity of betaigh3 towards high grade tumours with area under curve levels of 0.87 and 0.94 compared to hospital and population controls. All these differences were conserved after adjustment for important confounders including age, sex, smoking status and tumour grading. Conclusions: We were able to identify and confirm soluble betaigh3 as a promising biomarker candidate for high grade BC. Thereby, betaigh3 was capable of distinguishing BC patients from urological hospital and population controls. Thus, analysis of betaigh3 offers a significant step forward in non-invasive BC diagnosis. P102 Changing landscape in the histopathological presentation of invasive bladder cancer C. Öbek 1, C. Dogan 1, H. Demir 2, H. Durak 2, N. Uygun 2. 1 Cerrahpasa School of Medicine, Dept. of Urology, Istanbul, Turkey; 2 Cerrahpasa School of Medicine, Dept. of Pathology, Istanbul, Turkey Introduction & Objectives: Pure urothelial carcinoma is reportedly the histopathological diagnosis in approximately 90 95% of bladder cancer (BCa) cases. Our clinical observation has been that the rate of pure urothelial carcinoma (UC) has been decreasing over the years for invasive BCa. We reviewed our database to investigate whether the prevalence of the other non-pure UC and/or aberrant differentiation of UC were in a rise in the recent years. Material & Methods: Pathology archives of our institution were retrospectively reviewed regarding BCa for the years 2000 through All pathological analysis was performed at the same department by a dedicated uro-pathology team. Transurethral resection material were entirely submitted for processing. Patients with invasive bladder cancer were identified and further sub classified based on histology: 1. Pure UC, 2. Non-UC or aberrant differentiation of UC. Trend analysis was performed to investigate whether there was a statistically significant change in the histopathological presentation of the disease. Results: A total of 1245 BCa cases were reviewed; 746 non-invasive BCa and 1 paraganglioma were excluded leaving 478 invasive BCa for analysis. Mean age was 68±12years and male/female ratio 4.7/1. Pure UC was diagnosed in 291 (61%) and non-uc or aberrant differentiation of UC in 187 (39%). Non-UC was diagnosed in 27 (5.6%): squamous, adenocarcinoma, small cell neuroendocrine, large cell neuroendocrine, sarcoma and signet ring cell types. Aberrant differentiation of UC was noted in 160 (33.5%). Of these, squamous differentiation (19%) was the most common variant histology identified, followed by squamous with glandular, glandular, micropapillary, nested, sarcomatoid, lymphoepithelioma like, plasmacytoid, giant cell with trophoblastic differentiation, lipoid cell and signet ring cell. We observed a statistically significant increase in the presentation of non-uc or variants of UC with the frequency rising from

75 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) % to 61.9% within the fourteen years period examined. (Linearby-LinearAssociation, p: 0.003). Conclusions: The results of our study suggest that the histopathologic presentation of invasive bladder cancer has changed over the years with a significant decrease in pure urothelial carcinoma. Whether this results from a paradigm shift in the biology of the disease or form abuildupof cognizanceamong pathologists remains to be explored. P103 Positron emission tomography in the diagnosis of lymph node metastasis for patients undergoing radical cystectomy and extended lymph node dissection for muscle invasive bladder cancer C. Öbek 1, M. Gezer 1, C. Demirdag 1, F. Gevher 1, S. Ataus 1, M. Halac 2, K. Sonmezoglu 2. 1 Istanbul University Cerrahpasa School of Medicine, Dept. of Urology, Istanbul, Turkey; 2 Istanbul University Cerrahpasa School of Medicine, Dept. of Nuclear Medicine, Istanbul, Turkey Introduction & Objectives: We assessed the diagnostic accuracy of fluorine-18 fluorodeoxyglucose ([ 18 F]FDG) positron emission tomography-computed Tomography (PET-CT) in the diagnosis of lymphatic metastasis in patients undergoing radical cystectomy for invasive bladder cancer. Material & Methods: A pre-operative [ 18 F]FDG-PET/CT was obtained within 3 weeks prior to radical cystectomy and extended lymph node dissection in patients with a diagnosis of invasive bladder cancer. PET-CT findings were compared with the pathological diagnosis after surgery regarding lymphatic metastasis. Results: 52 patients underwent radical cystectomy with extended lymph node dissection between April 2009 and January Mean number of nodes removed were 25 (14 65). PET-CT was positive for lymph node metastasis in 17 (32%). Of these 5 (29%) had metastasis in pathological analysis.of the 35 patients with a negative PET-CT, 7 (20%) had histopathologically confirmed metastasis. The sensitivity of PET-CT to diagnose lymph node metatstasis was 41%, specificity 70%, positive predictive value 29% and negative predictive value was 80%. Conclusions: The diagnostic accuracy of PET-CT for diagnosis of lymphatic metastasis in invasive bladder cancer is not reliable. Extended lymph node dissection remains to be the most accurate means to determine lymphatic pathological staging. P104 Transurethral holmium laser resection of distal ureter and bladder cuff: A 10-year comparative study Y. Gong. The Second Affiliated Hospital, Zhejiang University School of Medicine., Dept. of Urology, Hangzhou, China Introduction & Objectives: To present innovative transurethral resection of the distal ureter and bladder cuff by holmium laser for upper urinary tract urothelial carcinoma, the perioperative and oncological outcomes were compared retrospectively following radical nephroureterectomy by three different methods. Material & Methods: From January 2002 to December 2012, 162 patients underwent excision of the distal ureter and bladder cuff by transurethral holmium laser (32 cases, Group A), transurethral electric resection (51 cases, Group B) or open procedure (79 cases, Group C) combined with open or retroperitoneal laparoscopic resection of kidney and proximal ureter. The therapeutic effectiveness, postoperative recovery, perioperative complications and oncologic outcomes were compared among groups. The follow-up time was 3 96 months. Results: Group A and B showed statistically significant better results on the operative time (203.6±31.5 min, 207.2±24.3 min), blood loss (127.4±63.2 ml,135.0±82.7 ml) and postoperative hospital stay (5.8±1.3 d, 5.6±1.2 d) than those of Group C (248.0±42.9 min, 484.5±217.7 ml,8.7±3.5 d) respectively (P<0.01). 6 cases of obturator neural reflex occurred in Group B, with 3 cases of bladder perforation and 2 conversion to open procedure. There were no differences in bladder tumors occurrence, retroperitoneal recurrence, seeding recurrence and cancer-specific survival among the three groups. Conclusions: The three techniques had comparable oncologic outcomes. Our data validate the superiority of transurethral holmium laser excision over electric resection with less complications and safety. The ureteral balloon catheter and early clip ligature of the ureter improved the obeying of oncologic principles. Transurethral holmium laser resection of the distal ureter and bladder cuff proved innovative feasible, safe, and oncologically equivalent method. P105 A pathologically confirmed diagnostic accuracy parallel NBI versus standard cystoscopy in NMIBC daily practice B. Geavlete, M. Jecu, C. Moldoveanu, F. Stanescu, C. Ene, C. Bulai, L. Adou, P. Geavlete. Saint John Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The trial aimed to assess the impact of narrow band imaging (NBI) cystoscopy in cases of non-muscle invasive bladder cancer (NMIBC). A single centre, prospective comparison to the standard white light cystoscopy (WLC) was performed targeting the specific diagnostic accuracy. Material & Methods: Over 12 months period, a total of 95 NMIBC suspected consecutive cases were enrolled in the study. The inclusion criteria were represented by hematuria, positive urinary cytology and/or ultrasound suspicion of bladder tumors. All patients underwent both WLC and NBI cystoscopy. Standard resection was performed for all lesions visible in WL and NBI-TURBT for solely NBI observed tumors. Results: The overall NMIBC (96.2% versus 87.2%) and CIS (100% versus 66.7%) patients detection rates were significantly improved for NBI when compared to WLC. Also, on a tumors related basis, NBI cystoscopy emphasized a significantly superior detection concerning the CIS (95.2% versus 61.9%), pta (93.9% versus 85.2%) and overall NMIBC (94.8% versus 83.9%) lesions. Additional tumors were diagnosed by NBI in a significant proportion of CIS (55.5% versus 11.1%), pta (26.5% versus 10.2%), pt1 (30% versus 10%) and overall NMIBC (30.8% versus 10.3%) patients. More over, pathologically confirmed positive tumoral margins secondary to white light TURBT were found at the NBI final control in 10.3% of the cases. The postoperative intravesical instillation treatment was significantly improved due to NBI results (16.7% versus 5.1%). Conclusions: NBI cystoscopy represents a valuable diagnostic alternative in NMIBC patients, bringing a significant improvement to the tumor visual accuracy as well as detection rates. NBI found significantly more malignant lesions and subsequently provided a substantial amelioration of the bladder cancer therapeutic management. P106 Tolerability of concurrent chemoradiotherapy with gemcitabine (GemX), with and without prior neoadjuvant chemotherapy in muscle invasive bladder cancer: Physician and patient reported outcomes C. Thompson 1, B. Sanderson 2, N. Alam 1, A. Tran 1, C. Coyle 1, J. Livsey 1, P.A. Elliott 1, J.M. Lyons 1, J.P. Logue 1, J. Wylie 1, A. Choudhury 1. 1 The Christie NHS Foundation Trust, Dept. of Clinical Oncology, Manchester, United Kingdom; 2 University of Manchester, Dept. of Medicine, Manchester, United Kingdom Introduction & Objectives: GemX is an effective and well tolerated treatment for bladder preservation in muscle invasive bladder cancer, previously investigated in a phase II trial and subsequently adopted into clinical practice. The purpose of this study is to assess the tolerability of GemX following neoadjuvant chemotherapy (neogemx). Material & Methods: Patients were treated between May 2010 and

76 150 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) September Toxicity was assessed weekly during GemX, at 6 weeks and 12 months post completion of treatment, using Radiation Therapy Oncology Group toxicity criteria and a previously validated LENT-SOMA (LS) questionnaire. Patients who had not completed a questionnaire at baseline and a minimum of 1 other time point were excluded. Results: 72 patients received GemX within this time period, 46 were eligible for analysis (NeoGemX: GemX 25:21). Baseline characteristics in the 2 groups are shown in table 1. There was no statistically significant difference in age (p=0.12) or performance status (p=.54) between groups. Table 1. Baseline characteristics for patients receiving GemX with and without neoadjuvant chemotherapy neogemx (n=25) GemX (n=21) Age (years) Performance Status: 0=14 1=10 2=0 0=11 1=9 2=1 Sex, m:f 20:5 16:5 Hydronephrosis 5 4 T stage: T2=21 T3=3 T4=1 T2=14 T3=8 T4=0 N stage: N0=24 N1=1 N0=21 Radiotherapy completion rates were 92% (23/25) for neogemx and 95% (20/21) for GemX. 76% (16/21) of patients in the GemX group and 20/25 (80%) in the neogemx group completed 4 cycles of gemcitabine. Bowel toxicity 3 was reported in 3/21 (14%) in the GemX group and 5/25 (20%) in the neogemx group. No grade 3 urinary toxicity was reported. There was no statistically significant difference between LS scores for neogemx and Gemx seen at any time points, for GI or GU toxicity. Allowing for the small number of patients, this excludes a difference in mean score between groups of 3. Conclusions: NeoGemX is well tolerated with acceptable toxicity and treatment completion rates. Grade 3 toxicity and failure to complete treatment is slightly more frequent in this cohort than previously reported, which may in part be due to bias related to questionnaire completion (as patients who did not have adequate questionnaire completion were excluded). In addition patients in this cohort, particularly those receiving GemX alone, were older than in the original trial. Allowing for small patient numbers, these results show no additional toxicity from the use of neoadjuvant chemotherapy prior to GemX. P107 Neoadjuvant chemotherapy for locally advanced bladder cancer, does it really work? B. Özdemir, B. Akdoğan, M. Altan, B. Çıtamak, O. Kahraman, H. Özen. Hacettepe University, School of Medicine, Dept. of Urology, Ankara, Turkey Introduction & Objectives: To determine the effectiveness of neoadjuvant cisplatin based chemotherapy prior to radical cystectomy (RC) for the patients with locally advanced muscle invasive bladder cancer (MIBC). Material & Methods: Data of 300 patients who have undergone RC for MIBC between 1999 and 2014 were evaluated retrospectively. 115 patients with findings of locally advanced disease on radiological imaging at presentation were included in the study. Those findings were locally advanced mass in the bladder or presence of any hydronephrosis or lymphadenopathy. Results of 60 patients who received neoadjuvant gemcitabine and cisplatin (NAC) are compared to the 55 patients who underwent directly RC. Results: Mean age, male to female ratio and presence of anaemia was not different between the groups. Mean follow up was 33.8 months. According to TNM, pathological down-staging was achieved in 33% and 23.6% of patients in NAC and RC groups, respectively (p=0.251). Surgical margin positivity was detected in 18.3% and 16.3% of patients, respectively. The rates of early complications were also similar. Overall survival was 26.7% and 35%, cancer specific survival was 38.1% and 49.3% for the corresponding groups, respectively (p=0.456 and p=0.224) (Table 1). Table 1. Clinical and pathological parameters Parameters NAC, n (%) RC, n (%) Total, n (%) P Age, years <62 31 (55.4) 25 (44.6) 56 (100) (49.2) 30 (50.8) 59 (100) Sex male 56 (52.8) 50 (47.2) 106 (100) female 4 (44.4) 5 (55.6) 9 (100) TNM stage group 2 20 (60.6) 13 (29.4) 33 (100) (48.8) 42 (51.2) 82 (100) pt stage 2 23 (57.5) 17 (42.5) 40 (100) (49.3) 38 (50.7) 75 (100) Anaemia yes 42 (56.8) 32 (43.2) 74 (100) no 18 (43.9) 23 (56.1) 41 (100) Surgical margin status positive 11 (55) 9 (45) 20 (100) negative 49 (51.6) 46 (48.9) 95 (100) Early complications yes 12 (44.4) 15 (55.6) 27 (100) no 49 (51.6) 46 (48.4) 98 (100) 5-years overall survival 26.7% 35% Conclusions: Neoadjuvant chemotherapy in locally advanced bladder cancer didn t reveal better survival compared to RC only in the present study. Besides small sample size and short follow up, selection bias could also cause those results. Patients with worse clinical stage were selected more to receive NAC. Novel strategies using molecular markers are needed to select candidates better for NAC. P108 Descriptive analysis of our clinical experience in the treatment of NMIBC with intravesical gemcitabine C. Baena Villamarín 1, P. Beardo Villar 1, M.J. Castro Dorantes 1, M. Soto Delgado 1, R. Gamaza Martinez 1, R. Gavira Moreno 2, R. Ibañez Suarez 1, J.M. Arroyo Maestre 1, A. Juárez Soto 1. 1 Jerez University Hospital, Dept. of Urology, Jerez De La Frontera (Cádiz), Spain; 2 Jerez University Hospital, Dept. of Pharmacy, Jerez De La Frontera (Cádiz), Spain Introduction & Objectives: Intravesical gemcitabine is used as a complementary treatment of transurethral resection (TUR) in patients with non muscle invasive bladder cancer (NMIBC) of intermediate/high risk or high recurrence with no previous response to intravesical bacillus Calmette-Guérin (BCG) treatment. Its good potential tolerance has been clinically confirmed in different trials. The most common pattern of administration is using intravesical gemcitabine at 4 8 weeks of TUR at a dose of 2,000 mg in 50 ml of saline for 60 minutes administered weekly for 6 weeks and monthly thereafter until completing a year. The aim of this study is the description of the treatment tolerance of the first 6 consecutive cases of patients with NMIBC treated with intravesical gemcitabine (Gemcitabine Actavis 1g/25 ml) at the dose and schedule described. Material & Methods: Retrospective descriptive analysis of 6 patients with NMIBC undergoing intravesical gemcitabine therapy during Results: All patients were male with a mean age of years (52 84). 50% were high-grade pta and 50% pta low grade with high recurrence. Half of them had been made prior intravesical treatment with MMC. From the 6 patients described, four (66.7%) had adverse effects attributable to the administration of intravesical gemcitabine as it appeared during or minutes immediately after the instillation, and also the existence of associated urinary tract infection by urine culture was discarded. As in other studies, in all cases, we have grades 1 2 toxicities but at a higher proportion than reported in the literature (11.5 to 58%). Adverse effects (AE) showed were mainly local, but two patients (33%) also showed systemic AE: Heavy sweating and hypotension, are described as a possible gemcitabine AE, but very rare with intravesical administrationdue to its minimal and transitorial systemic absorption. Adverse effects related to treatment were the main cause of discontinuation in our series (66.7%). In one case the

77 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) treatment was discontinued by chemical cystitis (case 1), in another by the recurrence of the AE (case 2) and in 2 cases (cases 3 and 4) by the refusal of patients to continue treatment. This contrasts with data published in other studies where treatment interruption for AE of gemcitabine was insignificant. None of the patients described had a history of pelvic radiotherapy, or intravesical treatment with BCG within previous 3 months, that could justify the bladder irritative symptoms. Since in all AE cases attributable to intravesical administration of gemcitabine occurred during the immediately or following minutes, does not suggest a relationship with increasing time of exposure to drug inside the bladder or a voiding dysfunction of the patients. Suspecting the adverse effects were related to the pharmaceutical preparation, we recently started treating patient nº 7 with Gemcitabine Accord with a magnificent tolerance. This new formulation, even when reconstituted has a lower ph (5.7) than the Actavis gemcitabine (ph 7.4) has 50% less alcohol. Conclusions: Intravesical gemcitabine therapy in our experience, has not been as well tolerated as stated in the literature. In 80% of patients the side effects led to discontinuation of treatment. Because these side effects have not been reproduced by changing pharmaceutical preparation, we believe were secondary to the high alcohol content of the initial pharmaceutical formula. P109 The initial 56 robot cystectomies of an experienced robotic surgeon: Trends in perioperative parameters and complications E.R.P. Collette, M. Gan, R.P. Engel, D. Van Den Ouden, D.C.D. De Lange, O.S. Klaver. Maasstad Hospital, Dept. of Urology, Rotterdam, The Netherlands Introduction & Objectives: Radical cystectomy is performed robot assisted in our hospital since 2012, including the intracorporal construction of a Bricker urine deviation or a Studer neobladder. This procedure is performed by one surgeon who already had experience with 700 robot prostatectomies. Material & Methods: Prospective registration and retrospective analysis. From January 2012 until May patients underwent robot cystectomy. Ten functional cystectomies were performed and 46 radical tumor cystectomies. 30 patients received neo-adjuvant chemotherapy. Four neobladders and 52 brickers were conducted. Results: 50 procedures were conducted intracorporeal and 6 procedures extracorporeal, of which 3 concerning conversions and 1 neobladder. Mean age is 67 year and BMI is 26. ASA score I n=2, II n=36 and III n=18. We observed a significant difference in mean operative time concerning the first half of the RARC-Bricker cohort (n=22, min=321) and the second half (n=21, min=280) (p=0.004) and the mean intra-operative blood loss also showed a significant decrease between the first (n=22, ml=695) and second half (n=21, ml=450) (p=0.03). Hospital stay showed a decreasing non-significant trend between the first (n=22, days=13.5) and second half of the cohort (n=21, days=11.9) (p=0.33). Six (6/56=11%) patients stayed >1 night at the ICU. Half of pts (23/46) showed <pt2 and half of pts (23/46) showed pt2, including 5 N+ pts. Two patients experienced a positive surgical margin (both ypt4b). We observed a significant difference in mean lymph node yield concerning the first half (n=21, Node=12) and the second half of the oncological cohort (n=22, Node=17) (p<0.05). There was a significant reduction observed in the number of complications: the first half presented 71% (20/28) and the second half 43% (12/28) (p=0.03). Low grade complications were seen in 45% (25/56) Figure 1. Significant reduction of complications (P=0.03). of pts; Clavien grade 1 n=7, grade 2 n=18. A high grade complication was observed in 13% (7/56) of pts; grade 3a n=2, grade 3b n=4, grade 5 n=1 (12 days after Salvage surgery). Conclusions: RARC including IC-Bricker derivation is feasible, but not without obstacles, even after extensive robotic experience (700 1,000 RARP). It is safe according to early oncological results. The results of this initial cohort of robot cystectomy show an increase in lymph node yield and a decrease in hospital stay. We observed a significant reduction in operative time, intra-operative blood loss and complications. We present only 13% high grade complications, despite the learning curve. P110 Chronic obstructive pulmonary disease (COPD) as a complications predictor for radical cystectomy V. Atduev, Y.O. Lyubarskaya, D.S. Ledyaev. Nizhny Novgorod State Medical Academy, Dept. of Urology, Nizhny Novgorod, Russia Introduction & Objectives: The rate of different complications after radical cystectomy (RC) with different urinary diversion types in patients with bladder cancer (BC) is still high. In this way the evaluation of risk factors which contribute to complications after RC is an actual problem. The aim of our study was to analyze correlation between comorbidity and postoperative complications rates. Material & Methods: Since 2008 to patients with BC were underwent RC: 140 (80.5%) men and 34 (19.5%) women. The mean age was 62.2±9.7 (range 34 80). Comorbidities rate was rather high: obesity 32%, diabetes mellitus 13%, coronary heart disease (CHD) 49%, arterial hypertension 59%, chronic obstructive pulmonary disease (COPD) 15.5%. After RC 109 (62.6%) patients underwent orthotopic urinary divertion, 41 (23.6%) Mainz pouch II, 12 (6.9%) Bricker, 12 (6.9%) uretherocutaneostomy. We have analyzed 30 days and 90 days complications in accordance with Clavien classification. Statistical analysis was done by SPSS statistics 16. Results: We did not find any correlation between 30 days or 90 days complication rate and the patient s age, sex and obesity, CHD, or diabetes mellitus. Positive correlation between COPD and 30 days and 90 days complication rate (R = +0.3±0.09 [CI ], p=0.005 for 30 days and R = +0.2±0.07 [CI ], p=0.01 for 90 days complication rate) were revealed. In general patients with COPD more often were underwent relaparotomies (χ 2 =6.74; p=0.009). Thus we have found positive correlation between patients with COPD and the rate of eventration (R = 0.2±0.08 [CI = ]; p=0.05). Also positive correlation between COPD and mortality (R = 0.24±0.08 [CI ]; p=0.001) was revealed. Conclusions: Among all comorbidity COPD is the factor which significantly increases the rate of postoperative complications. Patients with mentioned risk factors need special management. P111 Laparoscopic radical cystectomy in the elderly results of a prospective observational study T. Hermans, L. Fossion. Maxima Medical Center, Dept. of Urology, Veldhoven, The Netherlands Introduction & Objectives: Laparoscopic radical cystectomy, with promising perioperative and long-term oncological outcomes, might give elderly patients an other interesting treatment option for muscle-invasive bladder cancer in which they can benefit from an early radical surgical approach. We sought to compare perioperative and oncological outcome of laparoscopic radical cystectomy (LRC) in elderly ( 75 years) and younger (<75 years) patients. Material & Methods: A retrospective analysis of prospectively gathered data of a single institution series (two surgeons) of 73 patients who underwent LRC with ileal conduit and a standard pelvic lymph node dissection between September 2006 and February 2013 was performed. Perioperative outcomes, 90-day complication and mor-

78 152 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) tality registration data and oncological outcome were compared for 22 elderly and 51 younger patients. Results: Median age difference between groups was 9.0 years (77.0 vs years, p<0.001). Both groups had similar surgical indications, body mass index (25.4 vs kg/m 2, p=0.799) and gender distribution. Median Charlson Comorbidity Index score was 3 versus 4 for younger and elderly patients, respectively (p<0.001). Median operating time (340 vs. 341 min, p=0.852) and estimated blood loss (500 vs. 500 ml, p=0.346) did not differ between groups. Median total hospital stay was 12.0 vs days for younger and elderly patients, respectively (p=0.133). Minor complication rate (Clavien I/II, including blood transfusions) was higher for elderly vs. younger patients (68.2 vs. 43.1%, p=0.05), in contrast to major complication rate (Clavien III/IV/V), which was lower in the elderly (22.7 vs. 29.4%, p=0.557). 90-day mortality rate was higher for elderly patients (13.6 vs. 3.9%, p=0.157), although not directly related to surgery itself. In both groups main histologic tumor type was urothelial carcinoma. Non-organ confined disease (>pt3) was slightly more prevalent in the elderly (45.1 vs. 54.5%, p=0.458), as was the percentage of patients with lymph node involvement (29.4 vs. 31.8%, p=0.558) and the percentage of positive surgical margins (7.8 vs. 22.7%, p=0.118). The mean numbers of lymph nodes removed were 15.7 and 13.3, respectively. Mean and median overall follow-up did not significantly differ between groups and was 20.7 vs months for elderly and 14.2 and 18.5 months for younger patients, respectively. Overall survival and cancer specific survival were equal for both groups (Log rank p- value of and 0.976, respectively). At 24 months overall survival rates were 63% vs. 56% for younger versus elderly patients and cancer specific survival rates were 67% vs. 68%, respectively. Our study results are subjected to the limitations and biases of retrospective analyses of a prospective database and the small number of elderly patients. There was no selection bias between open radical cystectomy and LRC, since only LRC was preformed in patients found eligible for a surgical treatment, as there was no selection for elderly patients in the latter part of the learning curve. Conclusions: In experienced hands LRC is safe and feasible and might give selected elderly patients the opportunity to benefit from an early minimal invasive radical approach with favorable perioperative outcomes. P112 Treatment of bladder cancer at the third trimester of pregnancy V. Startsev 1, A. Kolmakov 2. 1 Saint Petersburg s Medical Information and Analitical Center, Dept. of Population-Based Cancer Register, St. Petersburg, Russia; 2 City Hospital of Lobitu, Dept. of Urology, Lobitu, Angola Introduction & Objectives: The frequency of verification of malignancies (MT) in pregnant women is rare %. The most common MT at pregnancy are: melanoma, cervical and breast cancer. Urinary MT are diagnosed in pregnancy by coincidence. Only 27 published cases of transitional-cell carcinomas in pregnancy have been founded in available literature in Material & Methods: The 27 y.o. black female, non-smoking housewife from region with high evidence of bilharzias was admitted in the maternity with macroscopic painless haematuria and moderate anemia. She had third trimester of her 7th pregnancy (35/36 weeks). The haematuria was occurred periodically 2 weeks before. Due to pelvic/obstetric exam, the fetus was in a satisfactory status. The vaginal exam revealed an immobile mass invaded the bladder. A diffuse tumor of the bladder wall along the entire length of organ, without hydronephrosis, was found by the ultrasound. A cystoscopy could not be done. Blood tests revealed a moderate anemia. Due to unsuccessful conservative treatment we organized an inter-disciplinary commission with MD s to determine the appropriate treatment. The main schema was: a Caesarean section, cystectomy with urinary deviation. Due to the haematuria and progressive anemia, it was decided to finish the pregnancy process prematurely at 37 weeks, with prior pulmonary maturation of the fetus. Results: The Caesarean section was done successfully. We revealed the bladder tumor (BT) which infiltrated the anterior wall of the uterus, extended into the right side of the common iliac artery, without any other areas of spreading. Anterior pelvic exenterating and pelvic lymph dissection was done. We constructed urinary deviation using the Mainz II pouch technique. The duration of surgery was about 4.5 hours with the blood loss 1800 ml. The common status of the male infant was satisfactory, Apgar scores of 7/8, weight 2700 g. The patient was observed in the intensive care unit (2 days) and in general surgery ward. At first 6 days the patient presented with spontaneous elimination of the ureteric stents, with 2 3 bowel movements and urinated 2 3 times daily with full control of anal sphincter further. The patient was discharged on the 20 th day in good status with normal renal function and mild anemia, without any complications and was referred to the oncology department for follow-up. The infant weight was 3100 g on discharge day. Histological report: complete infiltration of bladder wall with squamous-cell carcinoma, with invasion of the anterior wall of the uterus and metastasis to the right iliac lymph nodes. Conclusions: The patient was admitted with advanced BT. The preferred method was radical surgery, and Mainz II pouch technique was done with urinary deviation, to relative simplicity in terms of the time and volume of the surgery. The results were good, without complications. The fetus was in a satisfactory condition from the beginning, it was important to minimize the surgical trauma and impact, eliminate the source of hemorrhage and maximum excision of BT. Standard diagnostic tests for exclude tumors of the urinary tract should be done in all pregnant cases. In present, we have decided to exclude the use of additional radiological methods in the investigation due to the evident definition of the clinical presentation and the possibility of reviewing the tumor and intra-pelvic organs during the exploration. P113 Design of an exploratory phase I study of pemetrexed in addition to vinflunine as second-line treatment in patients with metastatic urothelial cell carcinoma after prior treatment with platinum H. Pappot 1, H. Von Der Maase 1, A. Ullen 2, M. Agerbæk 3, NUCOG. 1 Rigshospitalet, Dept. of Oncology, Copenhagen, Denmark; 2 Karolinska, Dept. of Oncology, Stockholm, Denmark; 3 Århus University Hospital, Dept. of Oncology, Århus, Denmark Introduction & Objectives: A phase III study has led to the registration of vinflunine (Javlor ) in many countries as monotherapy in second-line treatment of locally advanced or metastatic UCC progressing after platinum-based 1st line combination chemotherapy. The implementation of the treatment is based on a significant improvement in overall survival in the vinflunine group, 6.9 versus 4.6 months. Even though this increase in survival has been introduced, there is an urgent need for second-line treatments with better outcome in metastatic UCC. The effect of pemetrexed as single agent in second-line UCC has been investigated in small non-randomized clinical trials (n=12 47), reporting the response rate to be 9 28% and the median time to progression to be 2.9 months. Based on data from other solid tumours it is considered feasible, without unacceptable toxicity, to administer combined treatment with the two products with known activity in UCC (vinflunine (Javlor ) and pemetrexed (Alimta )) in second line. This abstract presents the study design of a phase I study combining these agents. The primary objective of the study is to explore the safety of pemetrexed in combination with vinflunine. Secondary objectives are overall response rate, ORR (= CR+PR), clinical benefit rate (= CR+PR+SD) and progression free survival, PFS. Material & Methods: A fixed dose of vinflunine per square meter will

79 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) be administered to all patients on day one every third week. Pemetrexed will likewise be administered on day 1, once every third week and escalated in dose steps. A minimum of three patients are to be treated at each dose level sequentially. Patients will be evaluated for toxicity weekly during cycle 1 and thereafter every third week. If none of three patients experiences a DLT (see definition of DLT) until the end of week 6, pemetrexed will be escalated to the next dose level for the following patients. The minimum total accrual of patients to define RPTD for starting dose of vinflunine is 9, and the maximum 18, since a minimum of 3 patients must be accrued at each dose level of pemetrexed. Efficacy parameters will be evaluated and presented by descriptive methods and statistics. Results: As a result of the study design indicated above vinflunine (Javlor, Pierre Fabre Pharma) will be administered as: 280 mg/m 2 I.V., day 1, repeated every 21 days and pemetrexed (Alimta, Eli Lilly) will be given day 1, repeated every 21 days: as: Step 1: 400 mg/m 2, Step 2: 450 mg/m 2, Step 3: 500 mg/m 2. Treatment continues until disease progression, unacceptable toxicity or patients wish to stop treatment. Conclusions: A tolerated dose of the two drugs in combination is sought and this dose will be further tested in phase II, provided this phase I study indicates activity of the combination. P114 Renal funtional deterioration after urinary diversion a retrospective comparison between ileal conduit and ileal orthotopic neobladder R.K. Shimpi. Uro-Andrology Clinic, Dept. of Uro-Oncology, Pune, India Introduction & Objectives: To study the long term effect on Renal function in patients of Radical Cystectomy following Urinary Diversion in the form of Ileal Conduit/Orthotopic Neobladder. Material & Methods: 53 patients (44 males and 9 females) in the age group of years, treated between 1999 and 2008 are included in the present study. Out of 53, 20 patients had undergone Ileal Conduit diversion while 33patients had Ileal Neobladder (Frog Type bladder in 28 patients) following Radical Cystectomy. Apart from the GFR, other factors such as age, type of Urinary Diversion, Hypertension, Diabetes, Pre-existing Renal medical Disease were also analysed. GFR was estimated yearly if no structural changes were seen in USG if the Serum Creatinine level was within normal limits. Results: The baseline GFR was more than 60ml/sec. The deterioration in GFR was seen in 11 patients of Ileal Conduit group and 13 patients of Ileal Neobladder technique. The factors related to the urinary system are Infection (A=12 B=17), Uretric Stricture (A=2 B=3), Urolithiasis, Large PVR, Anastomotic Stricture (2.2%) are analysed. Conclusions: The Renal Deterioration is commonly seen in Ileal Conduit than Neobladder. A significant reduction in the Uretric Stricture formation is seen in my technique of FROG Neobladder due to a different way of anastomizing the ureter to the ileum (tension free anastomosis due extra length of the tubular ileum, nipple technique of reimplantation) and D.J stenting for 2 months post-operatively and also tension free anastomizing with external stenting. P115 Neoadjuvant chemotherapy with gemcitabine plus cisplatine (GC) in urothelial carcinoma experience of a center DM Macedo 1, C. Pulido 1, A. Ferreira 1, A. Mansinho 1, I. Fernandes 1, C. Lourenço 1, A. Costa 2, J. Palma Dos Reis 3, L. Costa 1. 1 Centro Hospitalar Lisboa Norte, Dept. of Medical Oncology, Lisbon, Portugal; 2 Centro Hospitalar Lisboa Norte, Dept. of Pathological Anatomy, Lisbon, Portugal; 3 Centro Hospitalar Lisboa Norte, Dept. of Urology, Lisbon, Portugal Introduction & Objectives: Neoadjuvant cisplatin-based chemotherapy improves overall survival and disease free survival in muscleinvasive urothelial cancer, being MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) the standard regimen. In the metastatic setting, studies revealed similar efficacy with improved tolerability of gemcitabine plus cisplatin (GC) when compared to MVAC. These results led several centers to use GC in the neoadjuvant setting, despite the lack of prospective controlled studies. More recently Galsky et al presented in ASCO 2014 a large retrospective cohort comparing MVAC and GC and providing additional evidence to support current practice. Material & Methods: The authors retrospectively evaluated files from patients with muscle-invasive urothelial carcinoma who received neoadjuvant GC before radical cystectomy between January 2008 and December 2013 at our center. Disease free survival (DFS), overall survival (OS), complete pathological response (CPR) and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) grade 3/4 adverse events were the endpoints of interest. Results: Twenty four patients with muscle-invasive urothelial cancer were eligible for evaluation. The median age was ( ) years with a male predominance (91.67%). The median Eastern Cooperative Oncology Group performance status was 0 and the median TNM stage was III. All patients underwent neoadjuvant chemotherapy with a median total of 3 (3 4) cycles. The most frequent reported NCI CTCAE grade 3/4 adverse events were hematological (25%) and gastro-intestinal (4.17%). With a median follow up of months, median DFS was months, median OS was months and CPR rate was of 26.67% among the 15 patients who actually underwent radical cystectomy. In the subgroup of patients who experienced complete pathological response, there was no disease recurrence or patient death during the review period. Conclusions: In this single center study, neoadjuvant GC was well tolerated and brought clinical benefit to the patients. Although this study has a small sample size, the results observed are similar to those reported by recent retrospective cohort studies. P116 Gemcitabine plus split dose cisplatin is active and safe in cisplatin-unfit patients with advanced urothelial carcinoma Y.R. Kim 1, J.L. Lee 1, D.S. You 2, I.G. Jeong 2, C.R. Song 2, B.S. Hong 2, J.H. Hong 2, C.S. Kim 2, H.J. Ahn 2. 1 Asan Medical Center, Dept. of Oncology, Seoul, South Korea; 2 Asan Medical Center, Dept. of Urology, Seoul, South Korea Introduction & Objectives: Cisplatin based chemotherapies are standard treatment regimen of advanced urothelial cell carcinoma. But a significant proportion of patients with urothelial carcinoma have impaired renal or cardiac function, or poor performance status that preclude the use of cisplatin. Carboplatin in combination with gemcitabine has been a standard regimen in this group of patients. However, it is known that clinical outcome of carboplatin based regimens were inferior than that of cisplatin based regimens. We compared the renal function and treatment response between gemcitabine plus carboplatin regimen (GCb) and gemicitabine plus split dose cisplatin regimen (GP-S) in these patients. Material & Methods: Criteria of cisplatin-unfit were defined as glomerular filtration rate of 60 ml/min (calculated by MDRD method), ECOG performance status 2, or poor cardiac function precluding hydration for standard dose of cisplatin. Gemcitabine plus split dose cisplatin consists of cisplatin 35 mg/m 2 were given on day 1 and day 2 and gemcitabine 1,000 mg/m 2 (in a 30-min infusion) on day 1 and day 8 every 3 weeks. GCb regimen consists of carboplatin (AUC 4.5) on day 1 and gemcitabine 1,000 mg/m 2 on day 1 and day 8 every 3 weeks. Patients demographics, baseline and follow-up serum creatinine and calculated GFR, adverse events, and radiologic response were retrospectively reviewed. The primary endpoints were serum creatinine and GFR changes during the first two treatment cycles. The secondary endpoints were renal function over 6 cycles, RE- CIST response, and safety. Serum creatinine and GFR were analyzed

80 154 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) using repeated measure of ANOVA and responses of treatments at each group were analyzed using Fisher s exact test. Results: From April, 2011 to May, 2014, forty three patients with advanced urothelial carcinoma treated with GCb (n=21) or GP-S regimen (n=22) in our institution. Median age of GC group and GP-S group was 70.3 and 67.1, respectively. The number of patients who had GFR <60 ml/min/1.73m 2 were 14 of GCb group and 11 of GP-S group. GFR did not decline over two treatment cycles in both group. There was no difference at deterioration of serum creatinine or GFR between GCb and GP-S group (ρ=0.361, p=0.062). Actually there was trend of improvement in renal function in GP-S group. At subgroup analysis using patients who received 6+ cycles of GCb or GP-S, there was no difference in serum creatinine and GFR (ρ=0.161, p=0.060). For patients who had GFR <60 ml/min/1.73m 2 subgroup, similar results were produced (ρ=0.885, p=0.296). Tumor responses to GCb group were PR: 6, SD: 4, PD: 7. While, CR: 1, PR: 11, SD: 3, and PD: 2 in GP-S group (p=0.084). Both treatment were well tolerated and there were no unexpected serious adverse events. Conclusions: Based on preserved renal function, favorable response, and tolerability, for cisplatin-unfit patients with advanced urothelial carcinoma, GP-S regimen could be a promising alternative to GCb regimen. P117 Comparative study between surgery and radiochemotherapy in muscle invasive bladder TCC M. Wygoda 1, A. Wygoda 1, I. Nemirovski 1, D. Pode 2, R. Katz 2, O. Gofrit 2. 1 Hadassah University Hospital, Dept. of Oncology & Radiotherapy, Jerusalem, Israel; 2 Hadassah University Hospital, Dept. of Urology, Jerusalem, Israel Introduction & Objectives: Conventional therapy for muscle invasive bladder TCC is radical cystectomy. Radiochemotherapy after maximal TURBT has emerged as an alternative to surgery and is offered either to medically inoperable patients or to patients who refuse the morbidity and mutilation of the operation. This study aims at comparing the results of those two options in matched groups. Material & Methods: Between 2000 and 2011, 33 pts with muscle invasive bladder TCC (stage T2-4aN0M0) were treated in our institution with radiochemotherapy (group A: 33pts): median total dose of radiation was 61Gy. 21 pts were given concomitant Cisplatin and 12pts were given Carboplatin. For each patient we matched one patient of similar age who was treated in the same year with radical Cystectomy (group B: 33pts). Comparisons of outcome were made using the Kaplan Meyer method. Results: Median age in groups A and B was 74 and 73 respectively (range 62 82) with a male to female ratio of 77%. Mean Charlson Comorbidity Index was higher in group A than in group B (4.4 vs 3.4, p=0.01). 3/33 pts after Radiochemotherapy underwent eventual Radical Cystectomy (9%): two of them as Salvage procedure and one due to a post radiation non-functional bladder. 2yr and 5yr Overall Survival rates after surgery are 74.4% and 54.8%, and after Radiochemotherapy are 70.2% and 56.6%, without significant difference (p=0.8). Similarly 2yr and 5yr Relapse Free Survival (RFS) rates for Surgery (67.8% and 63.2%) and for Radiochemotherapy (63% and 54.3%) are equivalent (p=0.89). Conclusions: Radiochemotherapy and Surgery achieve similar Overall Survival rates and RFS rates for muscle invasive bladder TCC. Radiochemotherapy allowed to preserve the bladder in the vast majority of our patients ( 90%). Organ preserving strategy should be considered as an alternative to surgery not only for pts medically unfit for the operation. P118 FROG bladder a new type of neobladder the functional and metabolic characteristics R.K. Shimpi. Uro-Andrology Clinic, Dept. of Uro-Oncology, Pune, India Introduction & Objectives: There have been various modifications of surgical techniques of Neobladder. I report a new type of bladder The FROG Bladder which satisfies the principles of continent Urinary Diversion, such as reservoir of satisfactory capacity, low pressure, minimal PVR and minimal surface exposure to avoid metabolic disorders with sufficient length of the ileum for tension free anastomosis. To develop a Neobladder, with minimal intra-operative and post-operative complications after Radical Cystectomy. Material & Methods: 33 patients (30 males and 3 females) in the age group years (Mean 57.5 yrs.) who had undergone Radical Cystectomy between 1999 and 2010 are included in the present study and were offered FROG Bladder a type of Neobladder. The salient features of these bladder are- two segments of the ileum of 30 cm each are used and 5 cm of distal most l part of the ileum is not detubularized and both the segments are anastomized in such a way that these two non-tubularized segments can be used for tension-free uretro-ileal anastomosis which is stented with 8 Fr. RT. The patients were followed-up at 3, 6, 9, 12 months intervals in the form of USG abdomen, Urine Cytology, Serum B12, Uroflometry and UDS Results: The average age of the patients was 62 years intraoperatively, there was no problem in placing the Neobladder in the pelvis as well as there was no fear of tension on suture line of Uretro- Intestinal anastomosis. Bladder capacity at six months was 245±150 ml while at 1 year was 290±220 ml, PVR at six months was 10±30 (17) at 1 year, 10±90 (36), 24 hr Voiding frequency at six months was 11 (8 14) while at 1 year it was 7 (5 10), Day time continence was 76% while at 1 year it was 92%. Night time continence at 6 months was 56% while that at 1 year was 82%, Max flow rate was 16 ml/sec at six months while at 1 year it was 21 ml/sec. Conclusions: The FROG bladder at 1 year follow-up achieved an excellent result with good capacity, minimal PVR and minimal back pressure changes in the upper tracts. P119 Intravesical bacile calmette-guerin in high-risk Non-Muscle Invasive Bladder Cancer (NMIBC): Adherence to European Association of Urology guidelines and outcomes during the BCG crisis Z. Gates, M. Kitchen, L. Gommersall. University Hospital of North Staffordshire, Dept. of Urology, Stoke-on-Trent, United Kingdom Introduction & Objectives: More than cases of bladder cancer are diagnosed in the UK every year, approximately 95% are transitional cell carcinoma (TCC). Using the TMN classification, 70 75% TCC are non-muscle invasive (Tis, Ta, T1) (NMIBC) and 25 30% are Muscle invasive (T2 or above) at diagnosis. The EAU have produced clear guidance on the management of NMIBC which can be used as the gold standard of care. In July 2012 a shortage of Bacile Calmette-Guerin (BCG) led to suboptimal care of patients with high risk NMIBC. High-risk NMIBC accounts for 10 15% of all NMIBC. With documented higher rates of recurrence and progression compared to low- and intermediate-risk tumours intra-vesical immunotherapy, typically with BCG, is the first line treatment in most cases. BCG causes bladder mucosal inflammation which disrupts tumour growth, and stimulates numerous local immune pathways, most notably T-Cell activation, producing further anti-tumour effects. Level Ia evidence supports Induction and Maintenance BCG regimes, a strategy adopted by many countries worldwide. A typical regime includes an induction period of weekly intra-vesical instillations of BCG for 6+3 weeks, followed by check cystoscopy, then regular instillations of maintenance BCG for up to three years, although the optimal duration of maintenance BCG remains unclear.

81 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Objectives: 1. Assess compliance with EAU guidelines in the management of high-risk NMIBC with intravesical BCG. 2. Evaluate patient outcomes in our Tertiary Urology Cancer Centre. 3. Identify adverse patient outcomes associated with changes to management caused by the BCG crisis. Material & Methods: A retrospective cross-sectional analysis of all newly diagnosed high-risk NMIBC between November 2010 and November 2013 was performed. All patients who received BCG, without prior treatment of any urothelial malignancy, were included. Patients undergoing immediate cystectomy, patients declining, and patients unfit for treatment were excluded. The primary outcome measure was disease status at point of study. Results: Out of 88 new high-risk NMIBC diagnoses, 71 received intravesical BCG. 6/71 (8.5%) had not undergone first cystoscopy and thus disease state was unknown at time of study.5/71 (7%) had not completed induction, 4 due to side effects, and 1 changed to Mitomycin C (MMC) during National shortages. 11.3% Patients failed induction (disease recurrence or progression at first cystoscopy). 11.3% had disease recurrence, 14.1% had disease progression, and 54.9% were disease-free at time of analysis. Maintenance BCG patient outcomes were compared prior to and after BCG shortages. Of those affected by the shortage (n=27) 48.1% were disease-free and 51.9% had recurrence or progression. In the unaffected group (n=26) 76.9% were disease-free and 23.1% had recurrence or progression (p<0.05). Conclusions: Management of high-risk NMIBC in our Tertiary centre adheres 100% with EAU guidelines. Patient outcomes were affected by the BCG shortage; early withdrawal of maintenance BCG was significantly associated with increased disease recurrence and progression. Recommendations: 1. Continue adherence to EAU guidelines. 2. Increase duration of BCG maintenance therapy. 3. Re-audit 12 months from end point. P120 A multi-disciplinary approach to complex pelvic cancer N. Campain, N. Smart, I. Daniels, J.S. Mcgrath. Royal Devon and Exeter Hospital, Dept. of Urology, Exeter, United Kingdom Introduction & Objectives: With continuing centralisation of complex pelvic cancer and furthering of surgical expertise there is an increasing ability to remove multiple compartments within the pelvis. Coupled with improved staging of disease (for example with PET scanning) and better neo-adjuvant treatment, there are increasing numbers of patients with primary or locally recurrent pelvic cancer that are now candidates for surgical extirpation. We describe a series of patients undergoing multi-compartmental exenterative pelvic surgery. Material & Methods: Between 2006 and 2014, 47 patients underwent pelvic exenterative surgery in 2 or more pelvic compartments. A dedicated multi-disciplinary team was established comprising urological, colorectal, plastic, gynaecological and spinal surgeons as well as a specialist team of anaesthetists. Indications for surgery included primary and recurrent bladder cancer, prostate cancer, primary and recurrent rectal cancer, recurrent anal SCC, Marjolins ulcer and locally advanced cervical cancer. The majority of patients had received either pre-operative radiotherapy or neo-adjuvant chemotherapy. Techniques described include total pelvic exenteration, posterior pelvic exenteration, sacrectomy, coccygectomy, hemi-pelvectomy and pelvic floor reconstruction. The process of constructing a multidisciplinary clinical team, the choice of surgical techniques as well as the management of complications will be presented. Results: Mean age of patients was 64.9 years (range 39 86). The majority of patients (>75%) underwent total pelvic exenteration. Complications included 9 patients (19%) requiring at least one return to theatre (Clavien IIIb). 30 day and 90 day mortality was zero. Mean length of hospital stay was 20 days (median 15 days). 31 patients are still currently alive following surgery. 16 patients died during followup (mean survival following surgery was 469 days). Conclusions: Despite an increasing number of patients being eligible for complex exenterative surgery, there is both limited clinical experience and limited data available to guide the surgical management. We present outcomes from a large consecutive series and also describe the process to establish a multi-disciplinary complex pelvic cancer specialist team. We also describe a proposal for a national, cross-specialty prospective cancer registry. P121 Prognostic factors and survival differences between primary and progressive muscle-invasive bladder cancer L. Parra-Lopez, J.F. Villegas-Osorio, C.B. Congregado Ruiz, I. Osman-García, J.M. Conde Sánchez, R.A. Medina López. Virgen Del Rocío University Hospital, Dept. of Urology, Seville, Spain Introduction & Objectives: Muscle-invasive bladder cancer (MIBC) can be classified into two categories. Primary, for those which are muscle-invasive since the diagnosis. And Progressive, for those non muscle-invasive bladder cancers in its early that will become invasive during their follow-up. Only few studies have assessed the prognostic difference between them. Objectives: To determine differences in survival between the primary and progressive MIBC and to evaluate potential prognostic factors in muscle-invasive bladder tumors (MIBT). Material & Methods: We performed a retrospective study of patients who had undergone radical cystectomy (RC) for MIBC in our hospital from June 2010 to January We analyzed a total of 61 patients, 40 (65.57%) (Group A) with primary MIBC and 21 (34.42%) (Group B) with progressive MIBC. Mean follow-up time in months was 15.1 in A and 12.5 in B. The main variables studied were: age, sex, mean of TURs in group A, presence of carcinoma in situ in RC specimen, correct lymphadenectomy (>9 nodes) (LD), number of implants, metastatic progression, T/N stage, 1 and 3-year survival rate after surgery in A and B and overall survival rate by pn stage. Survival rate was investigated with Kaplan-Meier method and a multivariate analysis using the Cox regression method was performed to evaluate potential prognostic factors. Results: In Group B, mean time of progression to invasive cancer was 4 years, with an average of 3.23 TURs. 1 and 3-year survival rate after surgery was 86.9% and 70.2% in Group A and 75.7% and 32.4% in group B, respectively (p>0.05). Mean survival time estimated in months for primary MIBT was 25 (95% CI ) versus 30.4 in progressive (95% CI ) (p>0.05). (1)Analyzing pn stage, overall 1-year and 3-year survival rate were 90.7% and 64.3% for pn(+) tumors and 77.7% and 48.2% respectively for pn( ) (p<0.05). Positive nodes in RC specimens seems to be an independent factor that decreases survival in patients Figure 1. Kaplan-Meier curve: 1- and 3-year survival rate in primary and progressive muscle-invasive bladder cancer.

82 156 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) with MIBC with Hazard Ratio 2.39 (CI 95% ) p<0.05. Other parameters as a correct LD, number of implants, sex and age did not show statistically significant difference. No significant differences between the two groups for: age, sex, presence of carcinoma in situ, correct LD, positive nodes, number of implants and metastatic progression. Conclusions: Our study has shown that Progressive MIBC do not have a worse prognosis than Primary. Positive nodes in RC specimens seems to be an independent factor that decreases survival in patients with MIBC. In our series, parameters such as age, sex, correct LD, number of implants had not statistically significant differences regarding overall survival. P122 High visfatin expression predicts poor prognosis of upper tract urothelial carcinoma I-S. Lo, S-H Chen. Kaohsiung Medical University Hospital, Dept. of Urology, Kaohsiung, Taiwan Introduction & Objectives: Visfatin, a newly discovered adipocytokine, is a pro-inflammatory cytokine. This study aimed to evaluate the predictive value of visfatin on prognosis of patients with upper tract urothelial carcinoma. Material & Methods: One-hundred and five patients (median age = 64, range = years) were included in this study. Visfatin expression in upper tract urothelial carcinoma tissues was analyzed by immunohistochemistry. Visfatin expression was correlated with clinicopathologic variables using the χ 2 test. The prognostic value of visfatin for recurrence-free and cance-specific survival was evaluated by Kaplan-Meier estimates, and the significance of differences between curves was evaluated by the log-rank test. Cox regression model was also used to evaluate the hazard ratios of visfatin on survival. Results: High visfatin expression in upper tract urothelial carcinoma tissues was significantly correlated with tumor stage, grade and p53 expression. High visfatin expression was associated with poor recurrence-free and cancer-specific survival. Cox regression analysis also revealed that visfatin is an independent predictor of recurrencefree and cancer-specific survival. Conclusions: Our findings indicated that higher visfatin expression is a potential biomarker to predict patient survival. Further study is necessary to investigate the role of visfatin in the carcinogenesis of upper tract urothelial carcinoma. P123 Bladder tumour history, does it predict worse survival in upper tract transitional cell carcinoma? B. Akdoğan, B. Çıtamak, M. Altan, B. Özdemir, B. Haberal, H. Özen. Hacettepe University, Fac. of Medicine, Dept. of Urology, Ankara, Turkey Introduction & Objectives: To evaluate prognostic factors in upper tract transitional cell carcinoma (UUTTCC). Material & Methods: Since 1987, 127 patients (104 men, 23 women) with a mean age of 61.5±1.02 years have undergone nephroureterectomy and bladder cuff removal. Patient age, sex, anaemia, bladder tumour history, bladder recurrences, tumour stage, grade and location were evaluated as prognostic factors. Results: Mean follow up was 57.3±4.6 months. Overall 5-years survival was 60.6%. Univariate analysis revealed anaemia, positive blad- Table 1. Cox regression analysis for 5-years overall survival in UUTTCC Parameter Hazard ratio p Age, years ( ) Sex ( ) Bladder tumour history ( ) Stage ( ) Grade ( ) 0.09 Tumour localization ( ) der tumour history, T stage, grade and tumour location in the upper tract as significant prognostic factors (HR=). On multivariate analysis T stage, grade and bladder tumour history were significant variables for the 5-years overall survival (HR=1.903, and 2.04, respectively) (Table 1). Conclusions: Tumour stage and grade are well known prognostic factors as found in our study. Bladder tumour history is the most important prognostic parameter with highest HR in this series. Patients with bladder tumour should regularly and strictly followed-up for an upper tract recurrence which causes worse survival. P124 Cytoplasmic expression of iga1 protein is a factor of poor prognosis in urothelial bladder cancer B. Nodin, B. Jansson, E. Nilsson, C. Welinder, K. Jirstrom, A. Gaber. Facutly of Medicine, Dept. of Oncology and Pathology, Lund, Sweden Introduction & Objectives: Immunoglobulin A (IgA) has previously been found in various tumour tissue as well as in serum of epithelial cancer patients, and moreover IgA has been found to carry the Tn-antigen (GalNac α-ser/thr), which upregulated has been liked to poor prognosis. However to our knowledge, no study has previously investigated IgA expression and prognosis. In the present study, we examined the prognostic significance of IgA1 expression in a cohort comprising 110 cases of uroepithelial cancers. Material & Methods: Immunohistochemical expression of cytoplasmic IgA1 was evaluated in tissue microarrays with tumours from one retrospective cohort of uroepithelial cancer patients (n=110). Classification regression tree analysis was applied for selection of prognostic cutoff. Kaplan-Meier analysis, log rank test and Cox regression proportional hazards modeling were used to evaluate the impact of IgA1 overall survival (OS). Results: IgA1 expression could be evaluated in tumours from 99/110 cases. Cytoplasmic IgA1 expression correlated to more advanced T- stage (p<0.009), high grade tumours (p=0.008), male sex (p=0.003), loss of membranous expression of ezrin (p=0.030). Moreover, IgA1 expression was associated with an impaired OS (HR=1.99, 95% CI ), remaining sigificant in multivariable analysis, adjusted for age, grade, T-stage and ezrin expression (HR=2.04, 95% CI ). Conclusions: The results from this study demosntrate, for the first time, that IgA1 expression is differentially expressed in urothelial bladder cancer, and that high expression is associated with unfavourable clinicopathological characteristics and independently predicts an impaired survival. The utility of IgA1 as a prognostic biomarker in transurethral resection specimens merits further investigation. P125 Epidemiology of bladder cancer in Niamey: An analysis of the Niger cancer registry data S. Mamoudou Garba 1, H. Hami 2, H. Mahamadou Zaki 1, A. Soulaymani 2, H. Nouhou 1, A. Quyou 2. 1 Laboratory of Pathological Anatomy and Cytology, Faculty of Health Sciences, Dept. of Abdou Moumouni University, Niamey, Niger; 2 Laboratory of Genetics and Biometry, Faculty of Science, Dept. of Ibn Tofaïl University, Kenitra, Morocco Introduction & Objectives: Bladder cancer is the sixth most common malignancy of the urinary tract in men and the 11th most common cancer in women. It is also the 9th leading cause of cancer death in men and the 14th most common cause of cancer death in women in Western Africa, with about new cancer cases (1 741 men and women) and deaths from cancer in both sexes in 2012 (GLOBOCAN 2012). The aim of this study is to estimate the occurrence of bladder cancer in Niamey, in terms of incidence and describe its epidemiological characteristics.

83 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Material & Methods: This is a descriptive retrospective study of all patients treated for bladder cancer, reported between 1992 and 2009 to the Niger Cancer Registry, established in 1992, in the Faculty of Health Sciences at the Abdou Moumouni University in Niamey. Results: During this 18-year period, there were 131 cases diagnosed with bladder cancer in Niamey (1.8 new cases per people per year), accounting for 2.6% of all cancers reported during the study period. Nearly 63% of the cases were men with a male-female ratio of 1.7. The average age at diagnosis of bladder cancer was 51.9±14.9 years for all patients (range 2 85 years), 54.3±13.6 years for men and 47.9±16.2 years for women. Nearly three-quarters (73.3%) of people diagnosed with the disease were aged 45 years or older, with 52% of new cancer cases occurring among those aged years. Djerma- Sonrai was the most common ethnic group (66.4%). The most common histological type was urothelial carcinoma. Among the cases for whom the outcome was known, 20.6% died within the first year of diagnosis, accounting for 4.2% of all cancer deaths. Conclusions: Bladder cancer is the sixth leading cause of death from cancer in older adults (65 years and older) in Western Africa, accounting for 45.3% of all bladder cancer deaths. More research is needed to better understand the basic mechanisms that predispose elderly patients to develop this life-threatening disease. Renal cell carcinoma P126 Can we predict which patients with metastatic Renal Cell Carcinoma (mrcc) will develop Brain Metastases (BM)? L. Derosa, L. Albiges, Y. Loriot, C. Massard, K. Fizazi, B. Escudier. Institute Gustave Roussy, Dept. of Medical Oncology, Villejuif, France Introduction & Objectives: BM are commonly discovered in symptomatic patients (pts) because brain imaging is not routinely performed outside of clinical trials. The identification of differences between pts who develop BM vs those who do not, may allow to define a subgroup more at risk. Material & Methods: mrcc pts enrolled in clinical trials from 01/05 to 11/13 at Gustave Roussy with brain imaging either as part of the screening process or for the onset of symptoms were evaluated. We compared the clinical and pathological characteristics, including location and number of metastatic sites, as well as usual prognostic factors in pts who develop BM during the course of the disease (BM+) and those who did not (BM ). Results: 234 pts were included: median age was 56 years, 74% pts were male, 89% with clear-cell histology, 9% with sarcomatoid features, 67% with intermediate Heng risk group. N=44 pts (19%) developed BM either at diagnosis of mrcc (n=8) or during the follow-up with a median time of 20 months (range: months). There was no difference in prognostic groups between BM+ and BM. The median number of metastatic sites at the time of first line treatment was 3 vs 2(p<0.001). Incidence of lung and adrenal gland metastases at baseline was higher in BM+ group (84% and 67%) vs BM (67% and 13%) (p=0.02 and 0.04). Interestingly, PFS to first line as well as OS from the start of first line were not different between BM+ (9.5 and 23 months) and BM pts (9.3 and 31 months respectively). Conclusions: Classical prognostic factors as well as efficacy of firstline therapy do not seem to be different in pts who develop BM. The number of metastases and particular locations seems to be predisposing factors: pts with lung, adrenal gland metastases and at least three sites of metastases may deserve a brain imaging. Although this finding may have several biases, it warrants to be validated in larger cohorts of mrcc pts. P127 NBI assited flexible digital ureteroscopy a substantial improvement in upper urinary tract tumors detection B. Geavlete, D. Georgescu, R. Multescu, V. Mirciulescu, C. Moldoveanu, P. Geavlete. Saint John Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: Identifying characteristics suggestive for the malignant nature of an upper tract lesion and establishing the indication for biopsy may be challenging. The aim of the study was to determine the value of narrow band imaging (NBI) assisted digital flexible ureteroscopy in upper urinary tract pathology diagnosis. Material & Methods: Between January 2010 and September 2013, 84 white light and NBI assisted digital flexible ureteroscopic procedures were performed and divided in 2 groups. Group I (64 cases) included patients in which the procedures were performed for: upper urinary tract filling defects (26 cases), unilateral hematuria (24 cases) and abnormal urinary cytology (14 cases). Group II (20 procedures in 8 patients) comprised follow-up cases with conservatively treated upper urinary tract urothelial tumors. Results: Ureteral access sheath was used in 9.5% of the cases. Only 5.9% of the patients were pre-stented due to difficult ureteral access. In 2 cases, the large tip of the ureteroscope prevented the access to the thin caliceal infundibulum. In 97% of the cases in group I, flexible ureteroscopy identified upper urinary tract lesions: malignant tumors in 18 cases and benign lesions in 44 cases. Malignant lesions were identified by both white light and NBI in 10 cases. Only NBI detected tumors in 4 cases, while in 4 cases it identified supplementary lesions. In Group II, tumoral recurrence was found in 1 of the 8 cases of conservatively treated upper urinary tract tumors, visible both in white light and NBI (after a mean follow-up of 14 months, ranging between 6 and 36 months). Conclusions: Flexible digital ureteroscopy with NBI capability is a useful diagnostic method in upper urinary tract pathology, especially when imaging data are equivocal and malignant lesions are suspected. P128 Age does not matter; female sex is the most important predictor of benign pathology in renal masses smaller than 7 cm M. Altan, B. Akdoğan, B. Çıtamak, H. Özen. Hacettepe University, School of Medicine, Dept. of Urology, Ankara, Turkey Introduction & Objectives: To analyse which preoperative parameters can predict malign histology in non-metastatic renal masses smaller than 7 cm. Material & Methods: Data of 840 patients who underwent surgery for renal masses smaller than 7 cm between 1990 and 2014 was reviewed retrospectively. Univariate and multivariate analysis were done to predict malign histology. Preoperative parameters, age, sex, symptoms, type and time of surgery, solid/cystic appearance and size of tumour were used for statistical analysis. Results: The rate of renal cell carcinoma (RCC) and benign pathology (BP) were 83.4% and 16.6%, respectively. Mean age in RCC and BP were 55.4 and 53.4 years, respectively (p=0.001). Of the 698 RCC patients, clear cell, papillary and chromophobe RCC rates were 56%, 13.4%, 2.2%, respectively. Of the 142 BP, oncocytoma, angiomyolipoma and other BP rates were 39.4%, 28.9% and 31.7%, respectively. The rate of RCC in tumour sizes 0 1, 1.1 2, 2.1 3, 3.1 4, 4.1 5, and cm was 0%, 73.2%, 77%, 79.4%, 87.1%, 88.3% and 90.8%, respectively (p=0.001). RCC rates in 524 men and 316 women were 87.8% and 74.4% (p=0.001). RCC rates for the periods of , , and years were 75%, 81.3%, 83.4% and 86.2%, respectively (p=0.011), Table 1. Logistic regression analysis revealed that female sex, tumour size, type and year of surgery ( ) were the most significant parameters to predict RCC preoperatively (HR=2.621, 1.020, and 3.908, respectively), Table 2.

84 158 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Table 1. Clinical and pathological parameters Parameter BP RCC Total p Cohort, n (%) 142 (16.6) 698 (83.4) 840 Median age, years Sex, n (%) Men 64 (12.2) 460 (87.8) 524 Women 81 (25.6) 235 (74.4) 316 Presentation, n (%) Incidental 91 (19.4) 379 (80.6) 470 Symptomatic 47 (14.3) 282 (85.7) 329 Tumour size cm, n (%) 3 (100) 0 (0) cm, n (%) 19 (26.8) 52 (73.2) cm, n (%) 40 (23) 134 (77) cm, n (%) 34 (20.6) 131 (79.4) cm, n (%) 21 (12.9) 142 (87.1) cm, n (%) 17 (11.7) 128 (88.3) cm, n(%) 11 (9.2) 108 (90.8) 119 Year of Surgery, n (%) (25) 81 (75) (18.8) 130 (81.3) (16.6) 272 (83.4) (13.8) 212 (86.2) 246 Tumour characteristic, n (%) Solid 120 (17.9) 551 (82.1) 671 Cystic 25 (14.9) 143 (85.1) 168 Nephrectomy, n (%) RN 43 (10.2) 380 (89.8) 423 NSS 102 (24.5) 315 (75.5) 417 Table 2. Logistic regression analysis to predict malign histology Parameter HR (95% CI) p Age, years ( ) Sex, male vs. female ( ) <0.001 Tumour characteristic, cystic vs. solid ( ) Presentation, symptomatic vs. incidental ( ) Type of Surgery, RN vs. NSS ( ) Tumour size on CT (mm) ( ) Time of surgery, years ( ) ( ) ( ) Conclusions: Smaller tumours predicted BP and they underwent nephron-sparing procedures mostly in this series. Risk of RCC has increased over time. Female sex was the strongest predictor of benign pathology. P129 Primary endoscopic intramural ureter approach using bipolar plasma vaporization during nephroureterectomy a novel alteration of the pluck technique B. Geavlete, R. Multescu, D. Georgescu, C. Moldoveanu, P. Geavlete. Saint John Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: Nefroureterectomy with perimeatal cystectomy still represents the gold standard treatment of urothelial upper urinary tract carcinoma (UUTC). Ureteral endoscopic surgery was proposed as a complementary first step in nephroureterectomy in order to obviate the low abdominal incision. The value of a novel method of endoscopic distal ureteral management in one-step nephroureterectomy for UUTC was presently assessed: pluck technique using the bipolar plasma vaporization approach. Material & Methods: Nephroureterectomy with pluck transurethral detachment of the intramural ureter was performed using the bipolar plasma vaporization in 98 UUTC cases (pta in 32 cases, pt1 in 41 cases, pt2 in 13 cases and pt3 in 12 cases). The tumor was pyelocaliceal in 77 cases, ureteral in 18 cases and concomitantly ureteral and pyelocaliceal in 3 cases. The follow-up protocol included standard cystoscopy with the prelevation of urinary cytology, abdominal ultrasound, intravenous pyelography and contrast CT. The mean follow-up period was 32 months (range 8 to 44 months). Results: All procedures were successfully completed. The complication rate was 5.1%: 5 cases of hematuria, 4 imposing endoscopic hemostasis and 1 treated conservatively. During the follow-up period, 12.2% of the patients presented bladder recurrences, 3.1% had renal fossa tumors and 2% suffered secondary lymph-node invasion. The disease-specific mortality rate was 5.1%. Conclusions: The endoscopic approach of the terminal ureter using the bipolar plasma vaporization as part of one-step nephroureterectomy is a safe, technically feasible and surgically effective method benefitting from good oncological outcomes. P130 Clinicopathologic factors associated with the development of sunitinib induced hypertension (HTN) in patients (pts) with metastatic Renal Cell Carcinoma (mrcc) V. Neiman 1, M. Gottfried 2, H. Hammers 3, M. Eisenberger 3, M. Carducci 3, V. Sinibaldi 3, E. Rosenbaum 1, D. Sarid 4,E.Gez 4, A. Peer 5, A. Neumann 5, S. Kovel 6, A. Sella 6, W. Mermershtain 7, K. Rouvinov 7, R. Berger 8, D. Keizman 2. 1 Rabin Medical Center, Dept. of Oncology, Petah Tikva, Israel; 2 Meir Medical Center, Dept. of Oncology, Kfar Saba, Israel; 3 Johns Hopkins Hospital, Dept. of Sidney Kimmel Comprehensive Cancer Center, Baltimore, United States of America; 4 Tel Aviv Sourasky Medical Center, Dept. of Oncology, Tel Aviv, Israel; 5 Rambam Medical Center, Dept. of Oncology, Haifa, Israel; 6 Asaf Harofe Medical Center, Dept. of Oncology, Zerifin, Israel; 7 Soroka Medical Center, Dept. of Oncology, Beer Sheva, Israel; 8 Sheba Medical Center, Dept. of Oncology, Tel Hashomer, Israel Introduction & Objectives: The VEGFR inhibitor sunitinib is a standard treatment for metastatic renal cell carcinoma (mrcc). HTN, an on-target class effect of VEGF signaling-pathway inhibitors, has been shown to correlate with clinical outcome. Studies have shown the association between genetic polymorphisms in several genes and the development of HTN in patients treated with targeted therapies. We aimed to study the association between readily available clinicopathologic factors and the development of sunitinib induced HTN in mrcc patients. Material & Methods: Records from mrcc patients treated with sunitinib in 9 centers across 2 countries were retrospectively reviewed. Sunitinib induced HTN was defined as systolic blood pressure 140 mmhg and/or diastolic blood pressure 90 mmhg. Analysis of the association between clinicopathologic factors and the development of HTN was performed using logistic regression. Results: Between 2004 and 2013, 302 patients with mrcc were treated with sunitinib. The incidence of sunitinib induced HTN was 50% (n=152). Clinicopathologic factors included in the analysis were age (median 63), gender (67% male), HENG risk (good 22%, intermediate 59%, poor 19%), smoking status (active 21%), BMI (obese=bmi 30, 28%; overweight=bmi , 37%; normal weight = BMI <25, 35%), pre-treatment HTN (58%), past nephrectomy (83%), histology (73% clear cell), >1 metastatic site (82%), metastatic site (lung 72%, liver 25%, bones 40%), pre-treatment neutrophil to lymphocyte ratio (>3 in 45%), treatment line (first vs advanced), sunitinib dose reduction/treatment interruption (45%). Absence of liver metastases (OR 3.5, p=0.02), pre-treatment neutrophil to lymphocyte ratio 3 (OR 5.5, p=0.001), and BMI (overweight and normal weight vs obese, OR 2.2 and 2.3 respectively, p=0.01 both) were independently associated with the development of HTN. Conclusions: In metastatic renal cell carcinoma patients treated with sunitinib, readily available clinicopathologic factors may be used to identify patients who are prone to the development of HTN.

85 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P131 Percutaneous radiofrequency ablation of renal tumors in high surgical risk patients: Preliminary results I. Zachos, K. Dimitropoulos, A. Karatzas, A. Oikonomou, M. Melekos, V. Tzortzis. University Hospital of Larissa, Dept. of Urology, Larissa, Greece Introduction & Objectives: The aim of the current study was to estimate the safety and efficacy of percutaneous, guided by ultrasound or CT, radiofrequency ablation of small size, solitary renal tumors, in high surgical risk patients. Material & Methods: In total, 18 patients with 3 6 cm renal masses were subjected to a total of 33 percutaneous, ultrasound/ct guided radiofrequency ablation sessions. Prior to the procedure, a biopsy was performed to all patients and renal cell carcinoma was confirmed in all of them. Main indication for the procedure was the classification of patients into high risk group due to presence of severe comorbidities. Local and perirenal infiltration of anesthetic agent was used in the majority of sessions, while sedation was applied in 4 sessions. Follow up included physical evaluation, chest x-ray, CT scan and laboratory tests at 6 weeks and 6 months after the procedure, and then annually. Results: Mean duration of the procedure was 30 minutes and mean follow up duration was 12 months (min 3, max 24 months). One session was needed in 7 patients, 7 patients required 2 sessions, while 4 patients underwent 3 sessions. CT guidance was applied in 8 patients, while ultrasound guidance was selected in the remaining 10 ones. During the post-procedure follow up period, 17 patients had no residual contrast enhancement in the CT scans, while one patient was diagnosed with disease remission after the third session and underwent partial nephrectomy. No complications, such as infection or bleeding, occurred. Conclusions: Percutaneous, CT or ultrasound guided, radiofrequency ablation of solitary renal tumors is a safe and efficient method to treat high surgical risk patients. Further studies in this specific subgroup of patients, with longer follow-up are needed. P132 Effectiveness of nephron-sparing surgery in tumors more than 7cm I.V. Vitruk, O.E. Stakhovskyi, O.A. Voylenko, P.S. Vukalovych, E.O. Stakhovsky. National Cancer Institute, Dept. of Plastic and Reconstructive Onco-Urology, Kiev, Ukraine Introduction & Objectives: Resection of the kidney with tumors up to 4cm in diameter is recommended as standard of treatment and showed same oncological results as radical nephrectomy. Feasibility of partial nephrectomy for tumors more than 4cm remains controversial. The objective of the study was to evaluate the effectiveness of partial nephrectomy in tumors more than 7cm. Material & Methods: Retrospective analyzes of 56 patients with renal cell carcinoma treated with partial resection. Patients age ranging from 19 to 75 years (52.9±13.0). Male 36 (64.3%), female 30 (35.7%). Tumor size ranged from 70 to 208 mm (93.7±25.6). Total R.E.N.A.L. score from 6 to 12 points (9.5±1.8), and high-risk patients were 55.4%. Remaining functional parenchyma volume (RFPV) on the affected side ranged from 55 to 93% (68.0±9.7). The total GFR was 86.9±18.8, and on the affected side 40.0±11.7 ml/min. In 23 (41.1%) patients resection was performed with absolute indications, in 14 (25%) with cytoreductive purposes (metastatic disease). In all the patients, despite the large size of the tumor, the main indication for organ sparing surgery was the RFPV more than 55%. Results: In all cases, partial resection was performed with open approach: in 15 (26.8%) patients was performed with general ischemia, duration from 8 to 25 min (15.7±5.3). Blood loss ranged from 200 to 1500ml (483±365), 3 (5.4%) patients required blood transfusion. Restoring the integrity of the collecting system of the kidney by imposing double row suture was performed in 21 (37.5%) patients, intraoperative antegrade stenting of the kidney was performed in 3 (5.4%) cases. In 2 (3.6%) patients splenectomy was performed due to traumatic damage. Postoperatively 5 (8.9%) complications were recorded: 3 (5.4%) cases of urinary fistula diagnosed in early postoperative period and in 2 (3.6%) pyelonephritis with hyperthermia lasting more than 5 days. Fistulas were successfully managed with stent insertion. The follow up period ranged from 3 to 50 months (21.8±4.5). During this period 4 (7.1%) patients died with metastatic carcinoma from the progression of the underlying disease, respectively in 3, 6, 16 and 31 months. Local recurrence was diagnosed in three (5.4%) patients, respectively in 12, 13 and 27 months after resection, which was the indication for fulfillment of nephrectomy. Comparing preoperative rates of the total GFR with rates at 3 months and at one year after surgery, showed no statistically significant decrease (after 3 months decreased by 10.8% to 77.5±19.0 ml/min., in one year by 16.3% to 72.7±30.2) (p>0.05). However, when comparing the GFR on the affected side, statistically significance was received in reduction of function in both: at 3 months and at 1 year after the operation by 37% to 25.2±8.1 ml/min, and by 36% to the level of 25.6±13.4 ml/min (p<0.05), which was associated with a high postoperative kidney injury, but its function was preserved. Conclusions: Resection of the kidney in tumor more than 7cm can be done in the RFPV on the affected side more than 55% and localization of the formation in the kidney pole or laterally, which will help to retain its function in the postoperative period with low rates of intra- (8.6%) and postoperative (11.4%) complications and local recurrence (5.7%). P133 Long term outcomes in the management of small renal masses 4cm M. Iskander, C. Lynch. Royal Liverpool & Broad Green University Hospitals, Dept. of Urology, Liverpool, United Kingdom Introduction & Objectives: Small renal tumours 4cm are amenable to a partial (PN) or radical nephrectomy (RP), surveillance (AS) and radiofrequency ablation (RFA). We reviewed the long term outcomes of patients who underwent any of these treatments for small renal masses, with a view to identifying any potential superior survival in any group. Material & Methods: We performed a retrospective cohort analysis from 2006 to 2012 of patients discussed at the specialist multidisciplinary team meeting. Here we present the findings of patients with tumours 4cm who underwent PN (n=45), RN (n=35), AS (n=68) or RFA (n=28), with an intention-to-treat analysis. Mean tumour size was 2.91cm (0.4 4), and mean age (20 85). The primary outcome measure was overall survival. Mean Follow up was for months (2-102). Results: In the AS group, five had RN due to progression, four patients had five PN and six patients had seven RFA treatments. Two patients in the RFA group required repeated treatments. Three patients in the RN had metastases during follow up, with no metastases noted in the PN group. Mean age for patients managed with PN was 56.49, for RN 63.6, for RFA and for AS was Mean survival with AS was months (CI ), with RFA85.25 months (CI ), with PN (CI ) and with RN (CI ). PN offered a survival advantaged compared to other means of managing T1a RCC, although it did not reach statistical significance. Conclusions: AS may safely be adopted for managingrenal tumours 4cm, with PN reserved for patients with intervention for tumours that appear to be progressing. Younger patients are more likely to be treated with PN. RN can be used in managing these tumours when not amenable to PN, but may be associated with a long term detrimental effect on overall survival.

86 160 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P134 Treatment with antiangiogenics of advanced renal cancer: Are there differences between urologist and medical oncologist? C.B. Congregado Ruiz, J. Conde Sánchez, I. Osman-García, C. Corchuelo Maillo, R. Medina López. Universitary Hospital Virgen Del Rocio, Dept. of Urology, Sevilla, Spain Introduction & Objectives: The emergence of new molecules for the treatment of advanced kidney cancer of oral administration with manageable side effects profile has allowed urologists to be involved in the treatment of these tumors at all stages of the disease. This in some cases has been discussed. The objective of this study is to test whether there are differences in the management of patients with advanced kidney cancer treated with antiangiogenics, depending on the doctor who treat is a urologist or a medical oncologist. Material & Methods: Comparative study of two consecutive series of 12 and 11 patients with advanced kidney cancer treated with antiangiogenic, by medical oncologist (OM) and urologist (U), respectively. With a follow-up of 90 (56 123) in OM and 51 weeks (39 64) in U, the following variables were analyzed: Age, sex, ECOG, comorbidity (measured by the Charlson index), prior nephrectomy, type of pathological anatomy, risk group (MSKKC), drug used in first and second line, starting dose and maintenance, reduction or elimination of treatment toxicity, if it has specified interconsultation to another specialty or go to the emergency, toxicity dying due to toxicity, type of side effects, tumor progression and survival. Statistical analysis using SPSS Results: There were no statistical differences when comparing the two groups in any of the variables analyzed. Table 1 URO ONCO Statistical significance (p<0.05) Age 60 (53 68) 63.3 (56 69) p=0.5 Sex Male 10 9 p=0.5 Female 1 3 Comorbidity (Charlson) p=0.5 ECOG p=0.6 I 2 6 II 1 1 III 0 0 Nephrectomy 9 10 p=0.6 Pathology Clear cell 10 9 p=0.5 Not clear cell 1 3 Risk group (MSKKC) Low 4 6 p=0.4 Intermediate 7 5 High 0 1 Drug first line Sunitinib 8 6 p=0.4 Pazopanib 3 6 Second line Sunitinib 0 1 p=0.3 Pazopanib 1 0 Axitinib 2 2 Home full dose 10 8 p=0.3 Maintenance dose 3 4 p=1 Toxicity reduction 6 7 p=0.5 Toxicity suppression 3 4 p=0.9 Interconsultation toxicity 0 3 p=0.2 Urgent toxicity 0 3 p=0.2 Exitus toxicity 0 0 p=0.6 Although not the main objective of the study, have analyzed the progression and cancer-specific mortality, aiming four progressions in the OM group and 5 in the U group (p=0.6) and 1 exitus tumor in each group (p=0.9). The most frequent complications were: asthenia, anorexia, hand-foot Sdr, rush, nausea, vomiting, diarrhea, stomatitis, hypertension, anemia, hypothyroidism, hyperbilirubinemia and hypertransaminasemia. Does not exist difference in frequency of occurrence or the degree between the two groups. Conclusions: Our results support the hypothesis that a patient with advanced renal cancer treated with antiangiogenic drugs may similarly result whether your doctor is a urologist or medical oncologist. P135 The effect of sunitinib-induced hypothyroidism in the outcome of mrcc patients B. Gonçalves, L. Pinto, J. Paulo, G. Sousa, P. Madeira, M. Mariano, M. Teixeira, H. Gervásio. Portuguese Institute of Oncology Coimbra, Dept. of Medical Oncology, Coimbra, Portugal Introduction & Objectives: Sunitinib, a multitarget tyrosine-kinase inhibitor, has become a standard of care for first-line low and intermediate risk metastatic renal cell carcinoma (mrcc). The association between sunitinib and hypothyroidism was originally recognized in 2005, and since then, several other observational studies documented this association, with an incidence that ranged between 53% and 85%. Although sunitinib-induced hypothyroidism is an unwanted side effect of TKI therapy, data suggests that it may have an important prognostic value on survival. The purpose of this study is to evaluate the incidence of sunitinib-induced hypothyroidism in mrcc and its correlation with survival. Material & Methods: Retrospective analysis of consecutive records of 30 patients with clear cell mrcc, treated between January 2008 and December Sunitinib was prescribed at a dose of 50mg daily (on a 4 weeks on/2 weeks off schedule). Thyroid function was assessed prior to therapy and every 6 weeks during the treatment. Hypothyroidism was considered present if thyroid-stimulating hormone (TSH) exceeded the upper normal limit (UNL) with normal triiodothyronine (T3) and thyroxine (T4). Only patients with normal baseline TSH were included. Patients were divided in two groups according to the development of hypothyroidism in the first 6 months of treatment. Statistical analysis was performed using SPSS v20. Results: The median age was 61 years [33 79], with 74% males. Hypothyroidism occurred in 16 patients (59.3%), median of 3.6 months (range ) of treatment initiation. Thyroid replacement corrected TSH below the UNL in 13 patients (81%). At the mark of 6 months 12 patients (44.4%) had developed hypothyroidism. Median Progression Free Survival (PFS) under sunitinib treatment was 10.5 months for the entire cohort and Overall survival (OS) was 21.6 months. The hypothyroid patients tended to have longer PFS (10.5 vs. 9.7 months; p=0.247) and longer OS (median 29.9 vs months; p=0.5623) than the euthyroid patients. Conclusions: In this study we confirm the high incidence of sunitinib-induced hypothyroidism in mrcc. Patients treated with sunitinib for mrcc that developed hypothyroidism trend toward higher survival. P136 Complete remission of methastasic renal carcinoma in patients treated with tirosin kinase inhibitors. A multi institutional based study J.B. García Ramos 1, C.B. Congregado Ruiz 2, P. Beardo Villar 3, M. Soto Delgado 3, I. Osman 2, C. Baena Villamarín 2, M. Conde 2, F. Gutierrez Tejero 4, J. Moreno Jiménez 4, A. Juárez Soto 3, R.A. Medina López 2. 1 Ugc Urología Huelva, Dept. of Urology, Huelva, Spain; 2 Ugc Virgen Del Rocío, Dept. of Urology, Sevilla, Spain; 3 Ugc Hospital SAS Jerez, Dept. of Urology, Jerez, Spain; 4 Ugc Complejo Hospital Jaén, Dept. of Urology, Jaén, Spain Introduction & Objectives: Although treatment with antiangiogenic targeted agents has improved progression-free and overall survival in patients with metastatic renal cancer, complete remmisions (CR) are rare events. CR rates to treatment with TKI are below 2% and rise up to to 4.5% when combined with surgical treatment. The aim of this study is to describe the clinicopathologic features in a serie of patients with methastasic renal cell carcinoma (mrcc) in Complete Remission (CR) treated with Tirosin Kinase inhibitors (TKI). Material & Methods: Retrospective study conducted in 4 centers, which includes the variables related to treatment and clinicopathologic a series of mrcc with RC characteristics to treatment with TKIs.

87 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Results: Between July 2008 and December patients are treated with TKI at first line. The average age is 63.3±2.6 years. 92% patients have Karnofsky performance status (PS) >80%, and clear cell carcinoma. 58.3% are in favorable risk by model of Heng et al1. We observed 13 CR to the targeted therapy with TKI in 12 patients (17%), One patient has CR in the first and in the second line of treatment and other, only in second line of treatment, even not in first. 77% (10 RC) are with first line sunitinib, 8% (1 RC) with first line pazopanib and 15% (2 RC) with second line axitinib. All patients had previous nephrectomy although 2 of them began the treatment with TKI before the Surgery. 67% of patients have only one location metastasic and the most frecuent location was lung (75%). The median time to onset of CR after TKI is 4.1±0.8 months and the duration of CR of 17.8±5.3 months. 92% patients are alive and still present RC with a follow-up of 24.8±5.6 months since the first line TKI treatment beginning (1 patient not related death mrcc). One patient has to give up the treatment because grade three adverse effect but still maintains CR after 12 months without treatment. One half patients have to reduce TKI dosage. Conclusions: In our serie of patients with mrcc with CR to TKIs, all patients were nephrectomized and most of them are good Performance Status and single site methastasis. As described in other studies the RC occurs both in patients treated with TKI alone or in combination with local treatment; in all prognostic groups and in different metastatic sites. Treatment discontinuation or dose reduction of TKI seems a reasonable option in this patients. P137 The UK experience of stereotactic body radiotherapy (SBRT) in the management of oligometastatic renal cancer I.S. Bhattacharya, R. Hughes, M. Harrison, N. Shah, P. Ostler. Mount Vernon Cancer Centre, Dept. of Oncology, London, United Kingdom Introduction & Objectives: Oligometastatic (OM) renal cancer is defined as three or fewer sites of isolated metastatic disease. SBRT of OM disease has shown promising local control rates (80%) with minimal toxicity and may affect overall survival (OS) in between 20 and 40% of patients [1]. SBRT may potentially delay the initiation of systemic therapies including tyrosine kinase inhibitors (TKI) which are given long term with potentially toxic side effects. The aim of this study is to identify local control and OS of patients receiving SBRT for OM renal cancer. Material & Methods: Data was collected for patients receiving SBRT between September 2012-March 2014 including demographic details, SBRT date, date of local/distant progression, toxicity and date of death. Results: 7 patients received SBRT for OM renal cancer. Median age was 62 (45 66) years at time of SBRT. SBRT sites included brain (2), bone (3), para-aortic node (1) and diaphragmatic crus node (1). Median follow-up was 15.6 ( ) months. To date local control is 100%. 3 patients have no evidence of disease. For the 4 patients that developed distant disease progression, the median time from SBRT to distant disease progression was 7.1 ( ) months. 1 patient died from distant progression at 4.5 months following SBRT. There was no grade 3 or 4 toxicity. 3 patients have not been initiated on systemic therapy. 1 patient has remained on the same TKI and 3 patients have had a change in TKI. Conclusions: Our series confirms excellent local control with SBRT. SBRT may alter the outcome for patients with OM renal cancer and delay initiation of systemic therapies including TKIs which are continued long term with potentially significant toxicities. Randomised control data is required to support SBRT in OM in renal cancer and the CORE trial is currently in discussion. Reference [1] Tree AC, Khoo VS, Eeles RA et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol Jan;14(1):e P138 Prior high dose IL-2 therapy (HDIL2) may improve the outcome of sunitinib (Su) treatment (tx) in patients (pts) with metastatic renal cell carcinoma (mrcc) E. Rosenbaum 1, M. Gottfried 2, H. Hammers 3, M. Eisenberger 3, M. Carducci 3, V. Sinibaldi 3, V. Neiman 1, D. Sarid 4,E.Gez 4, H. Hayat 5, A. Peer 6, A. Sella 7, W. Mermershtain 8, K. Rouvinov 8, R. Berger 9, D. Keizman 2. 1 Rabin Medical Center, Dept. of Oncology, Petah Tikva, Israel; 2 Meir Medical Center, Dept. of Oncology, Kfar-Saba, Israel; 3 Johns Hopkins, Sidney Kimmel Comprehensive Cancer Center, Baltimore, United States of America; 4 Tel Aviv Medical Center, Dept. of Oncology, Tel Aviv, Israel; 5 Wolfson Medical Center, Dept. of Oncology, Holon, Israel; 6 Rambam Medical Center, Dept. of Oncology, Haifa, Israel; 7 Asaf Harofe Medical Center, Dept. of Oncology, Zerifin, Israel; 8 Soroka Medical Center, Dept. of Oncology, Beer Sheva, Israel; 9 Sheba Medical Center, Dept. of Oncology, Tel Hashomer, Israel Introduction & Objectives: Targeted txs are the tx of choice in most mrcc pts. However, HDIL2 which may produce durable responses in a small percentage of cases, is still an option in carefully selected pts. While the effect of prior HDIL2 on the outcome of targeted txs in mrcc pts is poorly defined, a recent single center report (Birkhäuser FD, Cancer J 2013) revealed an improved disease-specific survival in pts treated with prior HDIL2. We aimed to study the effect of prior HDIL2 tx on outcome of mrcc pts treated with sunitinib. Material & Methods: Records from 302 mrcc pts treated with Su from 2004 to 2013 in 9 centers across 2 countries were retrospectively reviewed. We compared the responserate, progression free survival (PFS), and overall survival (OS), between post HDIL2 pts (n=27) and individually matched tx naïve pts (n=27). Progression free survival and overall survival were determined by Cox regression. Results: All pts had prior nephrectomy and clear cell histology. The groups were matched by age (median 61), gender (male 74%), Heng risk (favorable 37%, intermediate 59%, poor 4%), sunitinib induced hypertension (67%), sunitinib dose reduction/treatment interruption (41%), smoking status (active 7%), use of angiotensin system inhibitors (41%), the presence of more than one metastases site (96%), and pre-tx neutrophil to lymphocyte ratio (>3 in 22%). Furthermore, they were balanced regarding the presence of lung (68%), liver (31%), and bone (43%) metastases, and the use of bisphosphonates (32%). In prior HDIL2 versus tx naïve pts, objective response was partial response/stable disease 89% (n=24) versus 74% (n=20), and progressive disease at first imaging evaluation within the first 3 months (mos) 11% (n=3) versus 26% (n=7) (p=0.29, OR 2.4). Median progression free survival was 21 versus 12 mos (HR 2.3, p=0.005), and median overall survival 25 versus 20 mos (HR 2.2, p=0.013). Conclusions: In metastatic renal cell carcinoma patients treated with sunitinib, prior high dose IL-2 therapy may improve the outcome. P139 Renal artery embolisation before laparoscopic radical nephrectomy for large renal tumours Y.L. Goh, P. Kumar, K. Jaganathan, M. Mokete, S.S. Matanhelia. Royal Preston Hospital, Dept. of Urology, Preston, United Kingdom Introduction & Objectives: The last two decades has seen the uptake and establishment of laparosocpic nephrectomy as the standard treatment for renal tumours with open surgery performed for larger tumours. Interventional radiology with pre-operative renal artery embolisation allows increasing number of large renal cell tumours to be dealt laparoscopically. Pre-operative embolisation allows us to clamp the renal vein prior to renal artery in transperitoneal approach. We present our experience of pre-operative embolisation before laparoscopic nephrectomy for large renal tumours and tumours with renal vein thrombus. Material & Methods: This is a retrospective review of 8 cases of laparoscopic radical nephrectomy performed following renal artery

88 162 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) embolisation at a tertiary referral centre from January 2012 to May Data related to time from embolisation to surgery, duration of surgery, local staging, blood loss, pre- and post-operative blood parameters (haemoglobin, creatinine and egfr), analgesic requirements, length of hospital stay and morbidity were collected and analysed. Results: Eight patients, four females and four males were identified over the 2.5 year period. Median age at surgery was 63 years old (range 50 89). Four patients had embolisation one day preoperatively and four had embolisation on the same day of surgery. All patients had their procedure completed laparoscopically. Median operative time was 2.36 hours (range ). 4 were right-sided tumours and 4 were left-sided. Median blood loss was 325ml (range ). Median size of tumour was 9.5cm (range ). Histologically, 4 cases were T3a or b, 3 cases were T2a or b and one case was T4. Median haemoglobin and egfr reduction post-operatively was 14.8% (range 32.9 to 26.3) and 23.6% (range 13.5 to 54.7) respectively. The median increase in creatinine levels was 21.1% (range 10.8 to 48.8). Analgesic requirements were less in the patients who had embolisation on the day of laparoscopic nephrectomy. There were two minor complications, one patient had paralytic ileus and the other required more analgesia. The median length of hospital stay was 4 days (range 1 9). The median follow-up is 10.5 months (range 2 30). There was one case of systemic recurrence having systemic therapy but there were no cases of local recurrence. Conclusions: Laparoscopic nephrectomy for large renal tumours are surgically challenging mainly due to its increase vascularity. In our study, pre-operative embolisation of large renal tumours makes the laparoscopic approach feasible, reduces the morbidity and the analgesic requirements were less if embolisation is done on the same day of surgery. P140 The influence of clinicopathological factors on treatment response after use of interferon or sunitynib in mrcc patients J. Huszno, E. Nowara. Maria Skłodowska Curie Memorial Cancer Centere and Institute of Oncology, Gliwice Branch, Dept. of Clinical and Experimental Oncology, Gliwice, Poland Introduction & Objectives: During the last decade the treatment of metastatic renal cell carcinoma (mrcc) patients evolved from best supportive care though cytokine based therapy to the use of targeted agents such as sunitynib, sorafenib, everolimus, temsyrolimus or pazopanib. Aim of the study was to identify the clinicopathological factors influenced the efficacy and safety of interferon and sunitynib in first line therapy in mrcc patients. Material & Methods: The analysis included 82 mrcc patients treated between 2006 and patients received sunitynib at oral dose of 50 mg given once a day for 4 weeks, followed by 2 weeks without treatment and 42 patients got interferon alfa at dose of 9 mln j given subcutaneously three times a week. The tumor response were evaluated on the basis of clinical data. We analyzed the influence of factors such as: age, sex, comorbid conditions (hypertension, diabetes), overweight, location of metastases, complications on treatment response. Results: Median age was 60.5 years (range 38 to 76) and 59.5 years (range 47 to 77) for sunitynib and interferon group, respectively. In group treated with sunitynib partial regression (PR) was detected in 8% patients, disease stagnation (SD) and progression (PD) in 55% and 38%, respectively. We do not observed complete response. PR was detected more frequently in women compared to men (21% vs. 0), p=0.03. Patients with a weight loss as the first symptom had more frequently SD than patients with stable weight (75% vs. 46%), p=0.09. Treatment toxicity of sunitynib were observed in 16 (40%) patients. Side effects did not influence treatment response. In group treated with interferon PR was detected in 5% patients, SD and PD in 33% and 62%, respectively. PD was detected more frequently in patients with comorbid conditions than in patients without diseases (89% vs. 52%), p=0.04. Treatment side effects were observed in 80% patients. Treatment response (SD + PR + CR) was associated with flu-like symptoms (fever, muscle and bone pain) compared to patients without symptoms (80% vs. 35%), p=0.07. Patients with liver metastases had also better response than patients with other metastases (78% vs. 30%), p=0.01. Patient s age did not influence disease treatment in both groups. Conclusions: Sunitynib treatment was associated with higher response rate and a better safety profile. Patients received interferonalpha experienced more frequently overall toxicity, p= Factors of treatment response for sunitynib were: female gender, a weight loss as the first symptom and for interferon: comorbid conditions, flu-like symptoms during therapy and liver metastases. P141 Simplified laparoscopic partial nephrectomy: Double layer technique S. Dimitriadi 1,O.Kit 2, V. Medvedev 3. 1 Rostov Cancer Research Institute, Dept. of Urology, Rostov-Na-Donu, Russia; 2 Rostov Cancer Research Institute, Dept. of Administration, Rostov-Na-Donu, Russia; 3 Kuban State Medical University, Dept. of Urology, Krasnodar, Russia Introduction & Objectives: In laparoscopic partial nephrectomy (LPN) the reconstruction stage takes the longest part of warm ischemia time (WIT) and thus influences renal function after LPN. Material & Methods: 62 LPN have been performed for 2 years. The tumors abutting pelvicaliceal system (PCS) or renal sinus were considered central. In 22 patients (35.5%) with central tumors PCS of the kidney was opened. These patients underwent double layer technique (DLT) during LPN and formed the first group. The second group consisted of 40 (64.5%) patients with peripheral tumors, and their PCS was not opened during LPN. Mean age in the first and second groups was 62.3±11.8 years (range 38 77) and 55.7±13.5 years (range 33 74), mean tumor size 35.3±6.8 mm (range 25 58) and 33.5±7.2 mm (range 23 58), mean RENAL nephrometry sum 7.1±1.5 (range 5 10) and 6.7±1.2 (range 4 8) respectively. The DLT was during the reconstruction stage of LPN in central tumors. It involves the following steps: transperitoneal approach, atraumatic hilar clamping (en bloc or artery only) and tumor excision by cold endoshears. The reconstructive stage excludes separate PCS suture repair. The renal wound is sutured using sliding clip technique in two steps. Firstly, the deep parenchymal running suture through fibrous capsule of the kidney is applied. Wherein every stitch of the running suture is performed by two needle punctures of the every edge of the renal wound without gripping opened PCS edges. On completing the deep parenchymal suture through the whole wound of the kidney the hilar clamp is removed, the blood supply of the kidney is restored and WIT is measured. Secondly, the superficial parenchymal running suture through fibrous capsule of the kidney is applied. Results: Mean operative time in the first and second groups was 236.4±168.5 (range ) and 128.8±50.4 (range ), mean WIT 13.6±2.3 min (range 9 18) and 12.3±3.1 (range 6 16) (p=0.09), mean blood loss 257.5±237.9 ml (range ) and 124±132.7 ml (range ) respectively. Intraoperative hemorrhage occurred in 2 patients of the first group. Delayed hemorrhage, urine leak, renal failure did not occur. All patients confirmed RCC with negative surgical margins. Mean follow up was 14.3±5.4 month (range 3 24). No local recurrence and no progression were diagnosed in the both groups. Conclusions: LPN can be safely performed for central tumors with comparable WIT of the same procedure for peripheral tumors. The use of simplified DLT during reconstruction stage of LPN for tumor defect closure may assist to reduce WIT without increasing the risk of complications.

89 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) P142 Long-term results of laparoscopic partial nephrectomy with radiofrequency ablation A. Kalpinskiy, B. Alekseev, A. Andrianov, K. Nyushko, N. Vorobyev, M. Golovaschenko, V. Polyakov, A. Kaprin. P.A. Herzen Moscow Oncological Research Institute, Dept. of Oncourology, Moscow, Russia Introduction & Objectives: Laparoscopic partial nephrectomy (LPN) has shown to be technically feasible and oncologically safe with better functional results. The aim of the study was to assess long-term functional and oncologic results of a new technique of LPN with radiofrequency ablation (RFA). Material & Methods: 179 patients with small renal masses after 180 LPN were included in the study. Standard LPN was performed in 87 (48.3%) and LPN + RFA in 93 (51.7%) cases. Mean age was 54.6±11.4 (27 75) and 55.3±11.7 (16 79) (p=0.8), in the groups of standard LPN and LPN + RFA, respectively. Mean tumor size was 33.4±11.6mm ( mm) in the standard LPN group and 27.9±10.5 mm ( mm) in LPN + RFA group (p=0.0003). Mean preoperative egfr was 76.5±19.3 ml/min ( ml/min) in standard LPN group and 78.1±19.8 ml/min ( ml/min) in LRP + RFA group (p=0.4). Monopolar Cool-tip RF system (Covidien) with one-needle probe was used for RFA. Neither cold nor warm renal ischemia was performed in LRP + RFA group. Results: Median follow up time was 30 (4 129) months and 49 (4 90) months in the groups of standard LPN and LPN + RFA, respectively (p=0.02). Median blood loss and mean operating time in LPN + RFA group were 100 ml ( ml) and 116.9±31.1 min ( min) and in standard LPN group 200 ml (50 40 ml) and 130.3±43.1 min ( min), respectively (p<0.05). Long-term functional outcomes were evaluated regarding changes in egfr. Mean egfr decrease after 3 months after surgery was comparable and normalization of renal function was observed in both groups. In standard LPN group mean reduction of egfr was %, in LPN + RFA group % (p=0.9). 5-year recurrent-free survival in standard LPN group was %, in LPN + RFA group % (p=0.11); cancerspecific and overall survival in standard LPN group was % and %, in LPN + RFA group % and % (p=0.63), respectively. Conclusions: LPN with RFA is a feasible and effective treatment option for small renal masses, which eliminates the need renal ischemia. Performed in selected patients it shows good long-term results, comparable to standard LPN. P143 Non-clamping partial nephrectomy by hydrodissection V. Zambon 1, M. De Bruin 2, F. Delaere 3, K. Aben 4, M. Gerritsen 5. 1 Orbis Medical Centre, Dept. of Urology, Sittard-Geleen, The Netherlands; 2 Laurentius Hospital, Dept. of Urology, Roermond, The Netherlands; 3 Orbis Medical Centre, Dept. of Urology, Sittard-Geleen, The Netherlands; 4 Comprehensive Cancer Centre, Dept. of Cancer Registry and Research, Utrecht, The Netherlands; 5 Erbe Nederland BV, Dept. of Research and Development, Werkendam, The Netherlands Introduction & Objectives: Open partial nephrectomy is currently the standard of care in treating small renal tumors. An absolute or relative indication for partial nephrectomy for larger tumors exists in patients with an anatomical or functional mono-kidney or impaired function of the contralateral kidney. Hydrodissection is a technique, which offers the possibility to operate in vulnerable, parenchymatous tissues using a fine but firm waterjet. Modulating the force of the waterjet provides tissue selectivity, which enables cutting tissue while vessels and other structures are spared. In this study this operative technique was used in partial nephrectomies. Material & Methods: In this study 41 patients underwent 42 partial nephrectomies by hydrodissection through a small lumbar incision. We used the Erbejet 2 (Erbe GmbH, Germany), which combines the functions of hydrodissection, coagulation and suction in one applicator, allowing simultaneous hydrodissection and coagulation. In this technique clamping of the renal pedicle is not necessary thus avoiding renal ischaemia. After resection of the tumor the wound surface is treated by soft coagulation in combination with a surgical patch for haemostasis and tissue sealing. Results: In a group of 41 patients (20 males, 22 females) 42 partial nephrectomies were performed. In 30 patients a renal cell carcinoma was found; 12 cases revealed a benign condition. Median operating time was 90 minutes; median blood loss was 200 ml. In the renal cancer group no recurrence was seen during a median follow-up of 28 months. The kidney function was stable in 39 cases and showed a slight reduction in two patients with a mono-kidney. The median reduction of MDRD clearance after surgery was just 2.2 ml/min. Histological assessment of the resection margins turned out to be difficult in half of the cases. Conclusions: Partial nephrectomy by hydrodissection offers the advantages of minimal blood loss, optimal intra-operative sight and a relatively short operation time by tissue selective preparation. Clamping of renal hilar vessels is avoided, which minimizes the risk of post-operative renal function reduction.histological assessment of the tissue margins may be difficult, probably related to the precise dissection technique, which is specific for the waterjet dissection. We advise regular post-operative radiologic controls. P144 Visceral adipose tissue and pathological subtypes of renal cell carcinoma or oncocytoma D. Garcia-Rojo 1, M. Capdevila 1, D. Preciado 2, J. Gual 1, J. Muñoz 1, R. Martos 1, A. Prera 1, C. Abad 1, Y. Fadil 1, E. Vicente 1, J.L. Gonzalez-Sala 1, L. De Bardonces 1, N. Hannaoui 1, A. Malet-Munte 2, J. Prats 1. 1 Corporacio Parc Tauli, Dept. of Urology, Sabadell; 2 Corporacio Parc Tauli, Dept. of Radiology, Sabadell, Spain Introduction & Objectives: There is increasing evidence that the risk of Renal Cell carcinoma (RCC) is greater in obese patients. The accumulation of adipose tissue causes secondary changes related to insulin signaling and lipid deregulation that may foster cancer development. Body adipose tissue is distributed into two main compartments with different structural and functional characteristic: visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). VAT is more biologically active in altering lipid metabolism, modulating numerous adipokines and contributing to chronic inflammation. Our objective is to find a relationship between SAT and VAT with clinical and pathological characteristics of RCC and oncocytoma. Material & Methods: Retrospective study of 94 RCC or oncocytoma treated in our institution from January 2005 to December 2009 with a minimum follow-up of 47 months or until the death. A single-slice computed tomography images were used to measure the area in cm 2 of VAT and SAT at the level of the umbilicus. We investigated a relationship between SAT and VAT with the patient s gender, tumor size, 2010 TNM stage, nuclear grade, lymph node invasion, metastatic extension, and cause-specific and overall survival rates. The association between predictors and tumor characteristics were assessed using logistic regression analyses and T Student s test. Results: Mean VAT ( ) cm 2. Mean SAT ( ) cm 2. The VAT was higher in male patients (p=0.003) and SAT was superior in female participants (p=0.000), but did not correlate with tumor size, nuclear grade, TNM stage, lymph node invasion or metastatic extension. In patients with clinical T1a renal tumors we were observed similar results. In univariate analyses the increased VAT were significantly associated with clear cell carcinoma (130.71±58.02 cm 2 ) compared to chromophobe carcinoma (90.9±40.61 cm 2 ) (p=0.042). No correlation exists between the SAT and the different pathological subtypes. With a mean follow-up of 55.2 months (1 115) we did not observe a correlation of VAT and SAT with cancer-specific survival nor overall survival.

90 164 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Conclusions: In contrast to previously published studies we have not observed correlation between VAT or SAT and nuclear grade, TNM stage or cause-specific survival in RCC. An increased VAT was found to be strongly associated with clear cell RCC compared with chromophobe RCC. These results have not been previously described. Further studies are needed to confirm these findings and discover the underlying biological mechanism. P145 Long term outcomes in the management of renal cancers M. Iskander, C. Lynch. Royal Liverpool & Broad Green University Hospitals, Dept. of Urology, Liverpool, United Kingdom Introduction & Objectives: Renal tumours in this cancer network can be managed by radical nephrectomy (RN), partial nephrectomy (PN), Active Surveillance (AS), and radiofrequency ablation (RFA). Material & Methods: We performed a retrospective cohort analysis from 2006 to 2012 of 322 patients discussed at the specialist multidisciplinary team meeting. Here we present the findings of patients with tumours who underwent PN (n=64), RN (n=126), AS (n=92) or RFA (n=40), with an intention-to-treat analysis. Mean tumour size was 4.55cm (0.4 14), and mean age (20 89). The primary outcome measure was overall survival. Mean follow up was months (2 104). Results: In the AS group, eight had RN due to progression, four patients had five PN and seven patients had eight RFA treatments. Two patients in the RFA group required repeated treatments. Three patients in the RN had metastases identified during follow up, with no metastases noted in the PN group. Mean age for patients managed with PN was 56.49, for RN 63.6, for RFA and for AS was Mean survival with AS was months (CI ), with RFA months (CI ), with PN (CI ) and with RN (CI ). PN offered a statistically significant survival advantaged compared to other means of managing renal tumours RCC, but this advantage became apparent only after 36 months (p<0.05). Conclusions: Partial nephrectomy is associated with an improved survival advantage compared to other methods of managing renal cancers. The advantage of partial nephrectomy is in part due to the age and fitness of these patients and supports the assertion that better renal function leads to improved survival over time. In addition, there were no deaths after 4 years, and no cases of disease recurrence after five years. Therefore, follow-up could be thus tailored for lowrisk patients, reducing the burden on the healthcare provider. P146 Heterogeneity in the clinic-pathological characteristics of long responder patients with metastatic renal cell carcinoma (mrcc) treated with targeted therapy M.J. Ledó Cepero 1, P. Beardo Villar 2, M. Soto Delgado 2, C. Baena Villamarín 2, R. Gavira Moreno 3, J. Soto Villalba 1, A. Juárez Soto 2, J.L. Alvarez Ossorio 1. 1 Puerta Del Mar University Hospital, Dept. of Urology, Cádiz, Spain; 2 Jerez University Hospital, Dept. of Urology, Jerez De La Frontera (Cádiz), Spain; 3 Jerez University Hospital, Dept. of Pharmacy, Jerez De La Frontera (Cádiz), Spain Introduction & Objectives: Tyrosine kinase inhibitors (TKIs) have achieved very favorable results in metastatic renal cell cancer (mrcc), obtaining partial response (PR) rates of 8 39% and a median overall survival (OS) higher than 2 years. Long responder (LR) or prolonged responder patient to TKI therapy is the patient who achieves a permanent complete response (CR) or remains free of disease progression during at least 18 months. The aim of this study is to describe the clinico-pathological characteristics of a series of long-responder (LR) patients with metastatic renal cell cancer (mrcc) and their outcome to first line treatment with a tyrosine kinase inhibitor (TKI). Material & Methods: This is a retrospective bi-institutional study including 44 consecutively selected patients with mrcc, receiving a TKI antiangiogenic treatment between july 2008 and december Results: Of the 44 patients treated with TKI, we identified 13 LR (29.5%). An early response to treatment was observed in all the patients, defined as the best treatment response in the first follow-up CT scan, after weeks of treatment initiation. The type of radiological response was 38.5% PR, 38.5% stable disease and 23% of CR. Average PFS with the first-line of TKIs is 27.8±3.7 months. PFS including subsequent treatment lines is 34.4±4 months. Patients underwent an average follow-up period of 36.5±3.7 months from treatment initiation with TKIs. 77% are alive at the time of analysis. OS was 51 months (95% CI: ). 30.8% of patients are classified as poor-prognosis in any of different prognostic models of response to treatment published in the literature 6 12 and only the French model classifies all our LR patients as favorable-intermediate risk. Conclusions: In our LR group, it is observed that all patients are nephrectomized and that the majority of patients presents a KP S>80%, a clear-cell histology, and a solitary metastatic location. In a publication analyzing 9 clinical trials, carried out by the MSKCC group, risk factors associated with long-term response included lack of bone metastases or lung metastases and favorable MSKCC risk status 1. Although in our series of LR patients, only 38.5% of patients are classified as favorable-prognosis, and 85% have bone and/or lung metastases. No other prognostic models classify all our LR patients as favorable risk. It is required not only to establish, but also to validate, a prognostic model in large series of patients. Nonetheless, there are probably other molecular factors still to be defined that influence response to these new therapies. Testicular cancer P147 Pictorial Review: Testicular lumps: One lump multiple pathologies K.A. Varghese 1, S. Chang 1, C. King 1, S. Agarwal 2, N. Vasdev 3, J. Adshead 3, T. Lane 3. 1 Lister Hospital Stevenage, Dept. of Radiology, Stevenage, United Kingdom; 2 Lister Hospital Stevenage, Dept. of Histopathology, Stevenage, United Kingdom; 3 Lister Hospital Stevenage, Dept. of Urology, Stevenage, United Kingdom Introduction & Objectives: The purpose of this pictorial review is to present a variety of cases of testicular lesions that can occur in patients who present with non-specific urological symptoms. We present our experience of testicular lumps and the varied benign and malignant pathologies that can be identified and the difficulty in differentiating them. We encountered a variety of cases of testicular lesions from commoner seminomas and teratomas to rare pathologies such as plasmacytomas, lymphomas and paratesticular rhabdomyosarcoma. These lesions often present in a similar pattern but the management of them is varied. Making a pre-surgical diagnosis is essential as it will lead to appropriate clinical management including testicular preserving surgery instead of orchidectomy or chemotherapy. A clear example of this is with testicular lymphoma the commonest testicular tumour of between 60 and 80 years and represents up to 7% of all testicular tumors, which has a poor prognosis and early accurate detection significantly improves patient outcome. Material & Methods: Data was collected from 173 patients over a 3 year period that initially presented with non specific urological symptoms, but later found to a lesion which was either biopsied/removed and examined histologically. We retrospectively investigated the imaging characteristics of testicular cases over the last 3 years. The imaging was reviewed by 2 consultant radiologists who reviewed all the imaging independently. The histology of the cases were reviewed by a consultant histopathologist who specialises

91 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Introduction & Objectives: Glycoproteins have recently been recognized as important regulators of cellular interactions and adhesion whose levels vary under different cancer conditions. Thus, glycans are currently under investigation as possible new biomarkers in cancer diagnostics. IgG glycans have been shown to deviate in gastric, ovarian, and lung cancer. The aim of the current study was to investigate the levels of selected glycans in seminoma and non-seminoma patients before and after chemotherapy and compare them with control levels in healthy control subjects. Material & Methods: 31 seminoma and non-seminoma patients and 31 control subjects matched by age and smoking habit were analyzed. Patients were sampled before and after chemotherapy by bleomycin/etopside/cisplatin (BEP) which they received throughout 2 months. Plasma samples were obtained from whole blood after immediate centrifugation and glycans from plasma were isolated using 96 well plates. We analyzed the IgG glycans (FA2G1, FA2G2, FM3, A2G2S1). AB labelled glycans were purified by microcrystalline cellulose and analyzed via UPLC (Ultra Performance Liquid Chromatography). Statistical analysis included Kruskal-Wallis test adjusted for multiple testing using the Holm-Bonferroni method and Wilcox paired test adjusted for multiple testing using the Holm- Boferroni method. Also, biclustering was carried out by BCCC method. Classification into three groups control, patients before and after treatment was attempted by the random forest algorithm. Results: No statistically significant difference between the control group and the patients before and after therapy was detected by Kruskal-Wallis test or Wilcox paired test. Biclustering could not distinguish between the groups. Classification into groups of patients (before and after therapy) and the control group according to the glycome composition by the random forest method could not correctly predict group membership, as shown by tenfold cross-validation (29.2% correctly classified instances). Conclusions: The serum glycans have shown promising results to become highly specific biomarkers for diagnostics of some cancer types in their earliest stages. Among the selected IgG glycans, no candidate that could be used in the diagnostics of seminoma and nonseminoma and their response to therapy was found in the current study. P149 Expression of MCT1, MCT4, CAIX, CD147 and GLUT1 in testicular germ cell tumors is related with clinicopathologic features Figure 1. Testicular lymphoma mimicking seminoma. in genito-urinary malignancy. The histological and imaging findings were analyzed and the findings are presented within the pictorial review. Results: The radiological features of the different testicular pathologies are compared to the histological diagnosis to highlight the radiological similarities. We will thereafter explore the key differentiating imaging features that can help to ensure correct clinical management. Conclusions: This pictorial review will seek to inform clinicians of the varied radiological appearances of both common and rare testicular lesions and how this can help determine clinical management. P148 Lack of difference in levels of IgG glycans before and after chemotherapy in testicular seminoma and non-seminoma patients M. Gamulin 1, I. Beceheli 2, I. Ugrin 2, A. Vojta 3, M. Pucic 2, A. Fucic 4, G. Lauc 2. 1 Clinical Hospital Center Zagreb, Dept. of Oncology, Zagreb, Croatia; 2 Genos Glycoscience, Genos Glycoscience, Zagreb, Croatia; 3 Faculty of Science, University of Zagreb, Dept. of Molecular Biology, Zagreb, Croatia; 4 Institute For Medical Research and Occupational Health, Independent Researcher, Zagreb, Croatia L. Queiroz 1, M. Ferreira 2, M. Almeida 1, C. Portela 1, H. Marques 1, F. Pardal 2, R. Nabiço 1, P. Costa 3, F. Santos 4, A. Longato-Filho 4, F. Baltazar 4. 1 Braga Hospital, Dept. of Oncology, Braga, Portugal; 2 Braga Hospital, Dept. of Pathological Anatomy, Braga, Portugal; 3 Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Dept. of Statistics, Braga, Portugal; 4 Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Dept. of Surgical Sciences, Braga, Portugal Introduction & Objectives: Neoplastic cells have higher metabolic rates and use the glycolytic pathway with lactate production, even in the presence of oxygen. Several studies have demonstrated a role of GLUT1, MCT1, MCT4, CAIX and CD147 behind this alteration. The expression of these proteins is increased in different types of tumors and is generally associated with aggressiveness features and poor prognosis. However, their role in testicular germ cell tumors is not known. The aim of this study was to evaluate the expression of MCT1/4, CD147, CAIX and GLUT1 in testis germ cell tumors and to assess possible associations between their expression and clinical pathologic features. Material & Methods: Fourty three cases of testicular germ cell tumors were evaluated for GLUT1, MCT1, MCT4, CD147 and CAIX expression by immunohistochemistry and the results associated with clinico-pathologic features. Results: All of these proteins demonstrated a positive expression of tumoral tissues. GLUT1 was not found in normal tissue but was expressed in tumor tissue and was associated with more advanced stages (p=0.026) and a more aggressive prognostic score (p=0.002). All metabolic markers studied presented higher expression in tumors with non-seminoma histology. MCT1 and MCT4 expression was significantly associated with a worse prognostic score (p=0.000 and p=0.012, respectively) and in the case of MCT1 with increasing tumor markers (p=0.019) at diagnosis. There was a significant association of co-expression of MCT1 with CAIX (p=0.013) and MCT4 with GLUT1 (p=0.002) and CD147 (p=0.005). Conclusions: GLUT1, MCT1 and MCT4 expression was associated with worse prognostic scores in testicular germ cell tumors and their expression was higher in non-seminomas. GLUT1 appears to have an important role in testicular tumors, since it is not expressed in normal testicular tissue and is associated with advanced stages and poor prognosis. P150 Radiotherapy or chemotherapy for clinical stage IIA and IIB seminoma: A systematic review and meta-analysis of patient outcomes P. Giannatempo 1, T. Greco 2, S. Tana 3, N. Nicolai 4, D. Raggi 1, E. Farè 1, B. Avuzzi 3, M. Marongiu 1, L. Piva 4, M. Catanzaro 4, D. Biasoni 4, T. Torelli 4, S. Stagni 4, M. Maffezzini 4, A. Gianni 1, R. Salvioni 4, L. Mariani 5, A. Necchi 1. 1 Fondazione IRCCS Istituto Nazionale Dei Tumori, Dept. of Medical Oncology, Milan, Italy; 2 IRCCS San Raffaele Institute, Dept. of Anesthesia, Milan, Italy; 3 Fondazione IRCCS Istituto Nazionale Dei Tumori, Dept. of Radiotherapy, Milan, Italy; 4 Fondazione IRCCS Istituto Nazionale Dei Tumori, Dept. of Surgery-Urology, Milan, Italy; 5 Fondazione IRCCS Istituto Nazionale Dei Tumori, Clinical Epidemiology and Trials Organization, Milan, Italy Introduction & Objectives: Outcomes of radiotherapy (RT) com-

92 166 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) pared to chemotherapy (CT) remain poorly defined for the management of clinical stage (CS) II seminoma, namely CSIIB, although some studies suggest an equal benefit. We aimed to update the current evidence on the role of RT and CT in this setting of advanced seminoma. Material & Methods: A comprehensive literature review was performed to identify all studies reporting on results of RT or CT in CSIIA and CSIIB seminoma. Search was limited to studies published after 1990 and included the Medline, Embase databases, and abstracts from ASCO (GU), ESMO, AUA, and ASTRO meetings up to 02/2014. A systematic review and meta-analysis (MA) was performed. Sensitivity analyses were applied by independently analyzing the effect of treatment in these subgroups: CSIIA and CSIIB, paraortic+iliac RT only in both stages, RT dose ( 30 Gy vs <30 Gy), and PEB/EP regimens only. A meta-regression model was also applied. Results: 13 studies have been selected for MA on relapse-free survival (RFS). No randomized trials compared RT and CT. There were 6 prospective and 7 retrospective studies, with a total of 527 patients receiving RT and 317 receiving CT. The pooled relapse-rate (RR) was similar between the RT (9%, 95% CI: 7 11, p for heterogeneity = 0.24, I-square = 22%, with 10 studies included) and CT groups (8%, 95% CI: 2 15, p for heterogeneity <0.001, I-square = 81%, with 7 studies included). Furthermore, the slope of the regression to evaluate the effect of CT respect to RT on RFS risk did not result significantly different from zero ( 0.46, 95% CI: 3.80 to 2.27, p=0.772). The outcome was similar across the clinical stages and treatment modalities. Of note however, the pooled RR for RT in CSIIB was 14% (95% CI, 9 18) while it was 8% (95% CI, 2 15) for CT. For OS endpoint, 9 studies were available and the pooled mortality rate was similar using RT (1%, 95% CI: 0.2 2, p for heterogeneity = 0.57, I-square = 0%,) or CT (1%, 95% CI: 0.2 2, p for heterogeneity = 0.37, I-square = 6%, with 5 studies included). Long-term side-effects and incidence of second cancers were more frequently reported following RT. The overall incidence of nontesticular second malignancies was 0.04 (95% CI: ) in the RT group and 0.02 (95% CI: ) in the CT group. Conclusions: Although RT and CT appeared to be equal options in CSIIA and IIB seminoma, a trend in favour of CT for a lower incidence of side effects and relapse rate in CSIIB was found. This evidence is limited by the retrospective quality of studies and their small sample size. Prospective randomized trials are needed to confirm the findings in CSIIB. P151 Efficacy of ultrasound-guided testicle-sparing surgery for tumors ( 1.5 cm) L. Dell Atti, C. Ippolito, L. Fornasari, G. Ughi, G.R. Russo. S. Anna Hospital, University of Ferrara, Dept. of Urology, Ferrara, Italy Introduction & Objectives: The incidental finding of small testicular cancer (TC) is not a rare event during a common scrotal ultrasound examination in age between 16 to 45 years. The aim of this study was the evaluation of conservative echo guided surgery (CES) for testicular tumors 1.5 cm performed at our Urology Department. Material & Methods: A mono-centred retrospective clinical study was performed from January 2001 to September During this period 47 patients diagnosed with ultrasonography testicular lesions (mono or bilateral) 1.5 cm and treated with CES were examined. The parameters considered in this retrospective analysis included case history, physical examination, scrotal abdominal ultrasonography, size of the nodule (maximum diameter) on ultrasonography, tumor markers, chest radiography, frozen section examination, histologic size of the tumor, overall survival (OS) and findings on followup. The surgical strategy was performed by inguinotomy with preventive clamping of the spermatic cord and exposure of the testicle in a separate operative field. Recurrence free survival was assessed using Kaplan-Meier method. Results: 7 patients with a bilateral synchrone tumor and 40 with a monolateral TC underwent CES. Mean age was 32 years (range 18 44), mean follow-up was 59 months (range 42 74), mean tumor size was 11.4 mm (range 5 15). Patients presented with a palpable testicular nodule 34% (16/47), gynecomastia 8.5% (4/47), precocious pseudopuberty 4.3% (2/47), scrotal pain 10.5% (5/47). Tumors types were: 22 seminoma, 13 non seminomatous or mixed germ cell tumors, 4 Leydig tumors, 2 hamartoma, 1 epidermoid cyst, 2 sertoli cell tumors, and 3 fibrous psueudotumor. Frozen section examination (FSE) show efficacy to detect germ cell tumors, as positive predictive value of FSE was 100% and negative predictive value was 80%. Sensibility and specificity of FSE were 84.23% and 100% respectively. OS was 100% and 6 patients (12.8%) presented a local recurrence after a mean follow-up of 34.7 months. Subsequently, radical orchiectomy was performed in these 6 patients. Follow-up was conducted for all patients every 3 to 6 months. All patients underwent CT. No metastases were observed. No patient with preserved testicle required androgen therapy, mean post-operative total testosterone was 4.0ng/ml. 18 patients were subjected to three cures of chemotherapy (BEP), and among these, only one was fertile after after these treatments. Conclusions: The practice of CES in TC should be considered for patients presenting with a bilateral tumor on a single testicle. However CES appears to be safe and effective in experienced ultrasonography centers. The 100% rate of OS and the low rate of local recurrence (12.8%) tend to demonstrate the safety of the procedure. The results of this study confirm the favourable data of literature that ultrasonography represented an excellent diagnostic method with a 100% of sensitivity in the diagnosis of testicular masses between 0.5 to 1.5 cm. Long-term follow up and multicenter studies suggest that testicle-sparing surgery does not compromise oncologic efficacy in treatment of these tumors as in our study. P152 Germ cell tumors of the testis: An 11 years retrospective study I. Pimentel 1, R. Gomes 1, C. Marques 1, D. Azevedo 1, I. Augusto 1, C. Rey 1, L. Vendeira 2, M. Damasceno 1. 1 Centro Hospitalar São João, Dept. of Medical Oncology, Porto, Portugal; 2 Centro Hospitalar São João, Dept. of Radiotherapy, Porto, Portugal Introduction & Objectives: Testicular cancer is the most common malignancy in young men, with an increasing incidence worldwide. The purpose of this study is to analyze the experience of a single Portuguese institution in the management of testicular germ cell tumors over the last 11 years. Material & Methods: Retrospective observational study of 100 patients with histologically confirmed testicular cancer, as identified by our pathology department, between April/2002 and March/2013. Results: From the 100 patients, 32 were diagnosed with seminoma and 68 diagnosed with non seminoma. The median age was 30 years [15, 58]. In the seminoma group, 26 patients were diagnosed with stage I (81%), 3 with stage II (9%) and 3 with stage III (9%). In the non seminoma group, 31 patients were diagnosed with stage I (46%), 13 with stage II (19%) and 24 with stage III (35%). The majority of patients received chemotherapy (74%), BEP being the most common administered regimen, and 7 patients needed retroperitoneal lymphadenectomy. 6 patients were excluded from the survival analyses due to follow-up loss. In the seminoma group, the disease free survival (DFS) and overall survival (OS) at 5 years were 100%, independent from the staging at diagnosis. In the non seminoma group, there were 8 deaths, 5 related to disease progression, 1 secondary to acute retroperitoneal lymphadenectomy complication and 2 from other causes. The DFS at 5 years was 92% for stage I, 72% for stage II and 82% for stage III. The OS at 5 years for stage I was 100%, 92% for stage II and 87% for stage III. 2 patients with stage III disease were submitted to high dose chemotherapy followed by autologous bone marrow transplant, with complete remission. There were no differences in survival rates in the stage IA group, regardless the choice of treatment (surveillance, chemotherapy or prophylactic lombo-aortic radiotherapy).

93 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Conclusions: The results presented in this retrospective study are similar to those obtained in the best centers. The differences in DFS in the non seminoma group can be explained by the fact that we have more stage III patients compared to stage II. In stage IA we observed that regardless of the treatment choice there were no relapses, what suggests that surveillance alone is a valid option in this group of patients. Penile cancer P153 Does pelvic lymph node dissection have a role in the treatment of penile cancer? T.L. Yap, M. Shabbir, C. Handalage, I. Cullen, M. Lucky, C. Jameson, R. Nigam, P. Malone, C. Akers, A. Freeman, A. Muneer, S. Minhas. University College Hospitals London, Dept. of Urology, London, United Kingdom Introduction & Objectives: The role of pelvic lymph node dissection for penile carcinoma is controversial. The EAU guidelines advocate pelvic lymph node dissection (PLND) in patients if more than 2 inguinal nodes are involved or in cases of extra-capsular spread, although this is based upon limited evidence. The aim of this study was to assess the detection rate and survival rates of patients who underwent PLND as recommended by the EAU guidelines. Material & Methods: A retrospective review of 37 patients undergoing PLND for penile cancer between for pn2 disease was performed. Age, tumour stage, grade, subtype, lymphovascular invasion (LVI), number of positive inguinal lymph nodes (ILN) and presence of extra nodal spread (ENS) were assessed and correlated with PLN status and survival outcome. Fisher s exact and unpaired t- tests were used for analysis (p values <0.05 taken as statistically significant). The diagnostic accuracy of CT in determining pelvic lymph node disease was also assessed. Results: 37 patients underwent PLND for pn2 disease. Nine patients (32%) had positive pelvic disease. PLND s were ipsilateral to the positive ILN s in all cases. At 5 years post PLND, four men (4/9; 44%) with positive pelvic nodes had died (median survival 472 days), range days) whilst 9 men (9/28; 32%) with negative pelvic nodes died (median survival 360 days, range days). There was no significant difference in the median survival between these two groups (p=0.22). There were weakly significant associations with stage T2 or more, basaloid subtype or >2 LN and the presence of pelvic nodal disease. The presence of inguinal ENS was the only factor significantly associated with mortality in patients undergoing PLND. CT staging, though sensitive for pelvic nodal disease, has a high false positive rate with an accuracy of only 51%. Conclusions: A low yield, combined with the associated morbidity and no clear survival benefit remains a barrier the continued use of PLND as a single treatment modality in men with N2 or greater disease. However the poor sensitivity and specificity of CT scanning make it difficult to abandon PLND as a means of accurate staging. Whilst some factors such as stage, basaloid histology and >2 inguinal lymph node involvement are weakly predictive of pelvic nodal involvement, they did not significantly predict survival. Only the presence of ENS was associated with disease mortality. A drive towards the use of multi-modality therapies should be advocated in the trial setting as surgery alone does not improve survival. P154 Factors predicting local recurrence of penile carcinoma (PC) an analysis of risk factors, patterns of recurrence and outcome T.L. Yap, M. Lucky, I. Cullen, P. Malone, R. Nigam, A. Freeman, C. Akers, A. Muneer, S. Minhas. University College Hospitals London, Dept. of Urology, London, United Kingdom Introduction & Objectives: There is limited guidance on management and outcome from recurrent PC. The aim of this study was to determine risk factors and recommend management strategies for recurrent disease. Material & Methods: A retrospective study of 416 penile cancer patients treated between , 45 patients (10.8%) developed recurrence. Predictors including age, presentation, tumour stage, grade, subtype, lymphovascular invasion, positive lymph nodes, extranodal spread, management and relationship with outcome were assessed using multiple regression analysis. Kaplan-Meier (KM) curves were constructed. Chi-squared and Fisher s exact tests were used to determine differences between local and regional/distant recurrence groups. P values <0.05 were taken as statistically significant. Results: Mean age was 64.2 years. Mean time to recurrence was 759 days (range ). Twenty-four (53.3%) recurrences occurred in the first 2 years. Twenty-six (57.8%) were local recurrences, 11 (42.3%) being node positive. Significant predictors of overall survival were histology (P=0.037) non-basoloid having the better survival, grade (P=0.037) higher grade correlating with poorer survival, time to recurrence (P=0.01) longer time to recurrence giving better survival. KM curves demonstrated a significant difference between survival in the local and regional/distant recurrence groups. Local recurrence did not have a negative impact on survival, with 2 (7.7%) deaths from PC. Five year survival was 83.3% in the local group versus 23.1% in the regional/distant group. Table 1. Time to recurrence Time from diagnosis of penile cancer Local recurrences Regional recurrences (% of total) (% of total) 6 months year years years years years Conclusions: There remains a significant risk of recurrent PC, even after 2 years from primary treatment. In particular men with adverse histopathogical factors should remain under long term surveillance. Men with early regional/distant recurrence have a poorer prognosis. Pathology P155 Loss of PTEN expression together with ERG overexpression leads to shorter disease-specific survival in prostate cancer after radical prostatectomy K. Lahdensuo 1, A. Erickson 2, J. Lundin 2, M. Lundin 2, S. Nordling 3, A. Sankila 4, A. Rannikko 1, T. Mirtti 2. 1 Helsinki University Central Hospital, Dept. of Urology, Helsinki, Finland; 2 Institute For Molecular Medicine Finland, FIMM, Helsinki, Finland; 3 University of Helsinki, Haartman Institute, Helsinki, Finland; 4 United Medix Laboratories, Dept. of Pathology, Helsinki, Finland Introduction & Objectives: PTEN deletion and ERG-TMPRSS2 fusion are suggested to have predictive value in prostate cancer (PC). Altered genetic expressions can be assessed by immunohistochemistry (IHC). The combination of these genetic transformations appears to have

94 168 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) more clinical significance than either of them alone the aim of this study was to evaluate whether this affects disease-specific survival (DSS) after radical prostatectomy (RP). Material & Methods: A tissue microarray (TMA) was constructed from archival RP specimens of 478 patients treated in at Helsinki University Central Hospital. Median follow-up was 12.4 years (range ). In final analysis, 380 patients had complete IHC results. See Table 1 for patient characteristics and cross tabulation outcomes. Uni- and multivariate Cox regression was run to examine possible effects of marker status on DSS. Kaplan-Meier analysis (Figure 1) compared markers for their effect on DSS. Results: There were no differences in the distribution of patients by ERG expression status in the clinically stratified groups. PTEN loss was more commonly associated with increasing Gleason score and pt stage, positive lymph nodes and likelihood of receiving secondary therapies. In Cox regression, neither ERG fusion nor PTEN loss alone had significant predictive value. Kaplan-Meier survival analysis demonstrated that low PTEN expression coupled with ERG positivity reduced DSS, especially with Gleason score was 8. Conclusions: ERG expression seems to precede PTEN loss, and PTEN loss was shown to be associated with clinical indicators of disease progression. Our results support the use of IHC in determining the combined effect of ERG and PTEN expressions to predict time to disease-specific death in PC. After RP, more careful follow-up, possibly with earlier secondary therapies might be needed for the patients with ERG overexpression and PTEN loss. Abstract P155 Figure 1. Kaplan-Meier curves for differences in disease-specific survival by marker expression.

95 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Late Breaking Localised prostate cancer LB1 Distinguishing favorable from non-favorable prostate cancer with novel prognostic proteomics prostate cancer biopsy test, ProMark F. Saad 1, J. Dunyak 2, M. Shipitsin 2, S. Choudhury 2, T. Capela 2, C. Ernst 2, A. Hurley 2, A. Kaprelyants 2, S. Hussain 2, H. Chang 2, T. Nifong 2, M. Latour 3, L. Coupal 4, D. Berman 5, P. Blume-Jensen 2. 1 University of Montreal, Division of Urology, Montreal, Canada; 2 Metamark Genetics, Dept. of Research and Development, Cambridge, United States of America; 3 University of Montreal Hospital, Dept. of Pathology, Montreal, Canada; 4 Impacts Inc, Dept. of Statistics, Montreal, Canada; 5 Queen s University, Dept. of Pathology, Kingston, Canada Introduction & Objectives: Currently, standard clinical and pathological parameters derived from diagnostic biopsy are insufficient for accurate assessment of final prostate tumor pathology for patients with biopsy Gleason grades of 3+3 or 3+4. To a large extent, this could be attributed to biopsy sampling variation and pathologist grading discordance. We report a novel test, ProMark that performs automated quantitative measurements of protein biomarkers from tumor areas of prostate biopsy FFPE sections. The test generates a risk score predictive of patient s final prostate tumor pathology. Material & Methods: In a previous study we identified 12 candidate biomarkers that could predict prostate tumor pathology and lethal disease despite sampling variation. A train-test study with a biopsy cohort (N=381) was conducted to identify the best marker subset and to develop a predictive model. The locked model was validated on a separate biopsy cohort (N=274). The model was validated as standalone and in conjunction with current biopsy based clinical risk assessment methods. Results: In the validation cohort, the Promark risk scores were strongly predictive of final prostate tumor pathology. The test was able to separate non-aggressive cases [Gleason scores of 3+3 or 3+4; organ-confined ( pt2)] from aggressive cases [non-organ-confined disease pt3a or Gleason scores 4+3] with a C-stat of 0.69 (95% CI = ) (p<0.0001). Odd s Ratio for lowest to highest quartile was 5.5 (95% CI = )). At risk score 0.8, the predictive value for aggressive cases is 76.9%. Importantly, ProMark provides individual risk information with better predictive values for non-aggressive and aggressive cases within each of NCCN or D Amico risk strata. While in validation cohort, NCCN risk stratification system had a C-stat of 0.69 (95% CI = ), a joint ProMark/NCCN model had an improved C-stat of 0.75 (95% CI = ). Conclusions: The Promark risk scores on prostate biopsy strongly correlated with final pathology on radical prostatectomy. The test could be useful as an aid for stratification of patients for active surveillance.

96 170 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) ESUI Oral Presentations Imaging EO6 Preoperative lymph node staging of intermediate and high-risk prostate cancer using whole body integrated PET/MR with a 68Gallium-labelled ligand of prostate-specific membrane antigen T. Maurer 1, L. Pähr 1, M. Souvatzoglou 1, G. Weirich 2, H. Kübler 1, H-J. Wester 1, B. Haller 1, M. Schwaiger 1, J.E. Gschwend 1, M. Eiber 1. 1 Klinikum rechts der Isar der Technischen Universität München, Dept. of Urology, Munich, Germany; 2 Klinikum rechts der Isar der Technischen Universität München, Dept. of Pathology, Munich, Germany Introduction & Objectives: Staging of primary intermediate and high-risk prostate cancer patients before curative treatment usually comprises bone scintigraphy and CT or MRI of the abdomen. Recently, Glu-NH-CO-NH-Lys-(Ahx)-[(68)Ga(HBED-CC)] as a novel 68 Galliumlabelled ligand of the prostate-specific membrane antigen ( 68 Ga- HBED-PSMA) has been developed. First reports state high sensitivity and specificity in the detection of prostate cancer lesions. Thus, the aim of this prospective analysis was to investigate 68 Ga-HBED-PSMA PET/MR for staging in this patient cohort and correlate it with the results of postoperative histological findings. Material & Methods: This analysis included 53 patients prior to planned radical prostatectomy with intermediate or high-risk prostate cancer according to d Amico classification. After injection of MBq 68 Ga-HBED-PSMA a fully-diagnostic PET/MR including multiparametric prostate MRI was performed and images were reviewed by one nuclear medicine physician and one radiologist in consensus. Visualization of local tumor, evidence of lymph node or distant metastases was evaluated and compared to postoperative histological findings. Results: Despite unremarkable conventional imaging 68 Ga-HBED- PSMA PET/MRI revealed metastasized disease in two patients who therefore did not undergo radical prostatectomy. Tumor involvement of the prostate could be visualized by 68 Ga-HBED-PSMA PET in 88.3% of patients (45/51). In patients with PSMA-positive primary tumor 68 Ga-HBED-PSMA PET detected 11 out of 13 patients with histological lymph node involvement (sensitivity: 84.6%) and correctly classified 31 out of 32 patients without histological evidence of lymph node metastases (specificity: 96.6%; accuracy 93.3%). Of note, the two patients with lymph node metastases that were missed by 68 Ga- HBED-PSMA PET only showed micrometastasis in one lymph node. Conclusions: In this initial series, 68 Ga-HBED-PSMA PET/MRI showed a high detection rate of the primary tumor within the prostate and proved to be of high sensitivity, specificity and accuracy regarding lymph node staging. Therefore, 68 Ga-HBED-PSMA PET/MRI as single investigation might have the potential to stage intermediate and high-risk prostate cancer patients more accurately than standard imaging. EO7 MRI use prior to prostate biopsy in a German tertiary care centre: A plea for standardization B. Beyer, H. Heinzer, A. Haese, M. Graefen, L. Budäus. Martini-Clinic, Prostate Cancer Center, Dept. of University Medical Center Hamburg-Eppendorf, Hamburg, Germany Introduction & Objectives: The number of prostate MRIs performed in patients with suspected prostate cancer prior biopsy steadily increases. Different attempts for standardization of prostate MRI reporting have been made. To assess the use of the PiRads reporting system and analyse its impact on detected tumour characteristics in patients scheduled for a prostate biopsies to a tertiary referral centre. Material & Methods: Based on suspicious digital rectal examination or increasing PSA levels, 97 patients from all across Germany were sent for prostate biopsies between 10/2013 and 04/2014. All patients received MRIs, performed in different MRI-institutions. In (73/97) patients, at least one suspect MRI foci was diagnosed and fusion biopsies were performed by using the Koelis system. Additionally, a standardized random 10-core biopsy was performed. Results: In all patients, prostate imaging was performed by using T2- weighted, diffusion-weighted and dynamic contrast-enhanced imaging (T2WI, DWI, DCE-MRI). A non-standardized reporting scheme 50/73 patients (group 1) was compared to patients diagnosed with the PiRads scoring system 23/73 (group 2). The overall detection rate for targeted vs. random biopsies was 38% vs. 50% in group 1 and 52% vs. 61% in group 2. A prostate cancer 3+4 diagnosis was made in 79% (15/19) vs. 60% (15/25) for targeted vs. random biopsies (group 1) and in 83% (10/12) vs. 57% (group 2). High-risk tumour (defined as Gleason score 4+4) was detected in 32% 6/19 patients vs. 20% (5/25) in targeted vs. random biopsies in group 1 compared to 42% (5/12 patients) vs. 15% (2/14) when using the PiRads system. Moreover, the amount of tumour per core was increased when using targeted biopsies in patients diagnosed with the PiRads system: Mean 8.8% (SD ±15.9) vs. 3.1% (SD ±5.1) group 1 (targeted vs. random) and 10.2% (SD ±15.4) vs. 5.2% (SD ±9.4) in group 2 (targeted vs. random). Conclusions: The use of MRI guided fusion biopsies increased the overall detection rate. Among patients diagnosed with cancer, the proportion of Gleason score 3+4 tumours was increased by simultaneously lowering the proportion of patients diagnosed with a Gleason score 3+3. This phenomenon was strongest detected in patients in whom cancer diagnoses was made by using a standardized reporting system. Therefore, the use of the PiRads systems for reporting findings in prostate MRIs should be strictly recommended. Moreover, the clinical and economic burden of non-standardized MRI reporting should be considered from a health care provider and national health authority s point of view. EO8 Initial experience with PSMA-radioguided surgery in prostate cancer patients T. Maurer 1, G. Weirich 2, M. Weineisen 1, H-J. Wester 1, M. Schottelius 1, B. Frisch 1, A. Okur 1, H. Kübler 1, M. Schwaiger 1, J.E. Gschwend 1, M. Eiber 1. 1 Klinikum rechts der Isar der Technischen Universität München, Dept. of Urology, Munich, Germany; 2 Klinikum rechts der Isar der Technischen Universität München, Dept. of Pathology, Munich, Germany Introduction & Objectives: With the advent of 68 Ga-HBED-PSMA PET hybrid imaging techniques even small and atypical localized metastatic lesions of prostate cancer can be visualized. However, these lesions might not be easy to localize intraoperatively. Thus, the aim of this feasibility study was to evaluate intraoperative detection of metastatic lesions using a gamma probe after injection of radioactive-labelled PSMA-ligands in correlation with postoperative histological findings. Material & Methods: Five prostate cancer patients with evidence of oligometastatic primary or recurrent disease on 68 Ga-HBED-PSMA PET hybrid imaging were included in this feasibility study. 24 hours before surgery patients received an intravenous injection of an 111 Inlabelled PSMA-ligand (PSMA I&T). Intraoperatively, metastatic lesions were detected by gamma probe with acoustic and visual feed-

97 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) back. Using the freehand SPECT technique opitcal tracking of the gamma probe allowed augmenting the live video stream of the field of surgery with reconstructed 3D image showing the position of the hotspots. Results of radioactive rating (positive vs. negative) in resected tissue were compared to findings of postoperative histological analysis. Results: Lesions declared radioactive-positive intraoperatively as well as positive measurements of resected tissue ex vivo by the gamma probe corresponded to metastatic prostate cancer lesions with a specificity of 100%. Detection of lesions as well as complete resection of even small metastatic lymph nodes was improved by the use of the gamma probe. Compared to preoperative 68 Ga-HBED- PSMA PET hybrid imaging the intraoperative use of the gamma probe detected all positive lesions and might even be more accurate due to reduced lesion-to-detector distance. Conclusions: In this feasibility study, PSMA-radioguided surgery proved to be of high value for intraoperative detection of even small metastatic lesions in prostate cancer patients. However, greater patient numbers including follow-up data are needed to determine its possible role in clinical routine. obtained for cytology; and a biopsy was performed in case of suspicious lesions. Before CLE, 10 cc of fluorescein 0.1% are instilled in UUT. A Cellvizio confocal miniprobe (UROFLEX B) was used in all cases. Video-clips of CLE sequences were reviewed for an interobservational study in correlation with cytology and histological samples. Results: From November 2013 to June 2014, 8 patients were included and 10 CLE were performed. Normal histological aspect of urothelium on CLE is found in all patients next to inflammatory or tumor lesion. The key criteria of normal urothelium include the presence of umbrella cells and normal capillary network on lamina propria layer (Fig. 1A). Inflammatory lesions show loosely arranged aggregations of smaller monomorphic cells and enlarged capillary network (Fig. 1B). Papillary tumor is characterized by a central fibrovascular core surounded by well organized neoplastic urothelial cells (Fig. 1C). Two Low-grade papillary tumor was found on CLE and confirmed in final histological analysis. All inflammatory lesions on CLE had a negative cytology. EO9 Contribution of the confocal microscopy in the exploration of the upper urinary tract tumors J-L. Bonnal 1, A. Rock 1, K. El Maadarani 1, R. Yakoubi 1, R. Bollens 1, B. Mauroy 1, P. Gosset 2. 1 Universite Catholique Lille Nord De France, Dept. of Urology, Lomme, France; 2 Universite Catholique Lille Nord De France, Dept. of Antomopathology, Lomme, France Introduction & Objectives: CT scan Imaging of the upper urinary tract (UUT) could find a lesion under 3 mm with a sensitivity of 40%. Ureteroscopy is the gold standard to explore UUT but the diagnosis is confirmed on biopsy and cytology. We present the preliminary results of a prospective UROVISIO study based on the use of confocal laser endomicroscopy (CLE) to explore UUT. This technology could give histological aspects of urothelium during ureteroscopy. Material & Methods: In this IRB approved prospective single-center study, the number of patients needed for enrollment is 30. All patients have indication of an exploration with ureteroscopy of the UUT for benign or malignant lesions. In all cases, urine samples were Figure 1 Conclusions: CLE could be used during reno-ureteroscopy and give an immediate histological imaging of the UUT urothelium. This new technology could add an extension to the diagnostic armamentarium of UUT carcinoma, and may change our guidelines as well.

98 172 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) ESUI Unmoderated Poster Presentations Imaging EP156 Using [ 11 C]-choline PET/CT for staging and restaging prostate cancer G. Giovacchini. Triemli Hospital, Dept. of Radiology, Zurich, Switzerland Introduction & Objectives: Imaging techniques are being used since several decades for preoperative staging of prostate cancer (PCa) patients as well as for restaging of PCa patients developing biochemical failure after primary treatment. Traditional imaging techniques, including bone scintigraphy and computed tomography (CT), have a low positive detection rate for low PSA levels; moreover, CT has limited sensitivity to detection of local recurrence and to micrometastasis in lymph nodes with diameter smaller than 1 cm. Positron emission tomography (PET) and subsequently in PET/CT with [ 18 F]- fluorodeoxyglucose also have a low positive detection rate in PCa patients, especially in androgen-sensitive patients, due to the low glycolytic metabolism of PCa. Material & Methods: The quest for a more accurate imaging modality in PCa received in the last years a new vigorous impulse when [ 11 C]-choline was synthetized and early proofs-of-concept [ 11 C]- choline PET/CT studies were performed in vivo, prevalently in patients with high PSA or known metastatic disease. The availability of dedicated PET/CT scanners allows fusioning of morphological and functional images, which enables accurate localization of sites of pathological tracer uptake and ease the differentiation between malignant and benign findings. A noteworthy advantage of this wholebody technique is that it provides information on multiple anatomic sites at a single time. As such, the technique has the capability of distinguishing between local relapse and distant metastases, and therefore has the potential to guide the medical treatment. Previous in vitro and in vivo spectroscopic studies had suggested a primary role of choline and choline-derived phospholipids in the development and progression of PCa. Results: Studies performed at initial staging indicate that the technique might have sufficient accuracy for detection of lymph node disease only in high-risk patients. On the contrary, [ 11 C]-choline PET/CT provides its best performance in restaging PCa patients with biochemical failure. The positive detection rate of [ 11 C]-choline PET/CT varies substantially in relation to the inclusion criteria. Studies which included unselected consecutive patients reported a positive detection rate ranging between 40% and 70%. Serum PSA level represents the single, most important factor affecting the rate of positive scans. Other positive predictive factors include fast PSA kinetics (PSA velocity, PSA doubling time), advanced pathological state at initial staging, previous biochemical failure, hormone resistance and older age. Recent studies indicate that [ 11 C]-choline PET/CT has the potential to early restaging PCa patients for PSA levels lower than ng/ml. Patients that develop biochemical failure during androgen deprivation therapy (hormone resistance) have a higher likelihood for a positive [ 11 C]-choline PET/CT scan in comparison to patients that are drug naïve (hormone sensitive) and are not required to withdraw the antiandrogenic treatment before PET/CT. Recent retrospective data indicate that [ 11 C]-choline may predict PCa-specific survival in PCa patients that develop biochemical failure during androgen deprivation therapy. Pitfalls of the technique are represented by possible false negative in lymph node metastases as well as unspecific uptake related to inflammation. Conclusions: In summary, [ 11 C]-choline PET/CT represents a very powerful technique for restaging PCa patients with biochemical failure. Future directions include prospective studies assessing clinically relevant outcomes, such as change of management and survival. EP157 Comparison of effectiveness of pericatheter Retrograde Urethrography and cystography in detecting urethrovesical anastomosis K.K. Park, S.D. Kim, Y.J. Kim, J.S. Huh. Jeju National University Hospital, Dept. of Urology, Jeju-Si, South Korea Introduction & Objectives: Urethro-vesical anastomosis (UVA) is a critical point of prostatectomy. UVA leaking can prolong catheterization. Properly evaluation of UVA leaking is important to remove the catheter. We evaluate the method of confirming UVA leaking. Material & Methods: We prospectively analyzed 30 patients who underwent robot assisted laparoscopic prostatectomy for prostate cancer at our institute from March 2013 to February All patients underwent pericatheter retrograde urethrography (RGU) and cystography at postoperative days 7. We compared the ability of detection of UVA leaking at mimimal filling of radiopaque dye and patient discomforts and ability of providing additional information about UVA. In cystography, bladder filling was stop at patients urinary urge sense or 300cc of filling and 50cc dye was injected intraurethrally in pericatheter RGU. Patients discomfort was evaluated with visual analogue pain scale. Results: Among 30 patients, UVA leaking was observed in 6 patients. After postoperative 14 days, all patients could remove their urethral catheter without UVA leaking. Both methods detected UVA leaking of 6 patients at postop 7 days. RGU could detect UVA leaking at mean 15.6cc (10 25cc) of injection, cystography did it at mean 83.3cc (50 120cc) (P<0.001). However, patient s pain scale during procedure were mean 6.45 in RGU, 3.75 in cystography (P<0.001). Cytography could understand the bladder shape and functional capacity more effectively rather than RGU. Conclusions: RGU could detect the UVA leaking with less usage of filling fluid and finely described the pattern of leaking flow than cystography. However, RGU produced more pain during procedure and was less informative rather than cystography. EP158 The performance of MRI in the detection of significant prostate cancer: Evolving practice in a tertiary centre S.M. Tribich 1, C.N. Molokwu 1, J. Buck 2, S.J. Kennish 3, F. Salim 3, D.J. Rosario 1. 1 University of Sheffield, Academic Unit of Urology, Sheffield, United Kingdom; 2 Royal Hallamshire Hospital, Department of Urology, Sheffield, United Kingdom; 3 Royal Hallamshire Hospital, Department of Radiology, Sheffield, United Kingdom Introduction & Objectives: MRI is becoming an integral part of the prostate cancer diagnostic pathway. Our centre serves a population of 1.8 million people, with approximately 1000 new referrals annually for prostate assessment. In men with previous negative TRUS biopsies and ongoing suspicion of prostate cancer, multiparametric MRI (mpmri) can potentially reduce the need for repeat prostate biopsies. A protocol was introduced at our institution, which included prostate MRI prior to repeat biopsies in men with persistently elevated PSA or abnormal DRE. MRI was initially performed using a staging protocol (stmri) and changed to mpmri as our practice evolved. We undertook a service evaluation to analyse the performance of MRI in tumour detection, using transperineal template mapping biopsies (TTMB) as the gold standard.

99 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) Material & Methods: Data from men who had MRI and TTMB between August 2012 and May 2014 was collected retrospectively. The diagnostic performance of MRI was analysed against histopathological findings from TTMB. Concordance with TTMB was determined at whole-gland level. Sub-group analyses were performed of men who had stmri or mpmri for clinically significant and non-significant lesions. Clinically significant lesions were defined as Gleason score >3 or maximum core length >5mm. Results: One hundred and eighteen (118) men were identified who had MRI prior to TTMB. Sixty-four (64) had mpmri and 54 had stmri. The median age was 66 (range 43-80). Of the men biopsied, 41.5% (n=49) had positive biopsies, of which 81.6% (n=40) were clinically significant. In the mpmri group, for any cancer, sensitivity was 87.5%, specificity 17.5%, positive predictive value (PPV) 38.9% and negative predictive value (NPV) 70.0%. For significant cancers, sensitivity was 100.0%, specificity 20.8%, PPV 29.6% and NPV 100.0%. In the stmri group, for any cancer, sensitivity was 72.0%, specificity 24.1%, PPV 45.0% and NPV 50.0%. For significant cancers, sensitivity was 70.8%, specificity 23.3%, PPV 42.5% and NPV 50.0%. Conclusions: A large proportion of malignant prostate lesions can be detected with MRI. In this cohort, mpmri demonstrated superior performance characteristics to stmri. The high sensitivity and NPV suggest that a negative mpmri can eliminate the necessity for further biopsy. Our findings support the use of mpmri in the diagnostic pathway of men with suspected prostate cancer. EP159 Experience of cryoablation for small renal masses in our institute F. Hongo 1, Y. Naya 1, Y. Yamada 1, T. Ueda 1, T. Nakamura 1, K. Kamoi 1, K. Okihara 1, O. Tanaka 2, K. Yamada 2, T. Miki 1. 1 Kyoto Prefectural University of Medicine, Dept. of Urology, Kyoto, Japan; 2 Kyoto Prefectural University of Medicine, Dept. of Radiology, Kyoto, Japan Introduction & Objectives: Thermal ablation for small renal masses (SRM) includes percutaneous radiofrequency ablation (RFA) and cryoablation. In Japan, cryoablation for SRM began to be covered by health insurance in We started cryoablation therapy for SRM in March 2013, and herein report our initial experience with this procedure. Material & Methods: In March 2013, our hospital started cryoablation therapy in patients who were not indicated for radical surgery under general anesthesia because of active double cancer or complications, or who did not wish to undergo surgery because of having only one kidney or for some other reason. Thirty patients underwent cryoablation therapy before March Their median age was 71 years (range, 31 86). The median tumor diameter was 25 mm (range, mm). Under local anesthesia, the cryoprobe was introduced under CT guidance. As a rule, percutaneous tumor biopsy was performed for histopathological diagnosis before or at the time of cryoablation. The response to treatment was evaluated using the mrecist by performing, in principle, contrast-enhanced CT. Results: Seventeen and 3 patients achieved CR and PR, respectively, and 4 and 3 patients had SD and PD, respectively. Intra- and postoperative complications included hematoma, pleural effusion, perforation into the renal pelvis, fever, and hydronephrosis in 1, 2, 1, 2, and 1 patient, respectively. Two patients who had PD underwent a second cryoablation: 2 of them had a CR, and 1 of them had PD. Conclusions: Although further studies involving more patients are needed to evaluate long-term treatment results, cryoablation therapy for SRM, a percutaneous thermal ablation procedure for renal cancer, seems to be a useful treatment option for SRM. The 3 patients with PD were among the 6 patients in our initial experience. The 7th and subsequent patients underwent preoperative marking with lipiodol in view of the tumor location and other factors, and none of them had PD. EP161 Diagnostic and clinical value of post PCNL nephrostogram A. Babu 1, M. Abdulmajed 1, I. Shergill 1, S. Agarwal 2, V. Jones 2. 1 Wrexham Maelor Hospital, Dept. of Urology, Wrexham, United Kingdom; 2 Wrexham Maelor Hospital, Dept. of Radiology, Wrexham, United Kingdom Introduction & Objectives: Nephrostomy tube insertion after percutaneous nephrolithotomy (PCNL) is commonly used in current practice. Post-PCNL nephrostogram (PPN) can be performed to ensure free urine drainage to the bladder post-operatively. We critically reviewed diagnostic and clinical value of performing PPN at our institution. Material & Methods: We performed a retrospective radiological and case note review of all patients at our institution that had undergone unilateral PCNL and nephrostomy insertion for stone disease, between January 2006 and December Demographic data on patients and clinico-radiological outcomes of PPN were assessed. Results: A total of 166 PPN were performed. The median age was 58 years (21 95); 87 males (53.0%) and 79 females (47.6%). PPN (Left, n=88; Right, n=78) was performed on all patients on median postoperative day 3 (range 1 8 days). 128 out of 166 PPNs (77.1%) were deemed satisfactory, with free drainage, and nephrostomy tube was removed uneventfully. Repeat PPNs were obtained in the remaining 38 patients (once, n=29; twice, n=7; thrice, n=2) and nine cases required antegrade ureteric stenting. Subsequently, only 2 of these patients had confirmed ureteric stone on retrograde studies requiring ureteroscopic stone extraction, the remainder had obstruction due to clot/oedema. There were no significant differences in outcomes in males and females, or timing of PPN. Conclusions: Unsatisfactory initial PPN was detected in less than a quarter of cases and resulted in no significant change to clinical outcome. Overall incidence of patients requiring antegrade ureteric stenting was found to be remarkably low. EP162 MRI-guided salvage IMRT for prostate cancer P. Dirix 1, G. Buelens 1, L. Van Walle 1, F. Deckers 2, F. Van Mieghem 2, R. Weytjens 1, B. De Laere 3, P. Huget 1. 1 Iridium Kankernetwerk, Dept. of Radiation Oncology, Antwerp, Belgium; 2 GZA St Augustinus, Dept. of Radiology, Antwerp, Belgium; 3 Iridium Kankernetwerk, Dept. of Translational Cancer Research, Antwerp, Belgium Introduction & Objectives: Radiotherapy can salvage patients with a PSA recurrence (rpsa) following radical prostatectomy, provided that all disease is encompassed within the planning target volume (PTV) and a sufficient radiation dose is delivered to the PTV. We hypothesized that both those requirements are easier to achieve with MRIguided radiation treatment planning. Material & Methods: From November 2012 to April 2014, 77 patients with a biochemical recurrence after radical prostatectomy were referred to our department for salvage radiotherapy. Patients received distant staging (bone scan and/or choline PET-CT) depending on the rpsa value and the discretion of the referring urologist. According to our protocol, patients received a planning CT without IV contrast as well as a planning MRI in treatment position. MRI consisted of T1-, T2-, and diffusion-weighted (with an apparent diffusion coefficient (ADC) map) sequences without gadolinium-enhanced contrast. Prescribed dose to the prostate bed PTV was 66.0 Gy in 33 fractions for all patients, delivered through intensity-modulated radiotherapy (IMRT). Results: Sixty-four patients received an MRI, 13 patients received CT-only radiotherapy planning because of pacemaker (n=5), MRIincompatible prosthesis (n=3), or patient refusal (n=5). None of the patients had clinically palpable disease on digital rectal examination. All distant staging, if performed, was negative. Patients were referred a mean 37.5 months (range: months) after radical

100 174 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) prostatectomy (with pelvic lymphadenectomy in 30 patients) for a pt1 (n=1), pt2 (n=36), or pt3 (n=37) prostate adenocarcinoma. Median PSA value at the time of referral was 0.3 μg/l (range: μg/l). MRI did not show any suspected macroscopic disease in 47 patients (73%). In 17 (27%) patients, MRI did indicate a possible local (n=9) or regional (n=8) recurrence. No suspected bone lesions were observed. The mean rpsa was significantly higher in patients with a suspected recurrence on MRI than in patients with a negative MRI (0.3 μg/l vs. 0.9 μg/l, p=0.03) on an unpaired 2-tailed Student t-test. Of the 24 patients with rpsa 0.2 μg/l, only 1 (4.2%) patient had a suspected recurrence (pelvic adenopathy on DWI). Of the 20 patients with rpsa between 0.2 and 0.5 μg/l, 4 (20%) patients had a suspected recurrence. Of the 20 patients with rpsa above 0.5 μg/l, 12 (60.0%) had a suspected loco-regional recurrence on MRI. In a further analysis, biochemical disease-free survival will be compared between patients with and without suspected macroscopic disease on MRI. Also, inter- and intra-observer variability for PTV delineation on CT vs. MRI will be compared. Conclusions: MRI, especially with diffusion-weighted sequences, can detect loco-regional disease in a substantial subset of patients with a biochemical recurrence after prostatectomy, especially when rpsa is above 0.5 μg/l. Undertreatment of these recurrences because of lack of MRI-based planning could explain some of the biochemical progression observed after salvage radiotherapy. EP163 MRI-guided high dose rate brachytherapy in the localized prostate cancer and the advantage to escalate the dose in the dominant intraprostatic lesion F. Mascarenhas 1, F. Marques 1, A. Guerra 2, A. Gaspar 2, M.F. Coelho 3. 1 Hospital Da Luz, Dept. of Radiation Oncology, Lisbon, Portugal; 2 Hospital Da Luz, Dept. of Imagiology, Lisbon, Portugal; 3 Hospital Da Luz, Dept. of Urology, Lisbon, Portugal Introduction & Objectives: High dose rate brachytherapy (HDRBT) combined with external beam radiotherapy (EBRT) is a good strategy to increase the biological effective dose and is now recognized as an effective means of dose escalation in the treatment of localized prostate cancer. The inclusion of MRI in the planning of brachytherapy allows an extreme accuracy to boost the dominant intraprostatic lesion (DIL). Our purpose is to present our methodology of MRIguided HDRBT, and to analyze the dosimetric goals for DIL and clinical target volume coverage, dose homogeneity and normal tissue constraints. Material & Methods: We retrospectively analyzed 8 patients with primary localized intermediate and high-risk prostate cancer consecutively undergoing to multiparametric MRI (mpmri) for diagnosis and staging. Brachytherapy included ultrasound guided-catheter insertion and the planning was based on rigid image fusion of staging mpmri, and postoperative T2 sequence MRI and CT imaging. The DIL, clinical target volume or prostate with 3mm margins, and normal tissues were contoured. Dosimetric parameters for DIL, CTV and normal tissues were analyzed. Results: The average prostate V100% and D90, DIL V120%, urethra D10 of the prescribed dose, urethra D0,1cc, bladder D2cc, and rectum D2cc have been assessed. The inclusion of MRI information allows to administer a synchronous integrated boost to the DIL while dose in the remaining prostate can be decreased keeping a substantial dose to guarantee high tumor control probability and simultaneously allows to spare the normal tissues. Conclusions: The planning treatment of HDRBT guided by mpmri image fusion with postoperative T2-sequence MRI and CT in localized prostate cancer is an attractive, effective and safe strategy for detecting and localizing cancer within prostate and to allow accurately dose escalation of the DIL without compromising the prostatic dose coverage and the sparing of the urethra, rectum and bladder. EP164 Audit of fiducial marker placement and utility in image guided prostate radiotherapy I.S. Bhattacharya, R. Hughes. Mount Vernon Cancer Centre, Dept. of Oncology, London, United Kingdom Introduction & Objectives: Markers are inserted prior to radiotherapy to allow image guided treatment. 3 single markers are inserted except for trial patients where 2 paired markers are used within our centre. There are no guidelines on the optimum separation between markers and what the acceptable proportion of usable markers is. The aim is to identify what proportion of markers are usable, compare single and double markers and measure the shifts performed. Material & Methods: Data on demographic details, usability of markers, shortest distances between markers and shifts applied, were collected on markers inserted between January and September Results: 113 patients had single markers inserted; these were not used in 13 patients. 7 patients had double markers inserted and all were used. In the 13 patients where markers were not used; 2 had changes of radiotherapy plan and 1 required CBCT to assess bladder filling. Markers were unusable in 10/13 patients; 4 had only 2 visible markers, 5 had inappropriately positioned markers either too closely related or positioned outside the gland and 1 of the markers moved during treatment. Table 1. Average distances between single markers on D1 and D19 AP distance 1 AP distance 2 PA distance 1 PA distance 2 Day ( ) 2.14 ( ) 0.98 ( ) 1.49 ( ) Day ( ) 2.13 ( ) 0.93 ( ) 1.43 ( ) Table 2. Average distances between paired markers on D1 and D19 AP distance 1 AP distance 2 PA distance 1 PA distance 2 Day ( ) 2.75 ( ) 0.82 ( ) 0.96 ( ) Day ( ) 2.71 ( ) 0.71 ( ) 0.98 ( ) Table 3. Shifts applied using single and double fiducial markers (cm) Average AP shift Average S/I shift Average R/L shift AP shift >0.5cm S/I shift >1cm R/I shift >1cm (n) (n) (n) Single markers Day (0 1.58) (0 1.69) (0 1.01) 0 D (0 1.33) (0 1.01) (0 0.8) 0 Double markers D ( ) (0 2.63) ( ) 0 D ( ) ( ) (0 0.5) 0 Conclusions: 10/113 (8.8%) markers were not used. Both types of marker allowed image guided radiotherapy however paired markers were more evenly distributed in the gland and may be more representative of prostate position. The majority of shifts applied were in anterior/posterior direction. This audit established a baseline of marker usability and implant technique. A switch to paired markers for all patients may allow better prediction of prostate motion and fewer unusable markers. Reductions in shifts may potentially allow us to reduce our margins. EP164A Post-nephrostomy sepsis and septic shock rate, predictive risk factors and ways of improving patient outcomes an audit S. Horsu. Counters of Chester Hospital, Dept. of Urology, Chester, United Kingdom Introduction & Objectives: Percutaneous nephrostomy is an accepted procedure for relief of acute renal tract obstruction complicated by sepsis. The Royal college of Radiology UK found (following nephrostomy audit), that sepsis was a major complication and the cause of all deaths. They therefore set combined major complication target of 5%-8%. Aim of this retrospective study is to determine proce-

101 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) dure related sepsis and septic shock rate, the causative organisms and antibiotics sensitivities, the predictive risk factors for septic shock and to design a multidisciplinary action plan for the management of such patients. Material & Methods: Data of sixty six patients who had nephrostomy over the period of 1/02/12 to 31/01/14 were collected in a retrospective study. For each patient only the first episode of the nephrostomy tube insertion within the period covered was included. Sepsis and septic shock were defined as in the international sepsis definition conference criteria. Patient notes including nursing records, observation charts, blood results were used to determine whether patient was septic or not. Nephrostomy was defined as any radiologically guided procedure for the insertion of percutaneous tube into the kidney for the purpose of draining it following obstruction of the urinary tract. Excel and SPSS were then used to analyse the data using descriptive statistics and odd ratio calculation was used to determine associations. Results: We found procedure related sepsis rate of 4.5%, septic shock rate 15%, haemorrhage requiring transfusion was 1.5% and mortality after septic shock was 1.5%. 3% of non-septic patients prior to procedure developed post procedure septic shock. Urinary calculi constitutes the most common cause of urinary tract obstruction (43%) then bladder cancer (17%), prostate cancer (17%), gynaecological cancer (8%) bowel cancer (4%). Vancomycin resistant E. coli colonization (VRE) (62.5%), urinary tract calculi (37.5%), diabetes mellitus (38.5%) and pre-procedural sepsis (40.0%) patients are more likely to develop post-procedural septic shock. Age appears to have no effect on severity of sepsis as patients affected were widely distributed. Patients with single kidney tends to have rapid deterioration though there was not enough data to make definitive statistical comment. All patients developing post procedure septic shock were on antibiotics prior to procedure and none received any additional prophylactic antibiotic. Only 3% (2) had prophylactic antibiotics. All had gentamycin and none developed septic shock. E. coli (21%) was the most isolated organism in the blood. The most effective and commonly used antibiotics were piperacillin tazobactam (58.7) and meropenem (10.9%) as second line. Conclusions: Septic shock is a major complication and indeed the most common cause of death following nephrostomy. It is more common in patients with VRE, urinary calculi, diabetes and those who have pre-procedural sepsis. Gentamycin prophylaxis should be given to all patients prior to nephrostomy. Multidisciplinary approach is required to improve patient outcome. The interventional radiologist, microbiologist and intensivist lead by the urologist must be involved readily in the management of such patients in other to improve their outcome. The intensivist must play a pivotal role in severe cases. EP165 Significant renal arteriovenous malformation in the context of a rare genetic disease: The Bannayan Riley Ruvalcaba syndrome A.D. Urbina Lima 1, A.B. Albano Del Pozo 1, J.J. Colombo Stenstrom 1, J. Murillo Mirat 1, A. Pijierro Amador 2, M.F. Manzanedo Bueno 1, E. Polo Alonso 1, J. Mariño Del Real 1, A.E. Alvarez Hodel 3. 1 Infanta Cristina Hospital, Dept. of Urology, Badajoz, Spain; 2 Infanta Cristina Hospital, Dept. of Internal Medicine, Badajoz, Spain; 3 Rio Hortega Hospital, Dept. of Family Medicine, Valladolid, Spain Introduction & Objectives: Vascular anomalies may be isolated lesions or be associated to some symptomatology, which may be a guiding sign or the main characteristic of a syndrome. Bannayan Riley Ruvalcaba Syndrome (BRRS) is a rare autosomical dominant disease in which the Phosphatase and Tensin Homolog (PTEN) gene anomaly is associated in 55 60% of patients clinically diagnosed. We report a case of a young male patient affected by arteriovenous malformation (AVM) in the context a BRRS. Material & Methods: 24 years old male with a history of intestinal polyposis, right gluteus and left forearm angioma, arrives at the emergency room with a month-long hematuria. Ultrasonography/CT angiography: tumoral formation in left kidney resembles vascular in origin, shows vessels of important caliber and an aneurismatic image in its inferior pole of mm, compatible with a vascular anomaly. There are 4 aorta-derived arteries nourishing the tumor and left kidney. The aneurismatic lesion communicates with the cava vein through the left renal vein. Cava vein presents increased lumen. Treatment: 1. Subsidiary left renal arteries embolization was made using a percutaneus access. 2. Control CT showed flow in the lesion no difference with previous exams. In light of these results, a left nephrectomy taking in the same piece the malformation and aneurism was performed. Results: Patient presents a satisfactory progress. Followed by internal medicine for treatment of multinodular goiter. Genetics department confirm the PTEN gene anomaly compatible with BRRS. Figure 1 Figure 2 Conclusions: Initial treatment of AVM requires embolization by an interventional radiologist. Surgery is a second alternative. The BRRS in a variety of rare syndromes are collectively known as Hamartoma Multiple Syndrome. First signs shown during pediatric age and young adulthood: macrocephalia, penile lentigines, thyroid disorders including thyroid cancer, gastrointestinal hamartomatous polips, lipomas and vascular anomalies mainly. In this case, we present an important challenge for an urologist, both in diagnosis and treatment alike for future patients, starting with a common symptom like hematuria and to have to branch out to a multidisciplinary management of these diseases. EP166 A retrospective study on the investigation of upper tract transitional cell carcinomas are we detecting enough cases? P. Kantachuvesiri, A. Mohammed, R. Parkinson. Nottingham City Hospital, Dept. of Urology, Nottingham, United Kingdom Introduction & Objectives: Upper tract transitional cell carcinomas (TCC) are relatively uncommon, but the diagnosis must not be missed. Majority of patients present with haematuria, both macroscopic and microscopic. The investigation of these patients plays a vital role in the diagnosis of upper urinary tract malignancy. The purpose of this

102 176 ABSTRACTS / EUROPEAN UROLOGY SUPPLEMENTS13 (2014) study was to investigate the effectiveness of different modalities such as ultrasonography (US) and i.v urography (IVU), to image the upper urinary tract to detect abnormalities in patients with urothelial cancers. This would potentially lead to the review of current pathways used to investigate patients with haematuria. Material & Methods: A retrospective study using electronic case notes of patients with histology proven upper tract TCC from 1998 to April Data on patient demographics, presentation and imaging of the upper urinary tract were collected and analysed. Results: A total of 148 upper tract TCC cases were recorded, 111 having presented with macroscopic haematuria. In these 111 patients, 76 had US as first line imaging of the upper tracts with 19 (25%) being normal (age range from 39 to 80). 45 patients had IVU (first and second line), only 2 (4.4%) were normal. Of the 18 patients with microscopic haematuria, 14 had US with 3 (21.4%) being normal (age range 47 to 86), 5 had IVU (first and second line) with 1 being normal. Overall a much lower proportion of upper tract TCC cases were missed by using IVU compared with US, 22.5% (n=23) vs. 3.4% (n=3) respectively. Simple patient risk factors, such as smoking, were poorly documented and therefore could not be analysed. Conclusions: A normal US scan cannot exclude upper urinary tract malignancy in haematuria patients. Further investigations such as IVU and CT urogram play a vital role in the haematuria pathways and must be incorporated appropriately. Patients with known risk factors for urothelial cancer need to be identified and may warrant more extensive investigation. EP167 A curiously large ureter: Imaging study of an incidental finding S. Ihsan 1, S.U. Khan 2. 1 Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, United Kingdom; 2 Basildon and Thurrock University Hospitals NHS Foundation Trust, Dept. of Radiology, Basildon, United Kingdom Introduction & Objectives: A 16 year old girl was being investigated for primary amenorrhoea. She had a pelvic ultrasound scan which revealed a tubular hypoechoic structure within the right lower quadrant, provisionally thought to be a hydrosalpinx an abdominal MRI scan was arranged for further study. The MRI incidentally revealed a dilated right distal ureter measuring cm which demonstrated an abrupt change to decreased calibre close to the ureterovesical junction, there was no significant past medical history. These dimensions are in keeping with a megaureter of which there are 3 main types: obstructing, refluxing and non-obstructing non-refluxing. Each of these subtypes may be congenital or acquired. The next steps were to classify the type of megaureter for which the patient underwent a series of imaging studies to establish the urodynamics and determine if there is reflux or obstruction at the site of the lesion. Material & Methods: Various imaging techniques were used to classify the structure of the ureter in this study. The patient underwent an intravenous urogram (IVU) with contrast at premicturition at 5 minutes, 10 minutes and 15 minutes and postmicturition for evaluation of the urodynamics in the ureter. To obtain real-time images of renal function and concluding if there was an obstruction or reflux at the lesion a dynamic Tc-99m MAG3 renogram was performed. CT urogram was not deemed suitable in this case due to the unnecessary dose of radiation in a young patient. Results: The IVU study demonstrated dilated pelvic calyces, an enlarged right ureter in keeping with the findings of the MRI scan, a transient hold up of the non ionic iodinated contrast in the right distal ureter but no absolute obstruction, to further evaluate a dynamic Tc- 99m MAG3 renogram was performed. The renogram demonstrated a hold up of the radiopharmaceutical in the right distal ureter, to determine if it was a truly obstructing megaureter, IV furosemide was administered after which there was a rapid fall in activity indicating that though there is transient hold up at the distal ureter, there was no absolute anatomical obstruction. Conclusions: This study beautifully illustrates how different imaging methods can be used to demonstrate different features of pathology, exclude and confirm features and function in both non-real time and real time to fully reach a diagnosis. It was a purely academic study to classify the subtype of megaureter in this patient in order to be able to provide the correct treatment and follow-up in the future if needed. EP168 Comparison of extracorporeal shock wave lithotripsy, ureterorenoscopy with YAG laser lithotripsy (URS), and percutaneous nethrolitholapaxy (PNL) methods for treatment of ureteral and kidney stones M. Kutluev, I. Pulin. Medservice, Dept. of Urology, Salavat, Russia Introduction & Objectives: The patients with renal or ureteral stones make up to 30 40% of the whole patient population of the urological departments. The first line of treatment has always been extracorporeal shock wave lithotripsy (SWL), but increasing number of residual stones motivates to improve the methods of lithotripsy. The establishment of new flexible and semi-rigid ureteroscopic devises enlarged the possibility to treat stones in any part of the kidneys or ureter to 92.2%. In comparison, the URS method showed to be less expensive as a first time treatment and had better patient outcomes. Objective: To determine the best clinical outcomes after SWL, URS and PNL in patients with ureteral and kidney stones. Material & Methods: A retrospective analysis was conducted of 251 patients with uretral and kidney stones in Medservis clinic. SWL was performed by using the devise Modulith SLX-F2 made by Storz Medical. URS was performed with YAG laser devise Auriga 3000, rigid ureterorenoscope and nephroscope made by Karl Storz company. Results: The sizes of stones were from 4 mm to 45 mm in the largest measurement (in average 10.3±1.6). Among 251 patients, there were 158 men and 93 women. Average age was 53.8±4.5 years. Kidney stones were discovered in 93 patients, proximal ureteral calculi in 35 patients, middle ureteral stones in 45 patients and the distal ureteral calculi in 78 patients (Figure 1). The total number of the procedures conducted was 347, SWL=182 (52.4%), URS=145 (41.8%), and PNL=20 (5.8%). The highest number of repeated procedure was after SWL 82 and maximum number of procedure was in one patient 5. The number of repeated procedures after initial URS-23 and PNL-5. Figure 1. Stone localization (%), total number = 251. Conclusions: 1. The employment of the newest methods of lithotripsy as a first line treatment allows to decrease the number of residual post-procedure calculi and prompt the status stone free. 2. Alternating SWL, URS and PNL in the completing treatment of the same patient minimizes his/her stress associated with the surgery, especially in the case of a large stones and difficult location.