1943AGE AT SURGERY IS THE MOST IMPORTANT PATIENTINHERENT RISK FACTOR FOR LONG-TERM URINARYLEAKAGE AFTER RADICAL PROSTATECTOMY

Andreas Nilsson*, Martin Schumacher, Stefan Carlsson, GunnarSteineck, Peter Wiklund, Stockholm, Sweden

INTRODUCTION AND OBJECTIVES: Conflicting results existregarding risk factors for long-term urinary incontinence after radicalprostatectomy (RP). The objective of this study was to assess patientspecific risk factors associated with long-term urinary incontinence afterRP for both open retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RARP).

METHODS: A consecutive series of 1418 patients were iden-tified, questioners were obtained for 1288 patients (91 %) of which1179 had a follow up exceeding at least one year, median 2.2 years.Data regarding co-morbidity, medical history and body mass index(BMI) was collected from the questioner. Clinical data was collected ina prospective manor. All patients underwent RP for prostate cancer. Inthe cohort there were 411 RRP and 768 RARP cases. When comparingcategories, we calculated the relative risk as the ratio of percentages,together with the 95 percent confidence interval.

RESULTS: Age at surgery was a strong predictor for urinaryleakage after RP, with a risk increase of 6.5 % annually. An increasedrisk of urinary incontinence was seen after salvage radiation therapyand in patients with respiratory disease, age adjusted RR of 2.5 (95 %CI 1.6-3.8) and 2.4 (95 % CI 1.3-4.4) respectively. Clinical stage T3 hadan increased risk for incontinence with an age adjusted RR of 2.1 (95%CI 1.2-3.7). No association between long-term urinary incontinenceand BMI, prostate weight, diabetes or previous transurethral resectionof the prostate was observed. No risk factors could be identified asspecific for either RARP or RRP, but the prevalence of urinary incon-tinence was higher after RRP compared to RARP in this cohort. Thestudy includes patients operated from 2002 and the results obtainedmay not reflect current surgical technique or current patient series.

CONCLUSIONS: The risk of acquiring long-term urinary incon-tinence after RP is strongly related to patient age at surgery. Thisfinding may help urologists in guiding patients between intervention andactive monitoring if indicated.

Source of Funding: None

1944PROSPECTIVE RANDOMIZED TRIAL TO EVALUATE THEINFLUENCE OF THE BLADDER NECK SUSPENSION ON EARLYCONTINENCE AFTER RADICAL PROSTATECTOMY.

Jens-Uwe Stolzenburg*, Leipzig, Germany; Panagiotis Kallidonis,Patras, Greece; Martin Nicolaus, Anja Dietel, Minh Do, Tim Haefner,Leipzig, Germany; Evangelos Liatsikos, Patras, Greece

INTRODUCTION AND OBJECTIVES: The aim of this prospec-tive randomized trial was to evaluate the influence of the bladder necksuspension (BNS) on early continence after endoscopic extraperitonealradical prostatectomy (EERPE).

METHODS: Totally, 180 patients underwent EERPE. Group 1included patients that underwent nsEERPE (n�45) while Group 2included patients that underwent nsEERPE with bladder neck suspen-sion (BNS, n�45). Groups 3 (n�45) and 4 (n�45) included patientsthat were operated by EERPE and EERPE with BNS, respectively.Random inclusion of patients regarding BNS or not technique wasperformed. Perioperative parameters were recorded. Continence wasevaluated by the measurement of number and weight of pads (pad-test) on the second day after catheter removal (7th postoperative day)as well as at 3 months postoperatively by questionnaire.

RESULTS: On the second day after catheter removal 11.1% ofpatients in Group 1 were continent, 11.1% of Group 2, 4.4% of Group

3 and 8.9% of Group 4. Average urine loss was 80.4grs, 70.1grs,324grs and 291 grs for the above groups respectively. An averagenumber of pads used by the patients of the above groups was 3.53,3.69, 6.51 and 5.87, respectively. At 3 months, 76.5% of Group 1 while81.25% in Group 2 was continent. The respective figures for Group 3and 4 were 48.5% and 43.8% respectively. Similar positive marginrates were observed in all groups.

CONCLUSIONS: Despite different reports in literature earlycontinence was never observed to be significantly higher in the BNSgroup in comparison to the non BNS group regardless of the EERPEtechnique performed. Further clinical evaluation for the introduction ofa technique providing early continence after radical prostatectomy isdeemed necessary.

Source of Funding: None

1945ASSOCIATION BETWEEN BODY MASS INDEX AND PERCENTTUMOR VOLUME IN PATIENTS WITH PROSTATE CANCER,UNDERGOING ROBOTIC RADICAL PROSTATECTOMY

Nilesh Patil*, Sanjeev Kaul, Akshay Bhandari, James Peabody, ManiMenon, Detroit, MI

INTRODUCTION AND OBJECTIVES: The association ofhigher body mass index (BMI) with aggressive prostate cancer is wellestablished. However the pathogenesis of this association is as yetunknown. Our aim was to evaluate the association between BMI andpercent tumor volume (TV) involved in the final pathology specimen inpatients undergoing robotic assisted radical prostatectomy (RP)

METHODS: From October 2001 to October 2007, 3327 pa-tients underwent RP. Information on age, pre-operative PSA, BMI, TVand prostate weight was retrieved from a prospectively maintaineddatabase. The pathology specimens were weighed and whole mountsections were analyzed. The slides with identifiable cancer were high-lighted. A visual inspection of these slides was carried out and anaverage percentage of area involved in cancer was estimated by thepathologist. Patients were grouped in six categories based on BMI i.e.�24.9, 25-29.9, 30-34.9, 35-39.9 and �40. BMI was evaluated for itsassociation with TV, prostate weight and PSA using analysis of vari-ance (ANOVA).

RESULTS: The number of patients in each group classifiedaccording to BMI �24.9, 25-29.9, 30-34.9, 35-39.9, �40 were 678,1723,742,148 and 36 respectively. Mean age in each of these catego-ries were 60.7, 60.5, 60.1, 59.2, and 59.4 respectively (Table1).MeanPSA was 5.7, 6.3, 6.4, 6.1 and 5.2 respectively. Mean prostate weightwas 45.8, 49.2, 50.9, 50.8 and 49.9 respectively. In this patient cohort,as the BMI increased the tumor volume (Fig.1.) increased synchro-nously (p�0.0006).

CONCLUSIONS: This study demonstrates a correlation be-tween percent tumor volume on final pathology and BMI. Larger per-centage of tumor volume may possibly be contributing to the aggres-sive nature of the disease in men with higher BMI.

Table1.Patient perioperative characteristics based on BMIBMI�24.9 BMI25-29.9 BMI 30-34.9 BMI 35-39.9 BMI �40

N 678 1723 742 148 36

MeanAge(yrs) 60.7�7.7 60.5�7.2 60.1�6.9 59.2�6.5 59.4�7.5

MeanPSA (ng/ml) 5.7�4.1 6.3�4.7 6.4�4.6 6.1�5.2 5.2�1.6

Mean Tumorvol (%) 15.6�12.7 16.8�13.3 18.1�14.1 19.6�13.9 20�11.9

Mean Prostatewt.(gm) 45.8�17.37 49.2�20.1 50.9�20.4 50.8�21.7 49.9�20

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Source of Funding: None

1946INVERSE CORRELATION BETWEEN PROSTATE SIZE ANDPOSITIVE SURGICAL MARGINS IN ROBOT ASSISTEDLAPAROSCOPIC PROSTATECTOMY AND RADICALRETROPUBIC PROSTATECTOMY

Adeep Thumar*, Thenappan Chandrasekar, Franklin Lee, StefanieLappe, Peter McCue, Costas Lallas, Leonard Gomella, EdouardTrabulsi, Philadelphia, PA

INTRODUCTION AND OBJECTIVES: RALP has been com-pared to RRP in terms of oncological outcomes. We hypothesized thatprostate size may be an inverse predictor of positive surgical margins(PSM)

METHODS: We retrospectively examined our departmental,IRB approved, database of radical prostatectomy procedures per-formed by several surgeons from 2001-2009. A total of 600 RALP and397 RRP patients were reviewed. Pathological reports yielding pros-tatic weight in grams was identified in 565 RALP patients and 355 RRPpatients. A standard whole mount, step sectioned pathologic evaluationwas used for all patients. Statistical analysis was conducted using theStudent’s t-test and chi-square statistical models.

RESULTS: The mean and median prostate weight for RALPwas 41.0g and 37g, and for RRP was 44.2g and 39g, respectively(p�0.15). For the RALP cohort, PSM was lower for prostate weights�40g than �40g, 17.6% (43/245) vs 29.0% (93/320), respectively(p�0.002). When examining higher prostate weights, this inverse as-sociation was maintained with PSM rate for glands �50g vs. �50g:11.5% (15/130) vs. 27.9% (121/435), respectively (p�0.0001); and forprostate sizes �60g vs �60g: 13.1% (8/61) vs. 25% (128/504), respec-tively (p�0.03). When examining organ confined disease (pT2), thePSM for larger prostates (�40g) were lower than prostates �40g: 9.3%(18/193) vs. 24.0% (63/263), respectively (p�0.0001); for even largerprostates (�50g), the PSM rate was similarly improved: 6.6% (7/106)vs. 21% (74/350), respectively (p�0.0001). Conversely, for pT3/T4disease prostate weight had no association with PSM in RALP patients.For the RRP cohort, larger prostate size (�40g) was similarly associ-ated with a significantly lower PSM: 10.7% (18/167) vs. 22.4% (42/145), respectively (p�0.003),. Examining pathologic stage for RRP,prostate size �40g in pT2 patients had lower PSM than prostates�40g: 6.4% (9/140) vs. 14.5% (20/138), respectively (p�0.03).Similarlyfor RRP, pT3/4 had no association between prostate size and and marginstatus.

CONCLUSIONS: Prostate size is inversely associated withPSM for both RALP and RRP. Prostate size greater than 40g are at alower risk of PSM with either technique. The benefit for PSM for eachtechnique appears to be present only for organ confined disease (pT2),with no significant association between prostate size and PSM forpT3/4 patients with either technique.

Source of Funding: None

1947AFRICAN-AMERICAN RACE IS AN INDEPENDENT PREDICTOROF PROSTATE CANCER SPECIFIC DEATH AFTER PSARECURRENCE

Jorge Caso*, Ping Tang, Matvey Tsivian, Vladimir Mouraviev,Thomas Polascik, Judd Moul, Durham, NC

INTRODUCTION AND OBJECTIVES: The effect of African-American (AA) race on cancer specific death following radical prosta-tectomy is unclear. We sought to evaluate race as a predictor ofprostate cancer specific mortality (PCSM) in men who experienced aprostate specific antigen (PSA) recurrence following surgery.

METHODS: We queried our prostate cancer database for menwho had undergone radical prostatectomy and had experienced a PSArecurrence. Men were divided by race into AA and non-AA. For PSArecurrence, a PSA level of � 0.2 ng/mL had to be recorded followingradical prostatectomy. A multivariate Cox proportional hazard modelwas used to determine which variables were associated with deathfrom prostate cancer. Kaplan-Meier and log rank tests were used toassess significant differences in PCSM between groups.

RESULTS: 406 men were identified with a PSA recurrence.After a median follow up of 7.8 years, and with a median time to PSArecurrence of 1.0 years, there were 22 (5.4%) deaths from prostatecancer. On multivariate analysis, using the variables of age, preoper-ative PSA, race, pathologic tumor stage, pathologic Gleason score,seminal vesicle invasion, extracapsular extension, and surgical mar-gins, it was found that AA race was significantly associated with anincreased rate of PCSM.

CONCLUSIONS: AA race appears to be an independent pre-dictor of PCSM following PSA recurrence. This may prove useful instratifying risk and offering more aggressive therapy if there is a PSArecurrence following radical prostatectomy. Our finding that AA racewas independently associated with cancer-specific death raises furtherquestions as to whether this finding is due to a biologic basis or whetherenvironmental and behavioral factors, such as suboptimal follow up,treatment during recurrence, or factors such as diet and obesity impactthe progression of the disease.

Source of Funding: Supported by research funds from theCommittee for Urologic Research, Education, andDevelopment (CURED) of Duke University.

1948THREE YEAR POSTOPERATIVE PSA FOLLOWING OPENRADICAL RETROPUBIC PROSTATECTOMY (ORRP) IS APREDICTOR FOR DELAYED BIOCHEMICAL RECURRENCES(BCR)

Rena Malik*, Judith Goldberg, Samir Taneja, Herbert Lepor, NewYork, NY

INTRODUCTION AND OBJECTIVES: Several preoperativeand postoperative parameters independently predict BCR followingradical prostatectomy (RP). The objective of the present is to determineif the three year postoperative PSA measurement predicts subsequentBCR after ORRP.

METHODS: Between the years 2000 to 2006, 1197 men un-derwent ORRP by a single surgeon. Men with a PSA level �0.2 ng/mlor those who underwent salvage radiation therapy following at least 3consecutively rising PSAs were categorized as BCRs. Serum PSAlevels were routinely measured 3,6,12,18,24,30 and 36 months follow-ing ORRP and then annually. Additional PSA levels were obtained ifclinically indicated. 956 evaluable men did not experience BCR 3 yearspostoperatively. Men were stratified into three groups based on theirPSA at three years: Group 1 PSA �0.01 (n�496); Group 2 PSA0.01-0.04 (n�297), and Group 3 PSA�0.04 (n�163). Delayed BCRrepresented those men who developed a BCR after 3 years of follow up.

RESULTS: BCR free survival rates for Groups 1, 2 and 3 were99.8%, 99.0%, and 90.1%, respectively (p �0.001). Using a univariateCox proportional hazards model, preoperative and postoperative Glea-

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