1.ANTICANCER RESEARCH 31: 1807-1956 (2011)ABSTRACTS OF THE 21st ANNUALMEETING OF THE ITALIAN SOCIETYOF URO-ONCOLOGY (SIUrO) 22-24 June, 2011, Naples, Italy Terminal Napoli - Expo Palazzo dei CongressiMolo Angioino-Stazione Marittima, Naples, Italy Chair: Vincenzo Altieri Honorary Chair: Vincenzo Mirone Advisory Committee: Matteo FerroMariano Marsicano Vittorino Montanaro

2. Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, ItalyItalian Society of Uro-Oncology (SIUrO) President: Giuseppe Martorana, Bologna, ItalyScientific Secretariat` Societa Italiana di Urologia Oncologica (SIUrO) c/o Clinica Urologica, Alma Mater Studiorum ` Universita di Bologna, Policlinico S. Orsola-MalpighiPadiglione Palagi, via P. Palagi, 9 40138 BolognaTel: +39 051 6362421 051 302082 Fax: +39 051 308037 e-mail: congresso@siuro.it web: www.siuro.it Organizing SecretariatEmilia Viaggi Congressi & Meeting S.r.l. Via Porrettana, 76, 40033 Casalecchio di Reno (BO) Tel: +39 051 6194911 Fax: +39 051 6194900e-mail: evcongressi@emiliaviaggi.it web: www.emiliaviaggi.it Expo Napoli "Palazzo dei Congressi"Molo Angioino Stazione Marittima, Permanent Training Office Tel: +39 081 5514448 - Fax: +39 081 5514473e-mail: expo@terminalnapoli.it web: www.terminalnapoli.itReferees of AbstractsV. ALTIERI, Naples, ItalyN. LONGO, Naples, ItalyC.S. BALBI, Genova, ItalyM. MAFFEZZINI, Genova, ItalyA. BERRUTI, Turin, Italy D. MARCHIORI, Bologna, ItalyA. BERTACCINI, Bologna, ItalyF. MASSARI, Verona, ItalyE. BOLLITO, Orbassano, Italy C. ORTEGA, Turin, ItalyS. BRAVACCINI, Meldola, ItalyC. PATRIARCA, Milan, ItalyR. CECCARELLI, Bologna, ItalyP. PAVLICA, Bologna, ItalyR. COLOMBO, Milan, Italy V. SCATTONI, Milan, ItalyG. FELLIN, Trento, Italy G. SICA, Rome, ItalyM. FIORENTINO, Bologna, ItalyM.S. SQUEO, Turin, ItalyA. FORNARI, Turin, Italy V. VAVASSORI, Bergamo, ItalyB. JERECZEK, Milan, ItalyS. VILLA, Milan, ItalyA. LAPINI, Florence, Italy A. VOLPE, Novara, Italy 3. ANTICANCER RESEARCH 31: 1807-1956 (2011)1scarring was found in six biopsies. Discussion andOPTIMIZATION OF THE DETECTION RATE Conclusion: The clinical significance of residual prostaticIN THE DIAGNOSIS OF LOCAL RECURRENCE OFtissue in follow-up is most important since it can beDISEASE AFTER RADICAL PROSTATECTOMY: responsible for biochemical failure and can increase in size,PERIANASTOMOTIC SATURATION thus simulating a local recurrence (3). Although there was noBIOPSY SCHEMEevidence of a significant correlation between PSA levels and local recurrence, Gleason score and positive biopsy, the BTPLucio DellAtti1, Gianni Ughi1, Maurizio Simone2 and conducted in a standardized manner with eight biopsies inGian Rosario Russo1 patients with relapsed disease allowed the identification of the1U.O. Urologia Arcispedale "S. Anna", Ferrara, Italy;site of recurrence in 59% of cases, thereby significantly2Ospedale Del Delta Lagosanto (Fe), Italyincreasing the detection rate of the procedure. Further studies are needed, including a systematic execution of the BTP inBackground: Serial measurements of PSA level and digital patients with disease relapse after RP. This can be a valuablerectal examinations are the standard tools used to monitor and statistically significant aid in identifying the presence oftumor recurrence after radical prostatectomy (RP) (1). local recurrence in patients with prostate cancer.Anastomotic biopsy is indicated in patients with clinicallysuspected local recurrence, which of course cannot be1 Carroll P, Coley C, Mc Leood D et al: Prostate-specificdiagnosed only by serum PSA, digital rectal examination or antigen best practice policy. Part II. Prostate cancer stagingimaging techniques (2). This study evaluated the optimizationand post-treatment follow-up. Urology 57: 225-229, 2001.of the detection rate using a perianastomotic biopsy transrectal 2 Minardi D, Galosi AB, DellAtti L et al: Detectable serumultrasound scheme with eight biopsies in the diagnosis of localPSA after radical prostatectomy. Clinical and pathologicalrecurrence in patients with prostate cancer who underwent RP relevance of perianastomotic biopsies. Anticancer Res 24:compared to four or six conventional standardized biopsies.1179-1185, 2004.These results were also related to the levels of PSA and 3 Sella T, Schwartz LH, Swindle PW et al: Suspected localGleason score. Patients and Methods: Between July 2007 and recurrence after radical prostatectomy: endorectal coil MRFebruary 2010, we evaluated 42 patients (range 56-74 years)imaging. Radiology 231(2): 379-385, 2004.who underwent consecutive RP (34 with the open techniqueand 7 with the laparoscopic technique) with recovery ofbiochemical disease (PSA>0.2 ng/ml). The pathologic stages 2of patients were: 18 with pT2, 23 with pT3 and 1 with pT4, THE RELATION BETWEEN OBESITY ANDrespectively. All patients had negative lymph nodes and only PROSTATE CANCER: THE ROLE OFone patient with pT4 disease had positive surgical margins.ABDOMINAL OBESITY AND BODY FRAMEThe staging examinations carried out at biochemical Cosimo De Nunzio1, Roberto Miano2, Luigi Schips3,recurrence (chest radiography, abdominal CT and Luca Cindolo3, Riccardo Autorino4, Francesco Esperto1,scintigraphy) were negative. All patients with a suspected local Hassan Fattahi1, Andrea Cantiani1,recurrence underwent rectal examination and transrectal Simone Albisinni1 and Andrea Tubaro1ultrasound-guided biopsy perianastomotic transrectalultrasound (BTP) using a G.E. ultrasound (LOGIQ 7) with an 1Departmentof Urology, SantAndrea Hospital, Universityend-fire multi-frequency convex probe under local anesthesia "La Sapienza", Rome, Italy;with lidocaine spray (10 g/100 ml). Results: Patients were 2Deparment of Urology, Policlinico Tor Vergata, Universitydivided into two groups. Group A: Twenty-five patients with"Tor Vergata", Rome, Italy;mean PSA 2.6 ng/ml, who were subjected to BTP: 11/25 3Urology, Ospedale Padre Pio da Pietrelcina, Vasto (CH),(44%) and 14/25 (56%) respectively with four and six Italy;biopsies. Group B: Seventeen patients with mean PSA 1.94Clinica Urologica, Seconda Universit degli Studi ding/ml who underwent the standard eight biopsies. Among Napoli, Napoli, Italypatients in the latter group, three had already undergone fourbiopsies. One patient belonging to Group B did not completeBackground: A possible relationship between obesity evaluatedthe entire biopsy procedure because of discomfort. In the firstby body max index (BMI) and prostate cancer aggressivenessgroup, there were no signs of local recurrence in 9/25 (36%),has been demonstrated in several studies, mostly in patientwhile in 16/25 (64%) local recurrence was found in three series from the USA and confirmed by our group. However,biopsies. In Group B: 10/17 (59%) patients were found to havethe use of BMI presents several limitations in defining the typerelapsed prostate cancer, whereas under biopsy, 7/17 (41%) of obesity and alternative measures have been proposed. Thepatients were found to have prostate tissue. Fibrous tissue andaim of our study was to investigate the association between0250-7005/2011 $2.00+.401811 4. ANTICANCER RESEARCH 31: 1807-1956 (2011)abdominal obesity (AO), body frame (BF) and prostate cancer Background: Prostate cancer (PCa) and androgens have anrisk and grade in a group of patients scheduled for prostateunclear interrelationship. Some data suggest that low totalbiopsy. Patients and Methods: From 2008 onwards, 751testosterone levels may enhance tumor aggressiveness, whileconsecutive men undergoing 12-core prostate biopsy at three data on free testosterone remain controversial. We analyzedcenters in Italy were enrolled to the study. Indications for aserum androgen concentrations in men who underwent initialprostatic biopsy were PSA4 ng/ml and/or a positive digital prostate biopsy, focusing on the free (fT) to total testosteronerectal examination (DRE). BMI, as well as waist and hip (T) ratio (fT/T) as a predictor of the risk for low- and high-circumference, were measured before biopsy. BF was definedgrade PCa. Patients and Methods: Between 2006 and 2010, weas small up to a wrist circumference of 191 mm. AO wascollected data on 812 Caucasian Italian men with no history ofdefined as a waist circumference >102 cm. Results: Out of 711 PCa who underwent 12-core biopsy. Digital rectal examinationmen, 273 (38%) were diagnosed with cancer on biopsy. The(DRE), body mass index (BMI), prostate volume, PSA, T andmedian age was 68 years, PSA 6.2 ng/ml, BMI 27.6 kg/m2 andfT were measured on the day of biopsy. The fT/T ratio waswaist circumference 102 cm. According to BMI measurement, computed by dividing free testosterone by total testosterone. T,153 men (21%) were obese. According to waist circumference, fT and fT/T were examined as continuous variables. Crude and319 (44%) men presented with AO. Large, medium and smalladjusted multinomial logistic regressions were performed toBF were observed in 89 (13%), 479 (67%) and 143 (20%) assess the association between T, fT, fT/T and the outcomes ofmen, respectively. No significant differences between age,low- (Gleason 6) and high-grade PCa (Gleason 7), bothprostate volume, PSA, BMI, waist and wrist circumferences,relative to the absence of cancer. Multivariate analyses wereand prostate cancer incidence and Gleason score distributionadjusted for age, PSA, BMI, prostate volume and DRE. Thewere observed among the three centers. Out of 273 men withfT/T ratio was also examined using tertiles to evaluate the riskprostate cancer, 149 (55%) had Gleason score 6 (65 (43%)in different fT/T ranges. Results: Overall cancer detection waspresented with AO) and 124 (45%) a Gleason score 7 (68 40% (321/812): 136 men had low-grade and 185 men had(55%) presented with AO). On univariate analysis, waist high-grade PCa. Age, PSA, DRE, prostate volume and BMI allcircumference (median value 101 cm in benign disease and 102showed a significant difference in distribution across the threecm in cancer, respectively) was not significantly associatedoutcome clusters (all p0.001). The fT/T distribution alsowith prostate cancer diagnosis (p=0.12). Among men with differed significantly across the outcome groups (p=0.017). Oncancer, higher waist circumference (median value for Gleasonmultivariate analysis, T (p>0.11) and fT (p>0.45) were notscore 6 was 102 cm and for Gleason score 7 was 104 cm, significantly associated with low- or high-grade PCa. Instead, arespectively) on univariate (p=0.029) and multivariate analysis higher fT/T ratio was a significant predictor of high-grade PCa(p=0.04) was associated with high-grade disease (Gleasonon both crude (p=0.01) and multivariate (p=0.02) analysis. Noscore 7). BF evaluation was not associated with prostate significant association was found with low-grade PCa (p0.38).cancer diagnosis (p=0.79) or high-grade disease (p=0.24). The tertile analysis demonstrated a two-fold increased riskDiscussion and Conclusion: Among men undergoing prostate(OR=2.04, 95% CI=1.23-3.37, p=0.005) of high-grade PCa forbiopsy in different centers in Italy, our study confirmed that AO patients in the highest fT/T tertile relative to the lowest tertile.is associated with high-grade disease. However, further studies Discussion and Conclusion: In Caucasian Italian men, a higherin a large patient population across multiple institutions andfT/T ratio significantly predicts against increased risk of high-countries are needed to confirm our results and to allow us tograde PCa on initial prostate biopsy. Men in the highest fT/Tbetter understand which precise factors related to obesity aretertile have a greater than two-fold increased risk of high-graderesponsible for the observed increase in high Gleason score disease compared to men in the lowest tertile. This studytumors. provides evidence that a high fT/T ratio (i.e. high percentageof free testosterone) rather than absolute androgen levels maybe associated with high-grade PCa. Nevertheless, the5 relationships between PCa and androgens remain complex andANDROGEN LEVELS AND HIGH-GRADEfurther studies are needed to confirm our findings.PROSTATE CANCER: FREE TO TOTALTESTOSTERONE RATIO ANALYSISSimone Albisinni1, Cosimo De Nunzio1, Andrea Tubaro1, 6Lionel Banez2 and Stephen J. Freedland2 PROSTATE BIOPSY ACCURACY: ANALYSIS1Sant Andrea OF 20- VERSUS 12-CORE TEMPLATESHospital, University "La Sapienza", II Schoolof Medicine, Department of Urology, Rome, Italy;Cosimo De Nunzio1, Luca Cindolo2, Cristina Avitabile1,2Duke University School of Medicine, Department ofAndrea Cantiani1, Alfonso Carluccini1,Surgery, Division of Urologic Surgery, Durham, NC, U.S.A. Andrea Tubaro1 and Luigi Schips21812 5. Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy1Department of Urology, Ospedale SantAndrea, UniversityDiscussion and Conclusion: This study shows that increasingLa Sapienza, Rome, Italy; the number of biopsy cores is not associated with an increase2Ospedale Padre Pio da Pietrelcina, Vasto (CH), Italy in prostate biopsy performance in the detection of prostatecancer. These data suggest that the standard number of coresBackground: Transrectal prostatic biopsy is considered theto be used in the first set of biopsies is still to be determined.standard procedure for the diagnosis of prostate cancer. Inrecent years, sextant biopsy schedule has been replaced bynew strategies consisting of sampling at least ten sites in the 7prostate; however, a standard number of cores is still to beBONE SCAN IN NEWLY DIAGNOSEDagreed upon. The aim of our study was to evaluate and PROSTATE CANCER: EXTERNAL VALIDATIONcompare the impact of two different biopsy templates for theOF A NOVEL RISK STRATIFICATION TOOLdiagnosis of prostate cancer. Patients and Methods: FromCosimo De Nunzio1, Costantino Leonardo2,December 2008 to September 2010 all patients referred toAndrea Cantiani1, Giovanni Simonelli2, Carlo De Domincis2,our prostate clinics with a PSA value of more than 4 ng/mlAlfonso Carluccini1, Aldo Brassetti1 and Andrea Tubaro1or an abnormal digital rectal examination (DRE) wereconsecutively scheduled for their first TRUS prostatic biopsy 1Department of Urology, SantAndrea Hospital, Universitywith a 12- or a 20-core template, respectively. Patients with "La Sapienza", Rome, Italy;a PSA >30 ng/ml were excluded from the series. Prostate 2Department of Urology, Policlinico Umberto I, Universitybiopsy was carried out as an outpatient procedure. Antibiotic "La Sapienza", Rome, Italyprophylaxis by means of levofloxacin 250 mg b.i.d. wasstarted 48 h before the procedure and continued for 72 hAim: To externally validate and test the performanceafter. All patients underwent a TRUS-guided biopsy using acharacteristics of a novel risk stratification tool recentlyFalcon ultrasound instrument (B-K Medical, Milan, Italy)proposed by Briganti et al. (1) regarding the need for baselineequipped with a 5-10 MHz bi-convex probe (8808 probe; B-staging bone scans in patients with newly diagnosed prostateK Medical). A 16-gauge biopsy needle (Magnum 1000;cancer. Patients and Methods: From 2009 onwards, aBARD, Rome, Italy) and a dedicated spring-loaded biopsy consecutive series of patients with a diagnosis of prostategun (MG1522; BARD) were used. Periprostatic anestheticcancer were enrolled to the study. Indications for prostaticblock was performed for each patient 10 min before thebiopsy were a PSA 4 ng/ml and/or a positive digital rectalbiopsy. Differences in cancer detection rate were evaluated.examination (DRE). All patients were staged withOne-way ANOVA and Chi-square were used as appropriate conventional total-body 99mTc MDP scintigraphy, performedfor statistical analysis. Results: A total of 550 patients were regardless of baseline prostate cancer characteristics. Theconsecutively enrolled. The mean age was 69.67.4 years,presence of skeletal metastasis (BM) on bone scan wasmean body mass index (BMI) was 27.43.8 kg/m2, the mean defined when either solitary or multiple asymmetric areas ofPSA value was 8.36 ng/ml and the mean prostatic volume increased tracer uptake occurred. Patients with positive orwas 4526 ml. 275 patients underwent a 12-core biopsy equivocal bone scan findings also underwent computed(group A) and 275 a 20-core biopsy (group B). A total of 69 tomography and/or magnetic resonance imaging to confirm(25%) patients presented with a positive DRE in group A and the scintigraphy findings. No patient was on hormonal therapy73 (26%) patients in group B (p=0.77). No significant at the time of the staging imaging. The AUC estimates weredifferences for age, BMI, PSA, prostate volume and prostate used to test the accuracy of the novel risk stratification toolcancer detection rate were observed between the two groups(the regression tree (CART)) proposed by Briganti which(see Table I). No significant complications requiring recommended staging baseline bone scan for patients with ahospitalization were observed in both groups. biopsy Gleason score >7 or with a PSA >10 ng/ml andpalpable disease (cT2/T3) prior to treatment. The new tool wasTable I.compared to the EAU guideline. The specificity, sensitivity,positive and negative predictive values of each model were 12-Core 20-Corep-Valuealso calculated Results: A total of 313 patients were templatetemplateconsecutively enrolled. The median age was 68 (range 49-95Age (years) 67.77.9 66.38.30.51 years), median PSA was 7 ng/ml (range 0.81-2670 ng/ml);BMI (kg/m2) 26.93.5 27.65.90.11 median prostatic volume was 40 cc (range 10-189 cc). A totalPSA (ng/ml)7.24.685.30.07 of 20 (6.4%) patients presented with BM at the bone scan. OfProstate volume (cc)52.4244829 0.06 these patients, all presented at least a PSA30 ng/ml; 8Prostate cancer rate 119/275 (43%) 96/275 (35%)0.06 patients (40%) had a Gleason score 7, and 12 (60%) had aGleason score >7; 10 patients (50%) presented with palpable1813 6. ANTICANCER RESEARCH 31: 1807-1956 (2011)Table I. Bone scans performed Rate of BM within OverallSensitivity Specificity NPV PPVusing the EAU the recommendedaccuracy (%) (%)(%) (%)and CART, patient group, (%)n (%) % (n)EAU151/313 (48%)9.9% (15/151)64%75% 54%97% 11%CART 90/313 (29%) 16.6% (15/90)75%75% 74%98% 16%disease. The AUC for the EAU guidelines was 0.64 (CI: 0.52- evaluated (from January 2008 to December 2010). Pathology0.761). However, the novel CART model was significantly review evaluated the number of tumor foci, overall Gleasonmore accurate (AUC: 0.75; CI: 0.632-0.859, p=0.001) than thescore (GsS), Gleason score (GsF), tumor volume (TTV),EAU guideline (p