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p> 0.05). However, there was a significant correlation between the decrease inpercentage of pyriform defects following repair with subsequent improvement inthe seminal parameters of sperm/ml and motile sperm/ml (p= 0.002, p=0.025,respectively).

CONCLUSIONS: Although there is no significant difference between thepercentage of pyriform sperm in subfertile men with and without varicoceles,patients who have a greater decrease in pyriform defects following varix repairwere more likely to show improvements in their other seminal parameters ofsperm/ml and motile sperm/m\.

Source of Funding: None.

Prostate Cancer: Localized (II)Moderated Poster

Wednesday, April 30, 2003 10:00 AM·12:00 PM

1705SIGNIFICANCE OF THE CRANIOCAUDAL DISTRIBUTION OFCANCER IN RADICAL PROSTATECTOMY (RP) SPECIMENSJunichiro Ishii ", Houston, TX; Makoto Ohori, Michael W Kattan, Peter TScardino, Toshiki Tsuboi, New York, NY; Kevin M Slawin, Thomas MWheeler, Houston, TX

INTRODUCTION AND OBJECTIVE: To understand the differences andpotential significance of the distribution of prostate cancer(PCa) in the craniocaudaldimension.

METHODS: We studied the 1253 patients with clinically localized Pea treatedwith RP by two surgeons from 1983 - 2000. Total tumor volume of each cancer oneach whole mount RP section was determined by a planimetric method and thelocation of largest Pea was assigned to the apex (distal 2 sections), mid and base(proximal 2 sections). The results were compared with other establishedpathological features and PSA non-progression rate. Median follow-up was 47(1­201) mo.

RESULTS: Of the 1253 patients, 456 (36%) had a largest cancer in apex,728 (58%) in mid and 69 (6%) in base. The cancers in apex appeared to be lessinvasive compared to those at mid or base because of lower frequency ofextracapsular extension (27% vs, 43/52%) and/or seminal vesicle invasion (5%vs. 13120%). Also, clinically indolent cancers (a confined tumor < 0.5 cc withno Gleason pattern 4 or 5) were more likely to be located in apex (20%)compared to 12% of the patients with cancer in mid or base (p<.0005).However, the frequency of Gleason score> =7 cancer was not different amongthe patients with a cancer at apex, mid or base. The largest cancers in apex weremore likely to be located in the transition zone (26%) compared to 17% and13% of cancers in mid or base (p< .0005), although this significancedisappeared when only patients with clinical stage TIc were assessed. Themedian of total tumor volume for patients with apex cancer was 1.16 cc whichwas significantly smaller than 2.11 cc of patients with mid cancer (p<.00005)and was similar to 1.3 cc of patients with base cancer (p =. 16). The frequencyof largest cancer at apex has significantly increased over the time, from 23%before 1990 to 46% after 1995 (p< .OOI). PSA non-progression rate at 10 yearsfor patients with apex cancer was 83%, which appeared to better than 76% and77% of patients with a cancer at mid or base (p= .028 and p= .13, respectively).However, the craniocaudal distribution of cancer was not significant in amultivariate analysis when other establi shed pathologic parameter s werecontrolled.

CONCLUSIONS: PCa dominant at apex appears to be less aggressivecompared to those in mid or base of the prostate. Although the craniocaudaldistribution of cancer was not significant in a multivariate analysis of a prognosis,this knowledge may be useful in understanding the biology of Pea or in how todevise the best way to target the prostate to maximize the detection of cancer.

Source of Funding: None.

1706PREDICTING THE RISK TO DEVELOP PERIOPERATIVECOMPLICAnONS IN MEN UNDERGOING RADICALRETROPUBIC PROSTATECTOMY (RRP) Axel Heidenreich,Andres Schrader", Vanessa Knarr, Rainer Hofmann, Marburg, Germany

INTRODUCTION AND OBJECTIVE: RRP represents the standard curativeapproach in patients with clinically localized prostate cancer. It is well known thatcomorbidities in patients undergoing radical oncological surgery have a significantimpact on perioperative complications and mortality. However, only a few data areavailable on the influence of associated cornorbidities on surgical outcome in PCApatients. Aim of our study was to evaluate the clinical utility of a simple scoring

system known as Physiological and Operative Severity Score for the enUmerationof Mortality and Morbidity (POSSUM) to predict perioperative complications inmen undergoing RRP.

METHODS: Perioperative mortality and morbidity was evaluated in 614consecutive men undergoing RRP using the POSSUM scoring system and the ASAclassification. The predicted risk of mortality and morbidity was calculated for eachpatient using a validated equation. 6 concomitant diseases (cardiac insufficiency,hypertension, diabetes, cardiac arrhythmia, COPD; renal insufficiency) wererecorded and compared to the frequency of perioperative mortality and morbidity.Significance was assessed using the Chi-square test.

RESULTS: 318 (51.8%) pts were classified A SA 2, 275 (44.8%) and 21 (3.4%)were ASA 3 and ASA 4, resp. There was no perioperative mortality among the 614pts. Increasing ASA score correlated significantly with the frequency ofperioperative card iopulmonary complicat ions (4.9%, p=O .00 2) and thedevelopment of deep wound dehiscence (2.8%, p=0.03) which also correlated withthe mean body mass index (BMI) (p=O.OI). The pre-existence of cardiovasculardisease (12.2%, p=O.Ol), renal insufficiency (8.5%, p=O.03) and arterialhypertension (27.8%, p=0.03) was significantly correlated with the occurrence ofperioperative complications. POSSUM scoring system correlated significantly withthe occ urrence of postop. compli cations (p =O.OOOS), cardiopulmonarycomplications (4.9%, p=O.003) and pcrioperative bleeding (2.4%, p< O.0005).POSSUM accurately predicted perioperative morbidity using a cut-off level of 20(1'<0.0001) .

CONCLUSIONS: POSSUM scoring system accurately predicts the risk for thedevelopment of perioperative complications following RRP. The scoring systemonly requires the results of basic screening investigations. Based on the presence ofa high or low score patients with PCA might be counselled objectively with regardto potential complications or might be considered for alternative, less invasivetherapeutic options.

Souree of Funding: None.

1707HOW DO PROSTATE CANCER SURVIVORS PERCEIVETREATMENT TRADE-OFFS FOR HYPOTHETICAL CLINICALSITUATIONS? Neil H Love", Mark Soloway, Michelle F Paley, Lilliam SPoltorack, Richard A Kaderman, Sally J Bogert, Miami, FL

INTROD UCTION AND OBJECTIVE: The most common informationsource guiding prostate cancer (PCA) treatment decisions is verbal consultationwith physicians. This pilot study assessed prostate cancer survivors (peAS)treatment preferences based on a prese ntation by a urologist (MS) during aday-long town meeting (TM). The objectives were to learn how PCAS perceivetreatment trade-offs and to evaluate the effectiveness of a TM to gather suchdata.

METHODS: 157 PCAS and 123 spouses/partners attended. Prior treatmentsincluded RP (44%), external beam radi ation therapy (EBRT- 14%) ,brachytherapy (BT- 7%), and hormonal therapy (HT- 37%). After an init ialeducation session reviewing potential risks and benefits of commonly utilizedinterventions, audience keypad responses were obtained for variati ons of 3hypothetical clinical scenarios .

RESULTS: Scenario I : Initial therapy for low-risk PCA: Watchful waiting(WW) and RP were the 2 most common choices for initial therapy. Theoreticalpatient (pt) age was an important variable in determining treatment preferences.(fable 1) Scenario 2: Immediate (adjuvant) versus delayed hormonal therapy (HT)after radical prostatectomy (RP): Preferences for immediate (adjuvant) hormonaltherapy (AHT) varied with the risk of PSA relapse. For theoretical risks of 85%,50%, and 25%, AlIT was chosen by 91%, 41%, and 28% of PCAS, respectively.Scenario 3: Choice of HT for PSA relapse after RP: PCAS choosing HT for PSArelapse were more likely to select antiandrogen (AA) monotherapy in scenarioswhere the hypothetical pt was sexually active. Complete androgen blockade waschosen more commonly than LHRH monotherapy.

CONCLUSIO NS: After verbal education/coun seling by a urologist,considerable heterogeneity was observed in PeAS perceptions of treatment trade­offs for hypothetical situations. The TM was an effective method to obtainpreliminary, hypothesis-generating data on these issues. Health care professionals,advocacy groups, and policy-makers should be informed about the spectrum ofpatient perceptions of treatment trade-offs and the need for information on abroader variety of treatment options.

Table 1: Preferred Initial therapy fortheoretical low-riskpeAcases

Age intheoretical case RP EBRT BT WON HT45 51 % 9% 15% 22% 3%60 31% 12% 22% 24% 11%72 14% 9% 21% 49% 7%85 1% 2% 4% 85% 8%

Source of Funding: Funding via an unrestricted educational grant fromAstr3Zeneca Pharmaceuticals, LP.

456 THE JOURNAL OF UROLOGY® Vol. 169, No.4, Supplement, Wednesday, April 30, 2003

1708ASSOCIATION BETWEEN NUMBER OF LYMPH NODESREMOVED AND FREEDOM FROM DISEASE PROGRESSIONIN PATIENTS RECEIVING PELVIC LYMPH NODE DIS­SECTION DURING RADICAL PROSTATECTOMY FORPROSTATE CANCER Christopher J Di Blasia", Paul Fearn, Hee SongSea, Michael W Kattan, Peter T Scardino, New York, NY

INTRODUCTION AND OBJECTIVE: We aim to study the associationbetween number of lymph nodes (LN) removed and freedom from diseaseprogression in patients receiving open pelvic lymph node dissection (PLND) attime of radical retropubic prostatectomy (RRP) for prostate cancer (CaP).

METHODS: Patients undergoing RRP with PLND between 11/1983 and9/2002 were studied retrospectively. Exclusion criteria included nee-adjuvanttherapy, salvage RRP, and clinical stage T4 (AJCCIUICC 1992) CaP. Variablesthat were analyzed included: number of positive and negative LN resected,pre-treatment prostate specific antigen (PSA) level, clinical tumor stage, transrectalultrasound guided prostate biopsy gleason grades (primary/secondary/sum), RRPhistopathological details (extracapsular extension, seminal vesicle invasion,gleason grades, surgical margin status), and adjuvant therapy. Biochemicalrecurrence was defined as 2 PSA rises of 0.2 ng/mL or greater. Cox multivariateregression models were used for analysis.

RESULTS: We analyzed 2457 males with complete records. Mean age at RRPwas 60.4 years (range 36.7-78.9). Mean number LN removed was 10.4 (range1-48). 119 patients (4.8%) demonstrated positive LN with a mean of 1.7 (range1-6) LN. Our analysis showed that the number of LN removed is associated withprogression (p= 0.044). Removing approximately 13 LN demonstrated the lowestrisk of disease progression, regardless of nodal disease status. A greater number ofnegative LN did not lower the risk of disease progression (p=0.78).

CONCLUSIONS: PLND during RRP for CaP should intend the removal ofapproximately 13 LN for maximal potential benefit, regardless of LN diseasestatus. These results should be confirmed with prospective studies to furtherevaluate this association.

Source of Funding: None.

1709BLOOD LOSS AND TRANSFUSION RATES IN ACONSECUTIVE SERIES OF CONTEMPORARY RADICALRETRPUBIC PROSTATECTOMY (RRP) PATIENTS Michael SCookson", David T Duong, Sam S Chang, Roxelyn Baumgartner, Joseph ASmith, Nashville, TN

INTRODUCTION AND OBJECTIVE: Historically, blood loss associatedwith RRP has been a source of significant potential morbidity. While still aconcern, routine blood donation has not been standard at our institution since12/93. The purpose of this study was to assess blood loss and transfusionrequirements among contemporary patients undergoing RRP. Furthermore, weattempted to identify factors associated with an increased risk of blood loss andtransfusion.

METHODS: A review of all patients who underwent RRP between 7/99 and12/01 was performed with a primary purpose of analyzing estimated blood loss(EBL) and blood transfusion(autologous or allogeneic) requirements. We alsoassessed potential factors predictive of increased blood loss including age, clinicalstage, Gleason score, nerve sparing, American Association of Anesethia (ASA)score, Charleson Index (CI), Ghali-CI modification, body mass index (BMI)defined as weight(kg)/height(m)2 on EBL and transfusion requirements. Univariateand multivariable analysis was performed.

RESULTS: A total of 436 consecutive pts underwent RRP under generalanesthesia with a mean age of 60 years (R 39-78). The mean ASA class was 2.3(R 1-3) while the mean BMI was 27.7 (R 18.2-44.3). The mean pre and post­operative HCTs were 44.1% and 32.5%, respectively. Overall, mean EBL was600mLs (R 100-3500) and transfusion rate was 4.8%. In univariate analysis, onlyBMI was correlated with EBL and transfusion requirement. There was asignificantly lower EBL among patients with an acceptable BMI «25) vs.overweight (25-30) and obese (>30) patients (p=0.021). Likewise, the rate oftransfusion was significantly higher among the overweight (6.9%) and obese(5.6%) as compared to the acceptable BMI group (1.9%) (p=0.009). There wasalso a direct correlation between BMI and EBL, which was the only pre-operativefactor predictive blood loss in the multivariable model (p=0.037).

CONCLUSIONS: This series demonstrates that contemporary RRP can beperformed with consistently acceptable EBL, even among the overweight andobese who have the highest EBL and transfusion rates. BMI may a usefulpreoperative tool in assessing individual risk of blood loss and transfusionrequirments. The overall low transfusion rate «5%) is attributed to proper patientselection combined technical refinements in the control of the dorsal venouscomplex rather than use of autologous blood donation, preoperative erythropoietinor anesthetic practices.

Source of Funding: None.

*Presenting author.

1710PRETREATMENT TOTAL TESTOSTERONE LEVEL PRE­DICTS PATHOLOGIC STAGE AMONG RADICAL PROS­TATECTOMY PATIENTS WITH LOCALIZED PROSTATECANCER Jason C Massengill*, Leon Sun, Judd W Maul, Hongyu Wu,David G McLeod, Christopher Amling, Raymond Lance, John Foley, WadeSexton, Leo Kusuda, Andrew Chung, Douglas Soderdahl, Timothy Donahue,Bethesda, MD

INTRODUCTION AND OBJECTIVE: To rigorously test pretreatment totaltestosterone levels as a potential staging and prognostic marker in a large cohort of879 radical prostatectomy patients with localized cancer.

METHODS: We retrospectively reviewed the clinical records of 879 radicalprostatectomy patients between January I, 1986 and June 30, 2002 from ninehospital sites. Nonparametric tests were used to study the relationship ofpretreatment testosterone and pathologic stage to other variables in univariateanalysis. Multivariable logistic regression analysis was used to assess for clinicalpredictors from pretreatment testosterone and eight covariates. Kaplan Meiersurvival methods and Cox regression analysis were used to assess for predictors ofbiochemical recurrence.

RESULTS: In univariate analysis, patients with non-organ confined prostatecancer (pT3-T4) showed significantly lower serum total testosterone than thosewith organ confined cancer (pTl-T2) (Nonparmetric p = 0.041). In a multivariatelogistic regression model, pretreatment total testosterone was a significantindependent predictor of extraprostatic disease (p = 0.046). Using Kaplan Meiersurvival methods, pretreatment serum total testosterone levels did not predictbiochemical (PSA) recurrence (p = 0.467).

CONCLUSIONS: Pretreatment total testosterone is an independent predictorof extraprostatic disease in localized prostate cancer patients. As serumtestosterone decreases, patients have a higher likelihood of non-organ confineddisease.

Source of Funding: U.S. Department of Defense and the Henry M. JacksonFoundation for the Advancement of Military Medicine, Inc.

1711LARGE PROSTATE SIZE AT RADICAL RETROPUBICPROSTATECTOMY DOES NOT ADVERSELY AFFECTCANCER CONTROL, CONTINENCE OR POTENCY RATESCharlotte L Foley*, Simon R Batt, London, UK; Kay Thomas, Sutton, UK; MConstance Parkinson, London, UK; Roger S Kirby, London, UK

INTRODUCTION AND OBJECTIVE: The size of prostates excised at radicalretropubic prostatectomy has increased since the introduction of the PSA test. Theremoval of a large prostate from within the confines of the pelvis may increase therisk of damage to the neurovascular bundles or urethral sphincter leading toimpotence, incontinence or inadequate cancer clearance post-operatively. Thisstudy aimed to determine the impact of a large prostate at radical retropubicprostatectomy on pathological outcomes, biochemical recurrence rates, potencyand continence.

METHODS: From a database of 440 radical retropubic prostatectomy patients,retrospective information on prostate weights, patient and tumour characteristics,and follow up was obtained. Post-operative potency and continence data was drawnfrom a self-reported validated questionnaire. Patients with prostates>75 or <75grams were compared.

RESULTS: Median prostate sizes were 87 grams (76-182) for the groupwith large glands (>75 grams), and 42 grams (4.1-75) for the group withsmaller glands «75 grams). Questionnaire response rate was 344 (78%).Patients in the large prostate group were older (median 65 (51-74) 10 61 years(40-76), p=O.Ol), and had higher pre-operative PSA levels (median 9.6(3.4-37.8) to 7.6ng/ml (0.1-30.0), p=O.OOl). Tumours within larger prostateswere of a lower stage (p=0.035), lower Gleason grade (median 6 to 7,p=0.015), smaller volume (median 1.0 (0.1-12.4) to 1.5ml (0.1-21.1), p=0.04)and more often clinically insignificant (23 to 6%, p=O.OOI). There was nodifference between the number or distribution of positive surgical margins. Fora median follow up of 20-25 months, patients with larger prostates were lesslikely to have biochemical recurrence (5 to 24%, p<0.0005). Potency andcontinence rates were similar between the two groups.

CONCLUSIONS: Prostate size at radical retropubic prostatectomy does notincrease the likelihood of post-operative impotence or incontinence. Prostate sizeover 75mg is associated with a decreased likelihood of PSA-relapse though this ispotentially due 10 lead-time bias. A large prostate may contraindicate otherpotentially curative cancer treatments rendering radical retropubic prostatectomythe treatment of choice. Therefore patients with large prostates undergoing thisoperation can be reassured accordingly.

Source of Funding: None.

Vol. 169, No.4, Supplement, Wednesday, April 30, 2003 THE JOURNAL OF UROLOGY® 457

1712STAGE MIGRATION HAS ALTERED SITE-SPECIFICPOSITIVE MARGIN RATES AND PROGRESSION-FREESURVIVAL RATES AFTER RADICAL PROSTATECTOMYBradley C Leibovich*, Horst Zincke, Jeffrey M Slezak, Erik J Bergstralh,Michael L Blute, Rochester, MN

INTRODUCTION AND OBJECTIVE: PSA screening has resulted in prostatecancer diagnosis at earlier stages. We have previously reported on the negativeprognostic impact of positive margins at the time of radical prostatectomy. Our aimwas to determine if stage migration has resulted in diminished rates of positivemargins and the impact of margin status on prognosis during the PSA screeningera.

METHODS: We conducted a retrospective review of the Mayo ClinicProstate Cancer Database from 1990 to 1999. There were 7272 radicalprostatectomies performed in this time period. The study cohort was dividedinto four groups by two-year intervals. Variables examined included age, PSA,clinical stage, pathologic stage, margin status, and margins status stratified bysite. The rank-sum chi-square test was used to examine associations betweenyear groups. All tests were two-sided and a p value less than 0.05 wasconsidered significant.

RESULTS: Over the interval studied, patient age at surgery, PSA level, andclinical stage T3 and T4 all decreased. The rate of pathologic organ confinedcancer and clinical stage Tic increased. The rate of positive margins andmultiple positive margins decreased from 42% and 16% in 1990-1991 to 29%and 6% in 1998-1999, respectively. For all cases, the rate of apical positivemargins has remained consistent over time, but the rate of positive margins atthe base, urethra, anterior, and posterior have diminished significantly. Fororgan confined cases (n=4948), the rate of margin positivity has remainedconsistent with the exception of positive base margins, which have significantlydecreased. Patients with organ confined cancer and a positive base margin inthe current era are more than 4 times less likely to have biochemicalprogression within 3 years of surgery than patients operated in 1990-1991(hazard ratio 0.23, 95% CI 0.09-0.62).

CONCLUSIONS: Our data clearly indicates that there has been migrationtowards lower stage, lower PSA levels, and lower margin positive rates. For thosepatients with positive margins at the base and organ confined cancer, the rate ofbiochemical progression after radical prostatectomy has decreased from 1990 to1999.

Source of Funding: None.

1713PROGNOSTIC SIGNIFICANCE OF THE SITE OF THEPOSITIVE MARGIN (+SM) IN RADICAL PROSTATECTOMY(RP) SPECIMENS Alex Gorbonos*, Makoto Ohori, New York, NY; NorioMaru, Houston, TX; Michael W Kattan, New York, NY; Thomas M Wheeler,Kevin M Slawin, Houston, TX; Peter T Scardino, New York, NY

INTRODUCTION AND OBJECTIVE: To assess the prognostic significanceof +SM at different sites in RP specimens.

METHODS: We studied 1379 consecutive patients treated with RP by 2surgeons from 1983 - 2000. Detailed pathologic features of cancers were assessedby one pathologist. Adjuvant radiation therapy before PSA recurrence was assessedas a time-dependent covariate to analyze PSA progression free probability (PFP).Median follow-up was 48 (1-201) mo.

RESULTS: Overall, 179 patients (13%) had +SM. Of 169 patients with thesite of +SM recorded, 123 (73%) had a single site, 32 (19%) had 2 sites, and14(8%)had 2':3 sites. PFP at 5 years for patients with a single or 2 +SM sites was71% and 74%, significantly better than 36% in patients with 2':3+SM sites(p=.006 and p=.02, respectively). Of a total of 246 +SM sites, 30% were in theapical shave sections, 29% in the apex (first 2 whole mount step sections), 24% inmid, 9% in base section (last 2 sections), 6% at bladder neck, and 2% over seminalvesicles. In transverse section, 24% were anterior, 19 postero-lateral, 14%posterior, 5% lateral. PFPs at 5 years for patients with a single +SM in the apicalwas 69% and in the apex, 84% - significantly better than 27% with a single +SMat the base (p=.008 and p=.OI, respectively). A +SM in mid or bladder neck hadan intermediate PFP. More cancers were confined to the prostate when the +SMwas at the apical (83%) or apex (74%) than at the base (14%). PFPs at 5 years forpatients with a single posterior +SM was 48%, significantly worse than 79% withan anterior (p=.033). In Cox hazard regression analyses for the various models,+ SM in the apical shave was the only significant predictor of PSA progression(p= .0021) when other established pathological features and serum PSA level wereconsidered. The +SM rate significantly decreased over time as did the number ofsites of +SM per prostate (p<.005), but the proportion of all +SM that were apicalor apex significantly increased (p<.005).

CONCLUSIONS: The prognostic significance +SM may depends on itslocation in RP specimens. Although patients with + SM at the base and/or posteriorhad a worse PFP than those at other locations in univariate analyses, the results of

multivariate analysis highlight the importance of apical +SM. More efforts isneeded to reduce the rate of apical + SM.

Source of Funding: Supported in part from the Leon Lowenstein Foundationand an NCI SPORE (CA58204).

1714THE INFLUENCE OF PERSONAL FACTORS IN THETREATMENT DECISIONS OF MEN WITH LOCALIZEDPROSTATE CANCER Donna L Berry*, William J Ellis, Alea Sando,John C Blasko, Seattle, WA

INTRODUCTION AND OBJECTIVE: No other disease condition with theincidence of prostate cancer has so many alternatives with so few certainties inoutcome. Along with the medical factors assessed by clinicians, men with localizedprostate cancer (LPC) bring personal factors and characteristics to the treatmentdecision-making process. The influence of these factors had not been investigatedand consequently, existing decision interventions lack empiric evidence on whichto address men's individual profiles and decision processes. The purpose of thismulti-method study was to systematically document relevant aspects of treatmentdecision making in men with LPC.

METHODS: Patients in both urology and radiation oncology practices ofthe Puget Sound region were invited to participate by their clinicians. Thispaper presents data from 259 men diagnosed with LPC and who completedPersonal Profile questionnaires at home prior to beginning treatment. Based onearlier inductive findings of the study, the following factors were queried:demographics, personal information, the influence of other individuals, age,potential complications, expected longevity, confidence in the doctor, andtreatment choice.

RESULTS: The typical respondent was a white, married man in his 60's,educated, currently employed. The Internet and friends/coworkers were the 2information sources most utilized after the clinic visit. Certain individuals werefrequently reported to be most influential regarding the treatment decisionincluding (rank order): doctors seen for a second opinion, first doctorseen, spouse/partner and friends. The respondent's own age was identified asan influential factor by 70% of the sample. Expected longevity and confi­dence level in a particular doctor were highly influential factors. Urinaryfunction was identified most often as having a lot of influence on the treatmentdecision. Recreational activities and work influenced the majority of men. Ofthe 219 men who had made a curative treatment decision by the time ofquestionnaire completion, 47% had chosen brachytherapy and 38% had chosensurgery.

CONCLUSIONS: In a sample of men who had opportunity and resources tomake an informed treatment decision, personal factors were clearly involved in theprocess of making the best choicefor me. These findings are the first quantitativedocumentation of personal factors that men bring to the LPC treatment decision.Understanding these factors will guide clinicians during the 'options talk' toprovide patient centered advice and information.

Source of Funding: National Cancer Institute.

1715COMPARISON OF RADICAL PROSTATECTOMY, RADIO­THERAPY, HORMONAL THERAPY, AND WATCHFULWAITING FOR SCREEN-DETECTED PROSTATE CANCERJulie M Krygiel*, Kimberly A Roehl, St. Louis, MO; Vivian Weinberg, SanFrancisco, CA; William J Catalona, St. Louis, MO

INTRODUCTION AND OBJECTIVE: There are limited data on theeffectiveness of treatments for localized prostate cancer. We previously reportedthe progression rates in a cohort of patients diagnosed in a screening study, treatedand monitored in a prospective follow-up study through 1998. Since then, we havegathered four more years of follow-up data and we are updating our results.

METHODS: We previously evaluated 2725 patients diagnosed with prostatecancer in a screening study from 1989 to 1998. We are currently evaluating 2904patients diagnosed with prostate cancer through 2002. Treatments included:1987(68%) radical prostatectomy, 462(16%) radiotherapy, 139(5%) hormonaltherapy, and 316(11%) watchful waiting. The follow-up protocol included PSAtesting every six months and review of clinical and pathological records. Cancerprogression was defined as PSA >0.2 nglmL for surgery patients and threeconsecutive PSA rises for all other treatments included in the analyses.

RESULTS: Results of % progressed and 7-year progression-free survival areshown in the table. These results are through 1998 and will be updated through2002. The preliminary analysis of radical prostatectomy showed 17% progressionrate and 80% 7-year progression-free survival rate, similar to previous results.Comparisons for non-surgical treatments are under analysis for data through 2002.

CONCLUSIONS: Radical prostatectomy provides a better 7-year progression­free survival than radiotherapy, hormonal therapy, and watchful waiting in menwith screen-detected prostate cancer.

458 THE JOURNAL OF UROLOGY® Vol. 169, No.4, Supplement, Wednesday, April 30, 2003

'presented previously

Source of Funding: Supported in part by Hybritech/Beckman, Inc., Fullerton,CA.

1717LONG·TERM CANCER CONTROL OF RADICAL PRO­STATECTOMY IN MEN YOUNGER THAN 50 YEARS OF AGE:UPDATE 2003 MasoodA Khans, Misop Han, Jonathan I Epstein, Alan WPartin, Patrick C Walsh, Baltimore, MD

INTRODUCTION AND OBJECTIVE: In the 1970s and 1980s men youngerthan 50 years represented approximately 1% of newly diagnosed prostate cancercases. However, with the widespread use of serum PSA and increased publicawareness of prostate cancer, this figure has risen (3.7% - 4%). Previous studies,mostly carried out prior to the PSA era, reported conflicting data with respect tocancer control for these younger men treated with radical retropubic prostatectomy(RR?). We, therefore, compared the cancer control of men younger than 50 yearswith men 50 years or more treated with RRP for localized prostate cancer, in acontemporary series.

METHODS: We analyzed data for 2897 men who underwent RRP betweenApril 1982 and September 2001. Preoperative PSA, clinical and pathological stage,and biochemical recurrence were compared between 341 men under 50 years and2556 men 50 years or older. Disease-free (PSA less than 0.2 ng/ml) survival rateswere compared using Kaplan-Meier analysis. Pathological staging was comparedusing logistic regression.

RESULTS: Younger men had lower extraprostatic extension (25% vs 29%;p<0.02), seminal vesicle involvement (2% vs 5%; p<O.03), and positive surgicalmargins (3% vs 7%; p<0.03) and a significantly greater organ confined disease rate(65% vs 54%; p<O.OOOI). Biochemical failure was 12% for men < 50 yearscompared to 17% for men aged 50 years or more. The 5, 10, and IS-year

1716A SURROGATE MARKER FOR PROSTATE CANCERSPECIFIC MORTALITY FOLLOWING RADICAL PRO·STATECTOMY OR EXTERNAL BEAM RADIATION THERAPYAnthony V D'Amico", Boston, MA; Judd W Moul, Rockville, MD; Peter RCarroll, San Francisco, CA; Leon Sun, Rockville, MD; Deborah Lubeck, SanFrancisco, CA; Ming-Hui Chen, Storrs, CT

INTRODUCTION AND OBJECTIVE: This study evaluated a recentlyproposed hypothesis that a short post-treatment prostate specific antigen doublingtime (PSA DT) may serve as a surrogate for prostate cancer specific mortality(PCSM).

METHODS: Two multi-institutional databases containing baseline,treatment and follow up information on 8,669 men treated with either surgery(N = 5918) or radiation (N = 2751) between 1988 and 2002 for clinical stageTl-4NXMO prostate cancer comprised the study cohort. The PSA DT interval(e.g. < 3 or 6 or 12 months) selected for study as a possible surrogate of PCSMcorresponded to maximum time interval that minimized the difference in theestimates of PCSM and all cause mortality (ACM) following PSA failure forpatients treated using surgery or radiation. Prentices criteria for a surrogateendpoint required that the surrogate was a prognostic factor and that thetreatment utilized did not alter the time to PCSM following PSA failure forpatients who achieved the surrogate. These criteria were tested using Coxregression.

RESULTS: The maximum value of the PSA DT interval that minimized thedifference in the estimates of PCSM and ACM following PSA failure for allpatients was < 3 months. A PSA DT < 3 months was a significant predictor ofboth time to PCSM (p < 0.0001) and time to ACM (p < 0.0001) following PSAfailure for patients treated using surgery or radiation. For patients with a PSADT < 3 months, the treatment received was not a significant predictor of time toPCSM (p = 0.37) or ACM (p = 0.74) following PSA failure. The additionalinformation provided regarding the prediction of the time to PCSM following PSAfailure by adding treatment received to the Cox model that contained a PSA DT <3 months was much less than 1%. Therefore, a PSA DT < 3 months satisfiedPrentices criteria.

CONCLUSIONS: These data provide evidence to support a post-treatmentPSA DT < 3 months as a surrogate for PCSM following surgery or radiationtherapy for the treatment of patients with clinically localized or locally advancedprostate cancer.

Source of Funding: None.

TreatmentRadical ProstatectomyRadiotherapyHormonal TherapyWatchful Waiting

%Progressed16244154

7·yearProgression-free Survival82676435

biochemical disease-free survival rates were 88%, 81%, and 69% in the youngermen and 85%, 76%, and 69% in the older men, respectively.

CONCLUSIONS: Men diagnosed with prostate cancer under 50 years of agewho are candidates for RRP tend to have a greater probability of organ-confineddisease than older men and have comparable long-term cancer control rates.

Source of Funding: None.

1718IMPROVED PREDICTION OF PATHOLOGICALLY ORGANCONFINED PROSTATE CANCER (PCA) USING QUAN·TITATIVE BIOPSY PATHOLOGY: A MULTIINSTITUTIONALVALIDATION STUDY Alexander Haese", Manisha Chaudhari,Baltimore, MD; M Craig Miller, Quakertown, PA; Jonathan I Epstein,Baltimore, MD; Hartwig Huland, Rein-Juri Palisaar, Markus Graefen,Hamburg, Germany; Edward C Poole, Oklahoma City, OK; Alan W Partin,Robert W Veltri, Baltimore, MD

INTRODUCTION AND OBJECTIVE: Quantitative biopsy pathologysignificantly improves prediction of pathological stage in clinically localizedprostate cancer. We recently reported a computational model to predict patient­specific likelihoods of organ confinement of PCa utilizing biopsy pathology andclinical data. This study validates the initial models and presents a new improvedtool for clinical decision making.

METHODS: We assessed ten biopsy pathological and two clinical parametersusing data from one US and one german institution. Of 1287 patients, 798 men hadpathologically organ confined (OC) PCa, 282 had capsular penetration only(NOC-CP) and 207 showed seminal vesicle or lymph node invasion (NOC-AD)after pelvic lymphadenectomy and radical prostatectomy. Patient input data wereevaluated by OLOGIT (Ordinal Logistic Regression)and Neural network modelsand the likelihood of OC, NOC-CP or NOC-AD cancer was calculated for thecombined and separate datasets and compared to the original presentation.Additionally, we constructed a new two-output model (OCINOC-CP vs. NOC­AD).

RESULTS: The three output OLOGIT and Neural network model predictedOC cancers with 95% and 98.6% accuracy, respectively, for the combineddataset and 93% to 98.6% on subset analysis. The combined accuracy forpredicting OC, NOC-CP and NOC-AD cancer in the entire validation set was66.7 % for OLOGIT and 66 % for the Neural Network. The two outputOLOGIT and NN models correctly predicted 94.9% and 100% of all OC/NOC­CP cancers respectively.

CONCLUSIONS: Either computation model predicted OC PCa with anaccuracy of 93 to 98.6% when validated with two different datasets. The LOGITand neural network based two-output model permitted an appropriate treatmentdecision for 85.2% to 90.2% of patients. These data support the use of quantitativepathology and clinical data and permit valuable aid in treatment decision makingin patients with clinically localized prostate cancer.

Source of Funding: GZ Ha3168 1/1.

1719FLUCTUATION OF <:: 0.5 NGIML IN SERUM PSA MORE THAN2 YEARS AFTER EXTERNAL-BEAM RADIOTHERAPYPREDICTS FOR BIOCHEMICAL FAILURE Ashish M Kamat*,Charles J Rosser, Lawrence B Levy, Ramsey Chichakli, Louis L Pisters,Houston, TX

INTRODUCTION AND OBJECTIVE: Based on current ASTRO definitions,to qualify as a failure after external beam radiation therapy (EBRT), patients arerequired to have three consecutive increases in PSA. We sought to identify andcharacterize single late fluctuations in PSA seen in patients who underwent EBRTfor localized prostate cancer and to correlate this with the development ofbiochemical disease progression.

METHODS: In this study, 964 patients received full-dose EBRT as primarytreatment alone. Follow-up PSA values were obtained 3 months after completionof EBRT and every 3-6 months thereafter. Mean follow-up of the entire studygroup was 50.7 months. Late PSA fluctuation was defined as an increase in serumPSA more than 24 months after EBRT. We then analyzed the data for patients whodid not have an ASTRO defined failure before their first rise of 0.5 ,0.75, 1.0 or 1.5ng/ml above nadir at the date of measurement.

RESULTS: Of the 964 patients, 81 patients met analysis criteria. Late PSAfluctuation was unrelated to age, race, pretreatment PSA, Gleason score, clinical Tstage, or radiation dose. For patients who had a late increase in PSA of at least 0.5,0.75, 1.0, or 1.5 ng/ml, 16.0%, 12.2%. 11.1% and 8.3% respectively developedbiochemical failure giving a relative risk of failure of 4.40, 7.13, 10.39, and 22.75,respectively.

CONCLUSIONS: A PSA increase of 2: 0.5 ng/ml 24 months or later afterexternal beam radiotherapy can be used to predict for biochemical failure.

Source of Funding: None.

'Presenting author.

Vol. 169, No.4, Supplement, Wednesday, April 30, 2003 THE JOURNAL OF UROLOGY® 459

1721ABILITY OF TWO PRETREATMENT RISK ASSESSMENTMETHODS TO PREDICT PROSTATE CANCER RECURRENCEAFTER RADICAL PROSTATECTOMY IN A COMMUNITY­BASED COHORT: DATA FROM CAPSURE™ Joseph A Mitchell",Matthew R Cooperberg, Eric P Elkin, Deborah P Lubeck, San Francisco, CA;Shilpa S Mehta, Lake Forest, IL; Christopher J Kane, Peter R Carroll, SanFrancisco, CA

INTRODUCTION AND OBJECTIVE: Two methods are widely used topredict risk of treatment failure after radical prostatectomy (RP) for localizedprostate cancer. Although both have been previously validated, they have not beencompared in a community-based cohort. We applied Kattan and D'Amico riskclassification schemes to the CaPSURE database, a national registry of prostatecancer patients, to assess their accuracy in a community-based cohort.

METHODS: Men were invited to join CaPSURE from 35 U.S. urologypractices (32 community based). 1,701 men with localized prostate cancer (stageTl-T3a) were treated with RP between 1989-2000. Patients who receivedneoadjuvant or adjuvant therapy were excluded. Recurrence was defined as 2 ormore consecutive PSAs 2: 0.2 or second treatment >6 months after RP.Recurrence-free survival (RFS) was based on life-table estimates and Kaplan­Meier. Risk groups were compared using Cox proportional hazards model andANOVA.

RESULTS: Based on pre-treatment PSA, T stage, and Gleason score(D' Amico), 671 patients (39%) were classified as low risk, 446 (26%) intermediaterisk, and 584 (34%) high risk. 5 year RFS after radical prostatectomy was 78%,63%, and 60% for low, intermediate, and high risk groups, respectively (H.R. 1.00,1.87, and 2.32, P<.OOOI).Mean 5 year RFS predicted by the Kattan nomogram forthe same risk groups was 91%,74%, and 69%, respectively. Outcomes for the lowrisk group were tightly grouped about the mean but there was considerabledispersion of outcomes for the intermediate (30%-98% RFS) and high-risk groups(17%-98% RFS).

172010-YEAR BIOCHEMICAL AND LOCAL CONTROLFOLLOWING REAL-TIME 1-125 PROSTATE BRACHY­THERAPY Nelson N Stone*, Richard G Stock, New York, NY

INTRODUCTION AND OBJECTIVE: We determined the IO-yearbiochemicaland local control results for 1-125 prostate brachytherapy in men implanted by thereal-time technique who have been followed a minimum of 4 years.

METHODS: 279 men with Tl-T2 prostate cancer with a minimum follow-upof 4 years were implanted with 1-125 alone using the real-time technique. 64 (23%)had 6 months of hormonal therapy (HT). 185 (66.3%) agreed to biopsy (6-12 cores)a minimum of 2 years post-implant and then yearly if positive or because of a risingPSA. Radiation doses (D90) were determined 30 days post implant by CT.Biochemical freedom from failure (FFF) was defined as 3 consecutive PSA rises(ASTRO). Survival curves were calculated by the Kaplan Meyer method. Theeffect of single and multiple variables was tested by Pearson Chi-square and Coxregression.

RESULTS: Median patient age was 67 years (range 42-82). Initial PSA(median 7 ng/ml) was :510 in 202 (72.4%) and> 10 in 77. GS was :56 in 272(97.5%) and stage was :5T2a in 198 (71%). There were 146 (52.3%) low risk(PSA :5 10, GS :5 6 and stage :5 T2a) patients. Median follow-up was 6 years(range 4-12).49 (17.6%) patients experienced a failure (IO-year FFF 78%). MedianPSA for non failures was :5 0.1 ng (range 0-1.6). Multivariate analysisdemonstrated D90 dose (p<O.OOI)and risk group (p=O.OI) as the only significantvariables. The risk of PSA failure (RR with 95% confidence) was 5.4 (3.8-11,p=0.002) and 9.3 (4.2-20.8, p<O.OOl) for doses below 140 Gy and 120 Gy,respectively. 166/185 (90%) had negative prostate biopsy. FFF was 85% vs 21%for those with a positive biopsy (p<O.OOI).Patients with a D90 dose of at least 160Gy had positive biopsy rate of 4.6% compared to 13.6% for those with a lesser dose(p<O.OOI). Patients receiving a dose less than 120 Gy had a 30% likelihood of apositive biopsy result. The RR for a positive biopsy for doses less than 140 Gy and120 Gy were 5 (1.7-15, p<O.OOI) and 8 (2.6-25, p<O.OOI).

CONCLUSIONS: These data demonstrate high biochemical and local controlin men with Tl-T2 prostate cancer treated with 1-125 brachytherapy. Deliveredradiation dose and risk category are important predictors of success. The risk ofbiochemical and local failure are high if the delivered dose is less than 120 Gy.Patients receiving a dose of at least 160 Gy have a 93% change ofFFF and a 95.4%likelihood of local control.

Univariate Analysis for 10yearBiochemical Freedom From Failure

Source of Funding: None.

Variable

%FFFPValue

PSAS10 Stage :sT2a Lowvs HT vsVB >10 VB~T2b highriBk noHT86vs63 88vs61 91 vs66 94vs75

0.001 0.0002 <0001 0.013

D90~160

VB <160 Gy93vs70<0.001

CONCLUSIONS: Stratifying CaPSURE patients into low, intermediate, andhigh risk categories for disease recurrence by pre-treatment PSA, Gleason score,and T stage as described by D' Amico or by using the Kattan nomogram results instatistically significant differences in predicted 5-year RFS. However, there wasconsiderable overlap of outcomes between the intermediate and high-risk groups.This analysis suggests that simply estimating disease recurrence using these criteriadoes not provide accurate enough information for predicting individual patientoutcomes in these risk groups.

Source of Funding: TAP Pharmaceutical Products, Inc., Lake Forest, n.

1722CRYOABLATION OF THE PROSTATE FOR LOCALIZEDPROSTATE CANCER. 8 YEAR EXPERIENCE WITH 215 CASESFletcher C Derrick», John J Britton, William C Carter, Alan W Fogle,Jonathan T Donaldson, Bonner Thomason, Ian Y Marshall, Stephen Bielsky,William H Holl, George B Delporto, Paul W Sanders, Benjamin K McInnes,Raymond Rosenblum, James W Kellett, Alex Ramsay, Charleston, SC

INTRODUCTION AND OBJECTIVE: Between Jan 1994 and Aug 2002, 215cases of Cryoablation of the Prostate (CryoP) procedures were performed at RoperHospital, Charleston, South Carolina. The objective was to determine the efficacyof this treatment modality in cases of primary cancer of the prostate and in casesof radiation failure. 90% of the cases treated had primary cancer (T-I and T-2disease) and 10% had radiation failure (both from brachytherapy and externalbeam). Gleason's numbers varied from 5-9.

METHODS: General or regional anesthesia was used. Patients were placed inthe lithotomy position. 100 cc of clear lubricant was placed in the rectum. In allcases, transrectal ultrasound guidance, "freeze-thaw-freeze" method, plus aurethral warming catheter was used. The urethral warming catheter was removedin the recovery room one hour after the completion of the surgery. Nitrogen andHelium gases were used early, with a change to Argon and Helium in 1999. In1999, with the introduction of thermal probes, the accuracy of the freeze andprotection of neurovascular bundles, sphincter, and Denonvillier's fascia wasgreatly enhanced.

RESULTS: Follow-up data is available on 201 cases. 8 year data on 65 casesreveals: 80% have a PSA < 0.5, 84% have a PSA < 0.7, and 90% have PSA <1.6. 10% of the 65 cases were not cured by CryoP and have gone on to other formsof treatment. 136 cases have data ranging from 7 yrs to 2 months and is as follows:82% have a PSA < 0.5, 84% have a PSA < 1.0, and 89% have a PSA < 1.2. Ofthose having a PSA higher than 1.2, 5% have a PSA <5.0, while 6% have a PSAranging from 5.0 - 8. 7 patients had a stricture or bladder neck contracture. Therewas one prostato-rectal fistula, and one prostate abscess. 15 patients needed a postCryoP TURP, to remove minimal devitalized tissue. 25 patients had temporary(30-60 days) incontinence; 23 completely recovered while 2 required transurethralcontigen. All patients were impotent for approximately 6 months after CryoP, but50% have regained partial spontaneous erectile function. There were no operativedeaths. 8 patients have died of prostate cancer. 3 patients died of causes unrelatedto cancer of the prostate.

CONCLUSIONS: It is our opinion that Cryoablation of the prostate is aminimally invasive, alternative treatment of primary cancer of the prostate. CryoPis also a treatment choice for radiation failure patients, when it can be determinedthat the cancer is still confined to the prostate gland.

Source of Funding: None.

1723THE CHANGING FACE OF LOW-RISK PROSTATE CANCER:TRENDS IN CLINICAL PRESENTATION AND TREATMENTPATTERNS (DATA FROM CAPSURE) Matthew R Cooperberg*, SanFrancisco, CA; Shilpa S Mehta, Lake Forest, IL; Deborah P Lubeck, MaxwellV Meng, Peter R Carroll, San Francisco, CA

INTRODUCTION AND OBJECTIVE: Prostate cancer screening over the pastdecade has contributed to earlier identification of disease and a migration to lowerstage at diagnosis. We sought to characterize global changes in the patterns ofdiagnosis and treatment for patients with low-risk prostate cancer, using a cohortof patients managed at community and academic medical centers.

METHODS: Data were abstracted from CaPSURE™, a disease registry of8685 men with various stages of prostate cancer. 2078 men were included whowere diagnosed between 1989 and 2001 and had low-risk disease characteristics(serum PSA < = 10 ng/ml, Gleason sum < =6, and clinical T-stage < =2a). Trendsin risk distribution, tumor characteristics, and primary treatment were evaluatedwith the Mantel-Haenszel X2 test for trend. Univariate and multivariate analysesidentified sociodemographic predictors of treatment type.

RESULTS: The proportion of patients with low-risk cancer features rose from29.8% in 1989-92 to 45.8% in 1999-2001 (p<O.OOOI). Over the same period, theproportion presenting with clinical stage Tl increased from 26.1 to 64.0%(p<O.OOOI), whereas the proportion with Gleason sum 2-4 disease fell from 41.5to 4.2% (p<O.OOOI). The proportion with PSA <4 ng/ml at diagnosis decreased

460 THE JOURNAL OF UROLOGY® Vol. 169, No.4, Supplement, Wednesday, April 30, 2003

from 25.2 to 16.9% (p=0.04). In the low-risk group, the proportions of patientsundergoing radical prostatectomy (RP), external-beam radiotherapy (EBRT), andwatchful waiting (WW) fell from 62.0 to 50.3%, 15.4 to 6.7%, and 13.3 to 7.9%,respectively, whereas the proportions of patients receiving brachytherapy (BT) andprimary androgen deprivation (AD) rose from 3.0 to 21.8% and 3.0 to 11.6%.Among patients undergoing definitive local treatment, rates of neoadjuvant ADrose from 3.9 to 11.0%; of these, the proportion receiving combined androgenblockade rose from 11.1 to 83.5%. In univariate analysis, age, education, type ofinsurance, and geographic region predicted treatment type. A multivariate model,correcting for time and risk characteristics, confirmed these variables as predictors.Individual practice sites exhibited wide variation in treatment patterns.

CONCLUSIONS: Low-risk features characterize a growing number of mendiagnosed with prostate cancer. Within this group, prevalence of stage TI diseasehas increased while Gleason sums <5 and PSA values <4 ng/ml have become lesscommon. Sociodemographic variables are associated with the type of treatmentselected. Overall, use of RP, EBRT, and WW have all decreased in favor of BT andprimary AD.

Source of Funding: CaPSURE is funded by TAP Pharmaceutical Products,Inc (Lake Forest, IL).

1724PREDICTORS OF DELAYED PROSTATE CANCER-DIRECTEDINTERVENTION IN WATCHFUL WAITING PATIENTS IN THEPSA ERA Mark Garzotto*, Irene Panagiotou, Yi-Ching Hsieh, MotomiMori, Laura Peters, Thomas Klein, Tomasz M Beer, Portland, OR

INTRODUCTION AND OBJECTIVE: The outcome of watchful waiting as astrategy for clinically localized prostate cancer has primarily been described on thebasis of data collected prior to the introduction of PSA. The use of the PSA inprostate cancer diagnosis and its availability during observation would be expectedto alter the outcome of watchful waiting. The goals of this study were to define theincidence of delayed cancer-directed intervention and to identify independentrisk-factors for delayed intervention in patients who chose watchful waiting forinitial management of prostate cancer.

METHODS: Data was prospectively collected on all patients diagnosed withTI-4NxMO adenocarcinoma of the prostate at a single institution between January1993 and December 2000. Factors that were recorded included: age, TNM stage,Gleason score, serum prostate-specific antigen (PSA), prostate gland volumemeasured by transrectal ultrasound (TRUS), total number of biopsies obtained, thenumber of biopsies positive for cancer, and the initial treatment selection. Theoutcome of all patients who elected watchful waiting was determined by a reviewof all medical records and cancer registry data.

RESULTS: Of the 561 patients with Tl-T4NxMO prostate cancer, 192 (34.3%)elected to undergo watchful waiting and follow-up data were available for 187patients. With a median follow-up of 3.6 years, 90 (48.1%) patients had aprostate-cancer directed intervention. Gleason score (p=0.0097) and percent­positive biopsy cores (p=0.03) were significant independent predictors of time tointervention. When PSA doubling time (PSADT) was added to the model, itbecame the most significant predictor of delayed secondary intervention(p=0.0057). These independent covariates were used to characterize low-,intermediate- and high-risk groups for cancer-directed intervention.

CONCLUSIONS: Cancer-directed intervention is common in modem patientswho choose watchful waiting as initial management of clinically localized prostatecancer. Gleason score and percent-positive biopsy cores are independent predictorsof intervention. When available, PSADT becomes the most important predictor ofintervention.

Source of Funding: PHS grants 5 MOl RR00334-33S2.

Uroradiology (I)Moderated Poster

Wednesday, April 30, 2003 10:00 AM-12:00 PM

1725COMPUTERIZED TOMOGRAPHY DENSITY ACCURATELYPREDICTS SUCCESS OF SHOCKWAVE LITHOTRIPSY JeffreyA Stern*, Simon Y Kimm, Chi-Hung Chang, Pankaj M Jain, Frederick L Hoff,Samuel C Kim, Herbert M User, Adam C Weiser, David S Kube, Robert BNadler, Chicago, IL

INTRODUCTION AND OBJECTIVE: Shockwave lithotripsy (SWL) is amainstay of therapy for urolithiasis. Nonconstrast computerized tomography (CT)can be used to differentiate stone composition by Hounsfield Units (HU). Weassessed the utility of HU as a predictor for SWL success.

*Presenting author.

METHODS: Three hundred thirty SWL procedures over a 24 month periodwere performed using the Healthtronic Lithotron Lithotriptor at our institution.Patients who had undergone noncontrast CT prior to their SWL were included inthe study, and all lower pole stones were excluded. Stone length and density weremeasured electronically. Followup imaging was assessed to categorize patients asSWL successes or failures. SWL was determined a failure if the patient underwentfollowup imaging at least 10 weeks following his SWL and demonstrated persistentstone or if the patient underwent a second stone procedure in the interim. The T-testand stepwise logistic regression were used to assess statistical significance.

RESULTS: The mean density of stone free (100 stones) and non-stone free (30stones) groups was 391.4 HU (range 129 HU to 774 HU) and 608.14 HU (range166 HU to 1017 HU), respectively. This difference was statistically significant(p<O.OOOI). At a density of 400 HU or less, 91 % of stones were successfullytreated by SWL. At a density of 800 HU all stones failed SWL. In the multivariateanalysis, stone density was the strongest predictor of SWL success (p<O.OOOI).

CONCLUSIONS: Stone density is a stronger predictor of success than stonesize. CT plays a crucial role in determining which patients can benefit from SWL.

Source of Funding: None.

1726NONDESTRUCTIVE ANALYSIS OF URINARY STONES USINGMICRO CT: CALIBRATION WITH INFRARED SPECTRO­SCOPY James C Williams*, Chad A Zarse, Erin K Hatt, Indianapolis, IN;Andre J Sommer, Oxford, OH; Ryan F Paterson, Mark Tann, Andrew P Evan,James E Lingeman, James A McAteer, Indianapolis, IN

INTRODUCTION AND OBJECTIVE: Stone research requires accurateknowledge of stone composition, which is traditionally determined by visualinspection and/or chemical analysis (requiring the stone to be broken/crushed).Some progress has been made toward identifying stone composition non­destructively using CT, but low resolution has limited this approach. This studyassessed the correlation of attenuation values from micro computed tomography(micro CT, with very high spatial resolution) with mineral composition in stones.Mineral distribution was mapped using reflectance Fourier transform infrared(FT-IR) microspectroscopy; then micro CT regions of interest were drawn tocorrespond to the FT-IR mineral maps, and CT attenuation measured. Further workwas done to correlate micro CT attenuation values with Hounsfield units measuredusing helical CT.

METHODS: Kidney stones were cut with a diamond wire saw, and the cutsurface was imaged using a Perkin-Elmer Spotlight 300 FT-IR imaging system toidentify mineral regions. Micro CT images (34 micron slice thickness) were alsotaken just beneath the cut surface. Regions of interest in CT images were identifiedfrom the IR mineral map, and attenuation values were measured. II stones werealso scanned both by micro CT and clinical helical CT with 1 mm slice width(Marconi MX 8000 quad-slice scanner).

RESULTS: Pure mineral regions showed CT attenuation values that werenon-overlapping. Apatite> whewellite (COM) > weddellite (COD) > cystine>struvite > uric acid. Brushite stones showed no regions of pure mineral, andyielded attenuation values generally higher than, but overlapping with COM.Comparison of focal regions of interest between micro CT and helical CT of thesame stones showed a significant correlation (p<O.OOOI) between attenuationvalues for pure mineral measured on these two instruments.

CONCLUSIONS: These data show that mineral regions in kidney stones canlargely be identified using x-ray attenuation values alone. Thus, full stone analysiscan be carried out in a non-destructive manner. Moreover, the distribution ofminerals in many mixed stones can be mapped in 3 dimensions using this method.This in vitro study anticipates a time when clinical CT will have sufficient spatialresolution to accurately yield stone analyses during patient work-up.

Source of Funding: NIH grants POI DK43881, ROI DK55674; Kidney StoneResearch Fund, Methodist Hospital of Indiana Institute for Kidney Stone Disease;American Foundation for Urologic Disease.

1727NATURAL HISTORY OF TOO SMALL TO CHARACTERIZERENAL LESIONS OBSERVED BY COMPUTED TOMOGRAPHYSCAN Kent T Perry*, Jim C Hu, Steve Raman, Blaine Kristo, Michael WPhelan, Peter G Schulam, Las Angeles, CA

INTRODUCTION AND OBJECTIVE: The continued increasing utilization ofcomputed tomography scan (CT scan) has led to the increasing detection of smalllesions of the kidney. Classifying lesions less than 1 em in size is difficult due toresolution limitations and psuedoenhancement which may occur, leading to thecommon "too small to characterize" label of hypodense renal lesions.

METHODS: Between 1/98 and 4/98 804 CT scans of the abdomen withintravenous contrast were performed at our institution. Of the 168 (21%) with toosmall to characterize, 118 (70%) had subsequent imaging with either CT scan orMRI. These 118 patients with available follow-up formed our study group. Womencomposed 48 (41%) of the subjects, while 70 (59%) were men. The mean age was