Vol. 191, No. 4S, Supplement, Monday, May 19, 2014 THE JOURNAL OF UROLOGY� e601

MP51-10PREDICTORS OF FAVORABLE URINARY OUTCOMES AFTERPROSTATE CANCER TREATMENT

Peter Chang*, Meredith Regan, Boston, MA; John Wei, Ann Arbor, MI;Larry Hembroff, East Lansing, MI; Jeff Michalski, St. Louis, MO;Christopher Saigal, Mark S. Litwin, Los Angeles, CA; Daniel Hamstra,Ann Arbor, MI; Irving Kaplan, Boston, MA; Jay Ciezki, Eric Klein,Cleveland, OH; Adam Kibel, Boston, MA; Louis Pisters,Deborah Kuban, Houston, TX; David Wood, Grosse Pointe, MI;Howard Sandler, West Hollywood, CA; Rodney Dunn, Ann Arbor, MI;Martin Sanda, Atlanta, GA

INTRODUCTION AND OBJECTIVES: While prostate cancer(PCa) treatment can result in bothersome urinary side effects, a subsetof patients may actually perceive an improvement in their urination afterPCa treatment. However, information on what factors may predictfavorable urinary outcome is sparse.

METHODS: We analyzed the 1,021 men in a multicenter pro-spective cohort of 522 radical prostatectomy (RP), 239 external radio-therapy (XRT), and 260 brachytherapy (BT) PCa patients who hadcomplete pre- and 2-year post-treatment urinary quality-of-life follow-up.We categorized pre- to post-treatment change in EPIC-26 overall uri-nary bother (5-point scale from no problem to big problem) into a five-item ordinal scale: “-2”: major worsening, “-1”: minor worsening, “0”: nochange, “1”: minor improvement, and “2”: major improvement, where“minor” ¼ 1 point and “major” ¼ 2 or greater point change. We usedordinal logistic regression to identify factors that predicted a higherordinal score across all levels of urinary bother change (i.e., a “better” or“less bad” urinary outcome). We then assessed how the effect oftreatment group interacted with the most powerful predictor.

RESULTS: Patients with moderate to severe pre-treatmentLUTS (AUA-SI � 8) were most likely to have a good urinary outcomeafter PCa treatment (45% improved and 25% worsened; Table), andafter controlling for other covariates, had an approximately 3 timeshigher odds of a favorable outcome (OR 2.8; p <0.0001). This effectvaried significantly by treatment group, and was especially strong in RPcompared to XRT and BT patients (OR 4.29 vs 1.89 and 1.86,respectively); of the RP patients with baseline LUTS, 52% had improvedand 22% had worsened urinary bother. Pre-treatment urinary medica-tions use also predicted better outcome (OR 1.41; p ¼ 0.04), while pre-treatment urinary incontinence was not a significant predictor.

CONCLUSIONS: The presence of pre-treatment LUTS is themost powerful predictor of a favorable (or less unfavorable) change inoverall urinary bother after PCa treatment. RP patients with pre-treat-ment LUTS generally preferred post-operative urinary incontinence overtheir pre-treatment symptoms. These results highlight the oft-over-looked importance of LUTS in PCa patients’ urinary health, and shouldbe used to guide patients with pre-treatment LUTS towards radicalprostatectomy.

Ordinal Distribution of Urinary Bother Change across Significant Factors onMultivariable Logistic Regression

-2

-1 0 1 2 N

(col %)

Treatment group

RP 9% 16% 47% 15% 13% 522 (51)

XRT

7% 17% 51% 18% 7% 239 (23)

BT

16% 21% 50% 9% 3% 260 (25)

Pre-treatment LUTS(AUA-SI)

Mild (0-7)

12% 18% 59% 8% 3% 648 (63)

Mod to Severe (�8)

7% 17% 31% 25% 20% 373 (37)

Pre-treatment urinarymedications

No

10% 18% 52% 13% 7% 870 (85)

Yes

13% 15% 31% 19% 23% 151 (15)

“-2” indicates major worsening, “-1” indicates minor worsening, “0” indicates nochange, “1” indicates minor improvement, and “2” indicates major improvement inoverall urinary bother after PCa treatment, where “minor” ¼ 1 point and “major” ¼2 or greater point change

Source of Funding: National Institutes of Health (R01CA95662, RC1 CA146596). This work was supported in partby a grant from the UrologyCare Foundation ResearchScholars Program and Dornier Medtech titled “MeasuringProstate Cancer Patient Reported Outcomes at the Point ofCare”.

MP51-11LOWERING THE RATE OF POSITIVE SURGICAL MARGIN ANDBIOCHEMICAL FAILURE BY INTRAOPERATIVE FROZEN SECTIONANALYSIS DURING LAPAROSCOPIC RADICALPROSTATECTOMY

Bela Kovacs*, Imre Bode, Andras Magyar, Aniko Hajdu, Tunde Mezei,Peter Tenke, Budapest, Hungary

INTRODUCTION AND OBJECTIVES: Positive surgical margin(PSM) is an independent risk factor of prostate cancer progression(biochemical recurrence (BCR), local relapse and mortality) after radicalprostatectomy. Intraoperative frozen section (IFS) reduces the rate ofPSM in cases with biopsy Gleason score 7 or higher tumors, whileprovides a more secure approach for the nerve sparing technique. Weanalyzed the impact of IFS on PSM and BCR in pT2 and pT3 tumorsafter laparoscopic radical prostatectomy (LRP) in the era of “operatehigh risk patients”.

METHODS: PSM, positive IFS and BCR of 234 consecutivepatients were determined after LRP. False negative IFSs gavethe number of cases, where further intraoperative resection couldnot be performed to reduce the risk of final PSM. The positive IFSand false negative IFS patients were sub-grouped into T2 and T3stages and the reduction effect of IFS on each sub-groupwas counted.

RESULTS: Operations were performed between March 2010and July 2013. Average PSA was 12,15ng/ml, 137 patients had post-operative Gleason score 7, 59 patients had Gleason score 8 or worse,average follow-up was two years. PSM was 97 (32 T2 (28 T2c), 64 T3)),61 of them showed positive IFS. In 45 cases, further resection wasperformed, 29 were tumor positive. In 36 cases the IFS was falsenegative, 14 T2 (13 T2c) and 22 T3, 6% and 9,4% of the total operationcount, respectively. BCR occurred in 7 (3%) and 21 (9%) patients, in thePSM and in total.

CONCLUSIONS: Although the PSM was high in this ratherhigh risk group of patients, the IFS revealed the two-third of it, andgave the opportunity to reduce the margin positive T2 and T3 casesfrom 13,6% to 6% and from 27,3% to 9,4%, respectively, with a rela-tively low BCR. Meanwhile, a better nerve preservation could beperformed for the sake of early continence and better erectile func-tion recovery.

Source of Funding: None

MP51-12PREDICTORS OF ADVERSE PATHOLOGY IN MEN UNDERGOINGRADICAL PROSTATECTOMY FOLLOWING INITIAL ACTIVESURVEILLANCE

Adam Reese*, Philadelphia, PA; Zhaoyong Feng, Patricia Landis,Bruce Trock, Jonathan Epstein, Ballentine Carter, Baltimore, MD

INTRODUCTION AND OBJECTIVES: The Epstein criteria canbe used to identify men with low-risk prostate cancer who may becandidates for active surveillance (AS). At our institution, men enrolledin active surveillance (AS) are reclassified if they no longer meetEpstein criteria during follow-up. We report pathological outcomes andpredictors of adverse pathology in men undergoing radical prostatec-tomy (RP) after initial AS.

e602 THE JOURNAL OF UROLOGY� Vol. 191, No. 4S, Supplement, Monday, May 19, 2014

METHODS: We studied pathological outcomes in men whounderwent RP after some time on AS. All men met the original Epsteincriteria (clinical stage T1, PSA density < 0.15, biopsy Gleason score �6,� 2 positive biopsy cores, � 50% involvement of any core) at the timeof diagnosis. We identified men who reclassified by the original Epsteincriteria, or by the modified Epstein criteria (clinical stage T1, PSAdensity < 0.15, biopsy Gleason score � 6, � 2 positive biopsy cores,unilateral tumor). Pathological outcomes were compared between menwith and without evidence of disease reclassification on AS, and factorsassociated with adverse pathology (defined as pathological stage-�pT3a, RP Gleason � 4+3, or lymph node involvement) weredetermined.

RESULTS: Of 1086 men enrolled in AS, 130 (12%) men whomet the Epstein criteria at the time of diagnosis underwent RP after amedian time of 1.96 years on AS. 97 (75%) of these men reclassified bythe original Epstein criteria while on AS. 95 of the 130 men met themodified Epstein criteria at diagnosis, and 85 (90%) men were reclas-sified by these criteria. Using the original criteria, rates of adverse pa-thology were greater in men with evidence of reclassification comparedto those without (p¼0.05). On multivariable analysis, reclassification byPSA density (p¼0.05) and biopsy Gleason score (p¼0.03) were asso-ciated with adverse pathology, whereas reclassification by number ofpositive biopsy cores (p¼0.78) and percent core positivity (p¼0.51)were not. Longer time on AS was likewise not associated with adversepathology (p¼0.68).

CONCLUSIONS: Adverse pathology after RP is more commonin men with evidence of disease reclassification on AS compared tothose undergoing RP for other reasons. However, we identified varyingoutcomes among these patients depending on the criterion that definedreclassification. These data may enable identification of men who cansafely continue on AS despite evidence of disease reclassification.

Source of Funding: Supported in part by The WarburtonFamily Foundation and Dr. Hugh Judge Jewett Fellowship inUrologic Oncology

MP51-13EXTERNAL VALIDATION OF THE QUANTITATIVE GLEASONSCORE IN PREDICTING PROSTATE CANCER RECURRENCEAFTER RADICAL PROSTATECTOMY

Adam Reese*, Philadelphia, PA; Elen Woldemichael, Pittsburgh, PA;Matthew Cooperberg, San Francisco, CA; Joel Nelson, Pittsburgh, PA

INTRODUCTION AND OBJECTIVES: The quantitative Glea-son score (qGS) is a modification of the current Gleason grading sys-tem for prostate cancer, based on the weighted average of high vs. lowgrade tumor in a pathology specimen. The qGS aims to capture thecontinuum of risk associated with higher volumes of poorly differenti-ated disease. The value of the qGS in predicting biochemical recur-rence (BCR) after radical prostatectomy (RP) has been previouslyreported in a single institution series. This study aims to validate thepredictive ability of the qGS in an external dataset.

METHODS: We identified patients who underwent RP at theUniversity of Pittsburgh Medical Center between 1999 and the present,and were found to have a traditional Gleason score (tGS) of 3+4 or 4+3on final pathology. The qGS was calculated in these men according tothe following equation:

qGS ¼ 2 x [(3 x %Gleason pattern 3) + (4 x %Gleason pattern 4)]

Time to BCR after RP was determined. Using Kaplan-Meier (KM)and Cox proportional hazards regression, we compared the ability ofqGS vs. tGS to predict BCR after RP.

RESULTS: 1277 men met the study inclusion criteria. Using thetGS, 1034 (81%) were pathological Gleason 3+4 and 243 (19%) wereGleason 4+3. Over a median of 56 months, 133 (10%) patients devel-oped BCR. In KM analysis, the qGS allowed for a finer assessment ofBCR risk compared to the tGS (see figures 1&2). In multivariableanalysis the qGS was significantly associated with BCR (HR 5.24, 95%CI 3.49-7.87). The c-index for the qGS model exceeded that of the tGSmodel (0.85 vs. 0.83). In a model incorporating both the qGS and the

tGS, the qGS remained significantly associated with BCR (P<0.01),whereas the tGS was not (p¼0.78).

CONCLUSIONS: The qGS is a simple modification of theGleason grading system, based on the weighted average of Glea-son patterns present in the pathology specimen. This externalvalidation confirms the ability of the qGS to predict BCR after RPwith greater precision than the tGS. The qGS may help to identifymen at high risk of recurrence who may benefit from adjuvanttherapy after RP.

Source of Funding: Partially supported by The WarburtonFamily Foundation and Dr. Hugh Judge Jewett Fellowship inUrologic Oncology

MP51-14A COMPARISON OF 111IN-J591 SPECT WITH 89ZR-J591 PETIMAGING FOR PROSTATE CANCER PATIENTS.

Sandhya Chalasani*, Shoaib Fareedy, Sarah Lindgren-Belal,Daniel Spratt, Brian Robinson, Joseph Osborne, Neil Bander,Douglas Scherr, New York, NY

INTRODUCTION AND OBJECTIVES: To compare pilot cohortsof men scheduled for radical prostatectomy imaged with novel antibodyconjugates: Cohort 1 (111In-J591) single photon emission tomography(SPECT) or Cohort 2 (89Zr-J591) positron emission tomorg-raphy (PET).

METHODS: 1) Cohort 1: Eight patients with abnormal digitalrectal exam and biopsy proven prostate cancer were injected intrave-nously with two milligrams of J591 labeled with 5mCi of 111In. SPECT/CT imaging was performed 2 to 5 days post injection. Prostatectomy