Introduction

1. The utility of the intra-operative prostate palpation method and the Memorial Sloan-Kettering Cancer Centre pre-treatment prostate cancer nomogram in predicting extracapsular extension in clinically localized prostate cancer No. 166 Genevieve Tan1, Mark Chatfield2, Manish Patel3 1Sydney Medical School, University of Sydney, Sydney, 2NHMRC Clinical Trials Centre, University of Sydney, Sydney, 3Department of Surgery, University of Sydney, Sydney Posters Proudly Supported by: Results Characteristics of the study population are displayed in Table 1. Pathological ssECE was present in 74 of the 576 prostatic lobes (13%) studied. Both methods performed reasonably well in predicting ssECE with increased sensitivity in more severe disease. (Table 2) The predictive power of the nomogram was AUC = 0.74, and this increased to 0.81 when IOP was added to the prediction model. The predictive power of IOP alone was AUC = 0.79. IOP was a significant predictor in the model for ssECE in apparently localized PCa, even after adjusting for the nomogram predictions (p<0.001). Introduction Extracapsular extension (ECE) is a risk factor for post-operative prostate cancer (PCa) recurrence1. An estimation of the likelihood of side-specific ECE (ssECE) in patients with clinically localized PCa is crucial in pre-operative counseling and identifying individuals suitable for nerve sparing radical retropubic prostatectomy (NSRRP). This has led to the development of various well-validated risk prediction models based on clinical and pathologic parameters2. Currently, there is a paucity of information regarding how these modalities fare when directly compared to one another in the prediction of ssECE. Aim To investigate the accuracy of the multivariate Memorial Sloan-Kettering Cancer Centre (MSKCC) pre-treatment PCanomogram and the intra-operative prostate palpation method (IOP) in predicting ssECE in apparently localized PCa Methods Single centre prospective cohort study on 288 consecutive patients with clinically localized PCa, and had undergone radical retropubic prostatectomy performed by a single surgeon between January 2005 and July 2009. Each prostatic lobe was evaluated separately. The type of NVB preservation (nerve sparing, partial or complete resection) performed depended on the MSKCC pre-treatment PCanomogram prediction of ssECE (in quartiles) and the results of IOP. This was entirely at the discretion of the surgeon who was not blinded to the nomogram results. Histopathological findings from the final RRP specimens determined the actual presence of ECE. Logistic regression models including the nomogram predictions and IOP were used to assess their importance as predictors of ssECE by reporting the area under the resulting receiver operating characteristic curve (AUC). Table 1. Clinical and pathological characteristics of cancer in 288 patients Table 2. Association of ssECE with predictions from MSKCC pre-treatment nomogram and IOP findings for 576 prostatic lobes Conclusions Findings from this study indicate that IOP adds useful information to the MSKCC pre-treatment nomogram in the prediction of ssECE in clinically localized PCa. IOP should ideally be incorporated into the risk assessment process to aid in the appropriate selection of patients for NSRRP. References 1. Wheeler, T. M., Dillioglugil, O., Kattan, M. W. et al.: Clinical and pathological significance of the level and extent of capsular invasion in clinical stage T1-2 prostate cancer. Human Pathology, 29: 856, 1998 2. Lowrance, W., Scardino, P.: Predictive Models for Newly Diagnosed Prostate Cancer Patients. Rev Urol, 11: 117, 2009 Acknowledgements Dr Chatfield and A/Prof Patel for their invaluable guidance and staff at Western Urology (Suite 12 Westmead Private Hospital, NSW) for their assistance throughout this project.