A. Volpe

C. Terrone

D. Giraudo

E. De Lorenzis

F. Sogni

F. Varvello

M. Zacchero

P. De Angelis

P. Mondino

English

Alessandro Volpe

Davide Giraudo

Paolo De Angelis

Elisa De Lorenzis

Monica Zacchero

Paolo Mondino

Francesco Varvello

Filippo Sogni

Carlo Terrone

AIR Universita degli studi di Milano

characteristics mentioned above. Results: Among our 60patients, 58 had organ confined disease (8 pT2a: 13%, 6pT2b:10 %, 41 pT2c: 68%) while 2 patients had extracapsularinvasion (pT3a: 3%), though no seminal vescicle involvement(pT3b) was detected in this cohort. In 50 cases (83%) theresection margins were free from cancer (R0), while 10 cases(17%) showed positive margins (R1). The pathological Gs was6 in 18 cases (30%), 3+4 in 27 (45%), 4+3 in 14 (23%) and 8-10 in 1 (2%). According to the risk based analysis, 45 patients(75%) were at low risk of aggressive disease, while thepercentage of intermediate risk patients was about 23%, andonly 1 patient (2%) harboured a high risk prostate cancer.Conclusion: According to our study, the inclusion criteria ofProstate Cancer Research International Active Survelliance(P.R.I.A.S.) have high accuracy in the prediction of organconfined and low-intermediate risk prostate cancer. Our resultsseem to be consistently better than those of the actual literature,maybe thanks to the anatomopathological review performed bya single experienced uropathologist, which allowed us toexclude 53 patients who would have compromised the accuracyof our results. Thus, according to our experience, the actualActive Surveillance parameters can be safely adopted, only ifthe review is performed by a single uropathologist of provenexperience.78TRENDS IN PARTIAL NEPHRECTOMY USE IN ITALY: DATA FROM PIEDMONT REGION IN THE LAST DECADEAlessandro Volpe, Paolo De Angelis, Michele Billia, Antonia Di Domenico, Luisa Zegna, Paolo Mondino, Irene Mittino, Elisa De Lorenzis, Carlo Terrone Clinica Urologica Università del Piemonte Orientale -Ospedale Maggiore della Carità, Novara, ItalyIntroduction: Recent studies have shown that partialnephrectomy (PN) has equivalent oncologic outcomes withradical nephrectomy (RN) for localized renal tumors. Themost recent international guidelines for renal cell carcinoma(RCC) recommend the use of nephron sparing surgery (NSS)for renal lesions up to 7 cm in size whenever technicallyfeasible. Despite this, PN remains underused in NorthAmerica. Aim of this study was to evaluate trends in PN useduring the last decade in a north-western Italian region.Patients and Methods: The regional archives of hospitaldischarge records in Piedmont region from January 2000 toDecember 2010 were retrospectively analysed. All proceduresrecorded with the ICD-9 codes 55.3, 55.4 (PN) and 55.5 (RN)performed for a primary diagnosis of renal tumor (189.0) wereincluded in the analysis (n=6180). The surgeries wereperformed in 43 different urological institutions, that werestratified according to academic status and hospitalnephrectomy volume (high >300, intermediate 100-300, low<100 nephrectomies in the study period). Trends in the use ofPN were assessed overall and according to institution type.Results: The overall number of surgical procedures for renaltumors performed in Piedmont region increased significantlyfrom 2000 to 2010 (+27%). RN is the preferred surgicaltreatment, but an increasing use of PN was observed over thestudy period. This trend is more significant in centres withhigh renal surgical volume (+ 19.9%) and in non academiccentres (+13.7%). Discussion and Conclusion: PN isincreasingly performed in the last decade in Piedmont region.The most significant increase in the indications to NSS wasobserved in institutions with high renal surgical volume.However, PN remains relatively underused and strategies toenhance conservative treatments of renal tumors should beimplemented. 79FLUORESCENT CYSTOSCOPY WITHHEXAMINOLEVULINATE: DIAGNOSTICACCURACY FOR NON MUSCLE INVASIVE BLADDER CANCERAlessandro Volpe, Davide Giraudo, Paolo De Angelis,Elisa De Lorenzis, Monica Zacchero, Paolo Mondino,Francesco Varvello, Filippo Sogni, Carlo TerroneClinica Urologica, Università del Piemonte Orientale,Ospedale Maggiore della Carità, Novara, ItalyIntroduction: The sensitivity of white light cystoscopy (WLC)can be improved especially for the detection of flat urothelialneoplasms. Fluorescent or blue light cystoscopy (BLC) has thepotential to overcome the limitations of WLC. Aim of thisstudy was to compare the diagnostic accuracy of WLC andBLC in the diagnosis of urothelial cancer and to identify theconditions where BLC can provide the highest diagnosticadvantage over WLC. Patients and Methods: 71 patients witha suspicious primary or recurrent bladder tumor were enrolledin the study. Patients who had intravesical instillations in the 3months before the procedure were not eligible. Afterintravescical instillation of Hexaminolevulinate 85 mg onehour before the procedure, the patients underwent WLCfollowed by BLC. All observed lesions were reported in adiagram, biopsied or resected. Detection rate and falsedetection rate of the two techniques were compared. Datawere stratified according to pathology of bladder lesions andbladder site where the lesions were observed. A subsetanalysis was also performed to assess the diagnostic accuracyof WLC and BLC in patients who had (n=36) or had not(n=35) undergone previous intravesical treatments to preventrecurrence and progression. Results: Overall 270 bladderAbstracts of the 22nd Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 13-15 June, 2012, Bologna, Italy1897lesions were detected (102 with BLC, 7 with WLC, 161 withboth techniques). At pathology 236 lesions were malignant,while 34 were benign. The detection rate was 62.2% for WLC(147/236) and 98.3% for BLC (232/236). The highestdiagnostic advantage for BLC was observed for the diagnosisof carcinoma in situ and for lesions located at the bladderdome. The false detection rate was 12.5% for WLC (21/168)and 11,4% for BLC (30/263). Overall, 32/71 patients (45.1%)had a diagnostic advantage with BLC (diagnosis of at leastone Cis, dysplastic or papillary lesion that was missed atWLC). The subset analysis showed that the detection rate ofBLC is not decreased in patients who have undergone previousendovesical treatment (98.1% vs. 97.8%), as well as the falsedetection rate is not increased (11.6% vs. 11.4%). Discussionand Conclusion: BLC is a promising technique that has asignificantly higher detection rate than WLC. The highestdiagnostic advantage with BLC can be obtained for thediagnosis of Cis and of lesions located at the bladder dome.The detection rate of BLC is not decreased in patients whounderwent previous endovesical treatments when the lastinstillation is not performed in the 3 months before theprocedure.80PROSTATE SPECIFIC ANTIGEN (PSA) USE ANDINCIDENCE OF PROSTATE CANCER (PC) AMONGELDERLY MEN IN NORTH-EAST ITALY: APOPULATION-BASED EVALUATION STUDYDiego Serraino1, Sivia Birri2, Lucia Fratino3, Ettore Bidoli2, Emilia De Santis2, Ornella Forgiarini2, Roberto Bortolus4, Loris Zanier51Epidemiologia, IRCCS Centro di Riferimento Oncologico,Aviano; 2Epidemiologia, IRCCS CRO, Aviano; 3Clinica di Oncologia Medica, IRCCS CRO, Aviano; 4Radioterapia IRCCS CRO, Aviano; 5Anatomia e Citoistologia Patologica, Direzione CentraleFVG, ItalyPurpose: The PSA blood test has changed the epidemiology ofPC, creating a dramatic rise in its incidence and helping to shiftthe stage of disease to much earlier and potentially more curableone. PSA testing remains, however, a source of uncertaintiessince periodic testing may increase the risk of treating manymen for screen-detected PC who would not have experiencedill effects if PC had been left undetected. The risk of overdiagnosis and over treatment associated with PSA is particularlysignificant among elderly men, among whom it is questionedwhether life expectancy is significantly reduced after PCdiagnosis. The study aim was to assess, from 1998 thru 2009,PSA use and PC incidence rates in elderly men (>= 70 years) inthe Friuli Venezia Giulia region (FVG), northeastern Italy.Methods: PC cases were identified through the population-basedCancer Registry that collects all cancer cases occurring since1995 in resident people. Individual history of PSA testing wasextracted from the regional digital health archive that providesthe identification of men tested for PSA and the date of testing.Joinpoint regression analysis was used to identify significantchanges over time in log-linear slopes. The annual percentagechange (APC) was computed by means of generalised linearmodels. Results: From 1998 to 2007, 10377 incident PC caseshave been identified, of which 56.5% were among elderly. Thecrude incidence rate of PC in elderly men increased from824.2/100.000 in 1998 to 875.4 in 2007, with an APC of +6.18(95%CI 2.01-3.16). 38.826 men (out of the approximately70300 elderly men residing in FVG) were tested for PSA in2009, with a total number of 58147 tests performed. Between1998 and 2009, the percentage of elderly men aged 70-79 whounderwent PSA test increased substantially (APC=13.02%),with a change in slope in 2002. Among elderly men aged 80years or older, the APC increase was 12.80%, and 2003 the yearwith the change in slope. Approximately 30% of elderly menwho underwent PSA were tested more than once. On average,there were 1.06 cases of newly diagnosed PC every 100 PSAtests. The number of elderly men tested for PSA who underwentecographic examination and/or biopsy strongly declined -from900 to 400 ecographic exams for every 10000 tested men; from300 to 200 biopsy for every 10000 tested men. Conclusion: Theincreasing incidence of PC in FVG reflects the rising use ofPSA testing also among elderly men, even for men aged 80years or older. The huge number of PSA tests was inverselyassociated with the number of ecographic examinations orbiopsies over the study period, indicating that PSA testing iswidely used in asymptomatic elderly men.81CONTRAST-ENHANCED ULTRASOUND FOREVALUATION OF RCCS: IDENTIFICATION OFHIGH-RISK TUMORS THROUGH SIGNALTIME/INTENSITY CURVESFederico Lanzi1, Elena Bertelli2, Claudia Giannessi1,Giancane Saverio1, Antonella Verrioli2, Lorenzo Masieri1,Livia Eleonora Quattrone2, Arcangelo Sebastianelli1, AndreaMoffa Marchetti1, Alberto Lapini1, Simone Agostini21Clinica Urologica [I] AOU Careggi, Firenze;2Dipartimento Di Radiodiagnostica AOU Careggi, Firenze,ItalyAim: The aim of the study is to evaluate the efficacy oftime/intensity curves (T/IS) for quantitative analysis ofcontrast kinetics during contrast-enhanced ultrasound (CEUS)in characterization of renal lesions. Patients and Methods: WeANTICANCER RESEARCH 32: 1843-1966 (2012)1898

FLUORESCENT CYSTOSCOPY WITH HEXAMINOLEVULINATE: DIAGNOSTIC ACCURACY FOR NON MUSCLE INVASIVE BLADDER CANCER

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FLUORESCENT CYSTOSCOPY WITH HEXAMINOLEVULINATE: DIAGNOSTIC ACCURACY FOR NON MUSCLE INVASIVE BLADDER CANCER

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