RESULTS: The average time from the completion of the resi-dency training was 16.2 years with 81.7% being fellowship-trained inoncology.86.1% of the responders practice in academic setting, 48.6%treated more than 10 testicular cancer patients per year and 40.6%performed more than 5 RPLNDs per year. The majority (63.1%) rec-ommended surveillance for low stage marker negative nonseminoma-tous germ cell tumors. The rest of the responders recommendedRPLND (36.9%) and adjuvant chemotherapy (6.2%). Tumor histology(63.1%) and patient�s level of anxiety and preference (53.8%) were themost important factors driving treatment selection.

CONCLUSIONS: Post-orchiectomy surveillance is becomingthe option of choice for the treatment of low-stage nonseminomatousgerm cell tumors. Both patient and disease disease characteristics arecontributing to this decision making process.

Source of Funding: None

645PENILE KAPOSI’S SARCOMA IN THE STATE OF CALIFORNIA

Jeffrey M. Woldrich*, Jonathan L. Silberstein, Sidney L. Saltzstein,Ithaar H. Derweesh, Tracy M. Downs, San Diego, CA

INTRODUCTION AND OBJECTIVES: Penile Kaposi’s Sar-coma (PKS) is a rare and poorly characterized disease associated withadvanced HIV disease. This study aimed to review epidemiologiccharacteristics and changes in the incidence of Penile Kaposi’s Sar-coma (PKS) using a large, population-based database.

METHODS: The California Cancer Registry (CCR) was re-viewed from the years 1988-2004, identifying all cases of Penile Can-cer (PC). This registry has required mandatory reporting for most typesof malignancy diagnosed in the state of California since 1988, with stateenforced penalties for failure to report. Currently the CCR is servicingmore than 36 million Americans. Tumors were classified by histologicsubtype and stage. Annual age-adjusted incidence rates were calcu-lated for the overall population and subdivided histology. Actuarialmortality rates were calculated. Data on the incidence of HIV and AIDSwere obtained from the California Department of Public Health, whichbegan confidential AIDS case reporting in 1983.

RESULTS: From 1988-2004, 2870 cases of PC were identified.Squamous cell carcinoma accounted for 87% of all PC (n�2507), andPKS was the second most common variant, accounting for 4.6%(n�132). Sarcoma not otherwise specified represented �1% (n�14).Patients diagnosed with PKS were significantly younger with a meanage of 43.7 years, compared with the overall cohort at 62.6 years(P� .0001). The incidence of PKS peaked in 1992 with a subsequentdramatic decline. The incidence of newly diagnosed cases of AIDS inthe state of California peaked at 12,241 in the same year, with a paralleldecline. The average age-adjusted incidence rate (AAIR) of penilecancer over the sixteen-year study period was 1.4/100,000 persons peryear, and the AAIR diminished throughout this time period. PKS ac-counted for 7.4% of penile cancer cases from 1988-1995 but only 1.7%of cases from 1996-2004 (p�.0001). Patients diagnosed with PKSdemonstrated a significantly lower 5 (p�.0001) and 10 year (p�.001)relative cumulative survival than those with SCC.

CONCLUSIONS: PKS is an uncommon and poorly character-ized tumor, though it is the second most frequent malignancy of thepenis. Patients diagnosed with PKS are younger and have a worseprognosis compared with other histologic subtypes of PC. The inci-dence of KS has a demonstrated, direct relationship with AIDS, and thisassociation may account for the differences in patient demographics,changes in incidence, and prognosis between the PKS and overall PCcohorts in our study.

Source of Funding: None

646NODAL METASTASES OF PENILE SQUAMOUS-CELLCARCINOMA (SCC): PROGNOSTIC PARAMETERS OF ARECENT SERIES OF PATIENTS UNDERGOING LYMPH-NODEDISSECTION (LND) � SYSTEMIC CHEMOTHERAPY.

Luigi Piva*, Andrea Necchi, Nicola Nicolai, Mario Catanzaro, TullioTorelli, Davide Biasoni, Silvia Stagni, Angelo Milani, RobertoSalvioni, Milano, Italy

INTRODUCTION AND OBJECTIVES: Nodal metastases frompenile SCC are the most crucial event in the history of disease.Prognosis of patients (pts) with nodal metastases is commonly consid-ered unsatisfactory, but majority of the few available reports refer to oldseries. We analyzed our most recent series of pts with lymph-nodeinvolvement from penile SCC to re-assess factors affecting prognosis.

METHODS: Between 2000 and 2009, 78 consecutive pts withnodal metastases from penile SCC have been referred to our Institu-tion. 68 pts (median age: 58 yrs), are fully evaluable for diseasecharacteristics and follow-up (F-UP). Bilateral and pN3 disease werepresent in 11 (16%) and in 26 (38%) cases. 10 pts underwent inguinalLND while 58 (85%) inguinal-pelvic one. LND was unilateral in 21 andbilateral in 47 cases, respectively and it was radical in 64/68 pts (94%).Chemotherapy was delivered as primary treatment in 13 (19%), asadjuvant in 25 (37%) and as a combination of neo-adjuvant andadjuvant in 4 (6%) pts, respectively. Medical treatment was heteroge-neous and included cisplatin and 5 fluoro-uracil � a taxane (T/PF) or acombination of vincristine, bleomycin and methotrexate (VBM).

RESULTS: 33 (49%) pts relapsed after a median time of 5 mos(IQR 3-9), while 35 (51%) remained progression-free following a me-dian follow-up of 14 mos (IQR 2.5-52). Significant factors associatingwith relapse were bilateral extension of disease (p�0.0013 at Log ranktest; HR 4.96, 95% CI 1.86-13.15) and pN3 disease (p�0.002 at Logrank test; HR 3.82, 95% CI 1.63-8.95). Systemic chemotherapy prior toor following surgery was not a significant parameter for recurrence(p�0.1989 at Log rank test; HR 0.61, 95% CI 0.29-1.29). Nine (27%) of33 relapsing pts could be rescued with further treatments and are stillalive (median overall survival of 10 mos; IQR 5-16). Currently 44 (65%)of 68 pts are still alive and without evidence of disease after a medianF-UP of 10.5 mos (IQR 3.75-33.25).

CONCLUSIONS: Our data indicate that radical surgery cur-rently plays a major role in controlling metastatic penile SCC, andconfirm that bilateral and pelvic extension of nodal disease are the mostsignificant unfavorable factors for recurrence. Systemic therapy exertssome effect in advanced disease, but its role needs to be still defined.Few pts can be rescued following further recurrent disease. Earlydetection and proper surgery remain the most important factors inpreventing disease progression.

Source of Funding: None

647PROGNOSTIC SIGNIFICANCE OF EXTRANODAL EXTENSION INPATHOLOGICAL NODE-POSITIVE PATIENTS WITH PENILESQUAMOUS CELL CARCINOMA

Niels Graafland*, Hester van Boven, Erik van Werkhoven, LucMoonen, Simon Horenblas, Amsterdam, Netherlands

INTRODUCTION AND OBJECTIVES: The most importantprognostic factor in men with penile squamous cell carcinoma is thepresence of lymph node involvement. Survival in patients with meta-static nodes ranges between 17 – 79% depending on the extent ofnodal involvement. The purpose of this study was to evaluate theprognostic impact of several risk factors for pathological node-positivepenile squamous cell carcinoma.

METHODS: We analyzed a consecutive series of 156 chemo-therapy-naı̈ve patients who had undergone therapeutic inguinal lymph-adenectomy because of lymph node metastases between 1988 and2008 at our Institute. Postoperative external radiotherapy to the groinand ipsilateral pelvic lymphadenectomy was indicated if histopatholog-

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