Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts MP1-10 African AmericanMen: ACritical Examination of the Dynamics Involving Their Decision to Pursue or Not Pursue Screening for Prostate Cancer C. Womack Fielding Graduate University, Santa Barbara, CA, USA Introduction: AfricanAmerican men have a high mortality rate related to prostate cancer. There is much debate in academic groups related to issues that contribute to the death rate, with the leading factor being the lack of early screening. The literature discusses that some of the obstacles to screening for African American men also exist for those belonging to other racial groups. Objective: The purpose of this study is to understand the role of risk assessment by African American men in pursuing (or not) prostate cancer screening. The interpretation of risk assessment could be a key component that influences health behaviors among African American men. Methods &Materials: The research design I used in the study applied qualitative methods with a thematic approach. The research participant population consisted of African American men between 40 years of age and older. The expected size of the participant population in the study consisted of 10–16 participants. The recruitment of research participants was made within networks of community, social organizations, and community-gathering areas (i.e., church, barbershops, and community centers). Each participant was expected to be available for a face- to-face or phone interviewnot exceeding 60 minutes. Sessions with each participant would be recorded and transcribed. Results: What is evident is there are influential factors that determine the decision of African American men related to prostate cancer screens. Those who pursued prostate cancer screening suggested they took protective measures against the risk of prostate cancer. The participants who choose not to have prostate cancer screens seem to be satisfied with their decision and feel that their risk is minimum. Conclusions: The contribution to research was the evolution of the established theme of Mistrust, Education, Masculinity, Family, Peer, and Community. Each of the themes plays an important role with risk assessment byAfricanAmericanmen. Urine Exosome Gene Expression Biomarker in 1212 Men Undergoing Prostate Biopsy – Performance AnalysisWithin USPSTF Age andNCCNPSAGuidelines R. Tutrone 1 ; M. Donovan 2 ; M. Noerholm 3 ; V. Tadigotla 3 ; S. Kumar 3 ; P. Torkler 3 ; G. Sant 3 ; J. Alter 3 ; J. Skog 3 1 Chesapeake Urology Research Associates, Baltimore, MD, USA; 2 Icahn School of Medicine at Mt. Sinai, New York City, NY, USA; 3 Exosome Diagnostics, A Bio-Techne Brand, Waltham, MA, USA Introduction: ExoDx Prostate (IntelliScore) (EPI) is a validated non-invasive urine gene expression assay that informs initial prostate biopsy decision-making in men with PSAlevels in the “gray zone’ of 2-10 ng/mL and age >/= 50 years. It provides an individualized risk assessment for likelihood of having >/= GG2 on prostate biopsy. Performance analysis of pooled data from 1212 men including subgroups from the 2018 USPTF age and 2019 NCCN PSA Early Detection Guidelines was performed. Materials & Methods: Pooled data (2 validation studies, control arm of clinical utility trial) was analyzed by (a) age 55-69 per USPSTF recommendation and (b) PSA level greater than 3 ng/mL per NCCN guidelines. Diagnostic needle biopsy outcomes were compared by EPI score, PSA and PCPT 2.0 risk calculator. Performance is reported using the area under the receiver operating characteristic curve (AUC), negative predictive value (NPV), and sensitivity for discriminating clinically significant ≥ GG2 from GG1 and benign disease. Number of clinically significant GG3 PCa < 15.6 cut-point was also assessed. Results: In the pooled cohort of 1212 men, EPI showed an AUC of 0.7 vs. PSA AUC 0.56, PCPT2.0AUC 0.62. Using a cut-point of 15.6 yielded an NPV 90.1%, and sensitivity 92.3% (p-values < 0.001) for discriminating ≥ GG2 PCa frombenign/GG1. Comparable results were identified when both the USPSTF age limits were applied (n = 833, AUC 0.69, PSAAUC 0.57, PCPT2.0 AUC 0.61; NPV 91.5% and Sensitivity 93.3) and NCCN PSA > 3 (n = 1097, AUC 0.7, PSAAUC 0.56, PCPT2.0 AUC 0.61; NPV 89.1 and Sensitivity 91.4%). The % of false negative >/= GG3 (Gleason 4+3) was < 5% across all three groups. Conclusions: EPI, a non-invasive urine exosome gene expression assay, provides discriminant risk stratification for clinically significant GG2 and higher prostate cancer fromGG1 and benign disease across multiple patient profiles and subgroups from the USPSTF and NCCN Guidelines. Pathologic Upgrading of Biopsy Grade Group 1 Prostate Cancers following Radical Prostatectomy K. Michel 1 ; R. Talwar 1 ; J. Raman 2 ; C. Fonshell 3 ; K. Syed 3 ; M. Smaldone 4 ; J. Danella 5 ; M. Hagg 6 ;A. Reese 7 ; J. Tomaszewski 8 ; E. Trabulsi 9 ; R. Uzzo 4 ; E. Singer 10 ; B. Jacobs 11 ; S. Ginzburg 12 ; T. Guzzo 1 1 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; 2 Penn State Milton S. Hershey Medical Center, Hershey, PA, USA; 3 Health Care Improvement Foundation, Philadelphia, PA, USA; 4 Fox Chase Cancer Center, Philadelphia, PA, USA; 5 Geisinger Medical Center, Danville, PA, USA; 6 Urology Health Specialists, Abington, PA, USA; 7 Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; 8 MDAnderson Cancer Center at Cooper University, Camden, NJ, USA; 9 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; 10 Rutgers Cancer Institute of New Jersey, NewBrunswick, PA, USA; 11 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 12 Einstein Healthcare Network, Philadelphia, PA, USA Introduction: In prostate cancer patients, accuracy of biopsy is particularly essential for patients with Grade Group (GG) 1 disease considering active surveillance (AS). We conducted an analysis of our GG1 prostate cancer population to understand the regional treatment pattern and factors that may affect biopsy accuracy. Materials & Methods: Within the Pennsylvania Urologic Regional Collaborative (PURC) database, we identified patients with GG1 biopsies and assessed treatment decisions. We then identified patients who underwent radical prostatectomy and compared patients who were upgraded versus not upgraded following prostatectomy based on race, family history, previous biopsy, biopsy type, number of positive cores, and practice site. We performed univariate regression for each variable and then included any significant variables in a multivariate model assessing upgrading. Results: There were 1,095 GG1 biopsies from 2015-2018. The three most common treatments for this groupwere radical prostatectomy (n = 553; 50.5%), external beam radiation therapy (n = 199; 18.2%), and active surveillance (n = 188; 17.2%). Of the 553 patients who underwent radical prostatectomy, only 10.1% had GG1 disease at prostatectomy. Table 1 shows the distribution of variables between the upgraded versus not-upgraded groups. In a multivariate regression to evaluate association with upgrading, only the presence of prior biopsy remained significant (OR 0.38, p = 0.008, 95%CI: 0.86-0.78). Conclusions: Our data indicate a regional pattern wherein about half of GG1 biopsies lead to prostatectomy, and 90% are upgraded after prostatectomy. This may indicate that providers in this region are using additional variables, such as imaging or PSA, to create favorable selection bias; further analysis to elucidate this is forthcoming. In this study, we found that history of prior biopsy was the only factor associated with decreased odds of upgrading at prostatectomy. MP1-11 MP1-09 17 Poster Session 1: Diagnostic Imaging and Risk Stratification in Cancer