Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts Variable Clinically Significant Prostate Cancer Detection Rates on Magnetic Resonance Imaging Fusion Prostate Biopsy - Experience from the Pennsylvania Urologic Regional Collaborative A.A. Ako 1,2 ; J. Raman 3 ; L. McClure 1 ; C. Fonshell 2 ; A. Reese 4 ; J. Tomaszewski 5 ; M. Smaldone 6 ; R. Uzzo 6 ; E. Trabulsi 7 ; T. Guzzo 8 ; J. Danella 9 ; L. Belkoff 10 ; E. Singer 11 ; B. Jacobs 12 ; S. Ginzburg 6,13 1 Drexel University Dornsife School of Public Health, Philadelphia, PA, USA; 2 Health Care Improvement Foundation, Philadelphia, PA, USA; 3 Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA; 4 Temple University Hospital, Philadelphia, PA, USA; 5 MD Anderson Cancer Center at Cooper-Camden, Camden, PA, USA; 6 Fox Chase Cancer Center, Philadelphia, PA, USA; 7 Jefferson University Hospitals, Philadelphia, PA, USA; 8 University of Pennsylvania Health System, Philadelphia, PA, USA; 9 Geisinger Medical Center, Philadelphia, PA, USA; 10 Midlantic Urology, Bala Cynwyd, PA, USA; 11 Rutgers Cancer Institute of New Jersey, NewBrunswick, NJ, USA; 12 University of Pittsburg School of Medicine, Hazle Township, PA, USA; 13 EinsteinHealthcare Network, Philadelphia, PA, USA Introduction: Magnetic resonance imaging (MRI) fusion biopsy has been shown to outperform systematic biopsy in detecting clinically significant prostate cancer (csPCa). We examined practice variability in detecting csPCa in a large regional quality collaborative. Materials & Methods: The Pennsylvania Urologic Regional Collaborative is a physician-led quality improvement collaborative comprised of 11 urology practices across Pennsylvania andNew Jersey. We analyzed 857 first-time MRI fusion biopsy procedures performed at 5 practices between January 2015 and June 2019.Analysis was restricted to practices with aminimumof 30 biopsies. Chi-square andmultilevel logistic regression analyzed the association between patient characteristics and csPCa detection (defined as Gleason ≥ 4+3 tumor) and the variability in odds of csPCa detection by practice. Results: Detection rates for csPCa ranged from 14% to 28% across practices (p = 0.02); (Table 1). Patient age, family history, race, digital rectal examination findings, prostate specific antigen, prostate volume and Prostate Imaging-Reporting andData System (PI-RADS) score varied significantly by practice and were all, except family history and race, significantly associated with csPCa (Table 2). PI-RADS score of ≥ 4 was associated with increased likelihood of detecting csPCa (OR 2.67, 95% CI 1.48, 4.83, p = 0.01). After controlling for patient characteristics, the odds of csPCa detection did not vary significantly by practice (intercept variance = 0.042, p = 0.26). Conclusions: Practice variability in csPCa detection rates was predominantly attributable to variability in patient characteristics. This suggests significant differences in practice patterns and patient selection for fusion biopsy. Furthermore, results highlight the importance of pre-biopsy MRI in the diagnosis of csPCa. MP1-15 19 Poster Session 1: Diagnostic Imaging and Risk Stratification in Cancer