Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 RPE-01 RPE-02 Concordance of Confirmatory Prostate Biopsy in Active Surveillance with National Guidelines: an Analysis from the Multi-Institutional PURC Cohort R.Talwar 1 ;B.Friel 1 ;S.Mittal 1 ;L.Xia 1 ;C.Fonshell 2 ;J.Danella 3 ;T.Lanchoney 4 ;J.Raman 5 ; J. Tomaszewski 6 ; E. Trabulsi 7 ; A. Reese 8 ; S. Ginzburg 9 ; M. Smaldone 10 ; R. Uzzo 10 ; P. Mucksavage 1 ; T. Guzzo 1 ; D. Lee 1 1 University of Pennsylvania, Philadelphia, PA, USA; 2 Health Care Improvement Fondation, Philadelphia, PA, USA; 3 Geisinger Medical Center, Danville, PA, USA; 4 Urology Health Specialists, Hershey, PA, USA; 5 Penn State Milton S. Hershey Medical Center, Hershey, PA, USA; 6 MDAnderson Cancer Center at Cooper University, Camden, NJ, USA; 7 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; 8 Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; 9 Einstein Healthcare Network, Philadelphia, PA, USA; 10 Fox Chase Cancer Center, Philadelphia, PA, USA Introduction: As the federal government expands bundled payment models in oncologic care, an emphasis has been placed on guideline adherence as a proxy for healthcare quality and value. NCCN guidelines recommend confirmatory biopsy within 12 months of active surveillance (AS) enrollment. Our objective was to determine if patients on AS within practices in the Pennsylvania Urologic Regional Collaborative (PURC) receive guideline concordant confirmatory biopsies. Materials & Methods: Within PURC, a prospective collaborative of diverse academic and community urology practices in Pennsylvania and New Jersey, we identified men enrolled in AS after their first biopsy with follow up for at least 1 year from 2015 to 2018. We analyzed time to re-biopsy and factors associated with time to re-biopsy. Results: 1,047 patients were enrolled in AS for a minimum of 12 months after initial biopsy. Of these, 477 (45%) underwent a second biopsy at a participating PURC practice. The number of patients undergoing re-biopsy within 6 months, 6-12 months, 12-18 months and > 18 months was 71 (14%), 218 (45.7%), 134 (28%) and 54 (11%), respectively. 60.5% underwent confirmatory biopsy within 12 months. On univariable analysis, re-biopsy interval was associated with number of positive cores, perineural invasion, and practice ID (all p < 0.05). Multivariable Cox regression did not identify factors predictive of time to second biopsy. Conclusions: Only 60.5% of patients who underwent a confirmatory biopsy at PURCpractices did sowithin 12months, per NCCNguidelines. We noted significant practice level variation; this suggests area for improvement in guideline adherence after enrollment inAS, as these variations are avoidable and may have policy level implications as a quality metric. Practices offeringAS should periodically perform similar analyses to monitor their performance. Systematic Endoscopic Evaluation in Predicting pT0 Bladder Cancer: a Prospective Trial A. Asghar; D. Parker; J. O’Neill; R. Greenberg; M. Smaldone; D. Chen; R. Viterbo; R. Uzzo; E. Bloom; D. Geynisman; M. Deng; E. Ross; E. Plimack; P. Abbosh; M. Zibelman; A. Kutikov Fox Chase Cancer Center, Philadelphia, PA, USA Introduction: Concern for discordance between endoscopic evaluation and final pathology drives current clinical management of patients deemed appropriate candidates for radical cystectomy (RC). Yet, > 30% of patients who undergo neoadjuvant chemotherapy (NAC) prior to RC do not harbor detectablemalignancy at the time of extirpative surgery. Our objective was to prospectively assess the reliability of Systematic Endoscopic Evaluation (SEE) in RC candidates. Materials & Methods: Patients undergoing RC for urothelial carcinoma (UC) were enrolled in a prospective, single-arm study to evaluate reliability of SEE in predicting pT0 UC. SEE consisted of cystoscopy with biopsy (and transurethral resection with loop after amendment) of visible tumor and/or tumor bed/scar, plus two random biopsies at the time of RC. A standardized bladder map was used to index cystoscopic findings. SEE and biopsy results were compared to RC pathology. Comparisons were considered congruent if both SEE and RC were T0, or if any level of disease seen at both SEE and RC (exception: cT0 but pTis at RC = congruence). Negative predictive value (NPV) less than 70% triggered study termination for futility. Results: In this trial, 61 patients underwent SEE and RC. 41 patients (67%) had MIBC and 20 patients (33%) had high-risk NMIBC. 38 patients (62%) received platinum-basedNAC. Based on RC final pathology, 16 patients (26%) were pT0 and 28 patients (46%) harbored residual ≥ pT2 disease. For detecting any disease, the positive predictive value was 96.7%, but the NPV was 48.4%, necessitating study closure. The sensitivity for detecting ≥ pT2 at RC was 71%. Conclusions: To our knowledge, this was the first prospective study exploring SEE as a predictive tool for residual malignancy. The NPV was below the pre-specified threshold, triggering study closure. SEE missed ≥ pT2 UC ~30% of the time. This study definitively demonstrates that current cystoscopic techniques are inadequate to guide decisions on bladder preservation. 2 Resident Prize Essay Podium Session