Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 MultiparametricMRI Findings Predictive of Adverse Pathology and Biochemical Recurrence After Radical Prostatectomy R. Alam; M. Huang; Z. Schwen; H. Patel; M. Biles; C. Pavlovich Johns Hopkins University School of Medicine, Baltimore, MD, USA Introduction: Multiparametric magnetic resonance imaging (mpMRI) has emerged as a valuable tool to improve the risk stratification of patients with clinically localized prostate cancer. To better stratify patients whomay harbor more aggressive disease, this study identifies preoperative mpMRI findings associatedwith adverse surgical pathology (ASP) or biochemical recurrence (BCR). Materials & Methods: Retrospective chart review of all patients who underwent mpMRI prior to radical prostatectomy from 2014 to 2017 was performed. Logistic regression was utilized to analyze associations. ASP was defined as Grade Group (GG) ≥ 3 disease, seminal vesicle invasion (SVI), and/or positive pelvic lymph nodes (+LN). Separately, we evaluated mpMRI characteristics predictive of ASP in patients with GG2 disease on biopsy to better risk stratify men with NCCN intermediate-risk disease. Results: There were 411 patients with a median PSA of 6.4 ng/mL, of whom 65 (15.8%) had no significant mpMRI findings, 258 (62.7%) had a PI-RADS lesion ≥ 4, and 96 (23.3%) had mpMRI positive for extraprostatic extension (EPE). On preoperative biopsy, GG1, GG2, and GG ≥ 3 disease was identified in 131 (31.9%), 150 (36.4%), and 130 (31.6%) men, respectively. On postoperative surgical pathology, GG ≥ 3 disease, SVI, and +LN were present in 132 (32.1%), 39 (9.4%), and 23 (5.5%) men, respectively. Multivariable regression controlling for PSA, PI-RADS score, and lesion diameter demonstrated that EPE onmpMRI was significantly associatedwith ASP (OR 3.18, P < 0.001). Among men with GG2 disease on biopsy, EPE remained significantly associatedASP (OR 4.62, P = 0.001). BCRwas associated with EPE (OR 3.86, P < 0.001), PI-RADS 5 lesions (OR 5.0, P = 0.03), and increased mpMRI lesion diameter (OR 1.78 per cm, P = 0.002) on univariable analysis. Conclusions: Findings on mpMRI, particularly EPE, are strongly associated with adverse pathological characteristics and BCR. This information may be useful to risk stratify patients prior to radical prostatectomy as well as better select more suitable candidates for active surveillance. Impact of African American Race on Upstaging at Time of Cystectomy and Overall Survival in Bladder Cancer J. Egan 1,2 ; F. de Carvalho 1,2 ; A. Zeymo 1,2 ; H. Lee 3 ; J. Dickman 1,2 ; C. Mallahan 3 ; C. Pellegrino 3 ; M. Davis 1,2 ; P. Kyriakides 3 ; I. Talati 3 ; R. Hankins 1 ; R. Krasnow 2 ; J. Hwang 2 ; J. Lynch 1 ; K. Kowalczyk 1 ; L. Stamatakis 2 1 MedStar Georgetown University Hospital, Washington, DC, USA; 2 MedStar Washington Hospital Center, Washington, DC, USA; 3 Georgetown University School of Medicine, Washington, DC, USA Introduction: Bladder cancer is less common in African-American (AA) than Caucasian patients. Population studies demonstrate that AA have worse overall survival, presumably associatedwith presentation at later stages and inferior quality of care. It remains unknown if biological differences exist inAAbladder tumors that contribute to worse overall survival. We aim to analyze racial disparities in quality of care as it relates to differences in outcomes in AA vs. non-AA. Materials & Methods: Demographics, pathology, treatment modalities, cancer recurrence and overall survival were collected prospectively in radical cystectomy (RC) patients at MedStar Georgetown UniversityHospital (2012-2019) andMedStar WashingtonHospital Center (2010-2019). Categorical variables were evaluated using chi-squared and Fisher exact test. Overall survival (OS) analysis was performed using Kaplan–Meier method and log-rank statistic. Results: Among 194 RC patients, 52 were AA (Table 1). There were no differences in tumor stage, nodal stage, or tumor grade at diagnosis betweenAAand non-AA. Rates of neoadjuvant chemotherapy, time from diagnosis to RC, rates of tumor recurrence and overall survival were not significantly different (Figure 1). However, AAwere more likely to be upstaged at RC (p = 0.03). Conclusions: At our institution, AA receive equal quality of care. In this setting, AA and non-AA have equivalent overall survival. However, AA are more likely to be upstaged at RC despite similar tumor stage at diagnosis, suggesting tumors in this population may be biologically different. MP4-12 MP4-10 Poster Session 4: Oncology Treatment and Outcomes 34