Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts Evaluating the Competing Risk of Mortality after Grade Reclassification inMen on Prostate Cancer Active Surveillance R. Alam; M. Huang; Z. Schwen; M. Biles; H. Patel; C. Pavlovich Johns Hopkins University School of Medicine, Baltimore, MD, USA Introduction: The risk of death from prostate cancer (PCa) and other causes is frequently changing for men on active surveillance (AS), particularly at the time of disease progression. To better inform which patients are more suitable for intervention versus watchful waiting, this study describes the 10-year competing risk of death at the time of grade reclassification (GR) for men on AS. Materials & Methods: Patients enrolled in our PCa AS program were reviewed to identify men who experienced GR between 2004 and 2018. All patients in our programhaveNCCNvery-low-risk or low-risk disease; by definition, all have Grade Group (GG) 1 disease. GRwas defined as upgrading to GG≥2 on surveillance biopsy. The 10-year mortality from untreated PCa and from other causes were calculated both at the time of AS enrollment and at GR using a validated nomogram based on patient comorbidities and PCa disease characteristics. Results: There were 292 patients with a median age of 67 years. At enrollment, the median 10-year PCa and non-PCa mortality was 2% and 27%, respectively. Patients were enrolled in AS for a median 2.0 years prior to GR, at which time the median 10-year PCa and non-PCa mortality increased significantly to 7% and 34%, respectively (P < 0.001). The relative risk of non-PCa mortality compared to PCa mortality was higher with increased age, greater comorbidities, or upgrading to a less aggressive GG [Table]. Conclusions: Patients whowere younger, healthier, or upgraded tomore aggressive disease demonstrated a greater relative risk of death from PCa than from other causes and could stand to benefit from intervention. Interestingly, patients with more comorbidities had both an increased risk of non-PCa mortality and a lower risk of PCa mortality. MP6-05 Contrast-Enhanced 4D Ultrasonography for the Evaluation of Complex Renal Cysts L. Glick; T. Han; C. Wessner; K. Nam; K. Smentkowski; J. Eisenbrey; L. Gomella; E. Trabulsi; C. Lallas; M. Mann; J. Mark; F. Forsberg; A. Lyshchik; E. Halpern; T. Chandrasekar Departments of Urology and Radiology, Thomas Jefferson University, Philadelphia, PA, USA Introduction: Management of complex renal cysts, historically dependent on the Bosniak classification system, is evolving. This pilot study used novel contrast- enhanced ultrasound (CEUS) technology to evaluate enhancing/solid components of complex renal cysts and correlate to final surgical pathology. Materials & Methods: 7 patients with Bosniak 2F-4 lesions participated in this IRB-approved study (accrual ongoing). Ultrasound imaging was performed immediately pre-operatively using Logiq scanner with multiple probes. Patients underwent baseline imaging of the mass in B-mode and power Doppler. Lumason ultrasoundcontrastwassubsequently injectedwhile imaging in2DwithdualB-mode and nonlinear harmonic imaging. After washout, the process was repeated using volumetric contrast-enhanced ultrasound. Following surgery, pathologist evaluation includedpathologicstageandestimationofthesolidproportionofthelesion.RadiAnt DICOMViewer and 4D View programs were used to select matching slices through the renal lesion. An internal MATLAB program selected regions of interest (ROI), definedontheB-mode imagesto includetheentire lesion,whileROIonCEUS images included non-enhancing areas (cystic avascular regions). % enhancing volume was calculated:FractionalTumorVascularity=1–(TotalNon-enhancingarea/Total lesion area) The primary endpoint was correlation of 3D-derived fractional vascularitywith pathological estimation and tumor staging on explant. Results: Figure 1 demonstrates the selection of ROI on B-mode and CEUS for Patient 2. The fractional vascularity, pathologic estimation of the solid component, and final stage and grade are shown in Table 1. Conclusions: Preliminary results show CEUS may be a useful and accurate way to evaluate the malignancy potential of complex renal masses. MP6-04 Poster Session 6: Urologic Oncologic Disease 41