Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 The Use of Neoadjuvant Chemotherapy Before Radical Cystectomy in Patients with High-Grade Clinical T1 Bladder Cancer M. Siddiqui; S. Wang University of Maryland School of Medicine, Baltimore, MD, USA Introduction: Neoadjuvant chemotherapy (NAC) can provide pathological down-staging and survival benefit for muscle-invasive bladder cancer. It has been reported that in patients with high grade T1 bladder cancer (T1HGBC) who undergo RC, 30-48% will pathologically upgrade and up to 20% will have lymph- node metastasis. These findings suggest that a portion of T1HGBC patients might benefit fromNAC. In this study, we aim to investigate the trend of NAC use among T1HGBC and its effects. Materials & Methods: The National Cancer Data Base was searched for patients diagnosed with high grade cT1N0M0 bladder cancer. The propensity of received NAC before RC and factors contributing to pathological down-staging were investigated using logistic regression. Kaplan-Meier curves were applied to compare the overall survival (OS) and Cox regression models were built to investigate the association of NAC delivery and OS. Results: 2,242 patients were diagnosed as high-grade cT1N0M0 and received RC, among which 283 (12.6%) received NAC prior to cystectomy. The use of NAC increased over time, from 4.9% in 2005 to 18.6% in 2014 (p = 0.001). In multivariate logistic regression, no variates were found as the predictors for the delivery of NAC. 1,599 patients were further identified eligible for the survival analysis. Patients received NAC achieved more down-staging (15.8% vs. 8.4%, p = 0.002) at the time of RC. The 5-year OS was 68.9% (131/190) in patients with NAC vs. 68.6% (967/1409) without NAC (p = 0.934). Multivariate Cox regression analysis revealed that NAC was not independently associated with improved OS (HR 1.188, 95%CI 0.881-1.601, p = 0.258), while down-staging significantly improved the OS(HR 0.276, 95%CI 0.164-0.463, p < 0.001). Conclusions: There was an increasing use of NAC for clinical T1HG bladder cancer before cystectomy and could bring in tumor down-staging. However, no predictors of NAC delivery were identified. MP6-11 DemographicandClinicalCharacteristicsAffectingUtilizationof18F-Fluciclovine Positron Emission Tomography in Biochemical Recurrence of Prostate Cancer M. Gay; J. Kurnot; P. Schellhammer Eastern Virginia Medical School, Virginia Beach, VA, USA Introduction: 18F-fluciclovine Positron Emission Tomography/Computed Tomography (PET/CT) has emerged as a tool to detect recurrent sites in men with biochemically recurrent (BCR) prostate cancer (PCa). However, the extent to which 18F-fluciclovine PET/CT has been implemented in this population in clinical practice has not been established. Therefore, we sought to characterize clinical and demographic factors associated with the use of 18F-fluciclovine PET/CT. Materials &Methods: Aretrospective chart reviewwas conducted on patients who developed BCR after curative intent primary therapy for PCa between December 2017 and February 2019. We classified men into two diagnostic groups: patients who received standard of care imaging and patients who received both standard of care imaging and a 18F-fluciclovine PET/CT scan. We then examined clinical and demographic factors associated with the receipt of a 18F-fluciclovine PET/CT. Results: We identified 218 men with BCR PCa. Of these, 171 (78%) did not receive a 18F-fluciclovine PET/CT and 47 (22%) received a 18F-fluciclovine PET/CT. Patients who received a 18F-fluciclovine PET/CT were older and on average had a lower comorbidity burden than those who only received conventional imaging (both p < 0.05). Provider variability in utilizing 18F-fluciclovine PET/CT was found to be significant (M 5.9, [95% CI 4.5 to 7.2]; p < 0.05). Of the 11 total urologists, 4 were urologic oncologists and ordered 49% of the total 18F-fluciclovine PET/CT scans. There was also significant variance among urologic oncologists with one urologic oncologist who obtained a 18F-fluciclovine PET/CT in 10% of men with BCR and another who obtained one in 55% of men with BCR (p < 0.05). Race and type of insurance was not associated with greater use of 18F-fluciclovine PET/CT. Conclusions: Receipt of 18F-fluciclovine PET/CT amongmenwith BCR PCa varied significantly across age, comorbidity burden and physician utilization. Further studies should investigate causes for provider variability and evaluate strategies for equitable, cost-efficient distribution of 18F-fluciclovine PET/CT. MP6-10 Poster Session 6: Urologic Oncologic Disease 44