Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

MA-AUA 2021 Abstracts Moderated Poster Session 1: Prostate Cancer MP1-14 Qualitative Evaluation of Differing Opioid Sparing Protocols Across the Pennsylvania Regional Collaborative: Understanding Barriers and Facilitators T. Chandrasekar 1 , N. Streeper 2 , A. Quinn 1 , C. Keith 2 , K. Syed 3 , A. Kutikov 4 , J. Danella 5 , S. Ginzburg 6 , T. Lanchoney 7 , J. Tomaszewski 8 , E. Trabulsi 1 , A. Reese 9 , M. Smaldone 4 , R. Uzzo 4 , T. Guzzo 10 , J. Raman 2 , A. Bernstein 4 , D. Lee 10 1 Sidney Kimmel Medical College Thomas Jefferson University, PHiladelphia, PA, USA; 2 Penn State, Hershey, PA, USA; 3 Health Care Improvement Foundation, Philadelphia, PA, USA; 4 Fox Chase Cancer Center, Philadelphia, PA, USA; 5 Geisinger Medical Center, Danville, PA, USA; 6 Einstein Health Network, Philadelphia, PA, USA; 7 Urology Health Specialists, Philadelphia, PA, USA; 8 Cooper University, Camden, NJ, USA; 9 Lewis Katz School of Medicine at Temple University, PHiladelphia, PA, USA; 10 University of Pennsylvania Health System, Philadelphia, PA, USA Introduction andObjective: Pennsylvania has the 3rd highest rate of opioid- related mortality across the US. Many studies have evaluated opioid sparing protocols (OSP), however, the heterogeneity of these protocols has yet to be compared. To that end, we provide a qualitative comparison of OSP across an endemic region. Methods: Within the Pennsylvania Urologic Regional Collaborative (PURC), OSP had been implemented for robotic prostatectomies (RALP) at four different institutions within PURC. To better understand the variability across QI protocols a survey was conducted to capture information on the baseline protocol, the details of the interventions, the primary outcome of interest at the institution. Results: Across the four institutions there was wide variability in themethods employed to decrease patient exposure to opioids. All interventions targeted inpatient utilization of opioids through the addition of standing ketorolac and acetaminophen. All programs only prescribed opioids if they were required as an inpatient. Environmental changes to influence prescribing behavior were found to be essential, including provider “nudges” in the form of order set modifications, especially to remove default prescription settings. All institutions reported need to engage key stakeholders including Advanced Care Providers and Housestaff to improve compliance with OSP. However, there are concerns of returns to baseline prescribing practices over time, with one institution reporting a relative increase of 20% in opioid prescriptions during year 3 after the OSP implementation. Conclusions: OSP are feasible to implement on a large scale across multiple academic practices. Utilizing multi-faceted approach to implementation, including key stakeholders, and reducing friction in complying with OSP were key to decreasing opioid use. Long-term studies on implementation strategies are needed to understand how potential gains can be maintained to improve patient care. Gleason Upgrading Between Targeted and Systematic Template Biopsy for mpMRI PIRADS 5 Lesions C. Klose 1 , B. McSweeney 2 , D. Nemirovsky 2 , J. Chen 2 , A. Reddy 2 , M. Atienza 2 , D. Imtiaz 2 , S. Haji-Momenian 2 , M. Whalen 2 1 The Brody School of Medicine at East Carolina University, Greenville, NC, USA; 2 The George Washington University School of Medicine and Health Sciences & The George Washington University Medical Faculty Associates, Washington, DC, USA Introduction and Objective: Multiparametric MRI/transrectal ultrasound fusion biopsy has improved detection of clinically significant prostate cancer and involves targeted biopsy of suspicious regions of interest (ROI) along with systematic template biopsy. Given the high incidence of cancer detection for PIRADS-5 lesions, a targeted-only biopsy paradigmmay afford sufficient detection of index pathology while minimizing morbidity. We analyze rates of upgrading between template and targeted samples in PIRADS-5 lesions to determine the clinical utility of template sampling. Methods: Upon retrospective examination of institutional data, we identified n=62 patients with PIRADS-5 lesions who underwent fusion biopsywith both targeted and extended sextant template-directed cores. Gleason group (GG) >1 pathology was analyzed for rates of upgrading (i.e. GG ≥2) between ROI- targeted and template-directed pathology. PIRADS-5 was defined as ≥1.5cm hypo-/hyperdense lesion or definitive extraprostatic extension. Results: Clinically significant cancer (GG ≥2) was found in 89% of patients with a PIRADS 5 score, with 5% revealing benign pathology and 6% clinically insignificant (GG=1). Average ROI cores taken in the cohort was 3.1. Targeted biopsy yielded dominant cancer pathology in 80% of the cohort with an upgrading of 20%upon additional template biopsy. Geographical partitioning analysis showed index pathology from systematic biopsy came from the same or adjacent ROI sextant in these upgraded cases. Only two (3.3%) ROI pathologies were upgraded from clinically insignificant to significant after template biopsy, with ROI and template sextant identical in these cases. Conclusions: A high rate of clinically significant prostate cancer was diagnosed relying only on ROI-directed biopsy of PIRADS-5. The addition of systematic, template biopsy detected an additional 3.3% of clinically significant cancers, both GG=2. In all cases of upgrading, template biopsy came from adjacent or identical sextants, suggesting a near miss in ROI- targeting. ROI-directed biopsy may be sufficient for PIRADS-5 patients, with future studies examining increased sampling at the ROI site to ensure index capture. MP1-13 11