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

© The Canadian Journal of Urology TM : International Supplement, October 2021 Display Posters Influence of Patient Clinicopathologic Variables on Prostate Tumor Upgrading at Radical Prostatectomy B. McSweeney 1 , D. Nemirovsky 1 , A. Reddy 1 , C. Klose 2 , J. Chen 3 , M. Atienza 1 , D. Imtiaz 1 , S. Haji-Momenian 4 , M. Whalen 4 1 The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; 2 The Brody School of Medicine, East Carolina University, Greenville, NC, USA; 3 College of Medicine, California Northstate University, Elk Grove, CA, USA; 4 The George Washington University Medical Faculty Associates, Washington, DC, USA Introduction and Objective: Tumor upgrading has been linked to worse surgical outcomes and a higher risk of biochemical recurrence. Factors associated with upgrading are important to identify in order to minimize potential adverse outcomes. Specifically, multiparametric MRI (mpMRI) has been proposed to improve diagnostic accuracy and reduce post-prostatectomy upgrading. In this study, we seek to determine how patient characteristics and screening tools may predict upgrading of tumor pathology. Methods: A single institution review of patients with Gleason grade ≤ 3+4 tumors on biopsy who had undergone a radical prostatectomy between 2016-2020 was conducted an IRB approved mpMRI database. Upgrading was defined as a Gleason score ≥ 4+3 on final pathology. Upgrading rates were compared via unpaired t-tests or one-way ANOVA. Multiple logistic regression was used to compare the impact of patient and pathologic characteristics on upgrading. Results: N=73 patients with biopsy Gleason ≤3+4=7 who had undergone radical prostatectomy were identified. 34.2% of tumors upgraded. Both Black and White patients had similar rates of upgrading (28.6% and 35.2%, p=0.5785). There was no significant difference in upgrading based on insurance (Medicare=35.3%, Medicaid=28.6%, Private=35.3%, p=0.9436). PSA measurements and 4K scores did not differ amongst upgrading and non-upgrading tumors, and upgrading rates were not significantly different for PSA<10ng/mL or PSA 10-20ng/mL (32.7% and 54.5%, p=0.2200). There was no difference in upgrading between patients with a PI-RADS score of 3, 4, or 5 (20.0%, 37.9%, and 36.4%, p= 0.5619). Upgrading odds ratios for race, insurance, PSA, and PI-RADS score were similar. Conclusions: The lack of significant differences in race- and insurance-based prostate Gleason grade upgrading is encouraging in regards to reducing discrepancies in patient care. The fact that the PI-RADS scoring, as well as PSA and 4K were unable to predict tumor upgrading likely reflects small sample size, but emphasizes the need for novel predictive tools for pathologic upgrading. DP-07 Decreased Inpatient Opioid Exposure After Robot Prostatectomy with Implementation of Opioid Stewardship Protocols– 2 Year Evaluation from the Pennsylvania Urologic Regional Collaborative (PURC) A. Bernstein 1 , A. Quinn 2 , C. Keith 3 , N. Streeper 3 , K. Syed 4 , A. Kutikov 1 , J. Danella 5 , S. Ginzburg 6 , T. Lanchoney 7 , J. Tomaszewski 8 , E. Trabulsi 2 ,A. Reese 9 , M. Smaldone 1 , R. Uzzo 1 , T. Guzzo 10 , J. Raman 3 , T. Chandrasekar 2 , D. Lee 10 1 Fox Chase Cancer Center, Philadelphia, PA, USA; 2 Sidney Kimmel Medical College Thomas Jefferson University, PHiladelphia, PA, USA; 3 Penn State, Hershey, PA, USA; 4 Health Care Improvement Foundation, 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: Exposure to postoperative opioids is associated with worse postoperative outcomes and opioid dependence. The objective of this study is to evaluate the impact of implementing an opioid sparing protocol(OSP) for robotic prostatectomy (RALP) on inpatient opioid use. Methods: An OSP was implemented for RALP at three institutions within the Pennsylvania Urologic Regional Collaborative (PURC). The intervention was based on three priorities: maximizing local anesthetic, expanded use of non-opioids and systematic decrease of opioid prescriptions. We compared inpatient opioid use 12 months before the intervention and 12 months after, with a one-month washout period during implementation. Opioids were measured as morphine milligram equivalents (MME). Pain scores were captured by visual analog scale of 0-10, 10 being the worst pain. Results: Overall, 981 patients underwent RALP. Prior to OSP, median MME was 20 (IQR 10-34), of which 1.34 MME (IQR 0-5.36) was given intravenously. After implementation, significantly less was given (median 16.5MME, IQR 1.34-30.4, p=0.01). Twenty-three percent (225/978) did not need any opioids at all postoperatively. Before OSP, 98% (44/45) of the patients who had no opioid use while an inpatient were still given an opioid prescription (median 10 pills). After implementation, only 25% (25/101) were given an opioid prescription (p<0.001). With decreased opioid use, the overall inpatient pain scores improved slightly, going from a median score of 4 (IQR 3-5) to 3 (IQR 2-4) after implementation (p<0.01). Conclusions: Adequate inpatient pain control is feasible without opiates for the majority of patients undergoing RALP. Implementing an opioid reduction protocol can decrease unnecessary opioid use and prescription rates when not needed. Policies to encourage opioid stewardship should be designed to encourage adoption of such programmatic change. DP-06 48