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

MA-AUA 2021 Abstracts Moderated Poster Session 1: Prostate Cancer MP1-03 Factors Associated with Use of Active Surveillance in NCCN Favorable Intermediate-Risk Prostate Cancer Patients Who Received a 17-gene Genomic Prostate Score Result B. Lowentritt 1 , E. Margolis 2 , C. Pieczonka 3 , J. Bennett 4 , M. Pavlova 4 , K. Wong 4 , M. Stoppler 4 , E. Uchio 5 1 Chesapeake Urology, Baltimore, MD, USA; 2 New Jersey Urology, Englewood, NJ, USA; 3 Associated Medical Professionals of NY, Syracuse, NY, USA; 4 Exact Sciences Corporation, Redwood City, CA, USA; 5 University of California, Irvine, CA, USA Introduction and Objective: This observational study retrospectively evaluated the association between use of active surveillance (AS) and relevant covariates in patients with NCCN favorable intermediate-risk (FIR) prostate cancer (PCa) who received the 17-gene Genomic Prostate Score® (GPSTM) molecular assay. Methods: Data were collected from patient charts at 7 urology practices in the United States. Eligible patients had localized PCa classified as FIR per NCCN guidelines and received a GPS report between May 2017 and April 2019. Higher GPS results (scale: 0-100) are associated with higher risk of adverse outcomes. The proportions of patients selecting active surveillance was calculated with 95% confidence intervals (CI). Uni- and multivariable logistic regression analyses were performed to determine the association between AS selection and relevant covariates. Results: 324 eligible patients had 3 to 48 biopsy cores (median 12); 79% had grade group 2 tumors, 19% had PSA10-20 ng/mL, and 2%were clinical stage T2b. GPS results for 76 patients were <20, 195 were 20-40, and 53 were >40. Overall, 31% (95% CI 26%, 36%) selected AS, with percentages decreasing as GPS results increased. In univariable models, Gleason Score, percent positive cores, PSA, and GPS result were significantly associated withAS selection. In a multivariable model including these variables, percent positive cores and the GPS result remained significantly associated with AS selection (Table 1). Conclusions: Percent positive cores and the GPS result appear associated with AS use after controlling for relevant clinical variables in NCCN FIR PCa patients. Does Deferred Prostatectomy for Grade Group 1 and 2 Increase Risk of Adverse Pathology? C. Williams, P. Gomella, M. Daneshvar, N. Khondakar, B. Wood, B. Turkbey, M. Merino, P. Pinto National Cancer Institute, Bethesda, MD, USA Introduction and Objective: To compare the pathological outcomes among patients with grade group (GG) 1 and GG2 prostate cancer initially managed with active surveillance (AS) who later underwent radical prostatectomy (RP) versus risk-matched patients who underwent immediate RP. Methods: Our prospectively maintained institutional database was queried for patients who enrolled in active surveillance from 2007-2020 with GG1 and GG2. All patients received combined MRI-targeted and systematic biopsies at the time of AS enrollment and surveillance biopsies. Patients who discontinued AS and underwent RP after AS were then compared to NCCN risk-matched patients who underwent immediate prostatectomy at our institution. Logistic regression analysis identified potential predictors of adverse pathology upon radical prostatectomy. Results: 486 patients were enrolled in AS, and 83 patients underwent RP after discontinuing AS. Of these, 27 (32.5%) patients were on AS with GG2 disease and 56 (67.9%) patients were on AS with GG1 disease. Median time to prostatectomy among AS patients was 39 months (IQR: 28-64). There was no difference in rates of any adverse pathology among these patients versus risk-matched patients who underwent immediate prostatectomy (median 4 months (IQR: 3-5) from diagnosis) (42/83 (51%) vs. 192/387 (50%); p = 0.9) (Figure 1). On multivariable regression analyses, pre-operative PSAD (OR: 1.20 [CI: 1.04-1.42]; p<0.001) and having intermediate unfavorable (OR: 3.42 [1.18-12.5]: p =0.036]), high and very high risk disease at final biopsy (OR: 16.8 [5.71-62.3]: p<0.001) were independent predictors of adverse pathology (C-statistic = 0.81). Time to RP did not predict adverse pathology. Conclusions: In well-studiedAS patients withMRI and combined biopsy, at a median of 39 months of surveillance, patients with GG1 and GG2 disease are not disadvantaged by enrolling in AS. MP1-02 5