Abstracts from the New England Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Concurrent Scientific Session IV: Oncology II 38 Associations of Neighborhood Deprivation Index, Household Income, Diversity, and Pollution with Prostate Cancer Incidence and Mortality from 2000-2020 in Rhode Island Borivoj Golijanin, BS , SarahAndrea, PhD, Justin Bessette, BS, Rebecca Ortiz, BA, Philip Caffery, PhD, Timothy O’Rourke, MD, Christopher Tucci, MS, RN- BC, CURN, NE-BC, Gyan Pareek, MD, Dragan J. Golijanin, MD The Minimally Invasive Urology Institute, The MiriamHospital; The Warren Alpert Medical School of Brown University, Providence, RI, USA Introduction: Despite advances in prostate cancer (PCa) screening and treatment, socioeconomic inequities continue to impact both PCa risk and survival. We investigated the association between neighborhood sociodemographic and neighborhood pollution composition and PCa incidence and survival. Materials & Methods: 4,614 patients received treatment for PCa from 2000 to 2020 Brown University affiliated hospitals. Patient addresses were linked to census tract-level data on neighborhood sociodemographic composition and locations of pollution sources. Pollution sources include superfund sites, sanitary and solid waste facilities, and leaking underground storage tanks. Using Poisson and Cox proportional hazards models, we assessed incidence of PCa as well as overall and progression free survival as a function of neighborhood pollution, area deprivation index (ADI), median household income (MHI), and racial composition quartiles (Q1, lowest; Q4 highest) in separate models adjusted for year and age at time of diagnosis. Results: Average age at time of diagnosis was 65 years, 82% of men were non- Hispanic white, andmean overall survival was 86 months. Likelihood of PCa diagnosis was positively correlated with greater neighborhood pollution (Q4 vs. Q1: RR: 1.26; 95%CI:1.09,1.45), greater composition of non-Hispanic white residents (Q4 vs. Q1: RR:1.37; 95% CI:1.18,1.59), and higher neighborhood MHI (Q4 vs. Q1: RR:1.46;95%CI:1.46,1.96). Overall, 5-, 3-, and 1-year survival rates are 75%, 82%, and 92%, respectively. Likelihood of dying within 5-years of diagnosis was greatest for those in neighborhoods with high ADI (Q4 vs. Q1: HR:1.33; 95% CI:1.05,1.69) and lowest for those in predominantly white neighborhoods (Q4 vs. Q1: HR:0.76;95% CI: 0.60, 0.96) and neighborhoods with higher MHI (Q4 vs. Q1: HR:0.72;95% CI:0.56- 0.91). Conclusions: Neighborhood sociodemographic and pollution composition are associated with both incidence of PCa diagnosis and survival, such that those in more polluted and more affluent areas are both more likely to have a PCa diagnosis ( Figure 1 and Figure 2 ) and to experience greater overall survival. These findings are in line with observed associations between higher individual-level income and higher probability of both detection of PCa and access to curative treatment in the literature. These findings might be explained by differential survival, and the inequities that affect different neighborhoods, racial groups, and socioeconomic statuses, including access to timely screening and treatment. Future research and policy programs may target specific areas of the state to better address the screening and treatment needs in high-risk neighborhoods and PCa hotspots. Discriminative Ability of Decipher to Predict Biopsy Upgrade on Active Surveillance Benjamin Press, MD , Ghazal Khajir, MD, Michael Leapman, MD, Preston Sprenkle, MD Yale University School of Medicine, New Haven, CT, USA Introduction: Although initially validated as prognostic tools in the setting of definitive prostate cancer (PCa) treatment, tissue-based gene expression tests have become increasingly utilized in active surveillance (AS) of favorable- risk PCa. We aimed to assess the prognostic significance of the Decipher assay, a 22-gene signature associated with PCa outcome, on biopsy grade progression during AS. Materials & Methods: Between July 2016 and November 2020, 133 men on AS underwent 146 separate MRI - ultrasound fusion targeted biopsies and systematic biopsies with their prostate tissue sent for Decipher testing. Demographic information, PIRADS, and Decipher scores were prospectively recorded. Decipher risk categories (DR) were labeled by commercial risk categories as low (<0.45), intermediate (0.45-0.60), or high (>0.60) score. Pathologic upgrade was defined as an increase in Gleason Grade Group (GG) on subsequent biopsy. We assessed the association between Decipher score and upgrade using univariate statistics and logistic regression adjusted for clinical and pathologic factors. Results: Median age was 67.7 years (IQR = 62.4 - 71.4). Median PSA was 5.6 ng/mL (IQR = 4.3-7.1). In this cohort, 75.9% and 24.1% of men had GG1 and GG2 PCa, respectively. Median time between biopsy was 13.6 months (IQR = 11.9-16.9). MedianDecipher scorewas 0.39 (IQR 0.25-0.48) and upgrade occurred in 32.3%. Decipher scores were similar among patients who did and did not experience upgrade (0.36 vs. 0.40, p = 0.27). Upgrade rates were also similar using DR (31.9% [low] vs. 32.4% [intermediate] vs. 46.7% [high], p = 0.455). Multivariable logistic regression revealed increasing Decipher score was associated with greater odds of upgrade (OR 1.31 per 0.10 unit increase, p = 0.033) ( Table 1 ). When stratifying by GG, Decipher score was associated with upgrade among patients with diagnostic GG1, (OR 1.43 per 0.10, p = 0.023), but not GG2 disease. Time to biopsy was not independently associated with upgrade. Decipher score remained predictive of upgrade with time to biopsy incorporated in our model (OR 1.36 per 0.10, p = 0.021). Conclusions: Increasing Decipher scores was associated with greater odds of upgrade among men AS for PCa. The lower spectrum of Decipher scores among men on AS may suggest that distinct categories may be appropriate for risk grouping in this population. 37 20