Abstracts from the New England Section of the AUA 2021

NE-AUA 2021 Abstracts Scientific Session V: ED/Infertility The Association Between the 17-gene Genomic Prostate Score Result and Active Surveillance, Therapy Intensity and Complications in NCCN Favorable Intermediate-Risk Prostate Cancer Patients Christopher Pieczonka, MD 1 , Benjamin Lowentritt, MD, FACS 2 , Eric Margolis, MD 3 , EdwardUchio, MD, FACS, CPI 4 , Marina Pavlova, MS 5 , Kenny Wong, BS 5 , John Bennett, PhD 5 , Melissa Stoppler, MD 6 1 Associated Medical Professionals of NY, Syracuse, NY, USA; 2 Chesapeake Urology, Towson, MD, USA; 3 New Jersey Urology, Englewood, NJ, USA; 4 University of California, Irvine, Irvine, CA, USA; 5 Exact Sciences, Pacific Grove, CA, USA; 6 Exact Sciences, Redwood City, CA, USA Introduction: This study determined how the 17-gene Genomic Prostate Score ® (GPS TM ) molecular assay guides treatment decisions in patients with NCCN favorable intermediate-risk (FIR) prostate cancer (PCa). Materials & Methods: This retrospective study included 324 patients from 7 urology practices in the United States. All had NCCN FIR PCa, defined as <50% positive biopsy cores and only one of the following risk factors: grade group 2 (Gleason Score 3+4), clinical stage T2b-T2c, or PSA 10-20 ng/mL. All had a GPS assay report dated May 2017 to April 2019. The GPS assay reports a result between 0 and 100, with higher values associated with higher likelihood of adverse pathology and higher risk of distant metastasis and PCa- specific mortality. Data were collected frompatients’ charts/electronic health records. The proportions who selected active surveillance (AS) and definitive treatment withmonotherapy or multimodal therapywere calculatedwith 95% confidence intervals (CI) using the Clopper-Pearson method. In addition, the association of several clinical variables, including Gleason Score, PSA, and number of positive cores, and the GPS result withAS selection was evaluated in uni- and multivariable logistic regression models. Results: Among the 324 patients, 79% had grade group 2 tumors, 19% had PSA 10-20 ng/mL, and 2% were clinical stage T2b. Median follow-up time was 18 months, and one PCa-related metastasis and 2 deaths (neither PCa- related) were reported. For the GPS assay, 76 patients had results <20, 195 had results between 20 and 40, and 53 had results >40. Overall, 31% (95% CI 26%, 36%) selected AS. Gleason Score, PSA, number of positive cores and GPS result were all significantly associated with AS selection in univariable logistic regression models and number of positive cores and GPS result remained significant in multivariable models including these four variables. AS percentage decreased as GPS results increased: 58% (95% CI 46%, 69%) selected AS with GPS results 0-19, 27% (95% CI 21%, 33%) with GPS results 20-40, and 6% (95% CI 1%, 16%) with GPS results 41-100. AS percentage was lower for patients with more positive cores: 39% (95% CI 31%, 46%) of patients with 1-2 positive cores selected AS and 22% (95% CI 15%, 29%) with 3 or more positive cores. Patients with GPS results 0-19 and 20-40 were more likely to receive monotherapy than with GPS results >40. Patients with GPS results >40 were more likely to receive multimodal therapy ( Figure 1 ). Complications (erectile dysfunction, urinary/bowel incontinence) were more common in treated than AS patients. AS persistence was 91% (95% CI 82%, 95%) at 12 months; patients discontinuedAS due to disease progression (61%) or patient preference/unknown reasons (39%). Conclusions: The GPS result appears to be associated with selection of AS and treatment intensity in this first examination of a genomic classifier in a cohort of NCCN FIR PCa patients. New Findings Regarding the Influence of Assistants on Intraoperative Inflatable Penile Prosthesis Complications Shuo-chieh Wu, MD , Amanda Swanton, MD, Martin Gross, MD Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA Introduction: Inflatable penile prosthesis (IPP) placement is a critical component of urology residency education. Resident trainees are useful in IPP cases, but resident assistance is not always available to prosthetic urologists. RegisteredNurse FirstAssistants (RNFAs) can also serve as capable assistants during IPP procedures. We reviewed our data to compare intraoperative and postoperative complications in IPP cases with residents or RNFAs as assistants. We also compared the differences in the surgical procedures with either type of assistant. Materials & Methods: Medical records of patients who underwent IPP placement by a single surgeon between 2017 and 2020 were retrospectively reviewed with IRB approval. Baseline patient characteristics, details of surgical procedure, and outcomes were collected. Alogistic regressionmodel was used to identify predictors of complications. Student’s T test was used to examine for differences in total OR time between different assistants. Results: A total of 210 patients who underwent IPP surgery were identified, among which 168 (80%) placements were assisted by RNFAs, and 42 (20%) by urology residents. Complications were reported in 37 (17.6%) patients. Clavien-Dindo complications were grades V (1%, n=2), IIIb (11%, n=23), II (0.5%, n=1), and I (7%, n=14). There was no significant difference in the rate of complications for IPP placement assisted by a resident or RNFA (OR 0.95, CI 0.35 - 2.31) but this was limited by the overall power in assessing complications. Resident-assisted IPP placements were found to be associated with longer operative time than those assisted by RNFAs (86.2 ± 23.1 min vs. 72.9 ± 35.5 min, p<0.01). Patient factors including new IPP, BMI>30, DM, and positive urine culture were also not associated with increased complication rate. Current smokers were noted to have more complications (OR 2.51, CI 0.94 - 6.30), although this was not statistically significant. Patients were followed for 12.2 ± 10.8 months postoperatively. Conclusions: Resident-assisted IPP placement with a high-volume surgeon is not associated with observable increase rate of complications comparing to those assisted by RNFAs. Moreover, resident involvement is only associated with slight increase in operative time compared to RNFA-assisted IPP placement. Overall complications were low in this series. 44 43 23