Abstracts from the New England Section of the AUA 2021

NE-AUA 2021 Abstracts Concurrent Poster Session II Lower Urinary Tract Symptoms in Patients with Prostate Cancer on Active Surveillance Da David Jiang, MSMD 1 , Jeannette Schenk, PhD 2 , Nicholas Chakiryan, MD 3 , Kyle Gillis, MD 4 , Menghan Liu, MS 2 , Lisa Newcomb, PhD 5 , Yingye Zheng, PhD 2 , Peter Chang, MD 1 , Andrew A. Wagner, MD 1 1 Beth Israel Deaconess Medical Center, Boston, MA, USA; 2 Fred Hutchinson Cancer Research Center, Seattle, WA, USA; 3 Moffit Cancer Center, Tampa, FL, USA; 4 University of Iowa, Iowa City, IA, USA; 5 University of Washington, Seattle, WA, USA Introduction: Prostate cancer (PCa) patients on active surveillance (AS) may have concurrent lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE). Few studies have addressed LUTS in this population and guidelines are lacking on the management of LUTS for patients with PCa. The objective of this study is to describe the prevalence of LUTS and rates of bladder outlet treatment among men with PCa on AS. Materials &Methods: Data are from the Canary ProstateActive Surveillance Study (PASS), a multicenter prospective cohort of men with PCa on AS. At enrollment and every 6months thereafter data onmedications and procedures for bladder outlet obstruction (BOO) were abstracted from medical records and assessments of LUTS viaAUAsymptom Score (AUASS) were completed. Men completed the enrollment and ≥ 1 post-enrollment AUASS and had a minimum of one year follow-up. Men who underwent bladder outlet procedures prior to enrollment or those with prostatitis at any follow-up visit were excluded. LUTS at enrollment were categorized as mild (AUASS 0-7), moderate (8-19) or severe (20-35). Rates of BOO treatments as well as PCa treatment were compared using univariable analyses. Results: A total of 1501 men were included in the study with a median follow-up of 6.4 (IQR 3.2,9.1) years. The median AUASS at enrollment was 7 (IQR 3,11). At enrollment, the prevalence of severe LUTS was 95 (6%). Of total patients, 396 (26%) received medical treatments for BOO, 18 (1.4%) men underwent BOO procedure during the study. Compared to men with mild LUTS, men with moderate or severe LUTS were more likely to receive BOO treatments; however even among patients with severe LUTS, only 4.2% underwent bladder outlet procedures. Menwithworse LUTSweremore likely to have more indolent prostate cancer (Gleason Grade group 1, p=0.03); and were less likely to undergo definitive treatment for PCa (p<0.01). Among men with severe LUTS that received definitive PCa treatment, the majority underwent radical prostatectomy. Conclusions: Patients with PCa on AS with severe LUTS were more likely to harbor indolent PCa and had a low treatment rate for PCa. Although those with severe LUTS were more likely to receive bladder outlet procedures, only 4% of those patients actually did. Additional efforts are necessary to evaluate treatment paradigms for BOO in AS patients. P26 Laboratory Reporting Parameters of Microhematuria within Academic Medical Centers and Commercial Laboratories: Implications for Interpreting the 2020 AUA Guideline Mohannad Awad, MD 1 , Mackenzie Goldsmith, MD 2 , Luke Hallgarth, MD 1 , Jay Raman, MD 2 , Kevan Sternberg, MD 1 1 University of Vermont Medical Center, Burlington, VT, USA; 2 Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA Introduction: To explore how laboratories in the United States report red blood cell per high powered field (RBC/HPF) counts on urinalysis and to evaluate whether their methods can effectively risk stratify patients in accordance with the 2020 American Urological Association/Society of Urodynamics, Female PelvicMedicine andUrogenital Reconstruction (AUA/ SUFU) microhematuria (MH) guidelines. Materials & Methods: Reporting methods for RBC/HPF counts (ranges or actual counts) were collected by querying urologists in United States academic medical institutions or contacting labs directly. Study outcomes were (1) to explore whether the reporting schemes were concordant with the risk stratification groups in the new MH guideline (3-10 [low risk], 11-25 [intermediate risk], and more than 25 [high risk]) and (2) to evaluate the potential for misclassification of these risk groups based on reporting methodology. Results: Methods of reporting RBC/HPF count were collected from 141 laboratories. Seventy-two (51%) use ranges, while the remainder use actual counts or actual counts to a certain threshold number. Sixty (43%) report ranges that do not include cutoffs concordant with the MH guidelines risk stratification groups. Fifty-six (40%) do not include the cutoff of 25 RBC/ HPF which impacts segregation of intermediate and high risk groups. Sixteen (11%) do not include the cut-off of 3 RBC/HPF that defines the presence of MH. Of labs that report ranges, only 12/72 (17%) include all the same cutoffs of the MH guidelines risk stratification groups. Figure 1 illustrates the distribution of labs reporting RBC/HPF counts that are concordant with MH risk stratification cutoffs vs those that are not and the breakdown of possible misclassifications that could arise from not including these cutoffs in the reported ranges. Conclusions: A significant number of laboratories report RBC/HPF counts in ranges that differ from thresholds in the 2020 AUA/SUFU guideline. The implication is potential misclassification of microhematuria both at minimum threshold diagnosis (3 RBC/HPF), but additionally between intermediate and high risk groups. Standardization of reporting schemes to actual RBC/ HPF counts may allow improved adherence to guidelines while providing data for future guideline development. P25 49