Abstracts from the New England Section of the AUA 2020: A Virtual Experience

NE AUA 2020 Abstracts *Max K. Willscher Award Eligible Is Repeat Prostate Biopsy Prior to Treatment Necessary for Active Surveillance Patients with Clinical and Radiographic Findings Suggesting Gleason Grade Progression? Jeffrey K. Twum-Ampofo, MD , Andrew Gusev, BS, Alberto C. Pieretti, MD, Florian Rumpf, BS, Keyan Salari, MD, PhD, MatthewWszolek, MD, Adam Feldman, MD, MPH, Douglas Dahl, MD Massachusetts General Hospital, Boston, MA Introduction: Studies have described an increased risk of prostate cancer (PCa) grade group (GG) progression with presence of high-risk lesions or lesion progression on active surveillance (AS) MRI. Given the known risks of prostate biopsy, we investigate whether patients at high risk for GG progression may proceed to treatment without repeat biopsy. Materials & Methods: We retrospectively reviewed our database of men on AS with localized PCa from 1996-2016. We identified men with Gleason Grade (GG) 1 disease on diagnostic biopsy, at least one prostate MRI, and at least one repeat prostate biopsy during AS. All MRIs were scored according to PIRADS version 2.0 and scores of 2 or less were considered to represent a negative MRI. Clinical and radiologic characteristics analyzed included age, PSA, PSA density (PSAd), index PIRADS score, PIRADS lesion size, and NCCN risk group. Univariate and multivariate logistic regression was used to identify factors associated with grade progression to GG 2 or higher on any subsequent surveillance biopsy. Results: Of 1268 men evaluated in ourAS database, 363 met criteria for this study. Median follow up time was 4.8 months (IQR 3.4-6.8). Median number of MRIs was 1 (Range 1-4). 42% of patients had no suspicious lesions on MRI, 13% had PIRADS 3, 30% had PIRADS 4, 15% had PIRADS 5 as their highest risk lesion. Of those with negative MRIs, 20% had GG progression on subsequent biopsy. For index MRI lesions of PIRADS 3, 4, and 5, the GG progression rates were 26%, 39%, and 62%, respectively (p < 0.001). For patients with PSAd > 0.15 and PIRADS lesions 3,4, or 5, GG progression rates were 45%, 32 %, and 71%, respectively (p = 0.002). On univariate analysis, age at diagnosis, PSAd, NCCN Risk Group (Low vs. Very Low), and PIRADS 4 and 5 lesions were predictors of biopsy GG progression [Table 1]. On multivariate logistic regression, PSAd as well as PIRADS 4 and PIRADS 5 on MRI remained significant predictors of GG progression. Compared to patients with negative MRIs, those with PIRADS 4 and PIRADS 5 lesion had increased risk of biopsy progression (OR 2.22 [95%CI: 1.17-4.21]) and (OR 4.55 [95%CI: 2.00-10.32]), respectively [Figure 1].Analysis of PIRADS 4 and PIRADS 5 lesions by size demonstrated no difference in GG progression on follow up biopsy. Conclusions: PatientsonASwithPIRADS3and4 lesionsmusthaveaconfirmatorybiopsy prior to consideration for surgery since a significant proportion of these patients may still be optimal for AS. GG 1 patients with PSAD > 0.15 and PIRADS 5 lesions may proceed to surgical treatment with omission of repeat biopsy; however, repeat biopsy should be performed prior to radiation to inform the need and duration of ADT. Using Preoperative Pelvic Floor Assessment to Predict Early Return of Continence after Robotic Radical Prostatectomy Alison Levy, MD 1 , Aaron Fleishman, MPH 2 , Max Jackson, MD 4 , Kyle McAnally, BA 2 , Jenna Leader, PT, DPT 2 , Marysa Warnhoff, PT 2 , Adrian Waisman, MD 2 , Marianne Chan, MD 4 , Allison Kleeman, MD 4 , Catrina Crociani, MPH 2 , Andrew Wagner, MD 2 , Peter Chang, MD, MPH 2 1 Lahey Hospital and Medical Center, Burlington, MA; 2 Beth Israel Deaconess Medical Center, Boston, MA Introduction: While long-termurinary continence is eventually achieved inmost patients who undergo radical prostatectomy, predicting when patients will become continent is challenging. The period of incontinence can be a source of uncertainty and distress for patients and may negatively impact quality of life. Prior studies aiming to predict return of post-operative continence have not evaluated patient-specific pelvic floor strength parameters. We evaluated the association of pre-operative pelvic floor physical therapy (PFPT) parameters with early return of urinary continence after robotic radical prostatectomy (RP). Materials & Methods: We reviewed a prospectively maintained database of all patients undergoing RP. Patients were included if they underwent pre-operative PFPT consultation and completed 3-month patient-reported quality of life evaluation using EPIC-CP. All patients were evaluated by one of two therapists specializing in PFPT with biofeedback, whodocumentedpelvicfloorrestingtone,pelvicfloorworkingtone,pelvicfloorendurance (defined as the ability to hold a 10-second pelvic floor muscle contraction), and dominant hand grip strength. We defined urinary continence as using 0 or 1 pad per day. We used multivariable logistic regression to evaluate the association of PFPT parameters with urinary continence at 3 months. We adjusted for other factors that could affect continence, including age, BMI, D’Amico risk classification, nerve sparing, and prostate volume. Results: 144menmet inclusion criteria. Nerve-sparingwas performed in 92.4%of patients. 89% of men had intermediate- or high-risk prostate cancer. At 3 months, 90/144 (62.5%) were continent, while 54/144 (37.5%) were not. Onmultivariable analysis, prostate volume (OR 0.98, 95% CI 0.96-1.00) and pelvic floor endurance (OR 2.70, 95% CI 1.23-6.25) were significantly associatedwith being continent at 3months. Pelvic floor resting tone, working tone, and dominant hand grip strength were not associated with continence at 3 months. 56/76 (74%) men with good pelvic floor endurance were continent at 3 months, while only 34/68 (50%) men with poor endurance were continent (p = 0.006). Conclusions: Pre-operative assessment of pelvic floor endurance is an objective measure that may allow more accurate prediction of early continence return after radical prostatectomy. Improved patient counseling could positively impact patient satisfaction and quality of life. 37 36* 17 Scientific Session IV: Oncology II