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

NE AUA 2020 Abstracts Learning to Hit the Target: Improving Accuracy of Fusion Biopsy over Time at Maine Medical Center Madeline Rutan, BA 1 , William C. Daly, BA 1 , Christina Gentile, MPH 2 , Moritz Hansen, MD 3 , Matthew Hayn, MD 3 , Stephen Ryan, MD 4 , Jesse D. Sammon, DO 3 1 Tufts University School of Medicine, Boston, MA, USA; 2 Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA; 3 Division of Urology, Maine Medical Center, Portland, ME, USA; 4 Tufts University School of Medicine, Portland, ME, USA Introduction: Multiparametric MRI (mpMRI) and fusion biopsy technology has allowed for more accurate diagnosis of clinically significant prostate cancer (PCa) while helping to limit the overdiagnosis of non-significant disease. Little data exists, however, about the feasibility and success of implementation outside of large academic centers. This study sought to evaluate fusion biopsy adoption at Maine Medical Center for improvement over time and to discover meaningful areas for improvement. Materials &Methods: Starting in 2016 data was collected for patients undergoingmpMRI at Maine Medical Center and subsequent biopsy with the Phillips Uronav system. We also collected urology specific and general demographic information. We analyzed this data with special focus on the probability of cancer detection (PCD) of PI-RADS 3, 4, 5 lesions, as well as the percentage of patients who had negative targeted biopsies but PCa on 12-Core biopsy (our “false negative” rate). Results: Data from 224 patients was analyzed (179 underwent both fusion and 12-core biopsy, 10%, 52%, 37% PI-RADS 3, 4, 5 respectively). 49% underwent MRI as part of active surveillance protocol. Our overall PCD increased yearly, from 39% in 2016 to 67% in 2019. Most importantly, the positive predictive value (PPV) of PI-RADS 5 lesions has increased, from 54% in 2016 to 100% in 2019. Our overall “false negative” rate was 50%, our “false negative” rate for clinically significant disease (≥ Gleason 3+4=7) was 24.6% (range 11%-35% annually). Conclusions: Our findings highlight the significant institutional learning curve associated with implementation of a fusion biopsy program at a large regional medical center. Our institution did not achieve desired outcomes immediately, but our results improved consistently over the study period. These outcomes highlight the importance of a rigorous iterative approach to quality improvement when implementing a fusion biopsy program. P22 Transperineal Prostate Biopsy - Comparing Diagnostic Accuracy and Patient Reported Pain to Standard TRUS and MRI/US Fusion Biopsy techniques Aaron Berkenwald, MD 1 , Kristian Stensland, MD 1 , Colette Osborne, MAS 1 , Linda Tropjian, BS 1 , Lori-Lyn Price, MAS 2 , Alireza Moinzadeh, MD, MHL 1 , William Faust, MD 1 1 Lahey, Burlington, MA, USA, 2 Tufts Medical Center, Boston, MA, USA Introduction: Transperineal Prostate Biopsy (TPBx) using the PrecisionPoint system (Perineologic, Cumberland, MD) allows for office based prostate cancer detection with the benefit of lower infectious complications when compared to Transrectal Prostate Biopsy (TRUSBx). We sought to evaluate our institutional experience, focusing on differences in pain experienced during TPBx vs. TRUSBx techniques, time of procedure, Cancer DetectionRate(CDR),clinicallysignificantCDR(csCDR)andthirty-daycomplicationrates. Materials &Methods: After Institutional Review Board approval, a retrospective review of all consecutive patients undergoing prostate biopsy (June 2019-Feb 2020) at a single institution was performed. A 10-point Numerical Rating Scale (NRS) was used to record for pain during probe insertion, anesthetic block, biopsy and post-procedure. Mean NRS scores were compared using theANOVAtest. CDR and csCDR (defined as Gleason Grade Group 2 or higher cancer) was compared between TPBx, TRUSBx and TRUS/MRI fusion biopsy using Fisher’s exact test. Results: 316 patients met inclusion criteria for cancer detection. CDR for TPBx, TRUSBx and MRI fusion were 0.65, 0.47 and 0.67 (p = 0.005), while csCDR were 0.38, 0.30 and 0.44 respectively (p = 0.10). NRS pain scores were reported in 253 total biopsies. Mean patient reported NRS scores for TPBx vs. TRUSBx or TRUS/MRI fusion showed a significant difference during anesthetic injection only (3.9 vs. 2.7 and 2.8 respectively, p = 0.002). Notably, probe insertion scores were lower in the TPBx group vs. TRUSBx or TRUS/MRI fusion (2.5 vs. 3.0 and 3.1 respectively, p = 0.14). Procedural time was 13, 8.5 and 12.4 minutes respectively. The Transrectal groups had nine total 30-day complications including two sepsis events. The TPBx group had no 30-day complications reported. Conclusions: Patients undergoing TPBx report similar levels of discomfort for all aspects of the procedure when compared to transrectal biopsies with the exception of anesthetic block (modest increase in pain). Procedural times were longer in the TPBx and TRUS/ MRI fusion groups compared to standard TRUS. Both the CDR and csCDR were higher in the TPBx group versus the TRUSBx group, although no direct comparison was made. Additionally, TRUS/MRI fusion appears superior to both TRUSBx and TPBx in clinically significant cancer detection, however this cohort contained over twice as many patients on active surveillance. Finally, our study supports the assertion that TPBx has fewer infectious complications than standard transrectal approach. P21 Poster Session II 39