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

NE AUA 2020 Abstracts Comparative Effectiveness of MRI-U/S Fusion versus In-bore MRI-targeted Prostate Biopsy Francisco Ramos, BS 1 , Ruslan Korets, MD 2 , Aaron Fleishman, MPH 2 , Michael Johnson, MD 2 , Aria Olumi, MD 2 , Leo Tsai, MD, PhD 2 , Boris Gershman, MD 2 1 Harvard Medical School, Boston, MA, USA; 2 Beth Israel Deaconess Medical Center, Boston, MA, USA Introduction: MRI-targeted biopsy has emerged as a standard of care in the management of men with elevated PSAand prostate cancer on active surveillance. Although two main biopsy techniques exist - MRI-ultrasound fusion (MRI-U/S) and in-bore MRI-targeted biopsy - the optimal MRI-targeted biopsy technique has not been established. We therefore examined the comparative effectiveness of MRI-U/S fusion biopsy performed in the office and in-bore MRI-targeted biopsy performed in Interventional Radiology. Materials & Methods: We identified men aged 18-89 with a diagnosis of elevated PSA or Gleason 6 prostate cancer on active surveillance who underwent MRI-U/S fusion prostate biopsy in the office or in-bore MRI-targeted biopsy performed in Interventional Radiology. MRI-U/S fusion biopsy comprised standard systematic (i.e., extended sextant) biopsies plus targeted biopsies, while in-bore MRI-targeted biopsy consisted only of targeted biopsies. The primary outcomes were cancer-detection rate (CDR; Gleason 6-10) and clinically-significant cancer detection rate (csCDR; Gleason 7-10). CDR and csCDR were compared across biopsy techniques using propensity-score adjustment for patient and MRI features using inverse probability of treatment weights (IPTW). In addition, the associations of biopsy technique with CDR and csCDR were evaluated, adjusted for patient and MRI features, using IPW-adjusted logistic regression. Results: Atotal of 169 patients were included in the study, of whom 49 (29.3%) underwent biopsy for Gleason 6 prostate cancer on active surveillance. Overall 93 patients underwent MRI-U/S fusion biopsy and 76 underwent in-bore MRI-targeted biopsy. Median patient age was 67 years (IQR 62-71), median pre-biopsy PSAwas 7.2 ng/mL (IQR 5.2-10.2), and 29.7% of men were biopsy-naïve. Before adjustment, the CDRwas 66% and 43% (p = 0.014) for MRI-U/S and in-boreMRI biopsy, respectively, while the csCDRwas 40% and 32% (p = 0.27).After propensity score adjustment, baseline characteristics were well-balanced.After propensity score adjustment, there was no statistically significant difference in overall CDR (57% vs. 55%; p = 0.83) or csCDR (35% vs. 37%; p = 0.86) for MRI-U/S and in-bore MRI biopsy, respectively. Similarly, there was no statistically significant difference in CDR or csCDRwhen stratified by PI-RADS category (Table 1). In IPW-adjusted logistic regression, there was no statistically significant difference in CDR (OR 1.03; 95%CI 0.81-1.29) or csCDR (OR 0.98; 95%CI 0.80-1.20) for MRI-U/S fusion compared to in-bore MRI-targeted biopsy. Conclusions: In this study, MRI-U/S fusion prostate biopsy and in-bore MRI-targeted prostate biopsy were associated with no statistically significant differences in CDR or csCDR overall or when stratified by PI-RADS score. Additional studies are required to determine if specific lesion characteristics may modify treatment effects. P26 The Impact of Residential Segregation on Prostate Cancer Treatment and Outcomes Samuel Helrich, BS , Michael Poulson, MD, Mark Katz, MD Boston University School of Medicine, Boston, MA, USA Introduction: There are well-documented disparities in black-white prostate cancer outcomes. Prior studies have suggested that race-associated genetic variances, screening guidelines, and treatment disparities may contribute to worse prostate cancer outcomes in black patients. We sought to examine the effects of racial residential segregation on the diagnosis, management, and outcomes of black prostate cancer patients. Materials & Methods: We obtained data on patients with prostate cancer from the Surveillance, Epidemiology, and End Results (SEER) program between 2005 and 2015 and limited to black and white patients within the 100 most populous participating counties. County demographics and socioeconomic characteristics were obtained from the 2013 5-year estimates of the American Community Survey (ACS). The racial index of dissimilarity (IoD) was used to assess the evenness with which white and black residents are distributed across census blocks within each county. Multivariable analyses were performed, predicting advanced stage at diagnosis (AJCC stage IV) in the overall cohort, and the resection of localized disease (AJCC stage I-II). Results: When adjusting for SEER region and age at diagnosis, black patients have a 98% increased risk (RR 1.98, 95% CI 1.41, 2.76) of presenting at advanced stage with increasing segregation. White patients comparatively have a 42% decreased risk (RR 0.58, 95% CI 0.48,0.70) of presenting at advanced stage with increasing segregation. When evaluating surgery for stage I and II cancers, black patients have a 26% decreased risk (RR 0.74, 95% CI 0.64, 0.86) of surgical resection with increasing segregation, while white patients have a 20% increased risk (RR 1.20, 95% CI 1.12, 1.29). Conclusions: Ourdatasuggest thatresidentialsegregationhasasignificant impactonboth black and white patients with prostate cancer. Black patients fare worse in higher levels of segregation with higher stage at diagnosis and lower likelihood of surgical resection, while white patients benefit from higher segregation with lower stage at diagnosis and higher likelihood of surgical resection. These findings underpin the importance of targeting structural racism and residential segregation when addressing black-white prostate cancer disparities. P25 Poster Session II 41