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

© The Canadian Journal of Urology TM : International Supplement, August 2020 The Relationship Between Health Literacy and Non-Recommended Screening for Prostate Cancer Relative to Other Malignancies Madeline Rutan, BA 1 , Jesse D. Sammon, DO 2 , David-Dan Nguyen, DES 3 , Kerry L. Kilbridge, MD 4 , Peter Herzog, MPH 5 , Quoc-Dien Trinh, MD 5 1 Tufts University School of Medicine, Boston, MA, USA; 2 Division of Urology, Maine Medical Center, Portland, ME, USA; 3 Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA; 4 Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA, USA; 5 Division of Urological Surgery, Brigham and Women’s Hospital, Boston, MA, USA Introduction: Cancer screening risks overdiagnosis of indolent tumors, and subsequent intervention introducescostandpoorhealthoutcomes.Shareddecisionmakingencourages screening choices that align with patient values; however, these conversations are difficult for patients with low health literacy (HL). We hypothesized that higher HLwould support guideline-concordant screening. We sought to assess the effect of HLon non-recommended prostate cancer (PCa) screening relative to other cancers. Materials & Methods: We examined the 2016 BRFSS, which includes HL modules. Respondents self-reported their ability to obtain and understand health information, resulting in 4 HL rankings. We assessed the effect of HL on non-recommended PCa screening and compared it to the effect on breast cancer (BCa) and cervical cancer (CC) screening. We calculated the population weighted proportion of patients in each HL category that underwent screening against USPSTF guidelines. The odds ratios of non- recommended screening for each malignancy was calculated, with the referent category of low HL. Results: IndividualswithhigherHLexhibitedhigherratesofnon-recommendedscreening for PCa and similar findings were seen for BCa and CC. Non-recommended PCa screening was performed in 27.4% (CI 23.7%-31.4%; p < 0.001) and 47.7% (CI 44.1%-51.3%; p < 0.001) of respondents with low and high HL, respectively. This compared favorably to BCa, which had the highest rates of non-recommended screening: 46.8% (CI 42.6%-51.1%; p = 0.002) and 67.7% (CI 64.2%-71.1%; p = 0.002) of respondents with low and high HL. Non- recommended CC screeningwas performed in 33.8% (CI 31.1%-36.5%; p < 0.001) and 48.4% (CI 46.3%-50.5%; p < 0.001) of low and high HL respondents. Individuals with high HL were significantly more likely than those with lowHLto screen against recommendations for PCa (OR 1.73; CI 1.34-2.23; p < 0.001), CC (OR 1.533; CI 1.31-1.80; p < 0.001) and BCa (OR 8.213; CI 4.90-13.76; p < 0.001). Conclusions: Patients with higher HLundergo increased rates of non-recommended PCa screening, contrary to our initial hypothesis. While this compared favorably to very high rates of non-recommended BCa screening in the high HLpopulations, the association was less pronounced in CC screening. P28 Adenocarcinoma of a Continent Urinary Conduit: A Case Report and Review of the Literature Michael E. Goltzman, MD 1 , Richard T. Kershen, MD 2 1 UConn Health, Farmington, CT; 2 Tallwood Institute of Urology, Hartford Healthcare Medical Group, Hartford, CT Introduction: Colonic segments are routinely utilized by Urologists for bladder augmentation as well as urinary neobladder formation. Colonic adenocarcinoma is the third most common cancer diagnosed in the U.S. affecting roughly 4% of both genders. 1 While the increased risk of developing colonic adenocarcinoma is well known in patients who have undergone ureterosigmoidostomy, adenocarcinoma arising in an Indiana pouch is extremely rare. 2 We aim to report a case of adenocarcinoma in an Indiana pouch treated with trans-stomal endoscopic resection, and address the screening, diagnostic and treatment-related issues surrounding this rare disease including a review of the literature. Materials & Methods: An extensive literature search on PubMed/MEDLINE was conducted. The keywords “Indiana pouch”, “carcinoma”, “adenoma”, and “adenocarcinoma” were used to find case reports and case series. Data were gathered and tabulated in regard to age, sex, tumor pathology, presence or absence of metastatic disease, therapy, and outcomes. Results: The patient is a 68-year-old man with a history of high-grade prostate cancer who underwentanabortedradicalprostatectomy in2009duetoextensiveextraprostaticdisease. He was subsequently treated with brachytherapy and external beam radiation therapy resulting insuccessful oncologicalcontrolbutsuffereddebilitating refractory lowerurinary tract symptoms related to posterior urethral stenosis, mixed incontinence and retention. In 2017, he underwent a simple cystectomywith creation of an Indiana pouch. Two years after the procedure, the patient presented for surveillance pouchoscopy and was found to have a polypoid mass within his pouch (Figure 1A). He subsequently underwent endoscopic resection of this mass via a trans-stomal technique utilizing a cystoscope and a “hot” snare (Figure1B).Pathologic investigationofthemassrevealedatubularadenomawithmultifocal high-grade dysplasia/intramucosal carcinoma without invasion of the submucosa. Repeat endoscopic biopsy and pathologic investigation revealed no evidence of residual disease. Literaturereviewrevealed thatadenocarcinomawasbyfar themostcommon tumorarising within the Indiana pouch (Table 1). While small tumors and/or polyps could be managed endoscopically, largermoreextensive lesionsrequiredopenresectionand/orpouchectomy. Conclusions: While large and/or invasive adenocarcinomas arising in an Indiana pouch may require partial or total resection of the pouch, small, non-invasive lesions may be managed endoscopically allowing pouch preservation. Given this fact, we advocate for regular (yearly) endoscopic surveillance of Indiana pouches as early detection of malignant lesions may enable less invasive management strategies and potentially better oncologic outcomes should a tumor or polyp be discovered.Adenocarcinoma continues to be a rare, but serious, complication of Indiana pouch urinary diversion. 1. KeyStatistics forColorectalCancer.TheAmericanCancerSociety. https://www.cancer.org/cancer/ colon-rectal-cancer/about/key-statistics.html 2. Austen M, Kälble T. Secondary malignancies in different forms of urinary diversion using isolated gut. JUrol.2004;172(3):831-8. fUrethralBulkingAgents forStressUrinary Incontinence:AnExtensive Review Including Case Reports. Female Pelvic Med Reconstr Surg 2018;24(6):392-398. P27 Poster Session II 42