A. Sood

641 Racial disparities in the surgical care of localized prostate cancer

INTRODUCTION AND OBJECTIVES: The Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score predicts prostate cancer (PCa) recurrence based on pathologic information from radical prostatectomy (RP). We independently validated the CAPRA-S in a European, single-institution database. METHODS: The study cohort comprised of 14532 patients treated with radical prostatectomy between January 1992 and August 2012. Prediction of biochemical recurrence (BCR), metastasis and cancer-specific mortality (CSM) by CAPRA-S was assessed by Kaplan-Meier analysis and the c-index. Performance of CAPRA-S in predicting BCR was assessed by calibration plot and decision curve analysis. RESULTS: Median follow up was 48.8 months (IQR 24.6 e 95.9). Biochemical recurrence occurred in 20.3% of men at a median time of 21.2 mo (interquartile range [IQR]: 7.7e44.9). When stratifying patients by CAPRA-S risk groups, biochemical recurrence-free survival estimates at 5 years were 91.4%, 70.4%, and 29.3% for the low, intermediate and high-risk group, respectively. The c-index for CAPRA-S in predicting BCR was 0.80. The cindices for CAPRA-S in predicting metastasis and CSM were 0.85 and 0.88, respectively. 374 men developed metastasis, and 184 men died from PCa. CONCLUSIONS: The postoperative CAPRA-S score was accurate when applied in a European study cohort and predicted biochemical recurrence, metastasis and CSM after RP with c-indices> 0.80. The score can be valuable for decision-making for adjuvant therapy.

18 The influence of physican recommendation on PSA screening

INTRODUCTION AND OBJECTIVES: PSA screening for prostate cancer is a controversial topic, and little is known regarding a physician’s impact on a patient’s decision to undergo screening. The study’s objective was to evaluate the impact of a patient’s understanding of the risks and benefits of PSA screening compared to the final recommendation of the health care provider on the patient’s decision to undergo PSA screening. METHODS: Using the 2012 BRFSS, males aged 55 years who did not have a prior history of prostate cancer/prostate “problem” and who reported a PSA test within the preceding 12 months were considered to have undergone PSA screening. The percentage of men informed and not informed of the risks and benefits of PSA screening and the percentage men receiving recommendations for PSA screening from their HCP was reported. Multivariable complex-samples logistic regression calculated the odds ratio of undergoing screening in men informed of PSA screening benefits, screening risks, and for those receiving a recommendation to undergo screening. RESULTS: Seventy-five percent of men were informed of screening benefits, however 32% were informed of screening risks. After being informed of both, 55.6% of men opted for PSA screening if the HCP recommended it, compared to only 20.6% when not recommended. Men receiving a recommendation to undergo PSA testing had higher odds of undergoing screening (OR 4.98, 95% CI: 4.53-5.48) compared to those who were only informed about screening benefits (OR 2.40, 95% CI: 2.18-2.65) or risks (OR 0.92, 95% CI: 0.86-0.98). Significant limitations of our study include recall and non-response bias. CONCLUSIONS: Physicians have a tendency to report the favorable aspects of screening while under informing patients of the possible risks of screening. A patient’s decision to undergo or forgo PSA screening is heavily influenced by the recommendation of their physician, and thus it is imperative that physicians are cognizant of their biases and facilitate an unbiased shared decision making process.

191 Cancer-control outcomes in patients with clinically high-risk prostate cancer (PCa) treated with robotic-assisted laparoscopic radical prostatectomy (RALP): A multi-institutional database analysis

INTRODUCTION AND OBJECTIVES: Contemporary adherence to European Association of Urology (EAU) guideline recommendation for pelvic lymph node dissection (PLND) at either open (ORP) or robot-assisted radical prostatectomy (RARP) in an European high-volume center is unknown. To assess guideline recommended and observed PLND rates at ORP or RARP in a high-volume center cohort. METHODS: We relied on a large European institutional database and focused on localized prostate cancer (PCa) patients, who were treated with either ORP or RARP, between 2010 and 2013. Categorical and multivariable logistic regression analyses targeted two endpoints: 1) probability of guideline recommended PLND and 2) probability of no PLND, when not recommended by EAU guidelines. RESULTS: Within 7,868 PCa patients, adherence to EAU PLND guideline recommendation was 97.1% at ORP and 96.8% at RARP. When PLND was not recommended, it was more frequently performed at RARP (71.6%) than at ORP (66.2%). At recommended PLND, 21.1% of ORP patients harbored lymph node invasion (LNI) (number needed to treat (NNT): 4.7) vs. 9.9% RARP (NNT: 10.1). At not recommended PLND, 2.9% of ORP patients harbored LNI (NNT: 34.5) vs. 1.4% in RARP (NNT: 71.4). CONCLUSIONS: Adherence to EAU guideline recommended PLND is high at this high-volume center. Neither ORP nor RARP represent a barrier for PLND, when recommended. However, a high number of patients underwent PLND despite absence of guideline recommendation. Possible staging advantages and PLND related complications needs to be individually considered, especially, when LNI risk is low.

235 Morbidity and mortality after benign prostatic hyperplasia surgery: Data from the national surgical quality improvement program

RESULTS: 484 patients had open or laparoscopic UOS, with 200 (41%) classified as high risk for VTE by CRSs. The rates of VTEs and median times to VTE were 6% and 74 days in Group 1, 13% and 44 days in Group 2, 15% and 40 days in Group 3, and 23% and 11 days in Group 4. Adjusted hazard ratios for VTE are shown in Table 1. Group 1 had no VTE’s or fatal pulmonary embolisms in the first 30 days after UOS. Bleeding and lymphocele rates were 0% and 2% in Group 1, 0% and 4% in Group 2, 3% and 3% in Group 3, 0% and 0% in Group 4. Complications were considered Clavien grades II-IIIa. CONCLUSIONS: VTE risk is lowest in patients who receive clinical protocol prophylaxis with EDP. Risk of VTE remains elevated for at least 90 days following UOS. A clinical VTE prevention protocol using perioperative prophylaxis and EDP is effective and safe in reducing VTE risk in UOS patients.