MP14-03 SIMPLIFIED FRAILTY INDEX PREDICTS ADVERSE SURGICAL OUTCOMES AND INCREASED LENGTH OF STAY IN RADICAL PROSTATECTOMY PATIENTS: AN ANALYSIS OF THE ACS-NSQIP DATABASE

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with prostate cancer. The EPIC 26 HR-QOL questionnaire has become a standardized measure of evaluating a patient’s urinary and sexual recovery after prostate cancer treatment. We believe this questionnaire may be used to assess other domains in a patient’s recovery. Currently the PHQ-2 and PHQ- 9 are validated questionnaires employed by primary care physicians. The PHQ-2 is used to detect depression and the PHQ-9 is used to assess depression. This study examines whether the EPIC 26 question on depression may be used as a surrogate for the PHQ-2 and 9 questionnaires. METHODS: A total of 4538 men with a positive biopsy between March 2011 and April 2013 were enrolled in the EPIC 26 QOL study. Men who completed a PHQ-2 or PHQ-9 as well as an EPIC 26 HR-QOL were included. Men who had more than 90 days between the time of their PHQ questionnaire and the EPIC 26 and men who received treatment for prostate cancer in between the time of the EPIC 26 and PHQ questionnaires were excluded. The responses on the PHQ-2 or PHQ-9 were compared with the same patient’s responses on the EPIC 26. RESULTS: After the inclusion and exclusion criteria were applied we had 220 matched surveys to compare. We first compared the patients that underwent the PHQ2 test with their most recent EPIC 26 score, a total of 124 patients. The PHQ2 responses were not significantly associated with the EPIC 26 responses: Spearman’s correlation coefficient ¼ 0.058, p ¼ 0.520. A total of 96 patients with PHQ9 and EPIC 26 responses were compared. We found a strong correlation between these two tests: Spearman’s Rank correlation coefficient ¼0.471 with p<0.0001. CONCLUSIONS: The EPIC 26 did not correlate well with the PHQ2 test and would likely not be a good test for the detection of depression in men with prostate cancer. However, the EPIC 26 has a strong correlation with the PHQ9 responses and therefore it could be used in the assessment of depression in men with prostate cancer. This may help us better track mental health in this population, as well as be helpful in tracking how different treatment modalities affect one’s mental health in the future.

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other groups. BT, however, demonstrated a decline in SF after 36 months vs ORP, RAP, and CRYO which had stable SF over the same period. For patients > 70 years, a near complete return to baseline UF and UB by 12 months was noted which persisted to 60 months vs the younger cohorts whose PBS plateaued at roughly 80. Conversely, at 60 months, SF PBS scores of 53, 41, and 29 were found for the <60, 60e70, and >70 years cohorts, respectively. CONCLUSIONS: In this cohort of patients followed to 5 years, BT and CRYO offer durable HRQOL benefits in both UF and UB over ORP and RAP. BT alone offers improved HRQOL outcomes for SF as compared to ORP, RAP, or CRYO. Patients age >70 have an excellent recovery of baseline UF and UB but do poorly with SF recovery as compared to younger cohorts. Certainly, these findings can be employed for appropriate counselling prior to treatment decisions.

Source of Funding: Intuitive Surgical, Inc.

MP14-02 PROSPECTIVE QUALITY OF LIFE IMPACT ANALYSIS FOLLOWING LOCALIZED PROSTATE CANCER TREATMENTS: BRACHYTHERAPY, CRYOTHERAPY, AND RADICAL PROSTATECTOMY LONG-TERM FOLLOW-UP Matthew Ingham*, Arjun Poddar, Mark Shaves, Michael Fabrizio, Raymond Lance, Robert Given, Kurt McCammon, Paul Schellhammer, Michael Williams, Norfolk, VA INTRODUCTION AND OBJECTIVES: A number of treatment modalities for localized prostate cancer (CaP) exist, often with similar oncologic outcomes. As such, health related quality of life (HRQOL) plays a significant role in treatment decisions. We sought to evaluate the long-term HRQOL impact of four such treatments. METHODS: Patients undergoing open radical prostatectomy (ORP), robotic assisted prostatectomy (RAP), brachytherapy (BT), or cryotherapy (CRYO) for localized CaP between March 2002 and October 2009 were asked to complete the UCLA-PCI pre-op and at 1, 3, 6, 12, 18, 24, 30, 36, 48, and 60 months post-op. 586 of 1094 patients returned surveys out to the 60-month endpoint. Outcomes were compared across treatment modalities and age cohorts (<60, 60e70, and >70 years). Baseline scores were obtained along with a percent of baseline score (PBS) for all subsequent surveys. RESULTS: For urinary function (UF) and bother (UB) domains, those undergoing BT or CRYO showed a significant improvement in HRQOL vs ORP or RAP, which persisted to the 60-month endpoint. BT and CRYO also showed a faster return of HRQOL, plateauing by 6e12 months compared with ORP and RAP which plateaued at 18e24 months (Fig 1). Sexual function (SF) and bother (SB) domains showed a significantly improved HRQOL for BT over ORP, RAP, and CRYO. By 12 months, BT patients had roughly double the improvement of the

Source of Funding: None

MP14-03 SIMPLIFIED FRAILTY INDEX PREDICTS ADVERSE SURGICAL OUTCOMES AND INCREASED LENGTH OF STAY IN RADICAL PROSTATECTOMY PATIENTS: AN ANALYSIS OF THE ACS-NSQIP DATABASE Danny Lascano*, Jamie S. Pak, Alexander C. Small, Mark V. Silva, James M. McKiernan, G. Joel DeCastro, Sven Wenske, Mitchell C. Benson, New York, NY INTRODUCTION AND OBJECTIVES: Frailty is usually assessed in a non-standardized manner with descriptions of patients such as appearing “older than stated age”. Currently, no suitable measure exists to qualify this parameter, despite its potentially large impact on surgical outcomes. Therefore, a modified frailty index (FI) was applied to the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data to evaluate whether it predicts adverse post-surgical outcomes. METHODS: The ACS-NSQIP Participant Utilization File was queried for the years 2005e2012 for inpatient radical prostatectomy (RP) patients (n¼16848). Employing the Canadian Study of Health and Aging frailty index, 11 variables were matched to NSQIP to create a modified frailty index (FI) using including diabetes mellitus, functional status, CHF, MI, prior cardiac surgery, hypertension, peripheral vascular disease, impaired sensorium, and TIA or CVA with neurological sequela. Four variables specific to cancer were also including: chemotherapy or radiation, weight loss, renal failure, and metastasis.

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Outcomes assessed included 30-day mortality, surgical site infection (SSI), MI, DVT/PE, Clavien IV complications, length of stay (LOS), and combined adverse events. Chi-square analysis was used for comparing categorical variables, Kruskal-Wallis for non-parametric continuous variables, and logistic regression for comparing different clinical tests. RESULTS: Increasing FI was significantly associated with Clavien IV complications, number of SSI and all combined adverse events (p<0.05 for all). A Kruskal-Wallis H test demonstrated a statistically significant difference in LOS between those with different FI (c2 ¼ 88.02, p<0.01) with a mean rank of 3, 4, 6, 5, 2 and 1 day(s) for FI of 1, 2, 3, 4, 5 and 6 respectively. Multivariate analysis indicated that FI was significantly correlated with Clavien IV complications (OR 1.368, p< 0.01), MI (OR 2.745, p < 0.01), and adverse events including SSI, UTIs and DVT/PE (OR 1.371, p <0.01). CONCLUSIONS: Using a large national database, a modified frailty index was shown to significantly correlate with 30-day morbidity and length of stay after RP but not with mortality. This simple tool may be useful for both risk assessment and surgical planning, especially in elderly patients with multiple comorbidities. Source of Funding: None

MP14-04 DISSATISFACTION WITH INFORMATION PROVISION AND PATIENT REPORTED OUTCOMES IN PROSTATE CANCER SURVIVORS Paul Kil*, Romy Lamers, Maarten Cuypers, Marieke De Vries, Tilburg, Netherlands; Ruud Bosch, Utrecht, Netherlands; Lonneke vd PollFranse, Tilburg, Netherlands INTRODUCTION AND OBJECTIVES: After being diagnosed with prostate cancer many patients await the difficult process of comparing and considering treatment options. Information provision plays a crucial role in this decision making process for the treatment of prostate cancer. Physicians provide information in different ways (e.g. conversations, leaflets, information books, websites, option grids). However, it remains unclear whether the information patients receive meets the patient information needs. Our objective is to determine the level of satisfaction with information received by prostate cancer survivors and its association with quality of life outcomes and illness perception. METHODS: A cross-sectional study was performed in 2011 among 999 patients, diagnosed with prostate cancer between 2006e2009, as registered in the Eindhoven Cancer Registry (10 hospitals). All patients received a questionnaire on health related quality of life (HRQoL) (EORTC QLQ-C30 and QLQ-PR25), Brief Illness perception Questionnaire (B-IPQ) and level of satisfaction with information provision (QLQ-INFO25-scale). RESULTS: The response rate was 70% (N¼697).34% (N¼222) indicated dissatisfaction with theinformation received at diagnosis. Dissatisfied patients scored significantly lower (p <0.05)on the global health scale (mean 74 vs. 80) and of the physical e (mean 80 vs. 85), role e (mean 76 vs. 84),emotional - (mean 84 vs. 89) and social functioning subscales( mean 86 vs. 91) compared to satisfied survivors (all range 0e100). See figure 1. Dissatisfied patients reported lower mean scores on sexual activity and sexual functioning(24 vs. 25, p>0.05 and 50 vs. 56, p<0.05,respectively)(all range 0e100). Dissatisfied patients indicate higher mean scores on urinary symptoms and incontinence (23 vs. 17, p <0.05 and 24 vs. 12, p <0.05, respectively)(all range 0e100). In multivariate regression analyses, satisfaction was negatively associated with illness perception subscales on consequences (p<0.05), treatment control (p<0.01),illness concern (p<0.05) and coherence (p<0.05)indicating better illness perception in satisfied patients. CONCLUSIONS: One in three of all prostate cancer survivors was not satisfied with the information received. Satisfaction with information provision is positively associated with HRQoL and illness perception. These results may emphasize the need for better patient information provision. Source of Funding: none

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MP14-05 A PROSPECTIVE COHORT STUDY OF TREATMENT DECISIONMAKING FOR PROSTATE CANCER FOLLOWING PARTICIPATION IN A MULTI-DISCIPLINARY CLINIC Lauren Hurwitz*, Jennifer Cullen, Sally Elsamanoudi, Rockville, MD; Daniel Kim, Jane Hudak, Maryellen Colston, Judith Travis, Bethesda, MD; Huai-Ching Kuo, Rockville, MD; Inger Rosner, Bethesda, MD INTRODUCTION AND OBJECTIVES: Patients diagnosed with prostate cancer (PCa) are presented with several treatment options of similar efficacy but varying side effects. Understanding how and why patients make the treatment decisions that they do is critical to ensuring effective, patient-centered care. This study examines treatment decision-making patterns in a racially-diverse, equal-access, contemporary cohort of PCa patients counseled on treatment options at a multidisciplinary clinic. The characteristics of treated patients are the primary focus of this study. METHODS: A prospective cohort study was initiated at Walter Reed National Military Medical Center in June 2006 to examine treatment decision-making patterns among newly-diagnosed PCa patients. Each patient completed surveys pre- and post- participation in a multidisciplinary clinic to assess patient preferences and reasons for treatment choice. Patients were also assessed for decisional regret and health-related quality of life at 6, 12, 24, and 36 months after treatment. RESULTS: As of January 2014, 925 newly diagnosed PCa patients were enrolled in this study. Of the 825 (89%) patients diagnosed with low- and intermediate-risk PCa, 52% chose radical prostatectomy (RP) and 20% chose external beam radiation therapy (EBRT) as primary treatment. In both univariable and multivariable analyses, patients who were older, African-American, and had at least one major comorbidity were significantly more likely to choose EBRT over RP (p<0.001, p<0.001, p¼0.003 respectively). Among the 100 high-risk patients, 33% chose RP and 57% chose EBRT plus neo-adjuvant hormones as primary treatment. Age was the only independent predictor of treatment choice in the high-risk PCa group (p¼0.0002). Patients cited the reason for choosing RP as: wanting the source of cancer taken out of the body (74%), having confidence in the surgeon (71%), and thinking surgery was a better way to get rid of the cancer (68%). Alternatively, patients reported that the choice to undergo radiation was influenced by: having confidence in the radiation doctor (45%), thinking radiation was a better way to get rid of the cancer (41%), and liking the advances made in radiation technology (40%). CONCLUSIONS: This is one of the first prospective cohort studies to examine treatment decision-making in newly diagnosed PCa patients attending a multi-disciplinary clinic. Future studies are planned to examine patients who chose active surveillance, as well as the impact of treatment choice on longitudinal decisional regret and quality of life. Source of Funding: HU0001-10-2-0002, Uniformed Services University for the Health Sciences, (PI: McLeod, David G., Director), October 2011- September 2017

MP14-06 SELF-REPORTED SEXUAL FUNCTION IS ASSOCIATED WITH PROSTATE CANCER RISK Daniel Zapata*, Lauren E. Howard, Jennifer Frank, Simon Ross, Catherine Hoyo, Dolores Grant, Stephen J. Freedland, Adriana C. Vidal, Durham, NC INTRODUCTION AND OBJECTIVES: Introduction and objectives: Erectile dysfunction and prostate cancer (PC) are prevalent conditions among older men. To date, few studies have explored the association between these two conditions. Therefore, we tested if there is an association between sexual function and the risk of PC among men undergoing prostate biopsy. METHODS: We reviewed data of 448 men undergoing prostate biopsy at a Veterans Affairs Medical Center. Sexual function data were obtained from the Expanded Prostate Cancer Index Composite sexual assessment which queries ability to have an erection, reach an orgasm,