Journal Urology UR001 THE EFFECT OF PROSTATE CANCER SCREENING GUIDELINE CHANGES ON STAGE MIGRATION OF PROSTATE CANCER IN AUSTRALIA JONATHAN KAM, VENU CHALASANI, AHMED GOOLAM, PHILIP BERGERSEN, MELANIE EDWARDS, WARICK DELPRADO AND MAX DIAS Sydney Adventist Hospital, NSW Purpose: A decrease in PSA testing and corresponding increase in diagnosis of advanced stage prostate cancer in the US has been linked to the USPSTF guidelines which recommended against prostate cancer screening in 2012. Screening guidelines by the Royal Australasian College of GPs recommended against prostate cancer screening in their 2009, 2012 and 2016 guidelines. There is no published data analysing the trends of prostate cancer testing and stage in Australia over this period. We aimed to determine if screening guidelines have resulted in decreasing PSA testing and a migration to more advanced stage prostate cancer in NSW. Methodology: Patients undergoing radical prostatectomy in NSW between 2007-2018 were identified in our prospectively maintained database. PSA testing and radical prostatectomy rates were obtained from Medicare Statistics database. Population data was obtained from Australian Bureau of Statistics. Joinpoint regression analysis was performed to analyse trends. Results: We identified 17,375 patients who underwent radical prostatectomy in our database, representing 69% of radical prostatectomies in NSW. The rates of non-organ confined disease (pT3) significantly increased from 31% to 55%, annual percentage change (APC) 5.36%, p<0.05. This was seen in both pT3a stage (extra-capsular extension), APC 5.41%, p<0.05 and pT3b stages (seminal vesicle invasion), APC 4.6%, p<0.05. There was a significant decrease in the rate of PSA testing being performed in NSW, APC -4.9%, p<0.05 with crude testing rates decreasing from 8342 to 4910 per 100,000 males. Conclusions: A significant decrease in PSA testing in NSW has been observed from 2007 to 2018 corresponding to a significant increase in more advanced disease being found at time of radical prostatectomy. UR002 PREDICTIVE ACCURACY OF THE CURRENT NEW ZEALAND NATIONAL PROSTATE CANCER SCREENING AND REFERRAL GUIDELINES BASHAR MATTI AND KAMRAN ZARGAR University of Auckland, Auckland, New Zealand Purpose: The current Prostate cancer (Pca) screening approach with Prostate Specific Antigen (PSA) testing, utilizes a “one-size-fits all” model, where all men aged 70 years or younger, with PSA >= 4.0 ng/ml or abnormal Digital Rectal Examination (DRE), are recommended to have a prostate biopsy. This study aims to estimate the predictive accuracy of these national guidelines for Pca detection. Method: All men in Auckland and Counties Manukau DHBs who had prostate biopsies between 2013 and 2017, were included. Exclusion criteria were men older than 70 years, known to have Pca, or underwent < 10-core sampling. Data collected included demographics, pre-biopsy PSA levels, DRE findings, and biopsy outcomes. Binary logistic regression was used to calculate the probabilities of detecting Pca in the biopsy sample. The predictive accuracy was estimated using the area under the receiver operator curve analysis (AUC). Results: The final cohort constituted of 1,222 men with a median age of 63 years. Most participants (93%) had PSA levels above the national cut-off values (4.0 ng/ml) and abnormal examination was reported in 21.4% of the cases. Overall, the biopsy outcome was positive in 710 men. The AUC of the PSA cut-off alone and combined with abnormal DRE, were 0.522 (p =0.181) and 0.518 (p = 0.281), respectively. Conversely, combining age, PSA levels and ethnicity improved the predictive accuracy (AUC = 0.644, p < 0.001). Conclusion: The current recommendations for Pca detection have limited predictive capacity. This can be improved by implementing an individualized risk based Pca screening strategy. UR003 DIAGNOSTIC VALUE OF DIGITAL RECTAL EXAMINATION IN PRIMARY CARE FOR PROSTATE CANCER BASHAR MATTI, GREER HUNTER AND KAMRAN ZARGAR University of Auckland, Auckland, New Zealand Purpose: The use of Digital Rectal Examination (DRE) for Prostate cancer (Pca) screening in primary care has recently been challenged. Nevertheless, several international guidelines continue to recommend this test as part of the Pca screening pathway. This study aims to assess the diagnostic accuracy of DRE in primary care for Pca. Methodology: All men who had transrectal ultrasound guided prostate biopsy at CMDHB between 2013 and 2017 were eligible. Men with previous prostate biopsy (negative or positive) or not referred to urology services from primary care, were excluded. Data collected included demographics, symptoms, DRE findings (benign or malignant), PSA levels and biopsy outcomes. The diagnostic accuracy was assessed as positive/negative predictive values (PPV/NPV) and area under the receiver operator curve (AUC) analyses. Results: Of the 946 included men, DRE by General Practitioner (GP) was documented in only 61% of the cases. Median age and PSA for the cohort were 65 years and 6.8 ng/ml, respectively. DRE was considered malignant in 144 cases (24.8%). Men with benign DRE were younger (p = 0.006) and had longer time from referral to urologist assessment (p=0.017). Conversely, no differences observed in symptoms (p = 0.976), PSA levels (p=0.486) or number of biopsy cores (p=0.376), between the DRE groups. The PPV and NPV for Pca were 77.8% and 35.7%, respectively. This corresponded to an AUC of 0.557 (p=0.025). Conclusion: DRE in Primary care remains a useful adjunct in the Pca diagnostic process. Improvements are needed to assure adequate documentation of DRE findings in patients’ records. UR004 PROSTATE CANCER SCREENING WITH PROSTATE SPECIFIC ANTIGEN: INTERPRETATION OF RANDOMIZED TRIALS BEYOND THE RESULTS OF SYSTEMATIC REVIEWS BASHAR MATTI AND KAMRAN ZARGAR University of Auckland, Auckland, New Zealand Purpose: Screening for Prostate cancer (Pca) with Prostate Specific Antigen (PSA) has been controversial. A recent meta-analysis of Randomized Clinical Trials (RCTs) by the Cochrane group concluded that evidence was against population-based screening. This review re-visits the topic with enhanced interpretation of the RCTs. Methodology: We searched the Medline electronic database for all RCTs that used PSA testing for Pca screening in the intervention arm with cancer specific mortality as the outcome of interest. This resulted in 1,654 citations (Inception – June 2020). Following title and abstract screening, 112 articles were subject for full text evaluation and eight RCTs were included. For each study, the latest publication with longest follow-up was considered. Intention-To-Screen (ITS) and Intention-To-Treat (ITT) analyses were conducted. Results: One study compared population screening to no screening (Quebec). This reported no difference and 77% mortality reduction on ITS and ITT analyses, respectively. Two studies compared opportunistic screening to no screening (Stockholm and CAP). Both demonstrated no differences on ITS analysis. On ITT analysis, the former continued to demonstrate no differences, while the later showed 19% reduction. Five studies compared population-based to opportunistic screening (PLCO, ERSPC core, ERSPC Rotterdam, ERSPC Finland, and Gotenberg). All but two (PLCO and ERSPC Finland) reported at least 20% reduction in Pca mortality. Major confounders were low response rate (Quebec and CAP), low intensity PSA testing (ERSPC Finland), high contamination (PLCO), and heterogenous practices (ERSPC core). Editorial material and organization © 2021 Royal Australasian College of Surgeons. Copyright of individual abstracts remains with the authors. ANZ J. Surg. 2021; 91 (S1) 259–289