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307 Background: Although definitive treatment is associated with improved survival for aggressive prostate cancer, a significant number of patients do not receive treatment. To identify gaps in practice, we sought to evaluate sociodemographic factors associated with non-treatment by clinical risk strata in the contemporary era. Methods: We performed a retrospective study of patients with prostate cancer using the National Cancer Database. A total of 616,479 patients diagnosed with localized prostate (cT1-4N0M0) cancer from 2010 to 2017 were included in the analysis. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-treatment, stratifying analyses by D’Amico clinical risk criteria. Results: The mean patient age at diagnosis was 65 years. 29.0% were diagnosed with low, 43.7% with intermediate, and 28.4% with high-risk prostate cancer. There were 71,848 (11.7%) who did not undergo initial treatment, including 46,269 (64.4%) with low, 18,376 (25.6%) with intermediate, and 7,203 (10.0%) with high-risk disease. Overall, non-treatment increased for low-risk (11.6% versus 47.0%), intermediate (4.4% versus 9.7%) and high risk (3.4% versus 4.7%). Compared with White patients, Black patients had lower odds of definitive treatment. This effect was more pronounced for patients with high (OR 0.63, 95% CI 0.59-0.67) than intermediate (OR 0.78, 95% CI 0.75-0.82) risk disease. Asian patients had lower odds of treatment compared with White patients across all disease risk strata (OR 0.82, 95% CI 0.77-0.87). There were lower odds of treatment among American Native/Alaskan Native versus White patients with high-risk prostate cancer (OR 0.58, 95% CI 0.39-0.85). Uninsured (OR 0.41, 95% CI 0.39-0.44, p

32 Background: A subset of patients are diagnosed with lethal prostate cancer early in life, before PSA screening is typically initiated. To identify opportunities for improved detection we evaluated patient clinical and sociodemographic factors associated with advanced versus localized prostate cancer diagnosis across the age spectrum. Methods: We conducted a retrospective cohort study using the National Cancer Database, identifying patients diagnosed with prostate cancer in 2004-2016. We compared characteristics of patients diagnosed at advanced (cN1 or M1) versus localized (cT1-4N0M0) stage. Using multivariable logistic regression, we evaluated the associations among patient clinical and sociodemographic factors and advanced diagnosis, stratifying patients by age as 75 years. Results: We identified668,486 patients who met inclusion criteria (mean age at diagnosis=64.6 years), including 33,455 (5.0%) with advanced disease at diagnosis. Uninsured (odds ratio, OR=3.78, 95% confidence interval, CI 3.56-4.02) and Medicaid-insured (OR 2.84, 95% CI 2.70-3.00) versus commercially insured patients were more likely to be diagnosed with advanced disease, however this effect was more pronounced for younger patients. Among patients