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To determine the correlation between ultrasound (US), cross-sectional imaging, and pathological renal mass sizes.Between January 2011 and January 2021, a cohort of patients from 14 academic institutions who had an US and cross-sectional imaging within 8 weeks of each other and within 6 months of surgery were identified. A second cohort of patients with small renal masses (≤4 cm) who had US and cross-sectional imaging within 8 weeks of each other were also examined, regardless of their treatment modality. Correlation coefficients, Bland-Altman plots, and sensitivity tables were generated.A total of 1464 patients were included in the surgical cohort and 1582 patients (1921 imaging pairs) were included in the small renal mass (SRM) cohort. Pearson correlation coefficients between computed tomography (CT)/magnetic resonance imaging (MRI) and pathologic size was 0.93 (P.0001) and between US and pathological size was 0.90 (P.0001). The correlation between US and CT/MRI was 0.93 (P.0001). Bland-Altman plots demonstrated a greater agreement for smaller renal masses. For the SRM cohort when comparing US to CT/MRI, 1441 (75%) SRM measurements were within 0.5 cm and only 149 (7.8%) were greater than 1 cm in difference. Subgroup analysis demonstrated that correlation between US and CT/MRI for SRMs were higher in patients with lower body mass index.There is a strong correlation between US and cross-sectional imaging in 75% of patients at baseline imaging. Our study provides support for utilization of US for active surveillance.

86 Background: Treatment options for patients with mCSPC have rapidly evolved with the introduction of androgen receptor axis targeted therapies (ARATs) and chemotherapy. The GURC cohort study is a phase 4, multicentre, non-interventional, longitudinal cohort study of Canadian men with advanced prostate cancer. We prospectively examined the evolving real world management and treatment patterns of patients with mCSPC, with a focus on treatment intensification beyond ADT and germline DNA damage repair (DDR) testing. Methods: Clinical management patterns, baseline patient characteristics, germline DDR alteration status, treatment intensification with ARATs (abiraterone acetate [AA], apalutamide [Apa], enzalutamide [Enza]) and chemotherapy within the mCSPC cohort were analyzed. Results: 204 patients with mCSPC were enrolled from 2018 to 2021 across 25 Canadian sites. The median age was 71 (range 64 - 77), median PSA at study entry was 24, 88% (158/180) of patients had de novo mCSPC, 69% (110/204) of patients had a Gleason Score > 7, and 4% (2/49) of the patients who received a germline testing harbored a germline DDR alteration (BRCA2 = 1, MUTYH/MEN1 = 1). The distribution of high and low volume mCSPC at study entry was 62% (118/189) and 37% (71/189), respectively. Overall, patients received ADT alone 27% (51/189), AA 45% (86/189), apalutamide 17% (33/189), docetaxel 8% (15/189), and enzalutamide 3% (6/189). Treatment intensification with ARATs/docetaxel was administered to 69% [141/189]) of patients. Patients treated with ADT alone had a significantly lower volume of disease at treatment initiation (low volume rates of 49% [24/49] in ADT alone vs 33% [47/143] in treatment intensified patients, p = 0.044). Among those receiving treatment intensification with ARATs/docetaxel, time to intensification was ≤ 3 months in 78.5 % (113/144). Conclusions: This cohort study demonstrates that patients with mCSPC continue to receive ADT alone and docetaxel over time, despite an ever-increasing list of accessible ARATs. Patients receiving ADT alone appear to have lower volume of disease. Germline DDR testing is not yet comprehensively performed. This underlines the real world need to provide greater education and resources to encourage ARAT treatment and genetic testing in this setting.

252 Background: The management of patients with mCRPC has evolved since the introduction of androgen-receptor axis targeted agents (ARATs). The Genitourinary Research Consortium (GURC) initiated a prospective, phase 4, multicentre, non-interventional, longitudinal cohort study of Canadian men with advanced prostate cancer to determine real-world treatment patterns and outcomes. Methods: 25 sites across Canada participated in this study including patients managed by urologists, medical- and radiation-oncologists between 2018 to 2021. Baseline patient characteristics and mCRPC treatment patterns are reported here. Treatment patterns reviewed included time to second-line treatment use and time to progression or death. Results: 136 mCRPC patients were enrolled. Median age was 73 years (range 66 to 80) with 54 (40%) having a Gleason score of >8 at diagnosis. Median PSA at enrollment was 8.9 (2.4 to 25.1) ng/ml. At study entry, 90/132 (66%) patients with mCSPC and 42/132 (31%) patients nmCRPC had progressed to develop mCRPC. One hundred and twenty-one (89%) of patients in this cohort received first-line treatment for mCRPC, the most common was abiraterone acetate + prednisone in 67 (49%) and enzalutamide in 41 (30%), followed by docetaxel in 6 (4.4%), and Radium-223 in 5 (3.7%) patients. During the 25-month median follow-up period (range 6-28), 59 (49%) of the patients receiving first line mCRPC therapy had documented disease progression or death. At the time of last recorded follow-up, 37 (28%) patients who progressed received a second-line therapy for mCRPC. Median time to progression in this cohort was 21 months (95% CI: 15.2 - NE), with ARAT-to-ARAT being the most common sequencing pattern observed in 15 (39%) patients, followed by ARAT to chemotherapy in 14 (37%). Conclusions: In this real-world analysis of mCRPC patients, ARAT therapy was the preferred approach for first-line treatment intensification in over 108 (80%) patients. Despite evidence of poor response rates, ARAT-to-ARAT was the most common sequencing for second line therapy, followed by ARAT-to-chemotherapy treatment. Further analysis and follow-up will help define optimal mCRPC management, in real world setting.

361 Background: Characteristics of patients with high risk for recurrence non-metastatic renal cell carcinoma (nmRCC) participating in adjuvant therapy clinical trials post-nephrectomy have not been well described. We evaluated high risk nmRCC patients in the CKCis database to explore differences between trial and non-trial patients. Methods: Adult patients undergoing partial or radical nephrectomy for clear cell nmRCC between January 1, 2011 and March 31, 2021 were included. CKCis is a prospective cohort of patients from 14 Canadian academic institutions. Patients with high risk nmRCC (using modified UCLA Integrated Staging System) were included. Demographic, clinical, and survival statistics were analyzed for all patients and comparatively for the trial and non-trial groups. Results: 1459 patients, including 63 in adjuvant trials, were evaluated. 71% were male, 91% had pT3N0M0 disease. Disease characteristics including tumor size, stage, grade, location, necrosis, and margin status were similar between groups. Trial patients were younger (mean age 58.1 vs. 63.6; p < 0.0001) and had lower Charlson Comorbidity Index scores (median 4 [3,6) vs. 5 [4,6] p < 0.001). Estimated overall survival (OS) at 5 years was 80.8% (95% CI, 65,90) for trial patients and 74.8% (95% CI, 71,78.2) for non-trial patients. Recurrence-free survival at 5 years for trial patients was 48.6% (95% CI, 34,61.7) and 39.2% (95% CI, 35.2,43.1) for non-trial patients. Conclusions: Patients in adjuvant trials were younger and healthier at baseline than the average high risk nmRCC CKCis patient. Trial patients appear to have had longer time to recurrence and longer survival compared to non-trial patients, although not reaching statistical significance. Selection bias is common in clinical trials and evaluation of real-world population-based evidence of patients receiving adjuvant therapy will be important to ensure phase 3 trial results have external validity.

INTRODUCTION AND OBJECTIVE:Cardiovascular disease (CVD) is the second most common cause of death in prostate cancer (PC) patients, yet the prevalence of CVD and its risk factors have been incomplet...