Real world US community urology adherence to prostate cancer guidelines.

449 Background: According to a 2010 Surveillance, Epidemiology, and End Results (SEER) Medicare analysis of prostate cancer (PCa) patients between 1992 and 2005, urologists accounted for more health services provided to PCa patients than any other specialty. Our study assessed the concordance of PCa care with two treatment-related Performance Indicators (PIs) derived from National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) in a real-world setting of community urologists. Methods: This retrospective analysis used PPS Analytics (Specialty Networks) Patient Population Health Management Platform, capturing 90 community urology practices with approximately 539,000 PCa patients treated between 7/1/2019-6/30/2022. Two PIs were identified from NCCN Guidelines through consultation with expert urologists to measure the quality of PCa care. PI-1 was defined as the proportion mCSPC patients who initiated an NCCN Category 1 preferred regimen for mCSPC. Guideline changes on 01/01/2020 created a need for two patient stratifications in PI-1. Patients in PI-1.1 had a mCSPC diagnosis between 05/2002 - 12/2019. Patients in PI-1.2 had a mCSPC diagnosis between 01/2020 - 06/2021. PI-2 was defined as the proportion of newly diagnosed intermediate-to-high risk localized PCa (Gleason score ≥ 7 or PSA ≥ 10) who received concurrent ADT with external beam radiation therapy (EBRT) based on the NCCN Guidelines recommendation for concurrent ADT in newly diagnosed intermediate-to-high risk localized PCa (LPC) receiving EBRT. Multi-level multi-variable regression was used to assess factors associated with concordance for each PI. Results: See table. Conclusions: Although changes in NCCN guidelines after 1/2020 led to improved systemic treatment in mCSPC, most patients still did not receive care concordant with recent NCCN recommendations. Our findings highlight opportunities for improving the quality of PCa care in a real-world community urology setting, notably for treatment in mCSPC. Future research should investigate reasons for deviating from NCCN preferred systemic regimens in mCSPC and intervene as appropriate.[Table: see text]