Background: Renal masses can be surgically treated by partial nephrectomy (PN) or radical nephrectomy (RN); however, in 2009 guidelines recommended PN as the standard of care for cT1a renal masses. Objective: To evaluate national trends of surgically appropriate patients using the National Cancer Database (NCDB) for utilization of PN focusing on guideline release, evaluating underlying health disparity. Methods: We identified 99,035 patients from 2004-2015 that underwent surgical resection of cT1a renal masses. We evaluated treatment proportions over time of patients treated with PN or RN. Logistic regression was utilized for multivariable analysis. Results: PN increased from 40.2% in 2004 to 71.3% in 2015 (p < 0.001). Older patients were more likely to be treated with RN (OR 1.018, p < 0.001), as were those with Charlson score 2 or 3+ (OR 1.288 and 2.074, p < 0.001). Patients with lower income were more likely to be treated with RN (OR 1.186, p < 0.001) as were uninsured patients (OR 1.108, p = 0.018) and low volume centers (OR 1.063, p < 0.001). Females were more likely to undergo RN (OR 1.123, p < 0.001) as were black patients (OR 1.339, p < 0.001). While these demographic trends persisted after the release of the guidelines, all associations decreased except for Charlson score and race. Black patients became more likely to undergo RN (pre-guideline OR 1.248 vs post-guideline OR 1.474, p < 0.001). Patients treated with RN had worsened mortality (17.4% vs. 7.3%, p < 0.001). Conclusions: Although use of PN in surgically appropriate patients for cT1a renal masses has increased over time, 30% of patients underwent RN in 2015. Socioeconomic disparities affect treatment decisions and require additional research.

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INTRODUCTION AND OBJECTIVES: Minimally invasive surgery (robotic, RS or laparoscopic, LS) results in decreased convalescence for renal cell carcinoma (RCC). Utilization of RS for nephrectomy (partial, PN and radical, RN) is increasing, but the change relative to other surgical approaches is not well described. We hypothesize that e522

Standard of care treatment based on national guidelines for men with clinically localized high risk prostate cancer includes radical prostatectomy (RP) or external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT). However, despite guideline recommendations, many patients undergo ADT alone or EBRT without ADT. We evaluated current trends in treatment of high risk prostate cancer and risk factors associated with non-standard of care treatment.METHODS: Men with high risk localized prostate cancer were retrospectively identified (cT3, PSA >20, Gleason 8-10, cN0M0) using the National Cancer Database (NCDB) between 2005-2015. Trends in treatment modalities were analyzed over this period. Multivariable logistic regression was performed to evaluate impact of clinical, racial, and socioeconomic factors on treatment method. Kaplan-Meier (KM) analysis was performed for overall survival (OS).RESULTS: A total of 149,343 patients with localized high risk prostate cancer were identified. 30,686 patients received non-standard of care treatment, categorized as EBRT without ADT or ADT alone. The percentage of men receiving non-standard of care treatment significantly decreased from 22.9% in 2005 to 18.7% in 2015 (P<0.001). The percent of men receiving ADT alone significantly decreased over this interval (13.2% in 2005, 11.5% in 2015, P<0.001), as did the percent of men receiving EBRT without ADT