Table. Cox multivariate regression analysis of factors associated with time to PSA decrease. Includes top 7 SNPs identified by linear regression. Result for each clinical factor is adjusted for the other three clinical factors listed; results for SNPs are adjusted for all four clinical factors. Initial PSA p-value Hazard Ratio (HR) 95% Confidence Interval for HR: Lower 95% Confidence Interval for HR: Upper Age  0.001 1.049 1.032 1.067 Treatment* 0.003 0.621 0.455 0.849 Total BED 0.001 1.008 1.003 1.012 Initial PSA 0.024 0.958 0.923 0.994 rs299847** TC 0.002 0.543 0.367 0.806 TT 0.106 0.488 0.204 1.164 rs127822 GT 0.783 1.065 0.679 1.671 GG 0.013 2.711 1.236 5.947 rs1323618 CT 0.094 1.382 0.946 2.020 CC 0.158 1.643 0.824 3.277 rs161405 AG 0.346 1.267 0.774 2.072 AA  0.001 17.416 4.754 63.797 rs9990565 TC 0.007 1.744 1.164 2.614 TT 0.439 2.198 0.299 16.141 rs161407 TA 0.222 1.368 0.828 2.262 TT 0.010 4.049 1.407 11.654 rs17380093 CT 0.007 0.579 0.388 0.864 TT  0.001 0.313 0.176 0.558 *reference category for Treatment is brachytherapy + EBRT; **reference cate- gory for SNPs is homozygous for the common allele Source of Funding: None Prostate Cancer: Localized Podium 8 Sunday, May 15, 2011 10:30 AM-12:30 PM 345 CONTEMPORARY NATIONALLY-REPRESENTATIVE TRENDS IN TREATMENT FOR LOCALIZED PROSTATE CANCER Matthew Cooperberg*, San Francisco, CA; Alexandria Smith, Santa Monica, CA; Anobel Odisho, Peter Carroll, San Francisco, CA; Mark Litwin, Christopher Saigal, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Primary treatment trends for localized prostate cancer, including substantial local variation, have previously been documented among selected community-based U.S. practices. We aimed to determine whether these trends are confirmed in larger, more broadly representative databases. METHODS: We analyzed treatments in two national adminis- trative datasets including men covered by Medicare in 1998 –2006 and by private insurance (i3 database) in 2002–2006. Treatment distribu- tions were determined in each year among watchful waiting/active surveillance (WW), radical prostatectomy (RP), radiation therapy (RT), cryotherapy, and primary androgen deprivation therapy (PADT). Trends in specific modalities were further examined within RP and RT. County-level variation was assessed, and treatment predictors were determined using multinomial regression. RESULTS: Among 54,322 Medicare patients (mean age at diagnosis 75), WW use fell from 30% in 1998 to 22% in 2002 and remained low. PADT use peaked at 24% in 2002 and fell to 17% by 2006. RP use varied between 11% and 13% during the study period, while RT use rose from 35 to 44%. Laparoscopic/robot-assisted RP (LRRP) and intensity-modulated radiation therapy (IMRT) were both first reported in 1999, and rose to 35% of RP and 53% of RT cases, respectively, by 2006. Among 16,161 privately insured patients (mean age 65), WW and PADT fell steadily from 25% and 12% in 2002, respectively, to 12% and 7% in 2006. RT use varied between 30 and 32%, while RP use rose from 33 to 48%. LRRP and IMRT use rose from 1% and 15% of RP and RT cases, respectively, in 2002 to 41% and 48% in 2006. Use of neoadjuvant androgen deprivation therapy (NADT) declined among RP and brachytherapy patients, to 6 and 25%, respectively, among Medicare patients and to 2% and 22% among private insurance patients by 2006. Use of NADT rose to 41% and fell to 37% among external-beam RT patients with Medicare and private insurance, respectively. There was considerable geographic variation in treatment selection. Across counties, use of WW, PADT, RP, and RT ranged, respectively, from 3 to 55%, 0 to 48%, 0 to 50%, and 15 to 71%. Comorbidity, age, income, year of diagnosis, and county-level sociodemographic variables predicted treatment. CONCLUSIONS: These trends echo those documented in prior studies in smaller datasets, and these data confirm extensive geo- graphic variation. In both databases, there is rapid, ongoing adoption of high-cost technologies among both RP and RT patients. These findings underscore the urgent need for high-quality cost-effectiveness re- search comparing these treatments. Source of Funding: NIH/NIDDK (Urologic Diseases in America Project) 346 PRIMARY TREATMENTS FOR CLINICALLY LOCALIZED PROSTATE CANCER: SYSTEMATIC REVIEW AND COST-UTILITY ANALYSIS Matthew Cooperberg*, San Francisco, CA; Naren Ramakrishna, Orlando, FL; Steven Duff, Carlsbad, CA; Kathleen Hughes, Sara Sadownik, Washington, DC; Joseph Smith, Nashville, TN; Ashutosh Tewari, New York, NY INTRODUCTION AND OBJECTIVES: The optimal manage- ment strategy for localized prostate cancer has not been determined definitively. Based on a comprehensive review of the published litera- ture, we conducted a lifetime cost-utility analysis comparing men un- dergoing open, laparoscopic, or robot-assisted radical prostatectomy (ORP, LRP, RARP), 3D conformal or intensity-modulated radiation therapy (3DCRT, IMRT), brachytherapy (BT), or combined external- beam radiation and brachytherapy (EBRT+BT). METHODS: A Markov model was constructed to determine outcomes in lifetime quality-adjusted life years (QALYs) for men with low-, intermediate-, and high-risk prostate cancer, with a normal distri- bution of starting ages centered at 65. A systematic literature review was conducted to determine event and transition probabilities in the model. Markov health states included remission, recurrence, metasta- sis, prostate cancer death, and death from other causes. Utilities were assigned for each health state, and additional disutility penalties ac- crued for complications and side effects. Salvage local and/or andro- gen deprivation therapies were allowed. Costs were determined from Medicare fee schedules, and patient time costs were also considered in a sensitivity analysis. Probabilistic Monte Carlo simulation was em- ployed to determine the final QALYs and costs. An extensive set of one- and multi-way sensitivity analyses also was performed to test the robustness of the findings. RESULTS: Likelihood of recurrence, progression, and mortality increased with increasing disease risk, as did associated lifetime costs. In most comparisons, surgical modalities were associated with more QALYs than radiation modalities, and there were no significant differ- ences between ORP, LRP, and RARP. For all strata, lifetime costs were significantly lower for surgical patients than for radiation patients, and did not differ substantially across surgical modalities. 3DCRT tended to be less effective than BT, IMRT, or EBRT+BT; QALYs e140 THE JOURNAL OF UROLOGY Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011