CONCLUSIONS: Wide practice level variation exists in treat- ment for patients with low- and FRPCa and <10 year LE. Utilization of WW is poor, suggesting overtreatment in men who will experience little benefit. Source of Funding: Blue Cross Blue Shield of Michigan MP44-10 VARIATION IN GUIDELINE-CONCORDANT CONSERVATIVE MANAGEMENT FOR LOW-RISK PROSTATE CANCER Stacy Loeb*, Dawn Walter, Nataliya Byrne, Danil Makarov, New York, NY INTRODUCTION AND OBJECTIVES: Conservative manage- ment is recommended as the preferred management option for most low-risk prostate cancer, with certain specific exceptions. Although many studies have documented significant heterogeneity in the utilization of conservative management among men with low-risk disease, less is known about the underlying reasons for this variation and whether the variation is due to differences in case mix with respect to the specific factors mentioned in the guidelines: age <55 years, African American race, and high-volume Gleason 6 disease. Our objective was to explore what proportion of the heterogeneity in the utilization of conservative management for low-risk prostate cancer could be explained by guideline-concordant factors. METHODS: We identified 15,667 men with low-risk prostate cancer in the VA healthcare system from 2010-2015 for whom data on biopsy cores was available. We examined the use of conservative management in the low-risk population, and within subgroups with a higher risk of progression as defined by the guidelines (age <55, black race, and >6% positive biopsy cores). Multivariable analysis was used to determine the contribution of guideline-concordant patient factors and other factors (e.g. hospital characteristics) with conservative management use in the low-risk population. RESULTS: From 2010-2015, 64% of low-risk veterans underwent conservative management, which varied from 25% to 100% by VA facility. There were 1,187 (7.6%) men <55 years old, 4,161 (26.6%) black men and 769 (4.9%) men with >6 positive biopsy cores. Each of these groups received conservative management at significantly lower than average rates (47%, 60%, and 34%, respectively, p<0.001), as were men with more than one of these factors (46% conservative management for black men age <55; 25% for men age <55 with >6 positive cores; and 36% of for black men with >6 positive cores). However, the logistic regression model showed patient factors other than those enumerated in the guidelines (e.g. comorbidity) as well as non-patient factors (e.g., geography, urban vs. rural, case volume) were also significantly associated with conservative management use. CONCLUSIONS: There remains significant heterogeneity in the uptake of conservative management for low-risk disease even within an integrated healthcare system. Only some of this heterogeneity could be explained by guideline-concordant patient factors, suggesting a complex decision-making process surrounding the selection of conservative management for low-risk prostate cancer patients. Source of Funding: This study was supported by The Edward Blank and Sharon Cosloy-Blank Family Foundation, The Gertrude and Louis Feil Family, the New York State Department of Health (#DOH01-C30697GG-3450000), The Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center (P30CA016087), the Prostate Cancer Foundation/VAlor/Barry Family COE, the National Institutes of Health (Award Number K07CA178258) to SL, and Veterans Affairs CDA11-257 & CDP 11-254 to DVM. MP44-11 PATIENT SELECTION AND OUTCOMES BETWEEN LOW AND HIGH VOLUME SURGEONS IN PERFORMANCE OF RADICAL PROSTATECTOMY IN THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE (MUSIC) Alex Tapper*, Alec Wilson, Royal Oak, MI; Stephen Lucas, Detroit, MI; Rodney Dunn, Khurshid Ghani, Tae Kim, David Miller, James Montie, Ann Arbor, MI; James Peabody, Detroit, MI; Ji Qi, Hugh M. Solomon, Jaya Telang, Ann Arbor, MI; Frank Burks, Royal Oak, MI; for the Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: In Michigan, the Amer- ican Cancer Society estimates 5,350 newly diagnosed prostate cancer (PCa) cases a year. Radical prostatectomy (RP) is commonly used to treat localized PCa. By comparing lower (<10 RPs per year) and higher (>10 RPs per year) volume surgeons, we aim to discern variation in patient selection and surgeon technique to identify avenues to improve functional outcomes. METHODS: The Michigan Urological Surgery Improvement Collaborative (MUSIC), a statewide quality improvement consortium of >250 diverse MI urologists, uses a web-based data registry to collect information regarding a patient’s RP. In April 2014, MUSIC began a patient reported outcomes (PRO) program. RP patients completed validated surveys pre- and 3, 6, 12, and 24 months post-RP, and a goal was set to increase the social continence (0-1 pads per day) rate at 3-months post-RP. In this study, bivariate tests compared patient characteristics between lower and higher volume surgeons, and a mixed-effects logistic regression model determined the independent effect of volume on 3-month social continence. RESULTS: The analysis included 2,704 patients treated by 108 RP surgeons (48 lower volume surgeons completing 202 RPs and 60 higher volume surgeons completing 2502 RPs). The social continence rate 3 months post-RP was 56% and 67% (p<0.001) for lower and higher volume surgeons, respectively. Lower volume surgeons were less likely to perform bilateral nerve sparing (46% vs 70%, p<0.001) and their patients had higher preoperative PSA (median 6.7 vs. 6.0, p[0.036). Other factors (BMI, race, clinical T stage, age) were not significantly different between volume groups. Higher volume surgeons’ patients were more likely to reach social continence at 3 months post-RP (OR[1.81, p[0.006, Table). CONCLUSIONS: RP for localized PCa is a complex operation, and these data provide further evidence that all RP surgeons should participate in PRO. MUSIC PRO provides a framework to identify sur- geon characteristics or techniques that may be useful in improving functional outcomes through activities such as skills workshops, video review, and mentoring. e632 THE JOURNAL OF UROLOGY Ò Vol. 201, No. 4S, Supplement, Saturday, May 4, 2019 Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.