were graded from 0-10 (0: no pain/willing to return for repeat procedure; 10: excruciating pain/not willing to return for repeat procedure). Pro- cedures were performed by a single urologist with a 1% Lidocaine periprostatic nerve block. Pain scores between groups were compared via Mann-Whitney U test. RESULTS: A total of 94 patients were included, with 50 FusionBx+TRUSBx and 44 TRUSBx. For each group, median age was 66.5 (range 47-84) and 68 years (range 44-86), and median number of cores was 14 (range 12-22) and 12 (range 6-14), respectively. Prostate biopsy pain questionnaire scores did not differ significantly for any of the questions (Figure 1). Patients in both groups had mild discomfort overall with the procedure (3 out of 10), the probe insertion (2 out of 10) and the biopsy portion of the exam (3 out of 10). If medically necessary, both groups were very willing to come back for the same procedure again (1 out of 10). CONCLUSIONS: Patients reported no difference in pain or discomfort with added FusionBx relative to TRUSBx alone. Both pro- cedures were mildly painful with patients very willing to return for repeat biopsy if necessary. Patients tolerate the addition of FusionBx to TRUSBx alone. Patients 0 pain experience or discomfort does not seem to hinder whether FusionBx of the prostate should be performed, or not. Source of Funding: none MP77-12 HEAD-TO-HEAD COMPARISON OF COMMONLY USED INTERNATIONAL PROSTATE CANCER RISK CALCULATORS FOR PROSTATE BIOPSY Nuno Pereira-Azevedo*, Porto, Portugal; Jan Verbeek**, Daan Nieboer, Ewout Steyerberg, Monique Roobol, Rotterdam, Netherlands INTRODUCTION AND OBJECTIVES: Multivariable risk calcu- lators (RC) predicting prostate cancer (PCa) aim to reduce unnecessary biopsies and improve detection of clinically significant PCa (Gleason 7). We aimed to evaluate well-known RCs in a head-to-head comparison. METHODS: Our multicentre study comprised 7158 men from 10 independent contemporary cohorts in Europe and Australia who underwent prostate biopsy in 2007-2015. We evaluated the perfor- mance of the ERSPC, Finne, Chun, ProstataClass, Karakiewicz, Sun- nybrook, and PCPT(HG) RCs in predicting the presence of any PCa and clinically significant PCa. RESULTS: A total of 3509 (49%) PCa were detected; 1866 (26%) men had clinically significant PCa. In predicting any PCa no particular RC stood out, pooled area under the ROC-curve (AUC) ranged between 0.66 and 0.73 (Fig. 1). Substantial heterogeneity in the AUC was found between the cohorts (range I 2 74%-94%). The ERSPC RC had the highest pooled AUC 0.77 (95% CI: 0.73-0.81) in predicting clinically significant PCa, and was statistically significantly better than the other RCs. CONCLUSIONS: No particular risk calculator stands out to discriminate between men with and without PCa across a range of settings, but the ERSPC is most promising to identify those with clinically significant PCa. Further research is necessary to evaluate the practical usefulness and clinical impact of these RCs. Source of Funding: None MP77-13 A PROSPECTIVE EVALUATION ON THE EFFECT OF INTER-OBSERVER VARIABILITY OF DRE ON THE PERFORMANCE OF THE DRE BASED ROTTERDAM PROSTATE CANCER RISK CALCULATOR Nuno Pereira-Azevedo*, Rotterdam, Netherlands; Isaac Braga, Braga, Portugal; Jan F. M. Verbeek, Rotterdam, Netherlands; Luís Os orio, Vitor Cavadas, Avelino Fraga, Eduardo Carrasquinho, Eduardo Cardoso de Oliveira, Porto, Portugal; Daan Nieboer, Monique J. Roobol, Rotterdam, Netherlands INTRODUCTION AND OBJECTIVES: To reduce overdiagnosis and overtreatment on Prostate Cancer (PCa), a biopsy (Bx) should only be offered to men with an increased risk of having a potentially life- threatening PCa. The Digital Rectal Examination (DRE) version of the Rotterdam PCa Risk Calculator (RPCRC), was developed to include information on prostate volume but to circumvent the need for imaging studies, enabling easier implementation into daily practice of urologists and general practitioners (GPs). Our objective was to assess the level of agreement between DRE findings (irregularities and estimation of volume) of two urologists in men suspicious for PCa and, subsequently, the potential effect on risk prediction using the DRE-based RPCRC. METHODS: A prospective cohort of asymptomatic and un- screened men with PSA <¼50.0 ng/mL and TRUS (transrectal ultra- sonography) volume <¼110 mL who underwent 16-core TRUS-guided Bx were evaluated. Both urologists’ DRE findings were graded normal or abnormal (i.e. nodularity and/or induration), and volume classified as 25mL, 40mL or 60mL, according to the RPCRC algorithm. Inter-rater agreement analysis using Cohens’s kappa (?) statistic was performed to determine consistency of DRE outcome and volume assessment. Receiver operating characteristic (ROC) curve analysis and calibration plots were constructed per urologist to determine the effect of inter-rater differences. Decision curve analysis (DCA) was applied to evaluate the clinical usefulness of the DRE based model. RESULTS: Of the 241 men included in the study, 41% (n ¼ 98) had a positive Bx (81 PCa were clinically significant). There was sub- stantial agreement in the DRE examination (abnormal/normal) (? ¼ 0.78; P < 0.001), and volume estimation (? ¼ 0.79; P < 0.001). ROC analyses showed good discrimination (0.75e0.78) and were highly comparable for both urologists. In our high risk cohort, at a probability threshold of 25%, the DRE-based RPCRC reduces the Bx rate by 9%, without missing cancers. CONCLUSIONS: This is the first study to validate the DRE- version of the RPCRC. Most crucial in this validation is the effect of the e1026 THE JOURNAL OF UROLOGY â Vol. 197, No. 4S, Supplement, Monday, May 15, 2017