Background and objective Readability of patient education materials is of utmost importance to ensure understandability and dissemination of health care information in uro-oncology. We aimed to investigate the readability of the official patient education materials of the European Association of Urology (EAU) and American Urology Association (AUA). Methods Patient education materials for prostate, bladder, kidney, testicular, penile, and urethral cancers were retrieved from the respective organizations. Readability was assessed via the WebFX online tool for Flesch Kincaid Reading Ease Score (FRES) and for reading grade levels by Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GFS), Smog Index (SI), Coleman Liau Index (CLI), and Automated Readability Index (ARI). Layperson readability was defined as a FRES of ≥70 and with the other readability indexes <7 according to European Union recommendations. This study assessed only objective readability and no other metrics such as understandability. Key findings and limitations Most patient education materials failed to meet the recommended threshold for laypersons. The mean readability for EAU patient education material was as follows: FRES 50.9 (standard error [SE]: 3.0), and FKGL, GFS, SI, CLI, and ARI all with scores ≥7. The mean readability for AUA patient material was as follows: FRES 64.0 (SE: 1.4), with all of FKGL, GFS, SI, and ARI scoring ≥7 readability. Only 13 out of 70 (18.6%) patient education materials’ paragraphs met the readability requirements. The mean readability for bladder cancer patient education materials was the lowest, with a FRES of 36.7 (SE: 4.1). Conclusions and clinical implications Patient education materials from leading urological associations reveal readability levels beyond the recommended thresholds for laypersons and may not be understood easily by patients. There is a future need for more patient-friendly reading materials. Patient summary This study checked whether health information about different cancers was easy to read. Most of it was too hard for patients to understand.

Purpose Brachytherapy as monotherapy is a recommended treatment option for men with low to intermediate risk prostate cancer, achieving biochemical progression-free survival rates >95% at 5 years. Local recurrence is difficult to identify due to sensitivity of conventional imaging and post-brachytherapy artefacts. Biochemical recurrence (BCR) in this setting is often considered as systemic recurrence, treated with androgen-deprivation therapy (ADT) as primary salvage therapy. This study investigated PSMA PET/CT for recurrence after low-dose rate (LDR) and high-dose rate (HDR) brachytherapy as monotherapy in men with low or intermediate prostate cancer, as well as subsequent management when recurrence occurred only within the prostate. Methods We performed a retrospective single-centre analysis for patients who were treated with brachytherapy as monotherapy for prostate cancer from May 2002 to May 2021 to identify men who underwent [68Ga]Ga-PSMA-11 or [18F]DCFPyL PET/CT (PSMA PET/CT) for BCR. We report the findings on PSMA PET/CT, quantitative parameters, as well as the subsequent management of the patients. Results Forty patients were identified who underwent PSMA PET/CT (26 LDR and 14 HDR) to investigate a rising PSA at a median (IQR) of 7 years (3.0-10.8) after initial therapy. Median (IQR) PSA at time of PSMA PET/CT was 6.6 ng/mL (3.9 - 15.5). On PSMA PET/CT, 20/40 (50%) men had prostate-only recurrence, 5/40 (12.5%) had nodal recurrence, 2/40 (5%) had bone-only metastases, 10/40 (25%) had multiple sites of recurrence and 3/40 (7.5%) had no visible sites of recurrence. Of the 20 patients with prostate-only recurrence, 8/20 (40%) had recurrence in a high-dose radiation zone, such as within the brachytherapy seeds, versus 7/20 (35%) in an under-covered zone, such as seminal vesicles or prostate base. On PSMA PET/CT, recurrence within the prostate had median (IQR) SUVmax 10.4 (5.1-15.7) and volume 2.9 mL (2.0-11.2). Subsequent management of these patients with local recurrence included surveillance followed by ADT (9/20, 45%), salvage SBRT (3/20, 15%), salvage brachytherapy (2/20, 10%), salvage radical prostatectomy (1/20, 5%) and not treated/lost to follow-up (5/20, 25%). For those with surveillance followed by ADT, the mean time before introduction of ADT was 4.1 years (range 1 to 8 years). Conclusion In the setting of BCR following mono-brachytherapy, PSMA PET/CT effectively identified local recurrence occurring within the prostate, including within high-dose radiation zones. It may be safe to delay the introduction of ADT, though more research is required.

Pre-operative patient education for robotic radical prostatectomy is a standard of care in many specialized centres that improves patient satisfaction and outcomes. We previously reported outcomes of our institution's Robotic Prostatectomy Care Pathway (Robocare). As a quality improvement initiative, we migrated Robocare to a telehealth platform (Tele-Robocare) and report our initial experience and outcomes. Between February 2020 and July 2021, all patients waitlisted for robot-assisted radical prostatectomy (RARP) were recruited. Patients with cognitive impairments, medical or mental health disorders that may preclude proper engagement in a group or online setting were excluded. Informed consent was sought for Tele-Robocare. Dedicated content was created specifically for delivery on digital platform. Patient handouts for pre-reading prior to Tele-Robocare were provided to facilitate consolidation of information. Post-session evaluation form was provided to assess patient receptivity and satisfaction. Qualitative feedback was captured and analysed according to distinct domains of session format, content, delivery and technical support. Between February 2020 and July 2021, 171 patients planned for robotic radical prostatectomy (RARP) were enrolled for Tele-Robocare. A total of 147 (86%) patients successfully attended the session. Of those recruited but did not attend, 8 were patient-initiated cancellations, 7 had other conflicting appointments, 2 had technical issues, 2 did not have enough time before surgery and 1 refused participation. Of the attendees, 135 (92%) completed evaluation. 134 (99%) patients expressed that Tele-Robocare was useful and 135 (100%) found that Tele-Robocare was adequate in addressing the pre-operative concerns and information gaps. We received 126 qualitative feedbacks distilled to 211 separate items. Content was the most liked feature (98, 46%), followed by the presenter (37, 18%) and session delivery (28, 13%). Areas of improvement identified included technical support (10, 5%), session format (5, 3%) and session length (5, 3%). Analysing other benefits of a virtual engagement, the total driving distance saved by these patients who would have to otherwise attend a physical session was 57 072 kilometres and total travel time saved was 43 956 min. Tele-Robocare is a novel patient education program. It is successful in providing virtual pre-operative education service with high patient acceptance, satisfaction and potential impact on climate change. Continued feedback from patients will help enhance the program to meet more patient needs in the future. This quality improvement initiative was reviewed and accepted by the Peter MacCallum Cancer Centre – Ethics Department, Melbourne, Australia.

Context: Prostate cancer (PCa) remains one of the leading causes of cancer-related deaths in men worldwide. Men at risk are typically offered multiparametric magnetic resonance imaging and, if suspicious, a targeted biopsy. However, false-negative rates of magnetic resonance imaging are consistently 18%; therefore, there is growing interest in improving the diagnostic performance of imaging through novel technologies. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is being utilised for PCa staging and, more recently, for intraprostatic tumour localisation. However, significant variability has been observed in how PSMA PET is performed and reported. Objective: In this review, we aim to evaluate how pervasive this variability is in trials investigating the performance of PSMA PET in primary PCa workup. Evidence acquisition: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed an optimal search in five different databases. After removing duplicates, 65 studies were included in our review. Evidence synthesis: Studies dated back as early as 2016, with numerous different source countries. There was variation in the reference standard for PSMA PET, with some using biopsy specimens or surgical specimens, and in some cases, a combination of the two. Similar inconsistencies were noted when studies selected histological definitions of clinically significant PCa, while some omitted their definition altogether. The most significant variations in performing PSMA PET were the radiotracer type, dose, acquisition time after injection, and the PET camera being utilised. Substantial variation in the reporting of PSMA PET was noted, with no consistency in defining what constitutes a positive intraprostatic lesion. Across 65 studies, four different definitions were used. Conclusions: This systematic review has highlighted considerable variation in obtaining and performing a PSMA PET study in the context of primary PCa diagnosis. Given the discrepancy in how PSMA PET was performed and reported, it questions the homogony of studies from centre to centre. Standardisation of PSMA PET is required for this to become a consistently useful and reproducible modality in the diagnosis of PCa. Patient summary: Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is being utilised for staging and localisation of prostate cancer (PCa); however, there is significant variability in performing and reporting PSMA PET. Standardisation of PSMA PET is required for results to be consistently useful and reproducible for the diagnosis of PCa.

MDT improves both biochemical relapse-free and ADT-free survival as compared to active surveillance with low rates of grade 2 or higher toxicity.

ObjectiveCoronavirus disease-19 (COVID-19) pandemic caused delays in definitive treatment of patients with prostate cancer. Beyond the immediate delay a backlog for future patients is expected. The objective of this work is to develop guidance on criteria for prioritisation of surgery and reconfiguring management pathways for patients with non-metastatic prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve a low likelihood of coronavirus disease 2019 (COVID-19) hazard if radical prostatectomy (RP) was to be carried out during the outbreak and whilst the disease is endemic.MethodsWe conducted an accelerated consensus process and systematic review of the evidence on COVID-19 and reviewed international guidance on prostate cancer. These were presented to an international prostate cancer expert panel (n = 34) through an online meeting. The consensus process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. The Consensus opinion was defined as >= 80% agreement and this was used to reconfigure the prostate cancer pathways.ResultsEvidence on the delayed management of patients with prostate cancer is scarce. There was 100% agreement that prostate cancer pathways should be reconfigured and measures developed to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritisation criteria of patients for surgery and management pathways for those who have delayed treatment. IPC measures to achieve a low likelihood of nosocomial COVID-19 were coined as 'COVID-19 cold' sites.ConclusionReconfiguring management pathways for patients with prostate cancer is recommended if significant delay (>3-6 months) in surgical management is unavoidable. The mapped pathways provide guidance for such patients. The IPC processes proposed provide a framework for providing RP within an environment with low COVID-19 risk during the outbreak or when the disease remains endemic. The broader concepts could be adapted to other indications beyond prostate cancer surgery.

The EAU guidelines panel on muscle-invasive and metastatic bladder cancer (MIBC) recently recommended open radical cystectomy (ORC) as the best surgical approach for MIBC patients. We critically re-examine the indications for considering ORC as the first choice over robot-assisted radical cystectomy. To the best of our knowledge, this is not supported by trials or meta-analyses.

word count: 300 Wound count: 3,205 Figure: 4 Tables: 1