BACKGROUND:Understanding changes in quality of life that occur with colectomy is critical to decision-making in management of recurrent diverticulitis. We hypothesized that patients choosing colectomy at surgical consultation would report better disease-specific quality of life at 1 year than those choosing observation. OBJECTIVE:To investigate the association between colectomy versus observation for recurrent sigmoid diverticulitis and disease-specific quality of life at 1 year. METHODS:We performed a multicenter prospective observational study including patients with recurrent uncomplicated diverticulitis choosing colectomy versus observation at initial consultation. The primary outcome was disease-specific quality of life at 1 year, measured by the Diverticulitis Quality of Life questionnaire total score. RESULTS:A total of 113 patients were enrolled (median age 57; 64% female, 92% white); 42 (37%) chose colectomy at surgical consultation. At enrollment, median lifetime episodes of diverticulitis were similar between groups (colectomy: 5, observation: 4); the colectomy group had a higher rate of hospitalization in the past 5 years (colectomy: 71%, observation: 49%). In an adjusted linear mixed effects model, choosing colectomy was associated with better quality of life by 1.73 points (95% CI: 1.02-2.46) compared with choosing observation. 7 people (17%) who chose colectomy experienced recurrence within 1 year compared with 32 who chose observation (45%). In an adjusted model, choosing colectomy was associated with lower odds of recurrence (aOR 0.16; 95% CI: 0.05-0.48). CONCLUSION:For patients with recurrent sigmoid diverticulitis presenting for surgical consultation, colectomy may offer meaningful improvement in disease-specific quality of life and may be associated with reduced 1-year recurrence rates.

Introduction Over 10% of men who underwent treatment for localized prostate cancer have treatment related regret in the first 1-5 years. Patients’ perceptions of both treatment efficacy as well as side effects were the largest drivers of treatment regret. However, there is a dearth of literature describing long-term patterns of treatment regret. The goal of this study was to define long-term drivers of treatment regret amongst men with prostate cancer. Methods The participants were accrued from five Surveillance, Epidemiology, and End Results (SEER)-based registries in the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) cohort. Men with clinically localized prostate cancer were recruited from January 1, 2011 to December 31, 2012. The exposure variables included type of prostate cancer treatment: surgery, radiotherapy and active surveillance. Main outcome measures were patient reported treatment regret using validated metrics. Regression models were adjusted for demographics, clinical characteristics and patient reported outcomes. Results Of the 1406 men included in the final analysis (median age, 63 [IQR 58-68] years), treatment related regret at 10 years after diagnosis was reported in 124 patients (15%) who underwent surgery, 52 (13%) who underwent radiation, and 12 (7%) on active surveillance. Compared with active surveillance, after adjusting for baseline factors and patient reported outcomes, both surgery (adjusted odds ratio [aOR], 2.6 [95% CI, 1.23-5.52]) and radiotherapy (aOR, 2.45 [95% CI, 1.11-5.42]) were associated in increased regret. No patient reported outcomes were associated with an increased likelihood of regret. Patient-reported worse treatment efficacy (aOR, 10.4 [95% CI 2.99-36.5]) and worse side effects (aOR, 7.92 [95% CI 4.86-12.9]), compared with expectations before treatment were both associated with treatment regret. Of those who had regret at 5 years, 70 (58%) and 28 (72%) also had regret at 10 years for surgery and radiation, respectively. Notably, for patients who were on active surveillance with no regret at 5 years, only 5 (3%) had treatment regret at 10 years. (Figure 1) Conclusions At 10 years from treatment more than 10% of men with clinically localized prostate cancer experience treatment related regret. When controlled for baseline factors and patient reported outcomes, surgery and radiation were associated with more regret at 10 years than active surveillance. No patient reported outcomes were associated with treatment regret. Patient expectations were significant predictors of patient regret. These findings highlight the importance of preoperative shared decision-making and counseling to set realistic expectations in an effort to ameliorate long-term regret.

Objectives: Compare functional outcomes and treatment-related regret over 10 years in Spanish- and English-speaking Hispanic men compared to non-Hispanic men following treatment of localized prostate cancer. Methods and Materials: Data from a prospective cohort study of men with localized prostate cancer treated with active surveillance, radical prostatectomy or radiotherapy were used to examine the effect of survey language (Spanish speaking vs. English speaking) and ethnicity (Hispanic vs. non-Hispanic) on functional outcomes and treatment-related regret over 10 years. Outcomes were measured using validated questionaries adjusting for baseline patient and disease characteristics. Results: A total of 770 men were included, 12% were Spanish-speaking and 12% were English-speaking Hispanic men. Compared to non-Hispanic men, Spanish-speaking Hispanic men had clinically meaningfully better urinary incontinence scores at years 3, 5 and 10 (adjusted mean difference [aMD], 12.4, 95% CI, 4.8 to 20.0; at year 10), as well as better bowel function scores at 10 years (aMD, 5.1, 95% CI 2.3 to 8.0). Englishspeaking Hispanic men had clinically worse urinary incontinence at 3 and 5 years (aMD,-10.7 [95% CI,-17.6 to-3.9]; at year 5) and bowel function at 10 years (aMD,-4.3 [95% CI,-8.2 to-0.4]) compared to Spanish-speaking Hispanic men. English-speaking Hispanic men were more likely to report regret than Spanish-speaking Hispanic men at 10 years (adjusted odds ratio, 7.9, 95% CI, 1.3-46.2). Conclusions: These findings underscore the importance of considering language and ethnicity when providing counseling and support for prostate cancer survivors, emphasizing the need for personalized patient-centered care. (c) 2024 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Introduction In patients undergoing major abdominopelvic surgery, history of prior abdominal surgery (PAS) is an established risk factor known to influence surgical complexity, peri-operative course, and patient outcomes. There are, however, limited data describing the impact of PAS on patients undergoing radical cystectomy for bladder cancer. The current study sought to evaluate the association of PAS with surgical and oncologic outcomes in patients undergoing radical cystectomy at a high-volume academic center. Methods The study cohort included consecutive patients undergoing radical cystectomy with ileal conduit diversion at a single institution from 2018 through 2020. Prospectively collected patient-level data were obtained from the medical record. Baseline comorbidities were quantified using the Charlson Comorbidity Index (CCI) and categorized as mild (CCI 1-2), moderate (CCI 3-4), and severe (CCI ≥5). The primary outcome was post-operative complications, categorized using the Clavien-Dindo classification (I-V). We performed multivariable analysis to determine the association of PAS with post-operative outcomes after adjustment for patient-level factors. Results The study cohort included 272 patients of median age 70 (65-75), of which 219 (80%) were male, 208 (76%) were current or prior smokers, and 131 (48%) had undergone PAS. Overall, 92 (33%) patients experienced a total of 170 Grade 2-5 complications. The incidence of Grade 2-5 complications was significantly higher in patients with PAS than those without (54% vs. 42%, p=0.028). On multivariable analysis adjusted for sex and CCI, prior abdominal surgery was associated with an approximate 32% increase in the odds of Grade 2-5 complication (OR 1.32, 95% CI 1.02-1.72, p=0.03). Conclusions In patients undergoing radical cystectomy for bladder cancer, a history of prior abdominal surgery was associated with increased rate of Grade 2-5 complications. As such, patients with PAS are likely to benefit from pre-operative interventions such as prehabilitation to mitigate risk and optimize the post-operative course.

You have accessJournal of UrologyCME1 Apr 2023MP54-06 EFFECT OF SMOKING ON PROSTATE CANCER SURVIVORS' FUNCTION AND QUALITY OF LIFE: AN ANALYSIS OF THE CEASAR (COMPARATIVE EFFECTIVENESS ANALYSIS OF SURGERY AND RADIATION) STUDY David-Dan Nguyen, Daniel A. Barocas, Li-Ching Huang, Zhiguo Zhao, Karen E. Hoffman, Tatsuki Koyama, David F. Penson, and Christopher J.D. Wallis David-Dan NguyenDavid-Dan Nguyen More articles by this author , Daniel A. BarocasDaniel A. Barocas More articles by this author , Li-Ching HuangLi-Ching Huang More articles by this author , Zhiguo ZhaoZhiguo Zhao More articles by this author , Karen E. HoffmanKaren E. Hoffman More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , David F. PensonDavid F. Penson More articles by this author , and Christopher J.D. WallisChristopher J.D. Wallis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Tobacco smoking negatively impacts cancer treatment and prognoses. However, there is limited evidence of its effect on cancer survivors' quality of life (QOL) and function. As the natural history of localized prostate cancer (PCa) is protracted, there is a need to identify modifiable risk factors that can influence survivorship, such as tobacco smoking. METHODS: We used 5-year data from the CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study, a prospective, population-based, observational study of men diagnosed with localized PCa in 2011-2012. We excluded patients that did not complete the smoking-related and baseline questions and those that did not have at least one post-baseline response. Survivors were categorized as never, former, and current smokers. Multivariable linear regression models adjusting for baseline quality of life and function, treatment type, patient characteristics, and disease characteristics were used to assess the association between smoking history and 5-year scores on the 26-Item Expanded Prostate Index Composite (EPIC-26; PCa-specific domains: sexual, urinary incontinence, urinary irritative, bowel, and hormonal) and the Medical Outcomes Study 36-Item Short Form Survey (SF-36; general-health domains: physical, emotional, and energy and fatigue). RESULTS: We included 2185 men of which 109 (5%) were current smokers, 925 (42%) former smokers, and 1151 (53%) never smokers. In unadjusted analyses, current smokers had worse scores on all domains of EPIC-26 and SF-36 compared to never smokers (p<0.05). In adjusted analyses, there was no association between smoking history with EPIC-26 domains (all p>0.05). With regards to SF-36 outcomes, in adjusted analyses, compared to never smokers, current smokers had worse physical function (-7.53, 95%CI -11.16 to -3.89, p<0.01), emotional well-being (-5.03, 95%CI -7.78 to -2.27, p<0.01), and energy and fatigue (-4.51, 95%CI -7.73 to -1.28, p<0.01). Compared to never smokers, former smokers were only found to have worse physical function (-2.46, 95%CI -4.10 to -0.82, p<0.01). There was no interaction between smoking history and treatment (p>0.05). These findings were robust to more lenient definitions of smoking. CONCLUSIONS: PCa survivors that continue to smoke experience worse PCa-specific functional outcomes and physical functioning compared to never smokers. After adjustments, active smoking was associated with clinically relevant worse physical functioning. Tobacco smoking cessation in PCa survivors can enhance QOL and function regardless of initial treatment and should be integrated into survivorship care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e755 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David-Dan Nguyen More articles by this author Daniel A. Barocas More articles by this author Li-Ching Huang More articles by this author Zhiguo Zhao More articles by this author Karen E. Hoffman More articles by this author Tatsuki Koyama More articles by this author David F. Penson More articles by this author Christopher J.D. Wallis More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (PD58)1 May 2024PD58-12 FINANCIAL TOXICITY IN NON-METASTATIC VERSUS METASTATIC RENAL CELL CARCINOMA PATIENTS Michael D. Staehler, Ulka Vaishampayan, Sumanta K. Pal, Pavlos Msaouel, Ithaar Derweesh, David F. Penson, and Dena J. Battle Michael D. StaehlerMichael D. Staehler , Ulka VaishampayanUlka Vaishampayan , Sumanta K. PalSumanta K. Pal , Pavlos MsaouelPavlos Msaouel , Ithaar DerweeshIthaar Derweesh , David F. PensonDavid F. Penson , and Dena J. BattleDena J. Battle View All Author Informationhttps://doi.org/10.1097/01.JU.0001008868.74763.2c.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little is known about the financial impact of renal cell carcinoma (RCC). We sought to ascertain real world data on financial implications and how financial toxicity (FT) impacts quality of life in patients with localized RCC versus patients with metastatic RCC. METHODS: An online survey was conducted by the Kidney Cancer Research Alliance (KCCure), a non-profit patient advocacy organization, from 7/22 to 9/22. The survey included questions about costs and financial concerns and the COST questionnaire. Pearson's correlation (r) and Kendal's tau test were used to analyze the COST questionnaire, financial burden and hardship. RESULTS: Out of 1062 responders 623 had localized RCC. Out of these patients 395 did not recur and 204 were willing to answer questions related to cost and financial hardship. 289 responders had metastatic disease and were on systemic therapy and 177 pts answered the COST questionnaire.In localized disease 28% of patients reported that their medical diagnosis has not reduced their income, in 26% the diagnosis had reduced their income very much. 31% experienced insurance denials for imaging, 30% faced delays in care due to pre-approval requirements, 45% faced high out-of-pocket costs for medical care, 18% reported being unable to go outside of a provider network. 24% of patients reported taking a hardship withdrawal from a retirement account, 28% stopped funding or lowered contributions to an existing retirement account, 20% borrowed from friends or family. In metastatic patients 14% reported difficulties to pay their premiums. 31% were retired and 24% not able to work. 28% reported that their medical situation has not reduced their income and 26% claimed that their disease reduced their income very much. The monthly out of pocket costs were independent of type of therapy with 50% of the patients reporting spendings of <50US$. 36% reported high out of pocket costs are a barrier to care. 44% have received financial support through a manufacturer or a foundation. Median COST score in non-metastatic RCC was 32 (range 19-44)) and was significantly correlated to age, NCCN distress score, risk of recurrence and supplement intake (p<0.05). Metastatic patients had a significantly higher median COST score of 22 (range 4-36)) that was also correlated to age, NCCN distress score, time since diagnosis and supplement intake (p<0.05). CONCLUSIONS: RCC imposes financial hardship on patients. Younger patients with a higher NCCN distress score and a shorter time since diagnosis are more likely to suffer financial hardships. Patients are willing to pay for supplements. Financial counseling should be considered in these patient subgroups regardless of stage. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1220 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Michael D. Staehler More articles by this author Ulka Vaishampayan More articles by this author Sumanta K. Pal More articles by this author Pavlos Msaouel More articles by this author Ithaar Derweesh More articles by this author David F. Penson More articles by this author Dena J. Battle More articles by this author Expand All Advertisement PDF downloadLoading ...

Since the widespread adoption of prostate-specific antigen-based screening for prostate cancer, the prevalence of Grade Group 1 (GG1) prostate cancer has risen. Historically, these patients were subjected to overtreatment of this otherwise indolent disease process, leading to significant quality-of-life detriments. Active surveillance as a primary management strategy has allowed for a focus on early detection while minimising morbidity from unnecessary intervention. Here we provide a comprehensive overview of the characteristics of GG1 prostatic adenocarcinoma, including its histological features, genomic differentiators, clinical progression, and implications for treatment guidelines, all supporting the movement to reclassify GG1 disease as a non-cancerous entity.

Introduction Magnetic resonance imaging-guided transurethral ultrasound ablation (TULSA) of the prostate uses ultrasound to thermally coagulate tissue under real-time MRI guidance. Real-time feedback from closed-loop MRI thermometry automatically controls treatment parameters to match tissue response in the prescribed ablation volume. The pivotal study of TULSA (“TACT”, NCT02766543), which included a low- to intermediate-risk prostate cancer (PCa) population, has reached the end of the 5-year follow-up duration. Here we report the safety and efficacy outcomes at 5 years Methods The TACT study enrolled 115 patients across 13 sites in 5 countries. Eligibility criteria included stage ≤ T2b, PSA ≤ 15 ng/mL, and Grade Group (GG) 1-2 disease. The protocol prescribed a single whole-gland TULSA treatment sparing the prostatic urethra and urinary sphincter, and repeat TULSA was not allowed. The primary endpoints were PSA reduction and adverse events, both assessed at 1 year. Histologic control on 10-core biopsy, and prostate volume reduction on multiparametric MRI (mpMRI) were also assessed at 1 year. Other secondary endpoints, assessed to 5 years, included adverse events, quality of life, PSA, and the rate of salvage treatment. Results Baseline (median [IQR]) age and PSA were 65 (59-69) years and 6.3 (4.6-7.9) ng/mL, with ≥GG2 disease in 72/115 men. At 1y, median prostate volume decreased from 37.3 to 2.8 cc (92%); 94/111 (85%) were free of ≥GG2 disease. By 5y, median (IQR) PSA decreased to 0.6 (0.18-1.9) ng/mL (n=68); 25 (21.7%) received salvage treatment (10 prostatectomy, 11 radiotherapy, 3 ADT, 1 surgery+radiation) without unexpected complications. Early predictors of treatment failure by 5 years included 1y PSA (OR=3; CI[1.7,5.4]) and visible lesion on 1y mpMRI (OR=12; CI[4.4,34]) (both p≤0.001). Failure modes include undertreatment due to patient selection or targeting error, and misalignment caused by intraprocedural swelling/motion. By 5 years, 61/66 (92%) recovered pad-free continence; 80/92 (87%) preserved erections sufficient for penetration. Grade 3 adverse events occurred in 12 men (10%), with no Grade≥4 event or rectal injury. Conclusions Effective disease control is durable to 5 years after a single TULSA procedure, with a favorable safety profile. Favorable preservation of genitourinary quality of life is also durable to 5 years. Treatment failure modes include screening and intraprocedural factors. While the pivotal study represents early experience with TULSA, the risk of failure is mitigated by modern protocols. Such protocols include best practices for screening for intraprostatic calcifications that can lead to undertreatment, refined strategies for device positioning, and thermal dose escalation to address undertreatment that is visible on intraprocedural imaging. Factors from intraprocedural imaging and early clinical follow-up can predict salvage therapy by 5 years.

OBJECTIVE:Understand the patient's decision-making process regarding colectomy for recurrent diverticulitis. BACKGROUND:The decision to pursue elective colectomy for recurrent diverticulitis is highly preference-sensitive. Little is known about the patient's perspective in this decision-making process. METHODS:We performed a qualitative study utilizing focus groups of patients with recurrent diverticulitis at 3 centers across the United States. Using an iterative inductive/deductive approach, we developed a conceptual framework to capture the major themes identified in the coded data. RESULTS:From March 2019 to July 2020, 39 patients were enrolled across 3 sites and participated in 6 focus groups. After coding the transcripts using a hierarchical coding system, a conceptual framework was developed. Major themes identified included participants' beliefs about surgery, such as normative beliefs (eg, subjective, value placed on surgery), control beliefs (eg, self-efficacy, stage of change), and anticipated outcomes (eg, expectations, anticipated regret); the role of behavioral management strategies (eg, fiber, eliminate bad habits); emotional experiences (eg, depression, embarrassment); current symptoms (eg, severity, timing); and quality of life (eg, cognitive load, psychosocial factors). Three sets of moderating factors influencing patient choice were identified: clinical history (eg, source of diagnosis, multiple surgeries), clinical protocols (eg, pre-op and post-op education), and provider-specific factors (eg, specialty, choice of surgeon). CONCLUSIONS:Patients view the decision to undergo colectomy through 3 major themes: their beliefs about surgery, their psychosocial context, and moderating factors that influence participant choice to undergo surgery. This knowledge is essential both for clinicians counseling patients who are considering colectomy and for researchers studying the process to optimize care for recurrent diverticulitis.

Purpose There is limited evidence of tobacco smoking's effect on cancer survivors' quality of life (QOL) and function. As the natural history of localized prostate cancer (PCa) is protracted, there is a need to identify modifiable risk factors that can influence PCa survivorship, such as tobacco smoking. Material and methods We used up to 10-year survey data from the CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study, a prospective, population-based, observational study of patients diagnosed with localized PCa in 2011-2012. Survivors were categorized as never, former, and current smokers during survivorship. Adjusted multivariable linear regression models were used to assess the association between smoking and 5-year and 10-year scores on the 26-Item Expanded Prostate Index Composite (EPIC-26; PCa-specific domains) and 5-year scores on the Medical Outcomes Study 36-Item Short Form Survey (SF-36; general health domains). Results We included 2426 patients of whom 142 (6%) were current smokers, 1039 (43%) were former smokers, and 1245 (51%) were never smokers. Current smokers were more likely to be Black, low-income, and less formally educated (all p < 0.01). After adjustments, there was no association between smoking history with disease-specific functional outcomes (EPIC-26) at 5 years or 10 years (all p > 0.05). However, in adjusted analyses assessing general health domains (SF-36), compared to participants who never smoked, current smokers during survivorship had worse physical function (- 10.96, 95% CI - 16.37 to - 5.55, p < 0.01) at 5 years. Conclusion PCa survivors who continue to smoke experience worse physical functioning though there is no significant independent effect on PCa-specific functional domains. Implications for Cancer SurvivorsProstate cancer survivors who continue to smoke experience worse physical functioning though there is no significant independent effect on PCa-specific functional domains. Smoking cessation may improve prostate cancer survivorship.

Anssi Auvinen, MD, PhD; Teuvo L. J. Tammela, MD, PhD; Tuomas Mirtti, MD, PhD; Hans Lilja, MD, PhD; Teemu Tolonen, MD, PhD; Anu Kenttämies, MD, PhD; Irina Rinta-Kiikka, MD, PhD; Terho Lehtimäki, MD, PhD; Kari Natunen, MSc; Jaakko Nevalainen, PhD; Jani Raitanen, MSc; Johanna Ronkainen, MD, PhD; Theodorus van der Kwast, MD, PhD; Jarno Riikonen, MD, PhD; Anssi Pétas, MD, PhD; Mika Matikainen, MD, PhD; Kimmo Taari, MD, PhD; Tuomas Kilpeläinen, MD, PhD; Antti S. Rannikko, MD, PhD; ProScreen Trial Investigators; Paula Kujala; Teemu Murtola; Juha Koskimäki; Antti Kaipia; Tomi Pakarainen; Suvi Marjasuo; Juha Oksala; Tuomas Saarinen; Kirsty Ijäs; Into Kiviluoto; Juhani Kosunen; Arja Pauna; Arya Yar; Pekka Ruusuvuori; Neill Booth; Jill Hannus; Sanna Huovinen; Marita Laurila; Johanna Pulkkinen; Mika Tirkkonen; Mona Hassan Al-Battat

Importance Adverse outcomes associated with treatments for localized prostate cancer remain unclear. Objective To compare rates of adverse functional outcomes between specific treatments for localized prostate cancer. Design, Setting, and Participants An observational cohort study using data from 5 US Surveillance, Epidemiology, and End Results Program registries. Participants were treated for localized prostate cancer between 2011 and 2012. At baseline, 1877 had favorable-prognosis prostate cancer (defined as cT1-cT2bN0M0, prostate-specific antigen level <20 ng/mL, and grade group 1-2) and 568 had unfavorable-prognosis prostate cancer (defined as cT2cN0M0, prostate-specific antigen level of 20-50 ng/mL, or grade group 3-5). Follow-up data were collected by questionnaire through February 1, 2022. Exposures Radical prostatectomy (n = 1043), external beam radiotherapy (n = 359), brachytherapy (n = 96), or active surveillance (n = 379) for favorable-prognosis disease and radical prostatectomy (n = 362) or external beam radiotherapy with androgen deprivation therapy (n = 206) for unfavorable-prognosis disease. Main Outcomes and Measures Outcomes were patient-reported sexual, urinary, bowel, and hormone function measured using the 26-item Expanded Prostate Cancer Index Composite (range, 0-100; 100 = best). Associations of specific therapies with each outcome were estimated and compared at 10 years after treatment, adjusting for corresponding baseline scores, and patient and tumor characteristics. Minimum clinically important differences were 10 to 12 for sexual function, 6 to 9 for urinary incontinence, 5 to 7 for urinary irritation, and 4 to 6 for bowel and hormone function. Results A total of 2445 patients with localized prostate cancer (median age, 64 years; 14% Black, 8% Hispanic) were included and followed up for a median of 9.5 years. Among 1877 patients with favorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference, -12.1 [95% CI, -16.2 to -8.0]), but not worse sexual function (adjusted mean difference, -7.2 [95% CI, -12.3 to -2.0]), compared with active surveillance. Among 568 patients with unfavorable prognosis, radical prostatectomy was associated with worse urinary incontinence (adjusted mean difference, -26.6 [95% CI, -35.0 to -18.2]), but not worse sexual function (adjusted mean difference, -1.4 [95% CI, -11.1 to 8.3), compared with external beam radiotherapy with androgen deprivation therapy. Among patients with unfavorable prognosis, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel (adjusted mean difference, -4.9 [95% CI, -9.2 to -0.7]) and hormone (adjusted mean difference, -4.9 [95% CI, -9.5 to -0.3]) function compared with radical prostatectomy. Conclusions and Relevance Among patients treated for localized prostate cancer, radical prostatectomy was associated with worse urinary incontinence but not worse sexual function at 10-year follow-up compared with radiotherapy or surveillance among people with more favorable prognosis and compared with radiotherapy for those with unfavorable prognosis. Among men with unfavorable-prognosis disease, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel and hormone function at 10-year follow-up compared with radical prostatectomy.

125 Background: Assessments of financial toxicity among patients with metastatic prostate cancer are lacking. We sought to describe the prevalence and severity of financial toxicity, identify coping mechanisms, and assess characteristics that may be protective of financial toxicity among such patients at our institution. Methods: All patients evaluated in the advanced prostate cancer clinic at Mayo Clinic, Rochester, MN, were approached to complete a survey between February and May 2022. The survey consisted of three parts: 1) demographic, cancer, and treatment characteristics; 2) a coping mechanism questionnaire; and 3) The Comprehensive Score for Financial Toxicity (COST-FACIT) questionnaire. COST-FACIT scores range from 0-44, with lower scores signifying higher financial toxicity. Patients were defined as having either high (COST-FACIT score >24) or low (COST-FACIT score ≤24) financial toxicity. Coping mechanisms were compared between patients with low and high financial toxicity using Fisher’s exact test. Multivariable linear regression was used to evaluate patient characteristics associated with high COST-FACIT scores. Results: Of the 786 patients approached, 417 (53.1%) completed the survey and 281 met inclusion criteria. The median COST-FACIT score was 30 (IQR 24-36). On multivariable analysis, characteristics associated with lower financial toxicity included older age, (estimate:0.36, 95%CI 0.21-0.52), applying for patient assistance programs (estimate:4.42, 95%CI 1.72-7.11), and an annual income of at least $100,000 (estimate:7.81, 95%CI 0.97,14.66). Patients with high financial toxicity were more likely to decrease spending on basic goods (34.6% vs. 2.5%, p<0.001) and leisure activities (61.5% vs. 16.9%, p>0.001), as well as use savings (61.5% vs. 16.9%, p<0.001) to pay for their treatment. However, few patients stopped or partially filled their prostate cancer treatments due to cost. Conclusions: In this cross-sectional study of patients with metastatic prostate cancer, older age, higher income, and applying for patient assistance programs were associated with lower financial toxicity. Greater self-reported financial toxicity was associated with decreased spending on basic goods, leisure activities, and tapping into savings. On rare occasion they delayed or skipped treatment. These findings are important to inform treatment shared decision-making and supportive interventions to mitigate financial toxicity in metastatic prostate cancer.

BACKGROUND:Previsit decision aids (DAs) have promising outcomes in improving decisional quality, however, the cost to deploy a DA is not well defined, presenting a possible barrier to health system adoption.OBJECTIVES:We aimed to define the cost from a health system perspective of delivery of a DA.RESEARCH DESIGN:Observational cohort.PATIENTS AND METHODS:We interviewed or observed relevant personnel at 3 institutions with implemented DA distribution programs targeting men with prostate cancer. We then created process maps for DA delivery based on interview data. Cost determination was performed utilizing time-driven activity-based costing. Clinic visit length was measured on a subset of patients. Decisional quality measures were collected after the clinic visit.RESULTS:Total process time (minutes) for DA delivery was 10.14 (UCLA), 68 (Olive View-UCLA), and 25 (Vanderbilt). Total average costs (USD) per patient were $38.32 (UCLA), $59.96 (Olive View-UCLA), and $42.38 (Vanderbilt), respectively. Labor costs were the largest contributors to the cost of DA delivery. Variance analyses confirmed the cost efficiency of electronic health record (EHR) integration. We noted a shortening of clinic visit length when the DA was used, with high levels of decision quality.CONCLUSIONS:Time-driven activity-based costing is an effective approach to determining true inclusive costs of service delivery while also elucidating opportunities for cost containment. The absolute cost of delivering a DA to men with prostate cancer in various settings is much lower than the system costs of the treatments they consider. EHR integration streamlines DA delivery efficiency and results in substantial cost savings.