Purpose: Pelvic lymph node metastases (ypN+) after multiagent neoadjuvant chemotherapy (NAC) is a poor prognostic sign in nonmetastatic muscle-invasive bladder cancer (nmMIBC). We sought to create a nomogram predicting probability of ypN+ after NAC for cN0 nmMIBC and determine association with overall survival (OS). Methods and Materials: We reviewed the National Cancer Database for patients with cT2-4N0M0 urothelial carcinoma of the bladder receiving multiagent NAC and surgery from 2004 to 2020. Following a data split, univariate logistic regression identified variables associated with ypN+ at P < .05. Eligible variables were used for multivariate logistic regression and nomogram generation. A threshold for 95% sensitivity defined high- and low-risk groups for ypN+. Fine-Gray models assessed ypN+ risk group and OS, accounting for competing risks of surgical mortality. Results: A total of 6194 patients were identified with a median follow-up of 39.5 months (interquartile range [IQR], 20.5-67.2 months). Most patients had high-grade (97.7%) cT2 disease (70.8%) with nonpapillary urothelial histology (67.3%) and initiated NAC at a median of 41.0 days after diagnosis (IQR, 28.0-59.0 days).The nomogram included age in decades (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.87-1.03; P = .172), weeks from diagnosis to NAC (OR, 1.02; 95% CI, 1.01-1.04; P = .004), nonpapillary histology (OR, 1.17; 95% CI, 0.99-1.39; P = .068), and clinical T-stage. Within the testing cohort, ypN+ was found in 392 (22.8%) high-risk and 12 (8.0%) low-risk patients (P < .001), with median OS of 36.1 and 74.0 months, respectively (P < .001). High-risk patients had worse OS despite competing risks of 30-day (subdistribution hazard ratio [SHR], 1.80; 95% CI, 1.49-2.18; P < .001) and 90-day surgical mortality (SHR, 1.68; 95% CI, 1.39-2.04; P < .001). Conclusions: This is the first study to provide a tool for predicting ypN+ and prognosticate worse OS in primarily high-grade nmMIBC and could select patients for alternative neoadjuvant therapy and facilitate future study. (c) 2024 The Author(s). Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Purpose This study aimed to identify factors associated with delays in initiating early salvage radiation therapy in prostate cancer patients with prostate-specific antigen (PSA) failure after prostatectomy. Methods We conducted a single-institution, retrospective study of patients receiving salvage radiation therapy after radical prostatectomy from 2011 to 2022. Patient demographics and clinical data were examined to identify factors that may have influenced the time to start of radiation therapy after surgery. Utilizing a PSA cut off of 0.25 ng/ml or less, we classified patients as receiving either early "PSA low" or late "PSA high" salvage therapy depending on their PSA at the time of initiating treatment. Results Of the 81 patients evaluated, the median age was 61.9 years (IQR 57.9 - 66.5), with most presenting with pT3 (65.4%), Grade Group 2 disease (35.8%), and positive margins 55%). Median PSA at salvage radiation therapy commencement was 0.30 ng/mL (0.18 - 0.48). 40 patients completed early salvage and 41 patients completed late salvage in the overall cohort. A significant association was found between patient insurance carrier and pre-radiation PSA levels. Patients with HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) insurance were more likely to complete late salvage radiation compared to non-managed Medicare patients (HMO OR 4.0, p <0.05 & PPO OR 3.3 p <0.05 vs non-managed Medicare). All uninsured patients in the cohort received late salvage radiation. Conclusions Insurance type was significantly associated with the timing of salvage radiation therapy post-prostatectomy, suggesting a relationship with providers requiring prior authorization (HMO and PPO coverage). This study supports proper PSA surveillance, in particular for those with HMO or PPO coverage.

Purpose/Objective(s) The NCCN has recently incorporated various genomic classifiers and risk stratifiers such as Decipher for more personalized treatment of prostate cancer. However, not all prostate cancer biopsies will undergo further classification. The aim of this study was to examine patient and socioeconomic barriers toward obtaining a Decipher score in patients who were considered for definitive radiation. Materials/Methods This single-institution study included prostate cancer patients evaluated for definitive radiation from 2016-2023 when Decipher was routinely obtained at this institution. The primary endpoint was whether patients’ biopsy underwent Decipher classification or not. We extracted variables from the electronic health record, including median household income determined by zip code, distance from the institution, age, primary language, marital status, insurance category, and race. Insurance was divided into four categories: non-managed Medicare, Medicaid, HMO, and PPO. We examined the correlation between ordering Decipher scores and the variables using Fisher versus chi-square for categorical data and Wilcoxon rank sum versus two-sided t-test for continuous data. The threshold of statistical significance was set to p<0.05. Results At the time of analysis, 196 patients met inclusion criteria. 106 patients (58.9%) had Decipher scores ordered. 9 patients had node or metastasis-positive disease. The majority of patients had clinical T stage of T1c (59.2%) and T3b (14.8%), Gleason score of 3+4 (28.5%) and 4+3 (23.8%), and Grade Group of 2 (28.5%) and 3 (23.83%). 110 patients (59.8%) had high-risk or very high-risk prostate cancer. On analysis, patients who obtained a Decipher score had a higher median income by zip code than those who did not (median = $104,971 IQR = $80,266-121,275 vs. median = $92,765 IQR = $74,002-112,118, p = 0.038). There were no differences between all other variables. Using a Poisson regression model, the incidence rate ratio of obtaining a Decipher was found to increase 18% per year across the study interval. This positive trend was still present when constrained to the COVID-19 pandemic. Conclusion While this study noted an annual increase in obtaining Decipher assays, differences existed in median household income between patients who obtained Decipher scores and those who did not. This suggests financial bias affects whether physicians offer or patients choose to obtain a Decipher score. This could lead to overtreatment and higher toxicity rates in lower-income patients and warrants further investigation.

163 Background: Treatment paradigms for oligometastatic castration-sensitive prostate cancer patients are evolving. Molecular imaging improves staging, intensified systemic and primary tumor directed therapy improves survival, metastasis-directed therapy improves local control. The impact of combining these imaging and therapeutic approaches into a planned multimodal treatment strategy is unknown. Here we report a prospective phase II single-arm trial combining local, metastasis-directed, and intensified systemic therapies of limited duration with the objective to durably render Veterans free of progression off therapy. Methods: Veterans with de novo M1a/b prostate cancer and 1-5 radiographically visible M1 lesions underwent radical local treatment, intensified systemic therapy for six months (leuprolide, abiraterone acetate with prednisone, apalutamide), and metastasis-directed stereotactic ablative radiotherapy (SBRT). Radical local therapy was either radical prostatectomy (n=12) with lymph node dissection and post-operative radiotherapy (pT≥3a, N1, or positive margins) or radical radiotherapy (n=12) directed to the prostate, SVs, and pelvic LNs. The primary endpoint was the percentage of patients achieving an undetectable serum PSA (for radical prostatectomy) or <2 ng/mL (for radical radiotherapy) six months after recovery of testosterone to ≥150 ng/dL. Secondary endpoints included time to biochemical progression, time to radiographic progression, time to initiation of alternative antineoplastic therapy, prostate cancer specific survival, health related quality-of-life, safety and tolerability. Results: Twenty-eight patients enrolled and 4 dropped out (3 prior to start of treatment). All were staged by PSMA PET/CT except two (one by Fluciclovine PET/CT, and one by NaF PET/CT, CT, MRI). Twenty-nine percent were M1a, seventy-one percent were M1b. Median follow-up was 30 months (range 20 - 61 months). Mean and median number of M1 metastases were both two. Sixty-two percent completed all planned systemic therapy without dose modification. One did not recover testosterone after 29 months. Twenty-two had >6 months follow-up after testosterone recovery, 19 of 22 (86%) remain free of any progression (primary endpoint). Three had metastatic progression, one poly nodal M1a progression, one multiple bone metastases, one multiple bone and nodal metastases. Grade 2 and 3 toxicities for primary tumor therapy were 46% and 4%; SBRT 0% and 0%; systemic therapy 42% and 4%. There was one Grade 4 toxicity. Conclusions: Although a small trial, a majority of patients with molecular imaging defined de novo oligometastatic prostate cancer treated with primary and metastasis-directed therapy with intensified systemic therapy of limited duration remained free of progression with a recovered testosterone off all active therapy. Clinical trial information: NCT03298087 .

Purpose To assess the diagnostic performance and utility of the ExoDx IntelliScore and an OPKO4K score to predict prostate cancer in men presenting with elevated PSA—both as independent predictors and in combination with clinical/MRI characteristics. Methods Patients with elevated PSA were retrospectively reviewed. Abnormal tests were defined as an OPKO4K score ≥ 7.5% and an ExoDx IntelliScore ≥ 15.6. Four regression models and ROC curves were generated based on: (1) age, PSA, and DRE, (2) model 1 + OPKO4K 4Kscore ≥ 7.5%, (3) model 2 + ExoDx IntelliScore ≥ 15.6, and (4) model 3 + MRI PIRADS 4–5. Results 359 men received an OPKO4K test, 307 had MRI and 113 had ExoDx tests. 163 men proceeded to prostate biopsy and 196 (55%) were saved from biopsy. Mean age was 65.0 ± 8.7 years and mean PSA was 7.1 ± 6.1 ng/mL. Positive biopsies were found in 84 (51.5%) men. The sensitivity and negative predictive value of an OPKO4K score were 86.7% and 72.3%; values for an ExoDx test were 76.5% and 77.1%, respectively. On regression analysis, clinical markers (Age, PSA, DRE) generated an AUC of 0.559. The addition of an OPKO4K score raised the AUC to 0.653. The stepwise addition of an ExoDx score raised the AUC to 0.766. The combined use of both biomarkers, patient characteristics, and MRI yielded an AUC of 0.825. Conclusion This analysis demonstrates the high negative predictive value of both the OPKO4K score and ExoDX IntelliScore independently while demonstrating that the combination of an OPKO4K score, an ExoDX IntelliScore, and MRI increases predictive capability for biopsy confirmed prostate cancer.

This study demonstrates the prognostic utility of a previously reported nomogram in predictions of OS. Investigation is warranted to explore how radiation and chemotherapy may offset worse OS in those at high risk for occult nodal disease progression.

Epidemiological evidence suggests that kava (Piper methysticum Forst) drinks may reduce the risk of cancer in South Pacific Island smokers. However, little is known about the anti-carcinogenic effects of kava on tobacco smoking-related bladder cancer and its underlying mechanisms. Here we show that dietary feeding of kawain (a major active component in kava root extracts) to mice either before or after hydroxy butyl(butyl) nitrosamine (OH-BBN) carcinogen exposure slows down urinary bladder carcinogenesis and prolongs the survival of the OH-BBN-exposed mice. OH-BBN-induced bladder tumors exhibit significantly increased expression of lysine-specific demethylase 1 (LSD1), accompanied by decreased levels of H3K4 mono-methylation compared to normal bladder epithelium, whereas dietary kawain reverses the effects of OH-BBN on H3K4 mono-methylation. Human bladder cancer tumor tissues at different pathological grades also show significantly increased expression of LSD1 and decreased levels of H3K4 mono-methylation compared to normal urothelium. In addition, kava root extracts and the kavalactones kawain and methysticin all increase the levels of H3K4 mono- and di-methylation, leading to inhibitory effects on cell migration. Taken together, our results suggest that modification of histone lysine methylation may represent a new approach to bladder cancer prevention and treatment and that kavalactones may be promising agents for bladder cancer interception in both current and former smokers.

This study demonstrates a clinically applicable risk stratification tool for identifying patients at risk for developing lymphadenopathy in T2-4 bladder cancer and may help guide future research in selecting patients eligible for escalation of therapy. Future studies should aim to externally validate this tool within prospective cohorts, and seek to determine if this nomogram may provide further prognostic utility.

Purpose: We report 5-year safety and efficacy outcomes of the Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia and large-volume prostate glands. Materials and Methods: A total of 101 men with moderate to severe benign prostatic hyperplasia symptoms and prostate volumes between 80 and 150 mL underwent a robotic-assisted Aquablation procedure in a prospective multicenter international trial (NCT03123250). Herein we report the final 5-year results. Results: The study successfully met its safety and efficacy performance goal, which was based upon transurethral resection of the prostate outcomes typically done in smaller prostates, at 3 months. Mean prostate volume was 107 mL (range 80-150) at baseline. Patient symptoms showed a significant improvement where the mean (SD) International Prostate Symptom Score of 22.6 (6.4) at baseline to 6.8 (4.6) at 5 years, resulting in a change score of 15.9 (7.7, P < .001). Uroflowmetry measurements also demonstrated improvement where the mean maximum urinary flow rate increased from 8.6 (SD 3.4) to 17.1 (9.8) mL/s at 5 years, resulting in a change score of 9.2 (11.1) mL/s at 5 years (P < .001). A regression analysis evaluating change in PSA as a function of baseline PSA across all time points out to 5 years resulted in a 50% reduction. A prespecified subgroup analysis using a baseline prostate volume cutoff of 100 mL showed no difference in efficacy outcomes through 5 years. Freedom from a secondary benign prostatic hyperplasia procedure at 5 years was 96.3% based on Kaplan-Meier. Conclusions: At 5-years of prospective follow-up, the Aquablation procedure was shown to be safe with durable efficacy and low rates of retreatment in men with large prostates (80-150 mL).

UPII-mutant Ha-ras transgenic mice develop urothelial hyperplasia and low-grade papillary carcinoma, which mimics human non-muscle invasive bladder cancer (NMIBC). We investigated the effects and mechanisms of kawain, a main kavalactone in the kava plant, on oncogenic Ha-ras-driven urothelial carcinoma in these mice. The mice were fed at six weeks of age with vehicle control or kawain (6 g/kg) formulated food for approximately five months. Seventy-eight percent of the mice or more fed with kawain food survived more than six months of age, whereas only 32% control food-fed male mice survived, (p = 0.0082). The mean wet bladder weights (a surrogate for tumor burden) of UPII-mutant Ha-ras transgenic mice with kawain diet was decreased by approximately 56% compared to those fed with the control diet (p = 0.035). The kawain diet also significantly reduced the occurrence of hydronephrosis and hematuria in UPII-mutant Ha-ras transgenic mice. Histological examination and immunohistochemistry analysis revealed that vehicle control-treated mice displayed more urothelial carcinoma and Ki67-positive cells in the bladder compared to kawain treated mice. Global metabolic profiling of bladder tumor samples from mice fed with kawain food showed significantly more enrichment of serotonin and less abundance of xylulose, prostaglandin A2, D2 and E2 compared to those from control diet-fed mice, suggesting decreased shunting of glucose to the pentose phosphate pathway (PPP) and reduced inflammation. In addition, kawain selectively inhibited the growth of human bladder cancer cell lines with a significant suppression of 4E-BP1 expression and rpS6 phosphorylation. These observations indicate a potential impact of kawain consumption on bladder cancer prevention by rewiring the metabolic programs of the tumor cells.

Introduction and Objective: Robot-assisted radical nephrectomy (RRN) is increasingly utilized as an alternative to laparoscopic radical nephrectomy (LRN), but there are concerns over costs and objective benefit. In the setting of very large renal masses (>10cm), comparison between techniques is limited and it is unclear whether a robotic approach confers any perioperative benefit over LRN or open radical nephrectomy (ORN). In this study, perioperative outcomes of RRN, LRN, and ORN for very large renal masses are compared. Methods: Using the National Cancer Database, patients were identified who underwent radical nephrectomy for kidney tumors >10cm diagnosed from 2010 to 2015. Patients were analyzed according to surgical approach. Perioperative outcomes, including conversion to open, length of stay, readmission rates, positive surgical margins, and 30- and 90-day mortality were compared among cohorts. Results: A total of 9288 patients met inclusion criteria (RRN=842, LRN=2326, ORN=6120). Compared with ORN, recipients of RRN or LRN had similar rates of 30-day readmission and 30- and 90-day mortality. Length of hospital stay was significantly shorter in RRN (-1.73 days 0.19; p<0.0001) and LRN (-1.40 days +/- 0.12; p<0.0001) compared with ORN. LRN had a higher rate of conversion to open compared with RRN (odds ratio 1.48; 95% confidence interval 1.10-1.98; p=0.0087). Conversion to open from RRN or LRN added 1.3 additional days of inpatient stay. Over the study period, RRN use increased from 4.1% to 14.8%, LRN from 20.9% to 25.6%, whereas ORN use decreased from 75% to 59.6%. Conclusions: Minimally invasive approaches are increasingly utilized in very large renal masses. RRN has lower rates of conversion to open but produces comparable perioperative outcomes to LRN. Minimally invasive approaches have a shorter length of inpatient stay but otherwise report similar surgical margin status, readmission rates, and mortality rates compared with ORN.

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD18)1 Sep 2021PD18-06 AQUABLATION FOR BENIGN PROSTATIC HYPERPLASIA IN LARGE PROSTATES (80-150CC): 3-YEAR RESULTS Kevin Zorn, Mo Bidair, Naeem Bhojani, Andrew Trainder, Andrew Arther, Eugene Kramolowsky, Leo Doumanian, Dean Elterman, Ronald P. Kaufman, James Lingeman, Amy Krambeck, Gregg Eure, Gopal Badlani, Mark Plante, Edward Uchio, Greg Gin, Larry Goldenberg, Ryan Patterson, Alan So, Mitch Humphreys, Steven Kaplan, Jay Motola, Mihir Desai, and Claus Roehrborn Kevin ZornKevin Zorn More articles by this author , Mo BidairMo Bidair More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Andrew TrainderAndrew Trainder More articles by this author , Andrew ArtherAndrew Arther More articles by this author , Eugene KramolowskyEugene Kramolowsky More articles by this author , Leo DoumanianLeo Doumanian More articles by this author , Dean EltermanDean Elterman More articles by this author , Ronald P. KaufmanRonald P. Kaufman More articles by this author , James LingemanJames Lingeman More articles by this author , Amy KrambeckAmy Krambeck More articles by this author , Gregg EureGregg Eure More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , Mark PlanteMark Plante More articles by this author , Edward UchioEdward Uchio More articles by this author , Greg GinGreg Gin More articles by this author , Larry GoldenbergLarry Goldenberg More articles by this author , Ryan PattersonRyan Patterson More articles by this author , Alan SoAlan So More articles by this author , Mitch HumphreysMitch Humphreys More articles by this author , Steven KaplanSteven Kaplan More articles by this author , Jay MotolaJay Motola More articles by this author , Mihir DesaiMihir Desai More articles by this author , and Claus RoehrbornClaus Roehrborn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002007.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To report 3 year safety and efficacy outcomes of the Aquablation procedure for the treatment of men with symptomatic BPH and large-volume prostates. METHODS: 101 men with moderate-to-severe BPH symptoms and prostate volumes of 80-150cc underwent a robotic-assisted Aquablation procedure in a prospective multicenter international clinical trial with scheduled follow-up at 6, 12, 24 and 36 months. RESULTS: Mean prostate volume was 107cc (range 80-150). Mean operative time was 37 minutes and mean Aquablation resection time was 8 minutes. IPSS scores improved from 23.2 at baseline to 5.2 at 36 months (change of -16.7 points, p<.0001). Qmax improved from 8.7 cc/sec at baseline to 19.0 cc/sec at 36 months. Improvements in both IPSS, IPSS Quality of Life, Qmax, and PVR were immediate and sustained throughout follow-up (Figure 1). Three subjects (3%) have required surgical retreatment over the course of three years post-Aquablation. CONCLUSIONS: In 3-year prospective follow-up, the Aquablation procedure was shown to be safe and effective in men with large prostates (80-150cc). ClinicalTrials.gov number, NCT03123250. Source of Funding: Procept Biorobotics © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e357-e357 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Zorn More articles by this author Mo Bidair More articles by this author Naeem Bhojani More articles by this author Andrew Trainder More articles by this author Andrew Arther More articles by this author Eugene Kramolowsky More articles by this author Leo Doumanian More articles by this author Dean Elterman More articles by this author Ronald P. Kaufman More articles by this author James Lingeman More articles by this author Amy Krambeck More articles by this author Gregg Eure More articles by this author Gopal Badlani More articles by this author Mark Plante More articles by this author Edward Uchio More articles by this author Greg Gin More articles by this author Larry Goldenberg More articles by this author Ryan Patterson More articles by this author Alan So More articles by this author Mitch Humphreys More articles by this author Steven Kaplan More articles by this author Jay Motola More articles by this author Mihir Desai More articles by this author Claus Roehrborn More articles by this author Expand All Advertisement Loading ...

AbstractObjectiveThe objective of this study is to determine if Aquablation therapy can maintain its effectiveness in treating men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with large‐volume (80–150 cc) prostates at 3 years.Subjects and MethodsOne hundred one men with moderate‐to‐severe BPH symptoms and prostate volumes between 80 and 150 cc were enrolled in a prospective, nonrandomized, multicenter, international clinical trial in late 2017. Baseline, procedural, and follow‐up parameters were recorded at baseline and scheduled postoperative visits. IPSS, Qmax, and treatment failure are reported at 3 years.ResultsThe mean prostate volume was 107 cc (range 80–150). Mean IPSS improved from 23.2 at baseline to 6.5 at 3 years (16.3‐point improvement, p < 0.0001). Mean IPSS quality of life improved from 4.6 at baseline to 1.1 at 3 years (improvement of 3.4 points, p < 0.0001). Maximum urinary flow increased from 8.7 to 18.5 cc/s. At 3 year follow‐up, 6% of treated patients needed BPH medication and an additional 3% required surgical retreatment for LUTS.ConclusionsThree‐year follow‐up demonstrates a sustained symptom reduction response along with low irreversible complications to Aquablation in men with LUTS due to BPH and prostates of 80–150 cc. Current treatment options available for men with prostates of this size have similar efficacy outcomes but are burdened with high rates of irreversible complications. There are now numerous clinical studies with Aquablation used in various prostates sizes, and it should be offered as an option to men with LUTS due to BPH.

7031 Background: There are a limited number of studies that have evaluated the association between National Comprehensive Cancer Network (NCCN) guideline adherence and survival across different cancers. We aim to assess the relationship between race/ethnicity, socioeconomic status (SES), insurance type and the receipt of NCCN guideline concordant cancer care and survival. Methods: This is a retrospective population-based cohort study of patients with 7 types of invasive cancer using the California Cancer Registry. Adherence with NCCN guidelines was defined by appropriate surgical, radiation, and chemo- or hormonal therapies. Multivariate logistic regression was used to evaluate the relationship between the patient, insurance type, tumor, and guideline adherence. Disease-specific survival analysis was performed using multivariate proportional hazards model. Results: A total of 543,198 patients were identified with invasive cancer between 2004-2017 (cases by disease type: breast 189,311, prostate 156,502, colon 80,102, liver 25,857, gastric 22,066, ovary 22,551, and cervix 16,691). The proportion of patients receiving NCCN guideline-concordant care varied by disease type. Non-concordant guideline treatment was associated with increased disease-specific mortality across all cancer types: breast (HR 1.28, 95%CI 1.23-1.33), prostate (HR 1.31, 95%CI 1.22-1.41), colon (HR 1.73, 95%CI 1.67-1.78), liver (HR 2.52, 95%CI 2.42-2.63), gastric (HR 2.38, 2.28-2.49), ovary (HR 1.32, 95%CI 1.26-1.38), and cervical cancer (HR 1.17, 95%CI 1.08-1.26). In multivariate models, compared to White, black patients were less likely to receive guideline concordant care for breast (OR 0.88, 95%CI 0.84-0.92), prostate (OR 0.90, 95%CI 0.86-0.93), colon (OR 0.85, 95%CI 0.79-0.92), and ovarian cancer (OR 0.71, 95%CI 0.62-0.82). Compared to Managed care insurance patients, Medicaid payer status was also associated with lower guideline concordant care for breast (OR 0.81, 95%CI 0.78-0.84), prostate (OR 0.91, 95%CI 0.86-0.97), colon (OR 0.70, 95%CI 0.65-0.75), gastric (OR 0.69, 95%CI 0.63-0.75), and liver cancer (OR 0.66, 95%CI 0.61-0.72). Conclusions: Less than half of cancer patients received NCCN guideline concordant care. There was an incremental relationship observed between SES and the likelihood of receiving guideline concordant care. Patients receiving non-guideline concordant care had worse disease-specific survival.

OBJECTIVE:To examine socio-demographic and treatment variables in an attempt to identify factors associated with survival differences between black and white patients with renal cell carcinoma (RCC). PATIENTS AND METHODS:We identified 79,618 white and 10,604 black patients diagnosed with RCC in the National Cancer Database. We compared the distribution of socio-demographic, presentation and treatment variables between Blacks and Whites and then utilized a multivariable cox proportion hazards regression model to evaluate the contribution of differences in these variables to disparities in overall survival (OS). RESULTS:Black patients were younger (60 vs. 63 years, P< 0.001) and with a lower stage (12.0% vs. 18.8% Stage III-IV P< 0.001). Blacks presented with a higher Charlson-Deyo score (P< 0.001), lower income (P< 0.001), lower education (P< 0.001) and were less likely to receive radical nephrectomy and systemic therapy for stage IV RCC (29.9% vs. 38.8%, P< 0.001). Unadjusted OS was lower for Whites (5-year survival 79% for Blacks and 77% for Whites). However, OS was lower for Blacks when adjusted for all variables (5-year survival 89% for Blacks and 93% for Whites). On multivariable analysis, black race was independently associated with worse OS, HR: 1.09 (95% confidence interval: 1.03, 1.14, P= 0.002). A sensitivity analysis including patients with complete data on tumor grade confirmed our results. CONCLUSION:Our study indicates that black patients present at a younger age and with lower stage RCC, but have worse OS. Blacks experienced disparities in socio-demographic characteristics, clinical presentation, treatment-related factors, and had an independently increased hazard of death.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I (PD02)1 Apr 2020PD02-11 COMPARISON OF PERIOPERATIVE OUTCOMES BASED ON SURGICAL APPROACH FOR RENAL MASSES > 10CM Felix Chen*, Jenny Chang, Argyrios Ziogas, John Sfakianos, Ketan Badani, Edward Uchio, Hoda Anton-Culver, and Greg Gin Felix Chen*Felix Chen* More articles by this author , Jenny ChangJenny Chang More articles by this author , Argyrios ZiogasArgyrios Ziogas More articles by this author , John SfakianosJohn Sfakianos More articles by this author , Ketan BadaniKetan Badani More articles by this author , Edward UchioEdward Uchio More articles by this author , Hoda Anton-CulverHoda Anton-Culver More articles by this author , and Greg GinGreg Gin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000822.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive approaches for radical nephrectomy have surpassed open surgery. Robotic-assisted laparoscopic radical nephrectomy (RRN) is increasingly utilized as an alternative to laparoscopic radical nephrectomy (LRN) but there are concerns over costs and measurable benefit. In the setting of very large renal masses (>10 cm), comparison between techniques is limited and it is unclear whether a robotic approach confers any perioperative benefit over LRN or open radical nephrectomy (ORN). In this study, we compare perioperative outcomes for robotic-assisted, laparoscopic, and open radical nephrectomy for very large renal masses. METHODS: Using the National Cancer Database, we identified patients who underwent radical nephrectomy for kidney tumors >10 cm diagnosed from 2010-2015. We excluded patients with cT3b-4 disease. Patients were analyzed according to surgical approach: RRN versus LRN versus ORN. Using multivariate logistic and linear regression, perioperative outcomes, including conversion to open, length of stay, readmission rates, positive surgical margins, and 30 and 90-day mortality were compared among cohorts. 1:1 Propensity matching was also performed to compare cohorts. We also analyzed utilization trends of each approach over the study period. RESULTS: A total of 9288 patients met inclusion criteria (RRN = 842, LRN = 2326, ORN = 6120). On multivariate analysis, LRN had a higher rate of conversion to open compared to RRN (OR 1.48; 95% CI 1.10-1.98; p=0.0087). Compared to ORN, recipients of either RRN or LRN had similar rates of 30-day readmission, 30-day mortality, and 90-day mortality. Length of hospital stay was significantly shorter in RRN (-1.73 days ± 0.19; p<0.0001) and LRN (-1.40 days ± 0.12; p<0.0001) compared to ORN. Conversion to open from RRN or LRN added 1.3 additional days of inpatient stay. RRN and LRN were less likely to have positive surgical margin than ORN (RRN: OR 0.75; 95% CI 0.56-0.99; p=0.044, LRN: OR 0.64; 95% CI 0.52-0.78; p<0.0001). Over the study period, RRN use increased from 4.1% to 14.8%, LRN from 20.9% to 25.6%, while ORN use decreased from 75% to 59.6%. CONCLUSIONS: Minimally invasive approaches are increasingly utilized in very large renal masses. After adjusting for covariates, RRN has lower rates of conversion to open but produces comparable perioperative outcomes to pure laparoscopy. Minimally invasive approaches have shorter length of inpatient stay but otherwise report similar readmission and mortality rates compared to open radical nephrectomy. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e70-e71 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felix Chen* More articles by this author Jenny Chang More articles by this author Argyrios Ziogas More articles by this author John Sfakianos More articles by this author Ketan Badani More articles by this author Edward Uchio More articles by this author Hoda Anton-Culver More articles by this author Greg Gin More articles by this author Expand All Advertisement PDF downloadLoading ...

To evaluate whether patients with improved sexual health function following prostate artery embolization demonstrate a specific anatomy of the prostate artery origin. Between January 2017 and March 2019, there was 42 patients that underwent successful bilateral prostate embolization for treatment of lower urinary tract symptoms. Of which 26 had a baseline and a follow-up IIEF/SHIM score and 6 of those patients demonstrate an improvement of at least 50% in the IIEF/SHIM score at the follow-up. Angiogram of these 6 patients were retrospectively reviewed to evaluate a correlation between the prostatic artery origin and improvement of the sexual health function. There were 12 prostatic arteries embolized in these 6 patients. Out of the 12 arteries, the origin of prostatic artery was a common trunk with superior vesical artery in 6 cases, from the internal pudendal artery in 5 cases and from the obturator artery in 1 case. In this small case series of patients with improved sexual health function, there is more prevalent anatomy of the prostatic artery originating from internal pudendal artery and common trunk with the superior vesical artery.