Purpose Radical cystectomy (RC) is associated with high rates of postoperative complications and readmissions. Despite the adoption of enhanced recovery after surgery (ERAS) protocols, there was no reduction in our complications, prompting the development of a modified ERAS (M-ERAS) pathway at our institution. Here, we evaluated the impact of an M-ERAS, featuring tailored antibiotic prophylaxis, earlier stent removal at 2 weeks, and enhanced care coordination, on postoperative outcomes following RC. Methods We retrospectively reviewed an Internal Review Bord (IRB)-approved database of 306 patients who underwent RC with an ileal conduit between 2015 and 2024. Outcomes from patients treated with the M-ERAS protocol (n = 74) were compared to those from a prior cohort (n = 232). Multivariable logistic regression was used to assess the impact on overall complications, genitourinary (GU) infections, and readmissions at 30 and 90 days. Results Patient demographics and comorbidities were similar between groups. The proportion of patients experiencing ≥1 complication at 90 days decreased following M-ERAS implementation (78.5% vs. 67.6%). Infectious complications were significantly reduced, driven by a decline in 30-day GU infections (35.3% vs. 12.2%, P ≤ 0.001). Readmissions due to GU infections also decreased at both 30 days (17.7% vs. 4.1%, P = 0.004) and 90 days (7.3% vs. 5.4%, P = 0.324). Adjusted analyses confirmed that M-ERAS was independently protective against GU infections at both 30 and 90 days. Conclusions A modified ERAS protocol incorporating targeted antibiotic prophylaxis and enhanced perioperative coordination was associated with fewer overall complications and a significant reduction in genitourinary infection-related readmissions after RC. These findings support the use of tailored, procedure-specific recovery pathways to improve outcomes for RC patients.

Introduction Radical Cystectomy (RC) is a morbid procedure with a known high risk of complications and readmissions. Our institution is the only academic center in a rural state and provides the majority of cystectomy care, leading to a robust bladder cancer program. Longitudinally, a series of peri-operative changes to our RC care pathway have been made with the aim of improving outcomes. After the introduction of ERAS in 2020, we did not observe a change in outcomes which prompted a change in our perioperative pathway. Furthermore, genitourinary (GU) infections represented the largest body of post-operative complications amongst our complications. We describe the introduction of a post-operative discharge pathway (PODP), incorporated in 2022, aimed to reduce low-grade complications and associated readmissions. Methods Data was extracted from a prospectively maintained database identifying 323 RC pts from 2015-2024. Complications were graded and classified by the Memorial Sloan Kettering Cancer Center system. A statewide health information exchange allows for record sharing across institutions. This allowed for capture of complete 90d follow-up. All 90d readmissions, complications, and GU infections after surgery were recorded and analyzed.An antibiogram specific to our RC pts was previously created, leading to prophylaxis (ppx) with low dose Levaquin or Bactrim starting POD#4 until stent removal at 2 weeks. This began April 1, 2022, as part of a larger PODP that included increased post-operative education, a post-discharge day 2 and 5 phone call with an oncology RN, and oral 30d DVT ppx post-discharge. Chi-square and multivariable logistic regression analyses were performed to assess the association between antibiotic ppx and 30 and 90d readmissions due to GU infection. Results 90d follow-up was available for all 323 pts. 462 complications were recorded pre-PODP. 75.4% and 24.6% occurred at 30d and 90d, respectively. Infectious (27.3%), gastrointestinal (17.7%), and genitourinary (12.6%) causes were the most common, predominantly due to GU infections, ileus, and renal failure (Table 1). The majority were grade 2 (35.5%, Table 1). 30d and 90d mortality was 2.7% and 5.0%, respectively. Post-PODP implementation, 93 complications were recorded. 66.7% and 33.3% occurred at 30d and 90d, respectively. Gastrointestinal (33.3%), infectious (19.4%), and genitourinary (16.1%) causes were the most common (Table 1). The majority were grade 1 (23.4%, Table 1).After PODP implementation, 53/56 pts received antibiotic ppx. The 30d risk of GU infections decreased following antibiotic ppx from 84/172 (48.0%) to 3/24 (12.5%), (p=0.001, Table 2). Of 66 pts readmitted at 30d pre-ppx, 41/66 (62.1%) were due to a GU infection vs 1/10 (10%) post-ppx (p=0.002, Table 2). Conclusions Here we show complete capture of follow-up for RC pts still living at 90d between 2015-2024. Our complications and readmissions are consistent with prior reports in both class and grade. Introduction of an updated PODP, which included targeted low dose daily antibiotics, increased education, and closer outpatient follow-up, led to reduction of our readmission rate due to GU infections and overall post-RC GU infection rate. Overall readmission rate is not statistically different, but limited by sample size and expected to be significant as the cohort increases.

Introduction: The 2018 U.S. Preventive Services Task Force recommendations endorsed shared decision making for men aged 55-69 years, encouraging consideration of patient race/ethnicity for prostate-specific antigen screening. This study aimed to assess whether a proxy shared decision-making variable modified the impact of race/ethnicity on the likelihood of prostate-specific antigen screening.Methods: A cross-sectional analysis of men aged between 55 and 69 years, who responded to the prostate-specific antigen screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System survey, was performed between September and December 2022. Complex sample multivariable logistic regression models with an interaction term combining race and estimated shared decision making were used to test whether shared decision making modified the impact of race/ethnicity on screening.Results: Of a weighted sample of 26.8 million men eligible for prostate-specific antigen screening, 25.7% (6.9 million) reported for prostate-specific antigen screening. In adjusted analysis, estimated shared decision making was a significant predictor of prostate-specific antigen screening (AOR=2.65, 95% CI=2.36, 2.98, p<0.001). The interaction between race/ethnicity and estimated shared decision making on the receipt of prostate-specific antigen screening was significant (p(int)=0.001). Among those who did not report estimated shared decision making, both non-Hispanic Black (OR=0.77, 95% CI=0.61, 0.97, p=0.026) and Hispanic (OR=0.51, 95% CI=0.39, 0.68, p<0.001) men were significantly less likely to undergo prostate-specific antigen screening than non-Hispanic White men. On the contrary, among respondents who reported estimated shared decision making, no race-based differences in prostate-specific antigen screening were found.Conclusions: Although much disparities research focuses on race-based differences in prostate-specific antigen screening, research on strategies to mitigate these disparities is needed. Shared decision making might attenuate the impact of race/ethnic disparities on the likelihood of prostate-specific antigen screening.(c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

You have accessJournal of UrologyBladder Cancer: Invasive II (MP22)1 May 2024MP22-19 POST-OPERATIVE ANTIBIOTIC PROPHYLAXIS IN RADICAL CYSTECTOMY PATIENTS REDUCES GU INFECTIONS Randie E. White, Joshua A. Linscott, Erin Santos, Connor Pelletier, Stephen T. Ryan, Matthew T. Hayn, Jeffrey E. Howard, Evelyn James, and Jesse D. Sammon Randie E. WhiteRandie E. White , Joshua A. LinscottJoshua A. Linscott , Erin SantosErin Santos , Connor PelletierConnor Pelletier , Stephen T. RyanStephen T. Ryan , Matthew T. HaynMatthew T. Hayn , Jeffrey E. HowardJeffrey E. Howard , Evelyn JamesEvelyn James , and Jesse D. SammonJesse D. Sammon View All Author Informationhttps://doi.org/10.1097/01.JU.0001008608.50694.4b.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical Cystectomy (RC) is a morbid procedure with frequent readmissions. Our prior work identified readmission due to genitourinary (GU) infections as a target for improvement. Here we developed an RC-specific antibiogram to guide antibiotic prophylaxis (ppx) and assess implementation. METHODS: Data was extracted from a prospectively maintained database identifying 227 RC/IC patients (pts) from 2015-2022. Complications were graded and classified by the Memorial Sloan Kettering Cancer Center system. Pts who developed GU infections were selected; uropathogens were analyzed for causative organism. Sensitivity patterns were used to create an RC-specific antibiogram.Beginning April 1, 2022, following discussion with antibiotic stewardship committee, low dose Levaquin or Bactrim was given POD#4 to RC pts with ileal conduits (RC/IC) until stent removal at 2 weeks. All GU infections were captured. Chi square and multivariable logistic regression analyses were performed to assess the association between antibiotic ppx and 30 and 90d readmissions due to GU infection. RESULTS: Enteric organisms were most likely to be identified as source pathogen. Levaquin covered 70.4% of organisms while Bactrim covered 50.0% (Figure 1).The 30d risk of any GU infections decreased following antibiotic ppx from 82/227 (36.1%) pre-ppx to 2/29 (6.9%) post-ppx (p<0.001, Table 1). Readmission due to GU infection was significantly reduced with 41/65 (63.1%) of pts readmitted with GU infection pre-ppx and only 1/5 (20%) post-ppx (p=0.05).After adjusting for covariates, receiving low dose antibiotic ppx was independently associated with a decreased risk of having a GU infection within 30 and 90d of RC/IC (Table 1). CONCLUSIONS: Targeted low dose daily antibiotic ppx is associated with a decrease in GU infections and 30d readmission due to GU infection. Overall readmission rates are not statistically different. This preliminary data is limited by sample size but is quite promising. Central to the success of this intervention is an institutional RC-specific antibiogram. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e351 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Randie E. White More articles by this author Joshua A. Linscott More articles by this author Erin Santos More articles by this author Connor Pelletier More articles by this author Stephen T. Ryan More articles by this author Matthew T. Hayn More articles by this author Jeffrey E. Howard More articles by this author Evelyn James More articles by this author Jesse D. Sammon More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: Radical cystectomy is a complex surgery with better outcomes reported when performed at high-volume centers. This may lead to patients traveling farther for care. We examined the impact of travel distance on clinical outcomes. Methods: A total of 220 patients undergoing radical cystectomy from 2015-2021 were retrospectively reviewed. Distance traveled to the treatment center by patient zip codes was classified as <12.5 miles, 12.5-49.9 miles, and >= 50 miles. Multivariable logistic regression was used to assess complications, readmissions, 90-day mortality, and length of stay by distance traveled. Time to treatment based on distance traveled was compared. Results: A total of 220 patients underwent radical cystectomy with complete 90-day follow-up. Of the patients 38.6% (85/220) were readmitted; 62.5% (53/85) presented to the treatment center or were transferred. All patients readmitted to an outside hospital traveled >= 12.5 miles (P < .001). Patients with high-grade complications were likely to be transferred to the treatment center with only 23.7% (9/38) definitively managed by outside hospital. Patients traveling >12.5 miles with low-grade complications were more likely to be managed at an outside hospital (57.5%, P = .01). There was no difference in time to initiation of neoadjuvant chemotherapy (P = .99) or time to radical cystectomy following neoadjuvant chemotherapy (P = .23) by distance traveled. For 49 muscle-invasive bladder cancer patients proceeding directly to surgery without neoadjuvant chemotherapy, time from diagnosis to radical cystectomy was increased if traveling >12.5 miles (P = .04). Conclusions: Increased travel distance did not impact early postoperative outcomes. Distance traveled may impact access to care, such as time to surgery or location of readmission to the treatment center postoperatively.

Purpose:Immigrants constitute 14% of the U.S. population, and this group is especially vulnerable to poor health care access. Prior research demonstrates U.S. immigrants have low rates of guideline-concordant breast and colorectal screening, but prostate cancer screening has not previously been evaluated. We sought to characterize screening behaviors among U.S. immigrants and to consider possible mechanisms to enhance PSA-based screening for this population.Materials and Methods:Data were obtained from the 2010, 2013, 2015, and 2018 National Health Interview Survey reports, which were the recent survey years that included questions about PSA testing. Complex samples logistic regression was performed to assess the relationship between immigrant-specific characteristics including region of birth, citizenship status, length of residence within the U.S., English language proficiency, and history of PSA testing.Results:There were 22,997 survey respondents; 3,257 were foreign-born and 19,740 were U.S.-born. Rates of PSA testing were much lower among the foreign-born population compared to the U.S.-born population (43% vs 60%). Citizenship status, length of residence in the U.S. for more than 15 years, and English proficiency were directly linked to increased rates of PSA testing. There was significant variability in PSA testing among immigrant subgroups and Asian immigrants had the lowest rate of PSA testing. Annual physician visits and English language proficiency were associated with increased PSA testing among the U.S. immigrant population.Conclusions:Immigrants have relatively low rates of PSA testing. Improving health care utilization and language services may help to narrow the gap in guideline-concordant prostate cancer screening between immigrants and nonimmigrants.

You have accessJournal of UrologyCME1 Apr 2023PD39-11 EFFECT OF SHARED DECISION MAKING ON RACIAL AND ETHNIC DISPARITY IN PROSTATE CANCER SCREENING: RESULTS FROM A NATIONAL BEHAVIORAL SURVEY Nicola Frego, Muhieddine labban, benjamin v. Stone, Mara Koelker, Edoardo Beatrici, Dejan K. Filipas, Giovanni Lughezzani, Nicolò Maria Buffi, Firas Abdollah, Nora Y. Osman, Sonja R. Solomon, Stuart R. Lipsitz, Adam S. Kibel, Jesse D. Sammon, Quoc-dien trinh, and alexander p. Cole Nicola FregoNicola Frego More articles by this author , Muhieddine labban Muhieddine labban More articles by this author , benjamin v. Stone benjamin v. Stone More articles by this author , Mara KoelkerMara Koelker More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Dejan K. FilipasDejan K. Filipas More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Nora Y. OsmanNora Y. Osman More articles by this author , Sonja R. SolomonSonja R. Solomon More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Jesse D. SammonJesse D. Sammon More articles by this author , Quoc-dien trinh Quoc-dien trinh More articles by this author , and alexander p. Cole alexander p. Cole More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003342.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 2018 United States Preventive Services Task Force recommendations endorsed shared decision making (SDM) for men aged 55-69 and encouraged consideration of patient race and ethnicity for prostate specific antigen (PSA) screening. We sought to assess whether SDM modified the effect of race and ethnicity on the likelihood of PSA screening. METHODS: A cross-sectional analysis of men aged between 55 and 69 who responded to the PSA screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System (BRFSS) survey was performed. Men without a diagnosis of prostate cancer who self-reported a PSA test in the previous 12 months as part of a routine examination were considered screened. SDM was defined based upon whether the respondents had been informed by a physician about the benefits and harms of PSA screening. The main predictors were patient race and the interaction between race/ethnicity and SDM. Complex weighted sample multivariable logistic regression models were fitted to test the associations. RESULTS: Out of a weighted sample of 26.8 million men eligible for PSA screening, 25.7% (6.9 million men) reported PSA screening. In adjusted analysis, SDM was a significant predictor of PSA screening (aOR:2.65, 95%CIs:2.36-2.98, p<0.001). The interaction between race/ethnicity and SDM on the receipt of PSA screening was significant (pint=0.001), meaning that the effect of race on the odds of PSA screening varied based on SDM. Among those who did not report SDM, both non-Hispanic Black (OR:0.77, 95%CIs: 0.61–0.97, p=0.026) and Hispanic (OR:0.51, 95%CIs: 0.39–0.68, p<0.001) men were significantly less likely to undergo PSA screening than non-Hispanic white men. On the contrary, among respondents who reported SDM, we found no race-based differences in the odds of PSA screening (Figure 1). CONCLUSIONS: SDM was a significant predictor of PSA screening use and has a direct impact on reducing disparities in PSA screening among racial and ethnic groups. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1049 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicola Frego More articles by this author Muhieddine labban More articles by this author benjamin v. Stone More articles by this author Mara Koelker More articles by this author Edoardo Beatrici More articles by this author Dejan K. Filipas More articles by this author Giovanni Lughezzani More articles by this author Nicolò Maria Buffi More articles by this author Firas Abdollah More articles by this author Nora Y. Osman More articles by this author Sonja R. Solomon More articles by this author Stuart R. Lipsitz More articles by this author Adam S. Kibel More articles by this author Jesse D. Sammon More articles by this author Quoc-dien trinh More articles by this author alexander p. Cole More articles by this author Expand All Advertisement PDF downloadLoading ...

Prostate cancer (PrCa) is one of the most genetically driven solid cancers with heritability estimates as high as 57%. African American men are at an increased risk of PrCa; however, current risk prediction models are based on European ancestry groups and may not be broadly applicable. In this study, we define an African ancestry group of 4,533 individuals to develop an African ancestry-specific PrCa polygenic risk score (PRState). We identified risk loci on chromosomes 3, 8, and 11 in the African ancestry group GWAS and constructed a polygenic risk score (PRS) from 10 African ancestry-specific PrCa risk SNPs, achieving an AUC of 0.61 [0.60-0.63] and 0.65 [0.64-0.67], when combined with age and family history. Performance dropped significantly when using ancestry-mismatched PRS models but remained comparable when using trans-ancestry models. Importantly, we validated the PRState score in the Million Veteran Program, demonstrating improved prediction of PrCa and metastatic PrCa in African American individuals. This study underscores the need for inclusion of individuals of African ancestry in gene variant discovery to optimize PRS.

Purpose: Medicaid expansion under the Patient Protection and Affordable Care Act occurred almost concurrently with 2012 U.S. Preventive Services Task Force recommendations against prostate specific antigen screening. Here the relative influence on prostate specific antigen screening rates by 2 concurrent and opposing system-level policy initiatives is investigated: improved access to care and change in clinical practice guidelines. Materials and Methods: Behavioral Risk Factor Surveillance System data from years 2012 to 2018 were analyzed for trends in self-reported prostate specific antigen screening and insurance coverage. Subanalyses included state Medicaid expansion status and respondent federal poverty level. Multivariable logistic regression was performed to evaluate factors associated with prostate specific antigen screening. Results: From 2012 to 2018 prostate specific antigen screening predominantly declined with a notable exception of an increase of 7.3% for men at <138% federal poverty level between 2011 and 2013 in early expansion states. Initial increases did not continue, and screening trends mirrored those of nonexpansion states by 2018. Notably, 2014 planned expansions states did not follow this trend with minimal change between 2015 and 2017 compared to declines in early expansion states and nonexpansion states (-0.4% vs -6.7% and -8.6%, respectively). Conclusions: Medicaid expansion was associated with increased rates of insured men at <138% federal poverty level from 2012 to 2018 in early expansion states. In this group, initial increases in prostate specific antigen screening were not durable and followed the trend of reduced screening seen across the United States. In planned expansions states the global drop in prostate specific antigen screening from 2016 to 2018 was offset in men at <138% federal poverty level by expanding access to care. Nonexpansion states showed a steady decline in prostate specific antigen screening rates. This suggests that policy such as U.S. Preventive Services Task Force recommendations against screening competes with and often outmatches access to care.

Introduction and objective: Research on the utility of meditative and mind-body (MB) practices has increased dramatically in the last two decades and both have been suggested as useful adjuncts in coping with stressors associated with cancer survivorship. There exists little data on use among genitourinary (GU) cancer survivors. This study seeks to describe meditative and MB utilization among GU cancer survivors. Methods: Analysis of data from the 2012 and 2017 National Health Interview Survey was conducted. Patients aged 40 and older reporting a history of any cancer diagnosis (including 3 GU cancers) were included in the analysis. We explored questions about meditative and MB practices in the past 12 months. Complex Samples Logistic regression was performed to compare the relationship between cancer status and use of these practices. Results: Self-reported meditative practices were more prevalent in 2017 (17%) than in 2012 (5%). Patients who self-reported a cancer diagnosis of any kind were significantly more likely to utilize meditative practices. Patients with kidney cancer were significantly more likely to meditate and trended towards higher MB utilization. In contrast, bladder cancer patients were less likely to meditate and use MB practices. Increases in meditation were greater than those seen for MB in all groups. Conclusions: Meditative and MB practices increased in prevalence between 2012 and 2017 with notable heterogeneity between cancer types. Given the potential benefit, more broad incorporation into survivorship programs may be warranted. Future work should explore the significance of this heterogeneity and the utility of these practices to patients with urologic malignancy. (C) 2020 Elsevier Inc. All rights reserved.

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety IV (MP58)1 Sep 2021MP58-16 RADICAL CYSTECTOMY WITH JUNIOR RESIDENTS: LONGER DAYS, EQUIVALENT OUTCOMES Joshua Linscott, Randie White, Stephen Ryan, Moritz Hansen, Jesse Sammon, and Matthew Hayn Joshua LinscottJoshua Linscott More articles by this author , Randie WhiteRandie White More articles by this author , Stephen RyanStephen Ryan More articles by this author , Moritz HansenMoritz Hansen More articles by this author , Jesse SammonJesse Sammon More articles by this author , and Matthew HaynMatthew Hayn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002088.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) is known to be a highly morbid, complex, and technically challenging operation. At academic centers, the assistant is traditionally a chief or senior resident. Our institution has one urology resident per year and annually performs a total of 40-50 open or robotic radical cystectomies. This leads to junior residents (PGY2, PGY3) frequently participating as the primary assistant. Here we explore the impact of resident experience level on operative, hospital, and post-operative outcomes in RC. METHODS: A single institution, prospectively maintained database identified 159 consecutive patients who underwent open or robotic RC from 2015-2019. Resident involvement was recorded in 154 cases. Operative time, estimated blood loss (EBL), intraoperative transfusion, length of stay (LOS), in hospital complication, complications in 90d, readmission at 90d, and urinary diversion complications (eg uretero-ileal stricture) were compared between junior (PGY2 & PGY3) and senior (PGY4 & PGY5) residents. Patient demographics including age, sex, BMI, neoadjuvant chemotherapy, and ASA score were examined. Statistical analysis was performed with SPSS. RESULTS: Over a 5-year period, junior residents assisted in 53 of 154 cases (34%) where a resident was involved. The number of cases done by PGY2, PGY3, PGY4, & PGY5 residents was 6, 47, 44, and 57, respectively. The percentage of open versus robotic cases was similar. There were no differences in examined patient demographics between groups. Cases with junior residents took 29.1 min (CI 3.4-54.8, p=0.027) longer than when a senior resident was present. No other significant differences between the two groups were seen when comparing EBL, intraoperative transfusion, surgical margin status, LOS, in hospital complication, 90d complication, 90d readmission, or urinary diversion complication (Table 1). CONCLUSIONS: RC remains a challenging urologic operation demanding technical excellence. Our data suggests participation by junior residents increases the length of operation by ∼10% (29.1 min) but does not negatively impact patient outcomes. We propose this is explained by increased time required for teaching and oversight from the attending surgeon, which allows junior residents to participate in a complex surgery without increasing the risk to the patient. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e994-e994 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Linscott More articles by this author Randie White More articles by this author Stephen Ryan More articles by this author Moritz Hansen More articles by this author Jesse Sammon More articles by this author Matthew Hayn More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Markers (MP60)1 Sep 2021MP60-06 PROSTATE: INCORPORATING GENETIC ANCESTRY IN PROSTATE CANCER RISK SCORES FOR MEN OF AFRICAN DESCENT Joshua Linscott, Meghana Pagadala, Hannah Carter, Matthew Hayn, Moritz Hansen, Jesse Sammon, Karim Kader, and Stephen Ryan Joshua LinscottJoshua Linscott More articles by this author , Meghana PagadalaMeghana Pagadala More articles by this author , Hannah CarterHannah Carter More articles by this author , Matthew HaynMatthew Hayn More articles by this author , Moritz HansenMoritz Hansen More articles by this author , Jesse SammonJesse Sammon More articles by this author , Karim KaderKarim Kader More articles by this author , and Stephen RyanStephen Ryan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002095.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer (PrCa) is the most heritable of the solid organ malignancies. In addition, incidence and aggressive phenotypes are higher in African American men. Prior research into genetic heritability has focused on ancestry as defined by the patient. We explored ancestral genetic backgrounds with forensic genetic tools to define and develop a polygenic risk score (PRS) in African Americans. METHODS: Single nucleotide polymorphisms (SNPs) were imputed from a PrCa case-control study of >99,000 men (ELLIPSE) using the Michigan Imputation Server, 1000 Genomes Project, Eaglev2.3. Ancestral likelihood ratios were calculated by Forensic Research Reference on Genetics (FROG)-kb based on a previously described 55-SNP panel and define genetically separate African and European cohorts. GWAS was performed to identify PrCa risk SNPs and PRSice 2.3.1 to develop a PRS. An 80:20 split training:testing groups was used with AUC and ROC analysis. RESULTS: FROG-kb identified 4,507 and 5,334 individuals of African and European ancestry, respectively (Figure 1). In the African group, 6 SNPs reached significance, 1 on chromosome 1, 4 on chromosome 8, and 1 on chromosome 11. Four SNPs unique to African ancestry, were used to create a PRS. Individually, family history (FH), age, and PRS achieved AUCs of 0.56, 0.54, and 0.60 respectively. Combined PRS, FH, and Age improved AUC to 0.64 (Figure 2). CONCLUSIONS: A 55-SNP panel identified genetic ancestral groups for GWAS analysis, which defined 4 PrCa associated SNPs specific to African genetic inheritance. The resulting PRS predicted PrCa better than FH and Age in African American men. A combined model performs similar to previously published studies in European cohorts. Here we have achieved comparable AUC using only 4 SNPs, in a group at higher risk for aggressive PrCa. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1043-e1043 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Linscott More articles by this author Meghana Pagadala More articles by this author Hannah Carter More articles by this author Matthew Hayn More articles by this author Moritz Hansen More articles by this author Jesse Sammon More articles by this author Karim Kader More articles by this author Stephen Ryan More articles by this author Expand All Advertisement Loading ...

INTRODUCTION AND OBJECTIVE: A proportion of the population utilise healthcare services at a higher rate compared to the general population, thereby costing a disproportionate amount of resources. We aimed to investigate urology patients frequently attending our hospital with a view to transform our services, thus improving their care and reducing attendances. METHODS: A locally approved prospective database was implemented to collate all emergency admissions presenting to our urology department over 15 years. Patients with fi ve or more atten-dances within eight years were included for analysis. Data on length of stay, reason for admission, co-morbidities and management were collected. RESULTS: During the 15-year period, 15611 patients were recorded in the database. Of these, 110 had recurrent attendances, contributing to 642 visits in total. The most common reasons for reattendance were catheter related issues (19.5%), haematuria (15.1%) and urinary tract stones (11.7%). Median length of stay was 1 (IQR 0-3), 3 (2-7) and 2 days (1-3.5) for catheter related issues, haematuria and urinary tract stones respectively. The biggest contributor for surgical management were urinary tract stones n [ 24 (19.4%). CONCLUSIONS: The key issues identi fi ed in this study informs the next stage of this quality improvement project. The view is to provide integrated multidisciplinary care to reduce reattendances by developing targeted pathways and services with community and allied healthcare professionals. If successfully implemented, these interventions may reduce admissions and improve the overall patient care and health economy.

INTRODUCTION AND OBJECTIVE: Multiparametric MRI (mpMRI) and fusion biopsy technology has allowed for more accurate diagnosis of clinically significant prostate cancer (PCa) while helping to limit the overdiagnosis of non-significant disease. Little data exists, however, about the feasibility and success of implementation outside of large academic centers. This study sought to evaluate fusion biopsy adoption at Maine Medical Center for improvement over time and to discover meaningful areas for improvement. METHODS: Starting in 2016 data was collected for patients undergoing mpMRI at Maine Medical Center and subsequent biopsy with the Phillips Uronav system. We also collected urology specific and general demographic information. We analyzed this data with special focus on the probability of cancer detection (PCD) of PI-RADS 3, 4, 5 lesions, as well as the percentage of patients who had negative targeted biopsies but PCa on 12-Core biopsy (our “false negative” rate). RESULTS: Data from 224 patients was analyzed (179 underwent both fusion and 12-core biopsy, 10%, 52%, 37% PI-RADS 3, 4, 5 respectively). 49% underwent MRI as part of active surveillance protocol. Our overall PCD increased yearly, from 39% in 2016 to 67% in 2019. Most importantly, the PCD of PI-RADS 5 lesions has increased, from 54% in 2016 to 100% in 2019. Our overall “false negative” rate was 50%, our “false negative” rate for clinically significant disease (≥ Gleason 3+4=7) was 24.6% (range 11%-35% annually). CONCLUSIONS: Our findings highlight the significant institutional learning curve associated with implementation of a fusion biopsy program at a large regional medical center. Our institution did not achieve desired outcomes immediately, but our results improved consistently over the study period. These outcomes highlight the importance of a rigorous iterative approach to quality improvement when implementing a fusion biopsy program.Source of Funding: None

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making I (MP02)1 Apr 2020MP02-06 CAUSES FOR REFERRAL DELAY IN PATIENTS REQUIRING CYSTECTOMY AT A TERTIARY CARE CENTER Joshua Linscott*, William Daly, Tracy Robbins, Lisa Beaule, Matthew Hayn, Moritz Hansen, Jesse Sammon, and Stephen Ryan Joshua Linscott*Joshua Linscott* More articles by this author , William DalyWilliam Daly More articles by this author , Tracy RobbinsTracy Robbins More articles by this author , Lisa BeauleLisa Beaule More articles by this author , Matthew HaynMatthew Hayn More articles by this author , Moritz HansenMoritz Hansen More articles by this author , Jesse SammonJesse Sammon More articles by this author , and Stephen RyanStephen Ryan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000816.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Delays in treating bladder cancer are an unintentional consequence of regionally centralizing cystectomy care. Our prior work identified barriers to timely cystectomy and led to development of an independent nurse navigator system to mitigate delays. The aim was for all patients to receive treatment within 90 days of diagnosis. Here, we perform follow-up analysis to determine the impact of nurse navigation and identify target areas for further improvement. METHODS: Patients requiring cystectomy for bladder cancer at a tertiary care facility were identified by retrospective review. Dates were recorded for (1) procedure prompting cystectomy, (2) referral to cystectomy provider, (3) consultation, and (4) receipt of treatment (neoadjuvant chemotherapy or cystectomy). Nurse navigation was instituted at the time of consultation. Delay was defined as >90 days from procedure to treatment. Travel time was mapped as minutes in drive time from patient home to facility. Intervening milestones to care were analyzed based on first 10 records, power analysis was estimated (n=50). Wilcoxon analysis compared patient related (travel time) and provider related factors (days to referral). RESULTS: Of the 53 patients reviewed, 18/18 (100%) internal and 30/35 (86%) external regional referrals were treated within 90 days. Time from bladder procedure to cystectomy consultation was longer for external referrals compared to internal referrals [Median (Interquartile Range): 21 days (IQR 17-44) vs. 13 days (IQR 7 – 21), p=<0.001]. Time from procedure to referral order was longer in the external group (13 days, IQR 6-26) compared to the internal group (3 days, IQR 3-4). Interestingly, patients in the upper quartiles of referral delay had shorter travel times to the treatment facility [≥13 days: 40 mins (IQR 31-52)] compared to those referred earlier [<13days: 74 mins (IQR 51-99), p=<0.002]. CONCLUSIONS: Nurse navigation for cystectomy patients resulted in high levels of treatment within 90 days. Patients with external referrals were more likely to experience delays, and notably, delays were more likely to happen in patients living closer to the treatment facility. We suggest nurse navigation earlier in care to help address structural, political, and cultural causes of delays. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e13-e13 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Linscott* More articles by this author William Daly More articles by this author Tracy Robbins More articles by this author Lisa Beaule More articles by this author Matthew Hayn More articles by this author Moritz Hansen More articles by this author Jesse Sammon More articles by this author Stephen Ryan More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION:Health literacy affects how patients behave within the healthcare system. Overutilization of screening procedures inconsistent with the U.S. Preventive Services Task Force guidelines contributes to the high cost of health care. The authors hypothesize that higher health literacy supports guideline-concordant screening. This study assesses the effect of health literacy on nonrecommended prostate, breast, and cervical cancer screening in patients older than the recommended screening age limit.METHODS:The 2016 Behavioral Risk Factor Surveillance System included health literacy modules. Respondents self-reported their ability to obtain and understand health information, resulting in 4 health literacy rankings. The authors calculated the population-weighted proportion of respondents in each health literacy category who underwent screening past the Task Force‒recommended age limit. The ORs of nonrecommended screening for each malignancy were calculated, with low health literacy as the ref category.RESULTS:Individuals with higher health literacy underwent more nonrecommended screening. Nonrecommended prostate cancer screening was performed in 27.4% (95% CI=23.7%, 31.4%) and 47.7% (95% CI=44.1%, 51.3%) of respondents with low and high health literacy, respectively (p<0.001). Nonrecommended breast cancer screening was performed in 46.8% (95% CI=42.6%, 51.1%) and 67.7% (95% CI=64.2%, 71.1%) of respondents with low and high health literacy, respectively (p=0.002). Nonrecommended cervical cancer screening was performed in 33.8% (95% CI=31.1%, 36.5%) and 48.4% (95% CI=46.3%, 50.5%) of respondents with low and high health literacy, respectively (p<0.001). Individuals with high health literacy were significantly more likely than those with low health literacy to screen against the recommendations for prostate (OR=1.73, 95% CI=1.34, 2.23, p<0.001), cervical (OR=1.533, 95% CI=1.31, 1.80, p<0.001), and breast (OR=8.213, 95% CI=4.90, 13.76, p<0.001) cancer.CONCLUSIONS:Higher health literacy correlates with increased rates of screening beyond the recommended age, contrary to the study hypothesis. Breast cancer demonstrated the highest rates of nonrecommended screening.

PURPOSE:Implementation of survivorship care plans has been emphasized as a key component to improving care for cancer survivors. Our objective was to determine the prevalence of survivorship care plan receipt for survivors of genitourinary malignancy including kidney, prostate and bladder cancer, and evaluate whether receipt was associated with a measurable health benefit. MATERIALS AND METHODS:Data from the Behavioral Risk Factor Surveillance System Cancer Survivorship modules in 2012, 2014, 2016 and 2017 were analyzed. The proportion of patients with bladder, kidney or prostate cancer receiving a survivorship care plan was calculated. Complex samples multivariable logistic regressions were performed to determine the association of survivorship care plan receipt with sociodemographic variables, and assess the relationship between survivorship care plan receipt and self-reported health status (general, physical and mental). RESULTS:Survivorship care plan distribution increased from 27.5% in 2012 to 39.5% in 2017. Patients with low income, less formal education and extremes of age were less likely to receive a survivorship care plan. Those receiving a survivorship care plan were less likely to report poor physical health (OR 0.70, CI 0.52-0.96, p=0.026). Subanalysis showed a similar result for physical health of patients with prostate cancer (OR 0.68, CI 0.48-0.96, p=0.030) and general health of patients with kidney cancer (OR 0.37, CI 0.19-0.75, p=0.006). CONCLUSIONS:Distribution of survivorship care plans to genitourinary malignancy survivors has increased since 2012 in response to advocacy from national organizations. Nonetheless, utilization is low and there is heterogeneity in the populations likely to receive a survivorship care plan. There is a measurable association between survivorship care plans and improved health status but further study is needed to determine causality.

Background Current guidelines endorse shared decision making (SDM) for prostate‐specific antigen (PSA) screening. The relationship between a patient's health literacy (HL) and SDM remains unclear. In the current study, the authors sought to identify the impact of HL on the rates of PSA screening and on the relationship between HL and SDM following the 2012 US Preventive Services Task Force recommendations against PSA screening. Methods Using data from the 2016 Behavioral Risk Factor Surveillance System, the authors examined PSA screening in the 13 states that administered the optional “Health Literacy” module. Men aged ≥50 years were examined. Complex samples multivariable logistic regression models were computed to assess the odds of undergoing PSA screening. The interactions between HL and SDM were also examined. Results A weighted sample of 12.249 million men with a rate of PSA screening of 33.4% were identified. Approximately one‐third self‐identified as having optimal HL. Rates of PSA screening were found to be highest amongst the highest HL group (42.2%). Being in this group was a significant predictor of undergoing PSA screening (odds ratio, 1.214; 95% confidence interval, 1.051‐1.403). There was a significant interaction observed between HL and SDM ( P for interaction, <.001) such that higher HL was associated with a lower likelihood of undergoing PSA screening when SDM was present. Conclusions In the uncertain environment of multiple contradictory screening guidelines, men who reported higher levels of HL were found to have higher levels of screening. The authors demonstrated that increased HL may reduce the screening‐promoting effect of SDM. These findings highlight the dynamic interplay between HL and SDM that should inform the creation and promulgation of SDM guidelines, specifically when considering patients with low HL.