Importance No prior trial has compared hypofractionated postprostatectomy radiotherapy (HYPORT) to conventionally fractionated postprostatectomy (COPORT) in patients primarily treated with prostatectomy. Objective To determine if HYPORT is noninferior to COPORT for patient-reported genitourinary (GU) and gastrointestinal (GI) symptoms at 2 years. Design, Setting, and Participants In this phase 3 randomized clinical trial, patients with a detectable prostate-specific antigen (PSA; >= 0.1 ng/mL) postprostatectomy with pT2/3pNX/0 disease or an undetectable PSA (<0.1 ng/mL) with either pT3 disease or pT2 disease with a positive surgical margin were recruited from 93 academic, community-based, and tertiary medical sites in the US and Canada. Between June 2017 and July 2018, a total of 296 patients were randomized. Data were analyzed in December 2020, with additional analyses occurring after as needed. Intervention Patients were randomized to receive 62.5 Gy in 25 fractions (HYPORT) or 66.6 Gy in 37 fractions (COPORT). Main Outcomes and Measures The coprimary end points were the 2-year change in score from baseline for the bowel and urinary domains of the Expanded Prostate Cancer Composite Index questionnaire. Secondary objectives were to compare between arms freedom from biochemical failure, time to progression, local failure, regional failure, salvage therapy, distant metastasis, prostate cancer-specific survival, overall survival, and adverse events. Results Of the 296 patients randomized (median [range] age, 65 [44-81] years; 100% male), 144 received HYPORT and 152 received COPORT. At the end of RT, the mean GU change scores among those in the HYPORT and COPORT arms were neither clinically significant nor different in statistical significance and remained so at 6 and 12 months. The mean (SD) GI change scores for HYPORT and COPORT were both clinically significant and different in statistical significance at the end of RT (-15.52 [18.43] and -7.06 [12.78], respectively; P < .001). However, the clinically and statistically significant differences in HYPORT and COPORT mean GI change scores were resolved at 6 and 12 months. The 24-month differences in mean GU and GI change scores for HYPORT were noninferior to COPORT using noninferiority margins of -5 and -6, respectively, rejecting the null hypothesis of inferiority (mean [SD] GU score: HYPORT, -5.01 [15.10] and COPORT, -4.07 [14.67]; P = .005; mean [SD] GI score: HYPORT, -4.17 [10.97] and COPORT, -1.41 [8.32]; P = .02). With a median follow-up for censored patients of 2.1 years, there was no difference between HYPORT vs COPORT for biochemical failure, defined as a PSA of 0.4 ng/mL or higher and rising (2-year rate, 12% vs 8%; P = .28). Conclusions and Relevance In this randomized clinical trial, HYPORT was associated with greater patient-reported GI toxic effects compared with COPORT at the completion of RT, but both groups recovered to baseline levels within 6 months. At 2 years, HYPORT was noninferior to COPORT in terms of patient-reported GU or GI toxic effects. HYPORT is a new acceptable practice standard for patients receiving postprostatectomy radiotherapy.

Objective. To examine one academic institution’s experiences with SpaceOAR placement, its associated complications, and periprocedural characteristics that affect outcomes for the purpose of quality improvement. Materials and Methods. We conducted a retrospective review of 233 patients who received SpaceOAR from four surgeons and one radiation oncologist between 2018 and 2021. Variables such as demographics, oncologic parameters, radiation plan, and radiographic assessment of hydrogel placement were recorded. The Charlson Comorbidity Index (CCI) was used to assess comorbidity risk. Mann–Whitney and Fisher’s exact tests were performed to compare patients with and without complications. Results. Of the 233 patients who received SpaceOAR, 24 (10.3%) experienced toxicity. All complications were Clavien I or II, such as pelvic pain postplacement, pelvic fullness, bleeding, and lower urinary tract symptoms. 16 patients (6.9%) had some portion of the hydrogel injected into the rectal wall, but it was never clinically significant. The average CCI was 3.2 ± 0.95 for patients who experienced complications; the average CCI was 3.6 ± 1.6 (p = 0.48) in the group without complications. Of the physicians with higher procedure volumes, Physician #1 had the highest rate of patient‐reported complications at 11 out of 68 (16.2%) and Physician #2 had the lowest rate of complications at 4 out of 96 placements (4.2%). Multivariate analysis found that patients who had received hormone therapy previously had less odds of reporting complications after SpaceOAR placement. Conclusions. The listed attending on the procedure had a significant correlation to complications with SpaceOAR placement on univariate analysis, and hormone therapy had some benefits to the tolerance for the procedure on multivariate analysis. Overall, the hydrogel placement was well tolerated with low incidence of mild and transient procedure‐related toxicity.

Primary adrenal angiosarcoma is an extremely rare malignant tumor with challenging diagnosis. A 66-year-old woman had a 4.3 cm right adrenal mass suspicious for adrenal cortical carcinoma. Pathological examination demonstrated a hemorrhagic adrenal cyst with numerous irregularly shaped anastomosing vascular channels lined by atypical endothelial cells that had frequent atypical mitotic figures (12/10 HPF, Ki67 10%). The tumor cells were positive for CD31, ERG, and FLI-1, but negative for adrenal and other tumor lineage markers by immunohistochemistry. NGS fusion gene testing ruled out epithelioid hemangioendothelioma. Accurate diagnosis and differential inclusion are important for appropriate treatment of this rare tumor.

3D printing is a growing tool in surgical education to visualize and teach complex procedures. Previous studies demonstrating the usefulness of 3D models as teaching tools for partial nephrectomy used highly detailed models costing between $250 and 1000. We aimed to create thorough, inexpensive 3D models to accelerate learning for trainees and increase health literacy in patients. Patient-specific, cost-effective ($30–50) 3D models of the affected urologic structures were created using pre-operative imaging of 40 patients undergoing partial nephrectomy at Thomas Jefferson University Hospital (TJUH) between July 2020 and May 2021. Patients undergoing surgery filled out a survey before and after seeing the model to assess patient understanding of their kidney, pathophysiology, surgical procedure, and risks of surgery. Three urological residents, one fellow, and six attendings filled out separate surveys to assess their surgical plan and confidence before and after seeing the model. In a third survey, they ranked how much the model helped their comprehension and confidence during surgery. Patient understanding of all four subjects significantly improved after seeing the 3D model (P < 0.001). The urology residents (P < 0.001) and fellow (P < 0.001) reported significantly increased self-confidence after interacting with the model. Attending surgeon confidence increased significantly after seeing the 3D model (P < 0.01) as well. Cost-effective 3D models are effective learning tools and assist with the evaluation of patients presenting with renal masses, and increase patient, resident, and fellow understanding in partial nephrectomies. Further research should continue to explore the utility of inexpensive models in other urologic procedures.

10598 Background: Germline genetic testing is important for prostate cancer management, clinical trial eligibility and hereditary cancer risk assessment. Despite this, genetic testing is underutilized and there is a shortage of genetic counselors. To address these gaps, we designed a webtool to provide patient-driven genetic education and conducted a randomized non-inferiority trial to compare it with traditional pre-test genetic counseling. Methods: TARGET is a multi-center randomized controlled trial comparing standard pre-test genetic counseling versus web-based genetic education (intervention) (NCT04447703). The study protocol was previously published (PMID 35710085). Briefly, patients with prostate cancer who met criteria for germline testing (based on tumor features, ancestry or family history) were randomized to pre-test genetic education through genetic counseling vs a 9-module webtool created by the study team and Prostate Cancer Foundation. The primary endpoint was non-inferiority in reducing decisional conflict between the webtool and genetic counseling by a margin of 4 (set in advance) on the validated Decision Conflict Scale. Analysis of covariance was used to compare decisional conflict between groups. All participants opting for testing received a 51-gene Invitae panel, with results delivered to the patient and their provider. Results: 346 patients with prostate cancer with a mean age of 63.7 years were randomized to genetic counseling (n=174) or web-based genetic education (n=172). Compared to baseline, there were reductions in decisional conflict in both arms following pre-test genetic education (Table). Adjusting for study site and baseline decisional conflict, the test of non-inferiority in reducing decisional conflict between arms was statistically significant (difference = -0.04, 95% CI: -∞ to 1.95, p<0.001). Overall 265 (76.6%) participants underwent genetic testing, including 146 (83.9%) in the genetic counseling and 119 (69.2%) in webtool arm, with the following results: negative (49.4%), variant of uncertain significance (35.5%) and pathogenic variant (15.1%). Conclusions: Delivery of pre-test genetic education through a webtool was non-inferior to genetic counseling in reducing decisional conflict. These results support a new standard of care for the use of patient-driven digital webtools for expanding access to pretest genetic education and informed decision-making for prostate cancer genetic testing. Clinical trial information: NCT04447703 . [Table: see text]

p[0.001), total length GP4 (HR[2.48; 95% CI 1.36e4.52; p[0.003), and total length GP4 in highest core (HR[1.32; 95% CI 1.11e1.57; p[0.001)dwere significantly associated with BCR. Models including all methods of GP4 quantification resulted in a meaningful increase in discrimination of BCR risk, with similar gains in Harrell's C-index ranging from 0.017 to 0.019. CONCLUSIONS: These findings further support routine reporting of and inclusion of GP4 quantification in pathology reports and risk prediction models for patients with Grade Group 2 prostate cancer. These data also support studying GP4 quantification as a surrogate endpoint for disease progression for trials, including those of men managed with active surveillance.

BJU InternationalVolume 130, Issue 2 p. 181-185 Case of the Month Case of the month from the Thomas Jefferson Sidney Kimmel medical college, Philadelphia, USA. Prostatic abscess and advanced prostate cancer: considering malignancy in the differential diagnosis Adam Schneider, Adam Schneider orcid.org/0000-0002-0923-7130 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USASearch for more papers by this authorJessica Bulafka, Corresponding Author Jessica Bulafka jessica.bulafka@students.jefferson.edu orcid.org/0000-0002-2865-073X Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA Correspondence: Jessica Bulafka, Department of Urology, Thomas Jefferson University Hospital, 215-584-1825 315 New St Apt 317 Philadelphia, PA 19106, USA. e-mail: jessica.bulafka@students.jefferson.eduSearch for more papers by this authorMaria F. Arisi, Maria F. Arisi Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USASearch for more papers by this authorLi Li, Li Li Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USASearch for more papers by this authorMark Mann, Mark Mann Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USASearch for more papers by this authorThenappan Chandrasekar, Thenappan Chandrasekar Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USASearch for more papers by this author Adam Schneider, Adam Schneider orcid.org/0000-0002-0923-7130 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USASearch for more papers by this authorJessica Bulafka, Corresponding Author Jessica Bulafka jessica.bulafka@students.jefferson.edu orcid.org/0000-0002-2865-073X Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA Correspondence: Jessica Bulafka, Department of Urology, Thomas Jefferson University Hospital, 215-584-1825 315 New St Apt 317 Philadelphia, PA 19106, USA. e-mail: jessica.bulafka@students.jefferson.eduSearch for more papers by this authorMaria F. Arisi, Maria F. Arisi Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USASearch for more papers by this authorLi Li, Li Li Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USASearch for more papers by this authorMark Mann, Mark Mann Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USASearch for more papers by this authorThenappan Chandrasekar, Thenappan Chandrasekar Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USASearch for more papers by this author First published: 15 July 2022 https://doi.org/10.1111/bju.15763 M.M. and T.C. senior author. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume130, Issue2August 2022Pages 181-185 RelatedInformation

You have accessJournal of UrologyCME1 May 2022MP33-04 CONTRAST-ENHANCED ULTRASONOGRAPHY FOR THE EVALUATION OF COMPLEX RENAL CYSTS Cassra Clark, Corinne Wessner, Shuo Wang, Andrew Denisenko, Andrew Shumaker, Joonyau Leong, Andrea Quinn, Erica Mann, Lydia Glick, Timothy Han, Kibo Nam, Katherine Smentkowski, John Eisenbrey, Leonard Gomella, Edouard Trabulsi, Costas Lallas, Mark Mann, James Mark, Flemming Forsberg, Andrej Lyshchik, Ethan Halpern, and Thenappan Chandrasekar Cassra ClarkCassra Clark More articles by this author , Corinne WessnerCorinne Wessner More articles by this author , Shuo WangShuo Wang More articles by this author , Andrew DenisenkoAndrew Denisenko More articles by this author , Andrew ShumakerAndrew Shumaker More articles by this author , Joonyau LeongJoonyau Leong More articles by this author , Andrea QuinnAndrea Quinn More articles by this author , Erica MannErica Mann More articles by this author , Lydia GlickLydia Glick More articles by this author , Timothy HanTimothy Han More articles by this author , Kibo NamKibo Nam More articles by this author , Katherine SmentkowskiKatherine Smentkowski More articles by this author , John EisenbreyJohn Eisenbrey More articles by this author , Leonard GomellaLeonard Gomella More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Costas LallasCostas Lallas More articles by this author , Mark MannMark Mann More articles by this author , James MarkJames Mark More articles by this author , Flemming ForsbergFlemming Forsberg More articles by this author , Andrej LyshchikAndrej Lyshchik More articles by this author , Ethan HalpernEthan Halpern More articles by this author , and Thenappan ChandrasekarThenappan Chandrasekar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002587.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complex renal cysts are evaluated using the Bosniak classification system. However, they remain difficult to manage because inter-reader variability and subjective interpretation of the Bosniak system. This pilot study intends to evaluate the use of contrast-enhanced ultrasonography (CEUS) to differentiate the solid and cystic components of complex renal cysts and compare these results to the final surgical pathology report. METHODS: 23 patients undergoing surgery for Bosniak 2F-4 lesions participated in this IRB-approved pilot study. Patients were scanned prior to surgery with both 2D and 3D ultrasound exams. Each injection consisted of a 2.0 mL bolus injection of Lumason contrast (Bracco Imaging, Monroe Township, NJ) followed by a 10 mL saline flush. A custom MATLAB program was used for selection of regions of interest (ROIs) (Figure 1). Fractional tumor vascularity (FTV in %) was then calculated and compared to estimated solid component on the final pathology report.Fractional Tumor Vascularity = 1 − (Total Non-enhancing area/Total lesion area) The primary endpoint of this study was the correlation of 2D/3D-derived fractional vascularity with pathological estimation and tumor staging on explant. RESULTS: No adverse events were observed during any contrast agent administration. Data was analyzed on 22 of 23 patients (Patient 22 excluded due to poor image quality). Mean age was 60.9±15.0 years (range 30 to 85) and mean preoperative lesion size was 4.0±1.6 cm (range 1.2 to 8.3 cm). Nine patients had radical nephrectomies and 14 had a partial nephrectomy. On final pathology, 4 lesions were benign and 19 were malignant. The results of 2D and 3D analysis as well as final pathology are included in Table 1. In general, malignant lesions and more aggressive histology had higher FTV. CONCLUSIONS: Quantitative 2D and 3D CEUS can evaluate FTV of potentially malignant complex cystic renal masses, which may be able to augment current radiographic classification systems. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e570 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassra Clark More articles by this author Corinne Wessner More articles by this author Shuo Wang More articles by this author Andrew Denisenko More articles by this author Andrew Shumaker More articles by this author Joonyau Leong More articles by this author Andrea Quinn More articles by this author Erica Mann More articles by this author Lydia Glick More articles by this author Timothy Han More articles by this author Kibo Nam More articles by this author Katherine Smentkowski More articles by this author John Eisenbrey More articles by this author Leonard Gomella More articles by this author Edouard Trabulsi More articles by this author Costas Lallas More articles by this author Mark Mann More articles by this author James Mark More articles by this author Flemming Forsberg More articles by this author Andrej Lyshchik More articles by this author Ethan Halpern More articles by this author Thenappan Chandrasekar More articles by this author Expand All Advertisement PDF DownloadLoading ...

Introduction: Wallis et al (JAMA 2017) demonstrated use of antithrombotic medications (ATMs) is associated with increased prevalence of hematuria-related complications and subsequent bladder cancer diagnosis within 6 months. Stage of diagnosis was lacking in this highly publicized study. This study examined the association of ATM use on bladder cancer stage at the time of diagnosis. Materials and methods: We completed a retrospective chart review of patients with a bladder cancer diagnosis at our institution. Patient demographics and bladder cancer work up information were assessed. Patients were stratified based on use of ATMs at time diagnosis. Descriptive statistics were completed to identify association between ATM use and stage of bladder cancer diagnosis, as stratified by non-muscle invasive bladder cancer (NMIBC) versus muscle invasive bladder cancer (MIBC). Results: A total of 1052 patient charts were reviewed. Eight hundred and forty-four were included and 208 excluded due to unavailability of diagnosis history. At diagnosis, 357 (42.3%) patients were taking ATMs. Patients on ATMs presented with NMIBC at similar rates as patients not taking ATMs (81.2% vs. 77.8%, p = 0.23). Subgroup analysis by ATM class similarly demonstrated no statistically significant differences in staging. Conclusion: While Wallis et al established that patients on blood thinners who present with hematuria are more likely to be diagnosed with genitourinary pathology, this factor does not appear to enable an earlier diagnosis of bladder cancer. Future study may assess hematuria at presentation (gross, microscopic), type of blood thinners, and low versus high risk NMIBC presentation.

You have accessJournal of UrologyEducation Research I (PD02)1 Sep 2021PD02-03 ASSESSING THE EDUCATIONAL IMPACT OF 3D PRINTED MODELS ON RESIDENT, FELLOW, AND PATIENT EDUCATION FOR PARTIAL NEPHRECTOMIES E. Reilly Scott, Andrea Quinn, Samuel Morano, Alice Karp, Erica Mann, Kaitlyn Boyd, Abhay Singh, Thenappan Chandrasekar, Mark J. Mann, Edouard Trabulsi, Vishal Desai, and Costas Lallas E. Reilly ScottE. Reilly Scott More articles by this author , Andrea QuinnAndrea Quinn More articles by this author , Samuel MoranoSamuel Morano More articles by this author , Alice KarpAlice Karp More articles by this author , Erica MannErica Mann More articles by this author , Kaitlyn BoydKaitlyn Boyd More articles by this author , Abhay SinghAbhay Singh More articles by this author , Thenappan ChandrasekarThenappan Chandrasekar More articles by this author , Mark J. MannMark J. Mann More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Vishal DesaiVishal Desai More articles by this author , and Costas LallasCostas Lallas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001966.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 3D printing is a growing tool in surgical education with the ability to visualize and teach complex procedures from multiple angles. Previous studies using highly detailed and expensive 3D models costing between $250-1000 demonstrated 3D models as useful teaching tools for partial nephrectomy for patient and trainee education. We aimed to create a less expensive and simpler 3D model to encourage these learning opportunities in a greater range of patients undergoing robotic partial nephrectomy. METHODS: Patient-specific, cost-effective 3D models of the affected urologic structures were created using preoperative imaging of 22 patients undergoing partial nephrectomies at Thomas Jefferson University Hospital between July 2020 and January 2021. The total cost for each model was $35-50. Patients receiving the surgery filled out two surveys about their understanding of their kidney, pathophysiology, surgical procedure, and risks before and after seeing the model. Three urological residents and one fellow filled out separate surveys to assess their surgical plan and confidence in the chosen surgical plan before and after seeing the model. Residents and fellows filled out a third survey after surgery ranking how much the model helped their comprehension and confidence during surgery on a scale of 1 to 10 (1=not helpful; 10=extremely helpful). RESULTS: 20 of the 22 patients filled out both surveys. Patient understanding of their kidney, disease, surgery, and risk all significantly improved after seeing the 3D model (p<.001). Urology residents and fellows filled out both pre-surgical surveys for 19 and 18 cases, respectively. Both residents (p<.001) and fellows (p<.01) reported increased self-confidence following seeing the model. Following surgery, the residents rated how much the model increased their comprehension and confidence 7.7 and 7.1 out of 10, respectively. The fellow rated increased comprehension and confidence 6.6 and 6.7 out of 10, respectively. CONCLUSIONS: Cost-effective 3D models could become part of standard of care as learning tools to increase patient, resident, and fellow understanding in robotic partial nephrectomies. Further research should continue to explore the utility of 3D models as a pre-operative educational tool for both patients and trainees in other Urologic procedures. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e38-e38 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information E. Reilly Scott More articles by this author Andrea Quinn More articles by this author Samuel Morano More articles by this author Alice Karp More articles by this author Erica Mann More articles by this author Kaitlyn Boyd More articles by this author Abhay Singh More articles by this author Thenappan Chandrasekar More articles by this author Mark J. Mann More articles by this author Edouard Trabulsi More articles by this author Vishal Desai More articles by this author Costas Lallas More articles by this author Expand All Advertisement PDF downloadLoading ...

PURPOSE Germline testing (GT) for prostate cancer (PCA) is now central to treatment and hereditary cancer assessment. With rising demand for and shortage of genetic counseling (GC), tools to deliver pretest informed consent across practice settings are needed to improve access to GT and precision care. Here, we report on Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWER), a patient-choice study for pretest video-based genetic education (VBGE) versus GC to inform urgent practice needs. PATIENTS AND METHODS Men with PCA or at risk for PCA (family history of PCA) were eligible and could choose pretest VBGE or GC. Outcomes included decisional conflict for GT, change in genetics knowledge, satisfaction, and intention to share results with family and/or providers. Descriptive statistics summarized results with counts and percentages for categorical variables and mean ± standard deviation for continuous variables. Data were compared with Fisher's exact, chi-squared, or Wilcoxon two-sample tests. Mean change in genetics knowledge was compared with t tests. The significance level was set a priori at .05. RESULTS Data on the first 127 participants were analyzed. Characteristics were White (85.8%), bachelor's degree (66.9%), and PCA diagnosis (90.6%). The majority chose VBGE (71%) versus GC (29%; P < .001). No differences were observed in decisional conflict for GT or satisfaction. Cancer genetics knowledge improved in both groups without significant difference (+0.9 VBGE, +1.8 GC, P = .056). Men who chose VBGE had higher intention to share GT results (96.4% VBGE v 86.4% GC, P = .02). Both groups had high rates of GT uptake (VBGE 94.4%, GC 92%). CONCLUSION A substantial proportion of men opted for pretest VBGE, with comparable patient-reported outcomes and uptake of GT. The results support the use of pretest video to address the critical GC shortage in the precision era.

PURPOSE Germline testing (GT) is a central feature of prostate cancer (PCA) treatment, management, and hereditary cancer assessment. Critical needs include optimized multigene testing strategies that incorporate evolving genetic data, consistency in GT indications and management, and alternate genetic evaluation models that address the rising demand for genetic services. METHODS A multidisciplinary consensus conference that included experts, stakeholders, and national organization leaders was convened in response to current practice challenges and to develop a genetic implementation framework. Evidence review informed questions using the modified Delphi model. The final framework included criteria with strong (> 75%) agreement (Recommend) or moderate (50% to 74%) agreement (Consider). RESULTS Large germline panels and somatic testing were recommended for metastatic PCA. Reflex testing—initial testing of priority genes followed by expanded testing—was suggested for multiple scenarios. Metastatic disease or family history suggestive of hereditary PCA was recommended for GT. Additional family history and pathologic criteria garnered moderate consensus. Priority genes to test for metastatic disease treatment included BRCA2, BRCA1, and mismatch repair genes, with broader testing, such as ATM, for clinical trial eligibility. BRCA2 was recommended for active surveillance discussions. Screening starting at age 40 years or 10 years before the youngest PCA diagnosis in a family was recommended for BRCA2 carriers, with consideration in HOXB13, BRCA1, ATM, and mismatch repair carriers. Collaborative (point-of-care) evaluation models between health care and genetic providers was endorsed to address the genetic counseling shortage. The genetic evaluation framework included optimal pretest informed consent, post-test discussion, cascade testing, and technology-based approaches. CONCLUSION This multidisciplinary, consensus-driven PCA genetic implementation framework provides novel guidance to clinicians and patients tailored to the precision era. Multiple research, education, and policy needs remain of importance.

Introduction: To assess whether standard American Urological Association (AUA) and other recommendations for prostate biopsy prophylaxis provide sufficient coverage of common urinary organisms responsible for post biopsy infections by comparing local antibiograms in Philadelphia-area hospitals. Materials and methods: De-identified culture results derived from antibiograms were collected from six academic and community hospitals in the Philadelphia region. Analysis specifically focused on four major bacterial causes of urinary tract infection following prostate biopsy (Escherichia coli (E. coli), Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis) along with commonly recommended antibiotics including fluoroquinolones (FQ's), trimethoprim/sulfamethoxazole, ceftriaxone, and gentamicin. Results: Bacterial sensitivities to each antibiotic across institutions showed variation in E.coli sensitivities to FQs (p < 0.001), trimethoprim/sulfamethoxazole (p < 0.001), ceftriaxone (p < 0.001) and gentamicin (p < 0.001). Klebsiella pneumoniae and Proteus mirabilis exhibited similar variations. Sensitivity comparisons for Enterococcus faecalis was unable to be performed due to absent or incomplete data across institutions. Conclusion: Institutional antibiograms vary within our regional hospitals. Standardized recommendations for commonly used antibiotic prophylaxis such as fluoroquinolones may be inadequate for peri-procedural prostate biopsy prophylaxis based on local resistance patterns. Valuable information about the potential effectiveness of antibiotic prophylaxis for prostate biopsies can be found in local institutional antibiograms, and should be consulted when considering antibiotic prophylaxis for prostate biopsy procedures.

INTRODUCTION AND OBJECTIVE:Research productivity amongst academic urologists is strongly encouraged, but little data is available on productivity metrics within the field of urology. We provide the...

INTRODUCTION:To evaluate the impact of an 'opt-in' non-narcotic postoperative pain regimen on narcotic utilization and patient-reported pain scores.MATERIALS AND METHODS:A prospective, non-blinded pre- and post-interventional trial was conducted, including a lead-in period for baseline evaluation. The intervention group received a new pain protocol prioritizing non-narcotic medications, an 'opt-in' requirement for opiates, and standardized patient education. Study outcomes included opiate prescription and utilization (measured in Morphine Equivalent Doses) and reported pain scores on postoperative day (POD) 1, discharge and follow up.RESULTS:At discharge, 70% fewer patients were prescribed any opioids (ARR: -0.7; p < 0.001); the amount prescribed was reduced by 95% (pre-intervention 69.3 mg versus post-intervention 3.5 mg, p < 0.001). Mean opioids used following discharge decreased by 76% (14.7 mg versus 3.5 mg, p = 0.011). In a subgroup analysis of robotic prostatectomies, there was a 95% reduction in mean opioids prescribed at discharge (64.6 mg versus 3.2 mg, p < 0.001) and 82% reduction in utilization over entire postoperative course (87.6 mg versus 15.7 mg, p = 0.001). There was no significant difference in pain scores between intervention groups at POD 1, discharge and follow up for patients (entire cohort and post-prostatectomy).CONCLUSION:A standardized pain protocol with 'opt-in' requirements for opiate prescription, emphasis on non-narcotic medications, and patient education, resulted in significant reductions in opioid use. Simple frameshifts in pain management can yield significant gains in the opioid epidemic.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III (MP66)1 Apr 2020MP66-11 HOW TO PREVENT PROSTATE BIOPSY COMPLICATIONS: TO AUGMENT OR TO SWAB? Lydia Glick*, Timothy M. Han, Christopher Caputo, Danielle Squadrito, Joon Yau Leong, Claudette Fonshell, Kaynaat Syed, John Danella, Serge Ginzburg, Thomas J. Guzzo, Thomas Lachoney, Jay D. Raman, Marc C. Smaldone, Robert Uzzo, Jeffrey Tomaszewski, Adam C. Reese, Edouard J. Trabulsi, Leonard G. Gomella, and Mark J. Mann Lydia Glick*Lydia Glick* More articles by this author , Timothy M. HanTimothy M. Han More articles by this author , Christopher CaputoChristopher Caputo More articles by this author , Danielle SquadritoDanielle Squadrito More articles by this author , Joon Yau LeongJoon Yau Leong More articles by this author , Claudette FonshellClaudette Fonshell More articles by this author , Kaynaat SyedKaynaat Syed More articles by this author , John DanellaJohn Danella More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , Thomas J. GuzzoThomas J. Guzzo More articles by this author , Thomas LachoneyThomas Lachoney More articles by this author , Jay D. RamanJay D. Raman More articles by this author , Marc C. SmaldoneMarc C. Smaldone More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Jeffrey TomaszewskiJeffrey Tomaszewski More articles by this author , Adam C. ReeseAdam C. Reese More articles by this author , Edouard J. TrabulsiEdouard J. Trabulsi More articles by this author , Leonard G. GomellaLeonard G. Gomella More articles by this author , and Mark J. MannMark J. Mann More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000941.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate biopsies are the current gold standard for the diagnosis of prostate cancer, but there is a lack of consensus regarding optimal prophylactic approach for infection prevention. Urology guidelines suggest a single agent or targeted therapy based on rectal swab cultures, balancing patient safety with antibiotic stewardship. The goal of this study was to determine if one prophylaxis method was superior to another at preventing infectious outcomes. METHODS: Data collected from the Pennsylvania Urologic Regional Collaborative was analyzed for patient, prostate and biopsy characteristics. Special attention was paid to antibiotic prophylaxis pathway: patients received “Culture-Directed” (based on rectal swab culture), “Augmented” (baseline antibiotic + another based on local antibiogram) or no specific antibiotic pathway. A univariate and multivariate analysis assessed predictors of infectious outcome including fever, urinary tract infection or sepsis. A Chi-square test was used to compare association between each prophylaxis pathway and occurrence of emergency department visit or readmission secondary to biopsy complication within 30 days. RESULTS: Data from 11,941 biopsies was collected. Predictors of infectious outcomes included a history of diabetes. Type of antibiotic prophylaxis pathway was not predictive of infectious outcome on multivariate analysis (Table 1). Chi-square analysis revealed a significant association (p < 0.001) between prophylaxis pathway and both ED visit and readmission within 30 days (Table 2). CONCLUSIONS: Antibiotics pathway was not associated with infectious outcome. However, hospital readmission and ED visit following biopsy were associated with type of antibiotic prophylaxis pathway used. Emergency visits and readmission may be an additional way to capture adverse events. Efforts to integrate culture-directed prophylaxis into urologic practices should be considered to benefit patient outcomes and limit antibiotic resistance. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e987-e987 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lydia Glick* More articles by this author Timothy M. 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