ABSTRACTIntroductionPSA screening remains a pivotal tool for early prostate cancer (PCa) detection. International guidelines rely on evidence from three major randomized clinical trials: ERSPC, PLCO, and CAP. We aim to examine the percentage of patients in real‐world practice who get PSA screening as defined by each of the aforementioned trials. Moreover, we seek to evaluate if the different PSA screening patterns have a different impact on PCa incidence and its features at diagnosis.Materials and MethodsOur institutional database was queried to identify men aged 55–69 who received at least one PSA test, did not develop PCa or die within 6 years of the initial test, had follow‐up within our system at least 6 years after the initial test, and did not have a previous PCa diagnosis. A total of 28,612 patients met our selection criteria. We categorized patients into three distinct PSA screening patterns based on testing frequency (PLCO: 1 PSA test per year for 6 years; ERSPC: 2 or 3 PSA tests over 6 years; CAP: 1 PSA test over 6 years). Our primary outcomes were any PCa incidence and clinically significant PCa (csPCa, defined as ISUP ≥ 3) incidence. Secondary outcome was the rate of cM1 disease. Competing risks cumulative incidence curves were used to depict any PCa and csPCa diagnosis with death before a diagnosis considered a competing risk. Multivariable competing risks regression (CRR) was used to assess the impact of the different screening patterns on any PCa and csPCa incidence, after adjusting for confounding factors.ResultsThe most prevalent PSA screening pattern was ERSPC, including 15,530 patients (54.3%), followed by the CAP with 9003 patients (31.5%), and the PLCO with only 4079 patients (14.2%). The median (IQR) follow‐up time was 4.8 (1.7–10.8) years. At 10 years, any PCa incidence was 7.4% versus 5.6% versus 2.5% for PLCO versus ERSPC versus CAP, respectively, while for csPCa, the rates were 2.5% versus 2.5% versus 1.2% (both p < 0.001). On multivariable analyses, PLCO and ERSPC patterns were associated with 2.92‐fold and 2.31‐fold higher risks from 1 year to the next of any PCa diagnosis, respectively, compared to CAP pattern (both p < 0.001). Similarly, patients with PLCO and ERSPC patterns had 2.07‐fold and 2.31‐fold higher risks, respectively, of csPCa diagnosis compared to CAP pattern (both p < 0.001). In men with PCa diagnosis, the rates of cM1 disease were respectively 1.7% vs 5.6% vs 10.8% for PLCO versus ERSPC versus CAP, respectively (p = 0.0009).ConclusionWe observed that the most common screening pattern in “real‐world” clinical practice is close to what ERSPC recommend, and this pattern seems to achieve a reasonable reduction in the risk of advanced PCa, while limiting overdiagnosis.

To assess the utilization and prostate cancer (PCa)-specific mortality (PCSM) between non-Hispanic Black (NHB) and non-Hispanic White (NHW) on active surveillance (AS) with intermediate risk PCa (iPCa). The Surveillance, Epidemiology, and End Results database was queried between 2010–2016. The rate of AS was calculated per year between NHB and NHW using univariable logistic analysis (UVA) and multivariable logistic analysis (MVA). Next, inverse probability of treatment weighting was performed on those that underwent watchful waiting (WW) and competing-risks cumulative incidence function (CIF) and MVA were used to assess the impact of race on other-cause mortality (OCM) and PCSM. Statistical significance defined as p < 0.05, but some observations were deemed non-statistically significant per our Benjamini–Hochberg procedures, 50,315 patients had iPCa, and 3,310 underwent AS/WW. The rate of AS increased amongst NHB (+ 3.1

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP19)1 May 2024MP19-03 TESTING FREE PSA PERCENTAGE AS A TOOL IN PREDICTING FUTURE RISK OF DEVELOPING PROSTATE CANCER: A SYSTEM WIDE ANALYSIS OF A CONTEMPORARY NORTH AMERICAN COHORT Giuseppe O. Cirulli, Giuseppe Chiarelli, Marco Finati, Alex Stephens, Sohrab Arora, Patrick Etta, Davis Matthew, Shane Tinsley, Chase Morrison, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Giuseppe Carrieri, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Craig Rogers, and Firas Abdollah Giuseppe O. CirulliGiuseppe O. Cirulli , Giuseppe ChiarelliGiuseppe Chiarelli , Marco FinatiMarco Finati , Alex StephensAlex Stephens , Sohrab AroraSohrab Arora , Patrick EttaPatrick Etta , Davis MatthewDavis Matthew , Shane TinsleyShane Tinsley , Chase MorrisonChase Morrison , Akshay SoodAkshay Sood , Nicolò BuffiNicolò Buffi , Giovanni LughezzaniGiovanni Lughezzani , Giuseppe CarrieriGiuseppe Carrieri , Andrea SaloniaAndrea Salonia , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Craig RogersCraig Rogers , and Firas AbdollahFiras Abdollah View All Author Informationhttps://doi.org/10.1097/01.JU.0001008716.22569.77.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Free PSA percentage (%fPSA) has been proposed by AUA Guidelines as a useful serum marker in guiding biopsy decisions when further risk stratification is needed, especially in patients with mildly elevated PSA. On the other hand, it is not explicitly recommended to consider %fPSA as a tool to guide future PSA screening. We aimed to examine the potential role of %fPSA in predicting future development of PCa in a contemporary North American population. METHODS: Men aged 40–59 years, who received their %fPSA between the years 1995 and 2019 were included. These selection criteria resulted in a total of 1,308 patients. Based on previously published methodology, Free PSA % was categorized in 3 different groups (<10%, 10% to 25% and >25%). Main outcome was PCa incidence. Cumulative incidence curves were used to depict the risk of deveoloping PCa over time, based on %fPSA categories. Multivariable Fine-Gray regression was used to examine the role of %fPSA as a predictor of future development of PCa after adjusting for available confounders. RESULTS: In our cohort, patients were most frequently in the 55–59 age category (33.4%), had a CCI of 0 (67.1%), and were white (75.6%). Most patients (68.8%) had a %fPSA between 10% and 25%. The median (IQR) follow-up time was 2.9 (0.9-5.1) years. Within this period, 228 (17.4%) patients, developed PCa. At 5-year the risk of developing PCa in patients with a %fPSA <10% vs 10%-25% vs >25%, was 22.8% vs 8.9% vs 3.1%, respectively (p<0.001). On multivariable analysis, patients with a %fPSA <10%, had a 6.21-fold (95% CI: 3.62-10.64) higher risk of developing PCa when compared to those with a %fPSA >25% (p: <0.01). CONCLUSIONS: Our report is the first to examine the role of %fPSA in the PSA screening context. Our findings showed that %fPSA measured in men without PCa is an important predictor of the future risk of developing PCa. This suggests that %fPSA has practical utility in enhancing PSA screening strategies in clinical practice, where patients with highest risk of developing PCa can receive more intese screening, and vice versa. Download PPT Source of Funding: Vattikuti foundation and Menon foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e310 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Giuseppe O. Cirulli More articles by this author Giuseppe Chiarelli More articles by this author Marco Finati More articles by this author Alex Stephens More articles by this author Sohrab Arora More articles by this author Patrick Etta More articles by this author Davis Matthew More articles by this author Shane Tinsley More articles by this author Chase Morrison More articles by this author Akshay Sood More articles by this author Nicolò Buffi More articles by this author Giovanni Lughezzani More articles by this author Giuseppe Carrieri More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD13)1 May 2024PD13-04 ACTIVE SURVEILLANCE FOR PROSTATE CANCER IN "REAL-WORLD" SETTING: EXPLORING RACIAL DISPARITIES IN SURVEILLANCE INTENSITY AND CANCER CONTROL OUTCOMES Giuseppe Chiarelli, Alex Stephens, Marco Finati, Giuseppe O. Cirulli, Mohit Butaney, Sohrab Arora, Shane Tinsley, Patrick Etta, Akshay Sood, Giuseppe Carrieri, Alberto Briganti, Francesco Montorsi, Giovanni Lughezzani, Nicolò Buffi, Craig Rogers, and Firas Abdollah Giuseppe ChiarelliGiuseppe Chiarelli , Alex StephensAlex Stephens , Marco FinatiMarco Finati , Giuseppe O. CirulliGiuseppe O. Cirulli , Mohit ButaneyMohit Butaney , Sohrab AroraSohrab Arora , Shane TinsleyShane Tinsley , Patrick EttaPatrick Etta , Akshay SoodAkshay Sood , Giuseppe CarrieriGiuseppe Carrieri , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Giovanni LughezzaniGiovanni Lughezzani , Nicolò BuffiNicolò Buffi , Craig RogersCraig Rogers , and Firas AbdollahFiras Abdollah View All Author Informationhttps://doi.org/10.1097/01.JU.0001009552.62973.71.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Black men have worse outcomes from prostate cancer (PCa) compared to White men. This is, at least partially, due to the racial disparity and health care delivery. Our aim was to evaluate the impact of race on surveillance intensity and Prostate Cancer Specific Mortality (PCSM) in patients on AS for PCa in a contemporary, real-world North American cohort. METHODS: We utilized our institutional database which was built by interrogating our electronic medical records for all men who got diagnosed with PCa within Henry Ford Health. Our cohort included White and Black men aged<76 years, who had a diagnosis of PCa Gleason Grade (GG) 1 or 2, with clinical stage2 was reported in 44.1% of Black patients and 31.2% of White patients (p<0001). Median PSA at diagnosis was 5.7 (4.6-8.0) ng/ml in Black patients and 5.0 (4.0-6.6) ng/ml in White patients (p<0.0001). The rate of GG 2 was higher in Black than in White patients (43,6% vs 30.1%, p<0.0001). Follow-up time was 6 years (2.5-9.6). Median PSAs testing/years after diagnosis was 1.4 (0.6-2.5) for Black patients and 1.6 (0.6-3.2) for Black patients (p<0.05). The rate of patients who underwent more than one biopsy after diagnosis was 14.6% of Black and 22.6% of White patients (p<0.001). In the overall period, PCSM was 4.1% in Black and 1.6% in White patients (p<0.01). The cumulative incidence of PCSM at 10 years was double for Black patients compared to White patients (5.2% vs 2.6% CI 95%, p=0.0502). At MVA Black patients had 2.1 folds higher PCSM than White patients (p=0.08). CONCLUSIONS: Black patients on AS tend to have more aggressive disease at diagnosis and seem to undergo less PSA testing and post-diagnosis biopsies. This might, at least partially, be explained by higher PCSM in Black patients on AS that we observed in our cohort. Our report is one of few examining the intensity and outcomes of AS in real-world practice with a focus on racial disparities. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e263 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Giuseppe Chiarelli More articles by this author Alex Stephens More articles by this author Marco Finati More articles by this author Giuseppe O. Cirulli More articles by this author Mohit Butaney More articles by this author Sohrab Arora More articles by this author Shane Tinsley More articles by this author Patrick Etta More articles by this author Akshay Sood More articles by this author Giuseppe Carrieri More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Giovanni Lughezzani More articles by this author Nicolò Buffi More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND:Previous studies found that Midlife Baseline PSA (MB PSA) predicts the risk of developing lethal prostate cancer (PCa), although the cohorts were homogenous in terms of racial compositions. We aimed to investigate racial disparities in the predictive value of MB PSA for lethal PCa in a diverse, contemporary, North American population. METHODS:Our cohort included White and Black men aged 40-59 years, who underwent MB PSA through our health system. Cumulative incidence curves depicted lethal PCa stratified by race and MB PSA above/below the median. We utilized time-dependent Receiver Operating Characteristic (ROC) curves and Area Under the ROC Curve (AUC) to compare the performance of MB PSA in predicting lethal PCa based on race. Multivariable regression (MVA) was used to examine the impact of the MB PSA in predicting lethal PCa by race. RESULTS:We included 112,967 men, of whom 27% were Black. The cumulative incidence estimate with MB PSA values equal to the median at 15 years of follow-up was 0.13 (0.04, 0.32) for White men and 0.55 (0.24, 1.11) for Black men. AUCs comparison showed no statistically significant differences in the predictive role of MB PSA for lethal PCa between White and Black men. At MVA, using White patients with PSA ≤ median as the reference group, the HR of lethal PCa for White men with PSA > median aged 40-44, 45-49, 50-54, and 55-59 was respectively 2.98 (1.59-5.57), 3.01 (1.89-4.81), 5.10 (3.38-7.70), and 3.38 (2.32-4.92). While for Black men was respectively 5.50 (2.94-10.27), 4.19 (2.59-6.78), 9.79 (6.37-15.04), and 7.53 (5.03-11.26) (all p < 0.001). CONCLUSION:Our findings indicate that for the same MB PSA and within the same age category, Black men have a greater risk of developing lethal PCa than White men. A separate cut-off should be created for MB PSA, if this is to be used to guide PSA screening in clinical practice.

Purpose This study examined the impact of cannabis use disorder (CUD) on inpatient morbidity, length of stay (LOS), and inpatient cost (IC) of patients undergoing urologic oncologic surgery. Methods The National Inpatient Sample (NIS) from 2003 to 2014 was analyzed for patients undergoing prostatectomy, nephrectomy, or cystectomy (n = 1,612,743). CUD was identified using ICD-9 codes. Complex-survey procedures were used to compare patients with and without CUD. Inpatient major complications, high LOS (4th quartile), and high IC (4th quartile) were examined as endpoints. Univariable and multivariable analysis (MVA) were performed to compare groups. Results The incidence of CUD increased from 51 per 100,000 admissions in 2003 to 383 per 100,000 in 2014 (p < 0.001). Overall, 3,503 admissions had CUD. Patients with CUD were more frequently younger (50 vs. 61), male (86% vs. 78.4%), Black (21.7% vs. 9.2%), and had 1st quartile income (36.1% vs. 20.6%); all p < 0.001. CUD had no impact on any complication rates (all p > 0.05). However, CUD patients had higher LOS (3 vs. 2 days; p < 0.001) and IC ($15,609 vs. $12,415; p < 0.001). On MVA, CUD was not an independent predictor of major complications (p = 0.6). Conversely, CUD was associated with high LOS (odds ratio (OR) 1.31; 95% CI 1.08-1.59) and high IC (OR 1.33; 95% CI 1.12-1.59), both p < 0.01. Conclusion The incidence of CUD at the time of urologic oncologic surgery is increasing. Future research should look into the cause of our observed phenomena and how to decrease LOS and IC in CUD patients.

BACKGROUND:Midlife baseline prostate-specific antigen (MB PSA), defined as a single PSA value measured between 40-59 years of age, has been proposed as a tool that can limit potential harms of PSA screening. This study aimed to examine the ability of MB PSA versus PSA doubling time (PSADT) and PSA velocity (PSAV) in assessing the likelihood of developing of lethal prostate cancer (PCa) in a diverse and contemporary North American population. METHODS:Men 40-59 years old, who received their first PSA between the years 1995 and 2019, were included. For MB PSA values, the first PSA test result was included. For PSADT, the first two PSA test results were included. For PSAV, the first three PSA test results within 30 months were included. Selection criteria resulted in a total of 77,594 patients with at least two PSA test results and 11,634 patients with at least three PSA test results. Multivariable Fine-Gray regression was used to examine the impact of the value of the PSA testing methods on the development of lethal PCa (defined as death from PCa or development of metastatic disease either at diagnosis or during follow-up). Time-dependent receiver operating characteristic/area under the curve (AUC) at 5, 10, and 15 years were plotted. RESULTS:In the main cohort, patients were most frequently in the 50-54 age category (32.8%), had a Charlson comorbidity index of 0 (70.5%), and were White (63.2%). Of these, 9.3% had the midlife baseline PSA in the top 10th percentile, and 0.4% had a PSADT 0-6 months. Lethal PCa was diagnosed in 593 (0.8%) patients. The median (interquartile range) time to lethal PCa was 8.6 (3.2-14.9) years. In the main cohort, MB PSA and PSADT showed significant associations with the occurrence of lethal PCa, with a hazard ratio (HR) of 6.10 (95% confidence interval [CI], 4.85-7.68) and HR of 2.20 (95% CI, 1.07-4.54) for patients in the top 10th percentile MB PSA group and in the PSADT between 0 to <6 months group, respectively. In patients with three PSA results available, MB PSA and PSAV showed significant associations with the occurrence of lethal PCa, with a HR of 3.95 (95% CI, 2.29-6.79) and 3.57 (95% CI, 2.17-5.86) for patients in the top 10th percentile MB PSA group and in the in the PSAV >0.4 ng/mL/year group, respectively. PSADT and PSAV did not exhibit higher AUCs than MB PSA in assessing the likelihood of lethal PCa. Specifically, they were 0.818 and 0.708 at 10 and 15 years, respectively, for the PSADT; 0.862 and 0.756 at 10 and 15 years, respectively, for the PSAV; and 0.868 and 0.762 at 10 and 15 years, respectively, for the MB PSA (all p > .05). CONCLUSIONS:The study findings are that PSAV or PSADT were not superior to midlife baseline in assessing the likelihood of developing lethal PCa. This suggests that these variables may not have practical use in enhancing PSA screening strategies in a clinical setting.

Objective The European POUT III randomized controlled trial provided level-one evidence that adjuvant platinum-based chemotherapy is the standard of care following nephroureterectomy (RNU) for locally invasive or node-positive upper tract urothelial carcinoma. We aim to assess this European randomized controlled trial's generalizability (external validity) to a North American cohort, using a nationwide database. Materials and Methods To compare trial patients with those seen in real-world practice, we simulated the trial inclusion criteria using data from the National Cancer Database (NCDB). We identified patients with histologically confirmed transitional cell carcinoma who underwent RNU. The available demographic characteristics of the NCDB cohort were compared with the POUT III trial cohort using Chi-squared test. Results The NCDB cohort (n = 3,380) had a significantly higher proportion of older patients (age ≥ 80: 23.5% vs. 5%), and more males (68% vs. 56.2%) than the POUT cohort (Table 1, both p < 0.001). Additionally, the rate of advanced nodal disease was higher in the NCDB (N1 9.6%, N2 9.3%) than in the POUT (N1 6%, N2 3%) cohort (p < 0.001). A more extensive lymph node dissection was performed in NCDB vs. POUT patients (node≥10 10.9% vs. 3%, p < 0.001). Sensitivity analysis removing all subjects with a Charlson Comorbidity Index > 0 did not change the significance of any results. Conclusions While the primary disease stage was similar, the rate of advanced nodal disease was significantly higher in NCDB, which might be explained partially by the more extensive lymph node dissection performed in the latter. These differences warrant caution when applying the POUT III findings to North American patients.

Background: Other-cause mortality (OCM) can serve as a surrogate for access-to-care. The authors sought to compare prostate cancer-specific mortality (PCSM) in Black versus White men matched based on their calculated OCM risk. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for Black and White men diagnosed with prostate cancer between 2004 to 2009, to collect long-term follow-up. A Cox regression was used to calculate the OCM risk using all available covariates. This calculated OCM risk was used to construct a 1:1 propensity score matched (PSM) cohort. Then, a competing-risks multivariable tested the impact of race on PCSM. Results; A total of 94,363 patients were identified, with 19,398 Black men and 74,965 White men. The median (IQR) follow-up was 11.3 years (9.8-12.8). In the unmatched-cohort at 10-years, PCSM and OCM were 5.5% versus 3.5% and 13.8% versus 8.4% in non-Hispanic Black (NHB) versus non-Hispanic White (NHW) patients (all p < .0001). The standardized mean difference was <0.15 for all covariates, indicating a good match. In the matched cohort at 10-years, OCM was 13.6% and 10.0% in NHB versus NHW (p < .0001), whereas the PCSM was 5.3% versus 4.7% (p < .01). On competing-risks multivariable analysis on PCSM, Black men had a hazard ratio of 1.08 (95% confidence interval, 0.98-1.20) compared to White men with a p = .13. Conclusions: The results of this study showed similar PCSM in Black and White patients, when matched with their calculated OCM risk. This report is the first to indicate at a population-based level that race has no impact on PCSM.

Introduction Neoadjuvant chemotherapy (NAC) has grown in popularity in the management of upper tract urothelial carcinoma (UTUC). Retrospective data on NAC has shown promise in pathological downstaging rates, a surrogate endpoint of improved cancer-specific survival. However, most NAC series are limited to single centers and no randomized trials have been published. The aim of our study is to provide a multinational matched comparison of pathological complete response (pCR) and nodal downstaging (NDS) rates between patients who receive NAC + RNU vs. RNU alone. Methods Patients were abstracted from an international cohort of 13 high-volume centers across the United States, Europe, and Asia (Robotic surgery for Upper Tract Urothelial Cancer Study, ROBUUST 2.0) undergoing treatment for UTUC from 2011-2022. We then focused on cM0, histologically confirmed UTUC. Clinical and pathologic data was collected. Endpoints consisted of PCR (defined as ≤pT0N0) and NDS (cN > pN). Subgroup analyses for >cN0 was completed for NDS.;;Inverse probability of treatment weighting (IPTW) adjusted Cox regression analyses were used to assess odds of pCR and NDS. To minimize baseline differences among groups, IPTW weighted by age, sex, multifocality, tumor site, presence of hydroureteronephrosis, and clinical tumor stage (cT). Patients with missing data on age, tumor site, pT, pN, etc. were excluded. Results 72 (6.5%) and 1,035 (93.5%) patients were treated with NAC + RNU vs. RNU alone, respectively. Follow-up length was 26.0 (22.7) and 31 (25.9) months for the NAC+RNU and RNU alone. The most common NAC regimen consisted of Gemcitabine/Cisplatin (61%), followed by ddMVAC (24%) (Figure 1), with a median (IQR) number of cycles of 4 (3-4). IPTW-adjusted Cox regression analysis demonstrated pCR to be significantly higher in the NAC+RNU group with an OR of 2.49 (95% CI: 1.75 – 3.54, P<0.001). Additionally, those who received NAC were significantly more likely to experience NDS, OR: 9.56 (95% CI: 4.11-22.26, P<0.001). Standardized differences between the two treatment groups were < 0.1 for all variables, indicating strong matching. Conclusions Real world data from high volume centers suggests that neoadjuvant chemotherapy confers patients 2.49 times greater odds of experiencing a pathological complete response, compared to a matched UTUC cohort on multivariable analysis. This is one of the largest multinational experiences of neoadjuvant chemotherapy in UTUC to date. Ultimately, these results should be interpreted within the framework of a retrospective design, and randomized trials evaluating the efficacy of NAC are necessary.

BACKGROUND:Non-Hispanic Black (NHB) men are at higher risk both for incidence and mortality from prostate cancer (PCa) compared to Non-Hispanic White (NHW) men, but these findings arise from biopsy-detected PCa reports. We aimed to compare the incidence, subsequent management and cancer-specific mortality (CSM) of incidental PCa among NHB and NHW men, using two different North American cohorts. METHODS:The Surveillance, Epidemiology and End-Result (SEER: 2004-2017) and our institutional Henry Ford Health (HFH: 1995-2022) databases were queried to identify men diagnosed with incidental PCa. Cumulative incidence estimates were used to calculate CSM differences between NHB and NHW men. Competing-risk multivariable regression analysis tested the impact of race on CSM, after accounting for all available covariates. RESULTS:A total of 418 and 6,124 incidental PCa cases were recorded in HFH and SEER database respectively. No pathological differences were observed between NHB and NHW men in both the cohorts, except for prostate-specific antigen (PSA) value at diagnosis, which was higher in NHB men. At 10-years, the CSM rates were 5.5% vs 7.2% in our cohort and 8.6% vs 10.3% in the SEER cohort for NHW and NHB men, respectively (all Gray's test p-value > 0.05). At multivariable, race was not an independent predictor of CSM in our HFH cohort (HR: 1.46, 95% CI: 0.57-3.71, p = 0.6). In the SEER cohort, NHB men were 34% less likely to die from PCa from 1 year to the next (95% CI: 0.49-0.90, p = 0.008), when compared with NHW men. CONCLUSIONS:In the comparison of incidental PCa findings between NHB and NHW men, both groups had similar pathological characteristic and survival outcomes. These findings are different from the 'conventional' screening-detected PCa and suggest that racial differences have minimal to no adverse effects on PCa-specific mortality after incidental diagnosis.

You have accessJournal of UrologyProstate Cancer: Detection & Screening VI (MP74), Moderated Poster 741 May 2024MP74-03 SUPERIORITY OF MIDLIFE BASELINE PROSTATE-SPECIFIC ANTIGEN VALUE OVER PSA DOUBLING TIME AND VELOCITY IN THE PREDICTION OF LETHAL PROSTATE CANCER DEVELOPMENT, AND MORTALITY: A SYSTEM WIDE ANALYSIS OF A RACIALLY DIVERSE NORTH AMERICAN COHORT Matthew Davis, Giuseppe O. Cirulli, Alex Stephens, Giuseppe Chiarelli, Marco Finati, Chase Morrison, Shane Tinsley, Sohrab Arora, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Giuseppe Carrieri, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Craig Rogers, and Firas Abdollah Matthew DavisMatthew Davis , Giuseppe O. CirulliGiuseppe O. Cirulli , Alex StephensAlex Stephens , Giuseppe ChiarelliGiuseppe Chiarelli , Marco FinatiMarco Finati , Chase MorrisonChase Morrison , Shane TinsleyShane Tinsley , Sohrab AroraSohrab Arora , Akshay SoodAkshay Sood , Nicolò BuffiNicolò Buffi , Giovanni LughezzaniGiovanni Lughezzani , Giuseppe CarrieriGiuseppe Carrieri , Andrea SaloniaAndrea Salonia , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Craig RogersCraig Rogers , and Firas AbdollahFiras Abdollah View All Author Informationhttps://doi.org/10.1097/01.JU.0001008632.59099.b9.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our findings are that PSAV or PSADT were not superior to midlife baseline PSA in predicting the development of lethal PCa. This suggests that these variables may not have practical utility in enhancing PSA screening strategies in a clinical setting. METHODS: Men aged 40–59 years, who received their first PSA between the years 1995 and 2019 were included. For MB PSA values, the first PSA test result was included. For PSADT, the first two PSA test results were included. For PSAV, the first three PSA test results within 30 months were included. Selection criteria resulted in a total of 78,625 patients with at least 2 PSA test results and 13,062 patients with at least 3 PSA test results. Multivariable Fine-Gray regression was used to examine the impact of the value of the PSA testing methods on the development of lethal PCa. Time-dependent ROC/AUC curves at 5, 10, and 15 years were plotted. RESULTS: In the main cohort, patients were most frequently in the 50–54 age category (32.8%), had a CCI of 0 (70.5%), and were white (63.2%). Of these, 9.3% had the midlife baseline PSA in the top 10th percentile, and 0.4% had a PSADT 0 – 6 months. Lethal PCa was diagnosed in 636 (0.8%) patients. The median (IQR) follow-up time was 11 (5.1 – 17.4) years. In the main cohort, MB PSA and PSADT were significant predictors for lethal PCa, with a HR 5.47 (95% CI: 4.40-6.78) and HR 2.81(95% CI: 1.45-5.45) for patients in the top 10th percentile MB PSA group and in the PSADT between 0-<6 months group, respectively. In patients with 3 PSA results available, MB PSA and PSAV were significant predictors for lethal PCa, with a HR 5.05 (95% CI: 3.16-8.06) and 3.26 (95% CI: 2.09-5.07) for patients in the top 10th percentile MB PSA group and in the PSAV >0.4 ng/mL/year group, respectively. PSADT and PSAV did not have higher AUCs than MB PSA in predicting lethal PCa. Specifically, they were 0.712 and 0.639 at 10- and 15-year, respectively, for the PSADT; 0.749 and 0.708 at 10- and 15-year, respectively, for the PSAV and 0.840 and 0.750 at 10- and 15-year, respectively, for the MB PSA (all p>0.05). CONCLUSIONS: Our findings are that PSAV or PSADT were not superior to midlife baseline PSA in predicting the development of lethal PCa. This suggests that these variables may not have practical utility in enhancing PSA screening strategies in a clinical setting. Source of Funding: Vattikuti foundation and Menon foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1193 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Matthew Davis More articles by this author Giuseppe O. Cirulli More articles by this author Alex Stephens More articles by this author Giuseppe Chiarelli More articles by this author Marco Finati More articles by this author Chase Morrison More articles by this author Shane Tinsley More articles by this author Sohrab Arora More articles by this author Akshay Sood More articles by this author Nicolò Buffi More articles by this author Giovanni Lughezzani More articles by this author Giuseppe Carrieri More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To examine the frequency and rate at which transfeminine patients receive prostate-specific antigen testing compared to a matched cisgender cohort. METHODS:Patients with prostates who had encounters in our health system, are currently age 46 or older, and who are alive were included in our study. Transfeminine patients were identified through diagnosis codes and chart review. A 1:5 matched cohort was created based on patient age, race, and area deprivation index. Conditional logistic regression was done to compare odds of receiving any testing and Poisson regression was done to compare the total tests. RESULTS:A total of 275,112 patients were included in the study, of which 315 were confirmed to be transfeminine. A well-matched 1:5 propensity-matched cohort was created. Our results suggest that transfeminine patients were 0.28 (95% CI 0.20-0.38, P <.001) times as likely as cisgender patients to receive at least 1 PSA test at our institution and received only 32% (95% CI 27%-37%, P <.001) as many total PSA tests. CONCLUSION:Until more is known about the best practices for PSA testing in the transfeminine population, these patients should receive PSA testing. However, our results suggest that transfeminine patients are significantly less likely to receive any testing and significantly fewer tests in their lifetimes, which may represent a significant healthcare disparity.

This study examined cancer control metrics between surgery and radiation for clinically positive nodal prostate cancer in an other-cause mortality weighted cohort, to circumvent limitations in previous studies. The Surveillance, Epidemiology, and End Results Research Plus database was queried to identify men with clinically positive nodal prostate cancer at diagnosis between 2004 and 2017 who were treated with surgery or radiation. A competing-risks regression model was used to calculate the 10-year other-cause mortality risk using available covariates, including treatment type. Inverse probability of treatment weighting was then used to balance covariates, including other-cause mortality risk. Then, competing-risks cumulative incidence curves and multivariable models, which were weighted on the calculated other-cause mortality risk, were used to examine the impact of treatment type on cancer-specific mortality, after accounting for covariates. 4739 patients underwent surgery whereas 1039 underwent radiation. The median follow-up was 4.7 years (2.6–8.2). Other-cause mortality was statistically different between treatment arms in the unweighted cohort (Gray’s p = 0.005), but that difference disappeared in the weighted cohort (Gray’s p = 0.2). At 10 years, the cancer-specific mortality rate was 27.6

BACKGROUND:Socioeconomic and demographic factors contribute to disparity in prostate cancer (PCa) outcomes. We examined the impact of Area of Deprivation Index (ADI) and race on PCa incidence and lethality in a North American cohort. METHODS:Our cohort included men who received at least 1 prostate-Specifig Antigen (pSA) test within our Health System (1995-2022). An ADI score was assigned to each patient based on their residential census block, ranked as a percentile of deprivation relative to the national level. Individuals were further categorized into quartiles, where the fourth one (ADI 75-100) represented those living in the most deprived areas. We investigated PCa incidence and lethality, using cumulative incidence estimates and competing-risk regression. An ADI × Race interaction term examined whether the relationship between ADI and outcomes varied based on race. RESULTS:We included 134 366 patients, 25% of whom were non-Hispanic Black (NHB). Median (IQR) follow-up was 8.8 (5-17) years. At multivariate analysis, individuals from the third quartile (ADI 50-74, 95% CI = 0.83 to 0.95) and the fourth quartile (ADI ≥75, 95% CI = 0.75 to 0.86) showed significant reduced hazard ratios for PCa incidence, when compared with the first quartile (ADI <25, all P < .001). In contrast to the overall cohort, PCa incidence increased with ADI in NHB men, who were persistently at higher hazard for both PCa incidence and lethality than non-Hispanic White (NHW), across all ADI strata (all P < .001). CONCLUSIONS:Living in more deprived areas was associated with lower PCa incidence and higher lethal disease rate. Conversely, PCa incidence increased with ADI for NHB, who consistently showed worse outcomes than NHW individuals, regardless of ADI.

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I (PD29)1 May 2024PD29-08 ASSOCIATION OF AREA DEPRIVATION INDEX AND RACE WITH PROSTATE CANCER-SPECIFIC MORTALITY AMONG BLACK AND WHITE MEN IN A CONTEMPORARY NORTH AMERICAN POPULATION Giuseppe O. Cirulli, Giuseppe Chiarelli, Marco Finati, Alex Stephens, Patrick Etta, Mohit Butaney, Davis Matthew, Shane Tinsley, Chase Morrison, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Giuseppe Carrieri, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Craig Rogers, and Firas Abdollah Giuseppe O. CirulliGiuseppe O. Cirulli , Giuseppe ChiarelliGiuseppe Chiarelli , Marco FinatiMarco Finati , Alex StephensAlex Stephens , Patrick EttaPatrick Etta , Mohit ButaneyMohit Butaney , Davis MatthewDavis Matthew , Shane TinsleyShane Tinsley , Chase MorrisonChase Morrison , Akshay SoodAkshay Sood , Nicolò BuffiNicolò Buffi , Giovanni LughezzaniGiovanni Lughezzani , Giuseppe CarrieriGiuseppe Carrieri , Andrea SaloniaAndrea Salonia , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Craig RogersCraig Rogers , and Firas AbdollahFiras Abdollah View All Author Informationhttps://doi.org/10.1097/01.JU.0001008736.23117.7f.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Increasing evidence indicates poor socioeconomic status and geographic residency in underprivileged areas as potential contributors to disparities in cancer outcomes. For this reason, the measurement of area-level social and economic deprivation index (ADI) can be useful as a predictor of cancer outcomes. We aimed to examine the impact of ADI and race on Prostate Cancer-Specific Mortality (PCSM) among Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) men in a contemporary North American population. METHODS: We included men who got diagnosed whit PCa within Henry Ford Health (HFH), between 1995 and 2019. ADI is a percentile rank of socio-economic disadvantage, calculated using indicators of income level and disparity, educational level, employment rate, home values and quality of life. These indicators were used to create a deprivation score and patients were categorized by race and for ADI quartiles (based on the available National ADI decile values). The highest quartile (Q4: 75-100) represented individuals with the most disadvantageous socio-economic status. The main outcome for our study was PCSM. Competing-risk cumulative incidence curves were used to depict PCSM, after stratifying patients into sub-cohorts based on race and ADI quartiles. MVA was used to examine the impact of ADI quartiles on PCSM after adjusting for all available confounders. RESULTS: A total of 13,039 patients were included. Of these, 4,402 (33.8%) were NHB men. Median (IQR) PSA at diagnosis was 6.0 (4.5, 9.5) ng/ml. In the 4th ADI quartile, there were more NHB patients (60.1%) than White patients (39.9%) (p<0.001). The median (IQR) follow-up time was 5.7 (2.3-10.3) years. At 10-year, PCSM in NHW vs NHB patients was statistically different in the 1st ADI quartile (5.2% vs 10.4%, p<0.001), but not in the 2nd, 3rd, and 4th ADI quartile groups (all p>0.05). On multivariable analysis, NHW and NHB patients in the 4th ADI quartile (most disadvantaged area) had a 1.27-fold (95% CI: 1.02-1.58; p=0.030) higher cancer-specific mortality compared to NHW and NHB patients in the 1st ADI quartile, but race was not an independent predictor of cancer-specific mortality (HR:1.05; 95% CI:0.89-1.23; p=0.564). CONCLUSIONS: Our study was the first to assess the differential impact of ADI as a predictor of PCSM based on race in a large contemporary North American cohort. Within the first quartile, NHB patients showed higher cancer-specific mortality compared to NHW patients. Race itself was not identified as an independent predictor of cancer-specific mortality. Source of Funding: Vattikuti foundation and Menon foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e621 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Giuseppe O. Cirulli More articles by this author Giuseppe Chiarelli More articles by this author Marco Finati More articles by this author Alex Stephens More articles by this author Patrick Etta More articles by this author Mohit Butaney More articles by this author Davis Matthew More articles by this author Shane Tinsley More articles by this author Chase Morrison More articles by this author Akshay Sood More articles by this author Nicolò Buffi More articles by this author Giovanni Lughezzani More articles by this author Giuseppe Carrieri More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

Background and objective: Studies evaluating the role of baseline midlife prostatespecific antigen (PSA) as a predictor of development and progression of prostate cancer relied predominately on cohorts from the pre-PSA screening introduction era. The aim of our study was to examine the role of baseline PSA prior to the age of 60 yr as a predictor of developing lethal prostate cancer using a contemporary North American cohort. Methods: Our cohort included all men aged 40-59 yr who received their first PSA through our health system between the years 1995 and 2019. Patients were divided into four categories based on age: 40-44, 45-49, 50-54, and 55-59 yr. Baseline PSA was the predictor of interest. Lethal disease was defined as death from prostate cancer or development of metastatic disease either at diagnosis or during follow-up. Cancer-specific mortality and overall mortality were obtained by linking our database to the Michigan Vital Records registry. Competing-risk regression was used to evaluate the association between PSA and lethal prostate cancer. Key findings and limitations: A total of 129 067 men met the inclusion criteria during the study period. The median follow-up for patients free from cancer was 7.4 yr. For men aged 40-44, 45-49, 50-54, and 55-59 yr, the estimated rates of lethal prostate cancer at 20 yr were 0.02%, 0.14%, 0.33%, and 0.51% in men with PSA 0.79%, 0.16%, 2.5%, and 5.4% in men with PSA >= 90th percentile, respectively. For the same age category, the estimated rates of any prostate cancer at 20 yr were, respectively, 1.6%, 2.9%, 3.9%, and 5.8% in men with PSA 25%, 28%, 38%, and 39% in men with PSA >= 90th percentile. On a multivariable analysis, men with PSA >= 90th percentile had a hazard ratio of 7.48 (95% confidence interval [CI]: 6.20-9.03) for lethal disease, when compared with those with PSA with PSA >= 90th percentile had a hazard ratio of 20.47-fold (95% CI: 18.58-22.55) for prostate cancer incidence, when compared with those with PSA 60 yr is the most effective tool for adjusting subsequent screening. Compared with studies of unscreened cohorts, there was a smaller difference in discrimination between incident and lethal disease, reflecting the influence of screening. Patient summary: In this study, we found that a single baseline prostate-specific antigen (PSA) value is strongly predictive of the subsequent risk of developing metastatic prostate cancer, as well as the risk of dying from prostate cancer. The initial PSA level can therefore be used to adjust the frequency of subsequent PSA testing. (c) 2024 European Association of Urology. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP19)1 May 2024MP19-02 MIDLIFE BASELINE PSA AS A PREDICTOR OF LETHAL PROSTATE CANCER: RACIAL DIFFERENCES BETWEEN BLACK AND WHITE MEN Giuseppe Chiarelli, Davis Matthew, Alex Stephens, Marco Finati, Giuseppe O. Cirulli, Chase Morrison, Shane Tinsley, Akshay Sood, Giuseppe Carrieri, Alberto Briganti, Francesco Montorsi, Giovanni Lughezzani, Nicolò Buffi, Craig Rogers, and Firas Abdollah Giuseppe ChiarelliGiuseppe Chiarelli , Davis MatthewDavis Matthew , Alex StephensAlex Stephens , Marco FinatiMarco Finati , Giuseppe O. CirulliGiuseppe O. Cirulli , Chase MorrisonChase Morrison , Shane TinsleyShane Tinsley , Akshay SoodAkshay Sood , Giuseppe CarrieriGiuseppe Carrieri , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , Giovanni LughezzaniGiovanni Lughezzani , Nicolò BuffiNicolò Buffi , Craig RogersCraig Rogers , and Firas AbdollahFiras Abdollah View All Author Informationhttps://doi.org/10.1097/01.JU.0001008716.22569.77.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most previous reports have examined prostate cancer (PCa) mortality in homogenous populations based on midlife baseline PSA (MB PSA), defined as the first PSA test performed between 40 and 59 years old. Our study aims to investigate racial disparities in the predictive value of MB PSA for lethal PCa, defined as death from PCa or the development of metastatic disease either at diagnosis or during follow-up, in a diverse, contemporary, North American population. METHODS: Our cohort included White and Black men aged 40-59 years, who underwent MB PSA through our health system between 1995 and 2019. Patients were divided into 4 categories based on age: 40 to 44, 45 to 49, 50 to 54, and 55 to 59 years. MB PSA testing during the study period represented the main predictor of interest, and it was categorized based on PSA above/below the median in the entire cohort and for each age group. Multivariable Fine-Gray regression (MVA) was used to examine the impact of the MB PSA in predicting lethal PCa by race, after accounting for all confounders including the Charlson comorbidity index among others. RESULTS: A total of 112,967 men met the inclusion criteria, of whom 82,084 (73%) were White and 30,883 (27%) were Black. White patients had their first PSA most frequently in the 50–54 age group (33.9%) while Black patients at 40-44 (27.6%). The rate of PCa diagnosis was 7.0% in Black patients vs. 3.9% in White patients, and lethal PCa was 1.2% vs 0.6%, respectively (both p<0.0001). White patients harbored more frequent Gleason score 3+3 disease (23.7% vs 16.0%), and less frequent cM+ (12.7% vs. 15.2%) than Black patients (both p<0.05). Median follow-up was 6.7 (IQR 2.9 - 14.4) years for White patients and 9.9 (4.4 - 16.4) years for Black patients. At MVA, using White patients with PSA£median as the reference group, the HR of lethal PCa for White men with PSA>median aged 40-44, 45-49, 50-54, and 55-59 was respectively 2.98 (1.59-5.57), 3.01 (1.89-4.81), 5.10 (3.38-7.70) and 3.38 (2.32-4.92). While the HR of lethal PCa for Black men with PSA>median aged 40-44, 45-49, 50-54 and 55-59 was respectively 5.50 (2.94-10.27), 4.19 (2.59-6.78), 9.79 (6.37-15.04) and 7.53 (5.03-11.26) (all p<0.001). CONCLUSIONS: Our findings indicate that for the same MB PSA and within the same age category, Black men have almost double the risk of developing lethal PCa than White men. This implies that separate and different cut-offs should be created for MB PSA, if this is to be used to guide PSA screening in clinical practice. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e310 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Giuseppe Chiarelli More articles by this author Davis Matthew More articles by this author Alex Stephens More articles by this author Marco Finati More articles by this author Giuseppe O. Cirulli More articles by this author Chase Morrison More articles by this author Shane Tinsley More articles by this author Akshay Sood More articles by this author Giuseppe Carrieri More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Giovanni Lughezzani More articles by this author Nicolò Buffi More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...