Bladder preservation remains a highly desirable therapeutic goal in urothelial carcinoma, particularly when durable survival can be achieved. Radical cystectomy is the standard treatment for muscle-invasive disease; however, it results in irreversible bladder loss and significant morbidity. Among patients with locally advanced or metastatic urothelial carcinoma, recurrence rates after standard therapy remain high. Consolidation therapy with enfortumab vedotin and pembrolizumab following cisplatin-based induction chemotherapy has demonstrated promising efficacy, with substantial complete response rates and improved bladder preservation. This single-center retrospective analysis evaluated the efficacy and safety of enfortumab vedotin plus pembrolizumab as consolidation therapy in 11 patients with metastatic urothelial carcinoma who completed cisplatin-based induction chemotherapy. More than 90% of patients achieved a radiographic or clinical complete response, and several maintained prolonged treatment-free remission. Treatment-related adverse events, including dermatologic toxicity, reversible peripheral neuropathy, and hyperglycemia, were observed but were predominantly manageable, allowing treatment continuation in most cases. Notably, the regimen demonstrated clinical activity in cisplatin-intolerant patients and in those who did not achieve an initial complete response after cisplatin therapy. Compared with conventional cisplatin-based therapy alone, consolidation with enfortumab vedotin plus pembrolizumab was associated with favorable tolerability, durable responses, and a high rate of bladder preservation. These findings support further investigation of enfortumab vedotin and pembrolizumab as a potential bladder-sparing strategy in advanced urothelial carcinoma.

BACKGROUND:Prostate cancer is the most common noncutaneous malignancy among men and disproportionately affects those with low socioeconomic status, particularly men from racial and ethnic minority populations. PURPOSE:This study describes the development of a culturally tailored Mediterranean diet intervention for medically underserved Black and Hispanic men with prostate cancer, using the Intervention Mapping Adaptation (IM ADAPT) framework. METHODS:Conducted at a county safety-net hospital in a large urban area, which serves a population with high medical needs and low socioeconomic status, the project aimed to ensure the intervention was culturally relevant and evidence-based. A collaborative process was used, involving community scientists and patient stakeholders to identify dietary barriers and preferences, while existing interventions were reviewed for cultural fit. Guided by the six steps of the IM ADAPT framework, stakeholder feedback was incorporated throughout the adaptation process. The result was a culturally adapted intervention that included tailored dietary modifications, food provision strategies, and educational materials specifically designed for Black and Hispanic men. RESULTS:Completion of the IM ADAPT steps yielded a culturally adapted Mediterranean diet intervention incorporating tailored dietary recommendations, provision of food, and distribution of educational materials designed to meet the specific needs of Black and Hispanic men. CONCLUSIONS:The IM ADAPT framework enabled the development of a culturally tailored, evidence-based dietary intervention ready for pilot testing among medically underserved men with prostate cancer. This approach may serve as a replicable model for designing interventions for other racial and ethnic minority populations affected by cancer.

Background and objective:Artificial intelligence (AI), capable of analyzing vast volume of data rapidly, presents a promising solution to optimize literature screening for systematic reviews (SRs). Using the INSIDE (artificial INtelligence to Support Informed DEcision making) platform, we compared the performance of AI against the "gold standard" traditional SR method in the context of prostate cancer (PC) to assess whether AI could potentially improve efficiency and quality of screening. Methods:Publications from traditional screening of four SRs (focused on PC therapies and potential cardiotoxicity) were compared with the AI-based approach. Publications were ranked based on relevance scores. Work saved over sampling (WSS), that is, efforts saved by automatically excluding nonrelevant publications, determined efficiency. For a quality analysis, data visualization using a scatter plot suggested the proportions of "relevant," "irrelevant," and "not screened" records. Key findings and limitations:For AI-based screening, an efficiency analysis used publications from the traditional approach (n = 3363) including 278 relevant records. Of the total 3363 publications, the first ranking method screened 2365 and active learning used 3361 records. This approach was more efficient; fewer publications were required to be screened to identify 80% and 95% of 278 relevant publications (WSS@80% 20.3%; WSS@95% 9.4%). Screening efficiency increased with active learning (WSS@80% 54.0%; WSS@95% 54.8%). A scatter plot analysis presented broader search results with the Dimensions database yielding 384 465 publications and helped identify outlier articles. Conclusions:This study confirms the impact of an AI-based approach in optimizing the SR process. It highlights best practices and benchmarks to assess the efficiency and possibly quality of literature screening, supporting the integration of AI into future SRs. Patient summary:Systematic reviews (SRs) help create a detailed and unbiased summary on a specific research question. This summary is based on published information. Development of SRs using the traditional method requires detailed in-person review of the records, which takes a lot of time and effort. With the use of artificial intelligence (AI), the key data from a large amount of text are identified faster. This process requires a review of fewer records to find the most relevant ones, which saves time. The aim of this study was to understand how an AI tool, known as INSIDE PC, could help with SRs. This study looked at how well INSIDE PC worked compared with the traditional method for SRs. The AI method scored articles based on their relevance with respect to the topic of this SR. Data visuals or graphs were used to compare data points and remove irrelevant records from the review. This process decreased workload and saved time. The AI method also used a learning algorithm known as active learning. This helps AI tools learn from a small training sample data. Useful records were identified much faster by this method, with less efforts. The results showed that AI could improve the ease and speed of reviewing records for SRs. It is important that these AI methods are tested and improved to meet the needs of SRs.

While the association between metformin and mortality in obesity-related cancers (ORC: breast (BrCa), colorectal (CRC), endometrial (ECa), and ovarian (OCa)) remains inconsistent, the impact of weight loss medication (WLM) on mortality in ORC is largely unexplored, particularly among older women. This study aims to investigate the association between pre-diagnostic use of metformin and WLM with all-cause and cancer-specific mortality in older women with ORC. A retrospective cohort of 63,907 women (≥ 65 years) with ORC was identified using SEER-Medicare 2007-2015 data. Pre-diagnostic prescriptions of metformin and WLM were ascertained, and inverse probability of treatment weighting using propensity score (IPTW-PS) was utilized to balance baseline patient characteristics. Cox proportional hazards and competing-risks models were conducted. Metformin was associated with all-cause- (HR:1.86; 95% CI: 1.81-1.92) and ORC-specific mortality (HR: 1.71; 95% CI: 1.63-1.77). Likewise, WLM was associated with all-cause- (HR:1.64; 95% CI: 1.59-1.71) and ORC-specific mortality (HR: 1.55; 95% CI: 1.48-1.62). Dual use of metformin and WLM was associated with all-cause- (HR:1.39; 95% CI: 1.34-1.45) and ORC-specific mortality (HR: 1.28; 95% CI: 1.21-1.53). Significant associations were observed in ORC subgroup analyses, except that WLM was inversely associated with ECa-specific morality. Pre-diagnostic metformin and WLM were associated with an increased mortality risk in older women with ORC, with effects more pronounced among metformin users. Further prospective studies are needed to substantiate these findings.

Introduction: Statins and testosterone replacement therapy (TTh) have been inconsistently associated with a reduced risk of hormone-related cancers (HRCs, prostate [PCa], colorectal [CRC], and male breast cancers [BrCa]). Yet, the joint association of statins and TTh with the incidence of these cancers, and whether these associations vary by race, remains poorly understood. The objective of this retrospective cohort study is to examine the independent and joint effects of pre-diagnostic use of statins and TTh on the risk of HRCs, including PCa, CRC, and male BrCa. Materials: and Methods: In 105,690 men (>= 65 yrs) identified using the SEER-Medicare 2007-2015 data, we identified 82,578 White and 10,256 Black men. Pre-diagnostic prescription of statins and TTh was ascertained for this analysis and categorized into four groups (Neither users, statins alone, TTh alone and Dual users). Multivariable Time-varying Cox proportional hazards and Accelerated Failure Time (AFT) models were performed. Results: We found inverse joint associations of statins and TTh with incident HRCs before (aHR: 0.39; 95% CI: 0.35-0.44) and after 3 years of follow-up (aHR: 0.74; 95% CI: 0.67-0.82). This included a lower risk for advanced stage HRC (only <3 years follow-up). Similar joint associations were identified with incident PCa, aggressive PCa, incident CRC, and its specific right- and left-sided CRC (only <3 years follow-up). In general, the inverse associations persisted among White (mainly <3 years follow-up) and Black men (high-grade HRC and <3 years follow-up). Findings from the AFT analysis were similar. Discussion: Pre-diagnostic use of statins and TTh were, independently and jointly, associated with reduced risks of HRC and specific cancer sites at three years of follow-up overall, and among White and Black men. Greatest associations of HRCs risk reduction were observed among dual users (statins plus TTh). Further studies are needed to validate these findings, including larger samples of Black men, and male BrCa sites.

BACKGROUND:The link between the pre-diagnostic use of statins and testosterone replacement therapy and their impact on hormone-related cancers, prostate cancer, colorectal cancer, and male breast cancer survival remains a topic of controversy. Further, there is a knowledge gap concerning the joint effects of statins and testosterone replacement therapy on hormone-related cancer survival outcomes. OBJECTIVE:To examine the independent and joint effects of pre-diagnostic use of statins and testosterone replacement therapy on the risk of all-cause and cause-specific mortality among older men diagnosed with hormone-related cancers, including prostate cancer, colorectal cancer, and male breast cancer. METHODS:In 41,707 men (≥65 years) of Surveillance, Epidemiology, and End Results-Medicare 2007-2015, we identified 31,097 prostate cancer, 10,315 colorectal cancer, and 295 male breast cancer cases. Pre-diagnostic prescription of statins and testosterone replacement therapy was ascertained and categorized into four groups (Neither users, statins alone, testosterone replacement therapy alone, and Dual users). Multivariable-adjusted Cox proportional hazards and competing-risks (Fine-Gray subdistribution hazard) models were conducted. RESULTS:No significant associations were found in Cox-proportional hazard models for hormone-related cancers. However, in the Fine-Gray competing risk models among high-grade hormone-related cancers, statins alone had an 11% reduced risk of hormone-related cancer-specific death (hazard ratio: 0.89; 95% confidence interval: 0.81-0.99; p 0.0451). In the prostate cancer cohort with both statistical models, the use of testosterone replacement therapy alone had a 24% lower risk of all-cause death (hazard ratio: 0.76; 95% confidence interval: 0.59-0.97; p 0.0325) and a 57% lower risk of prostate cancer-specific death (hazard ratio: 0.43; 95% confidence interval: 0.24-0.75; p 0.0029). Similar inverse associations were found among aggressive prostate cancer cases with testosterone replacement therapy alone and statins alone. No significant associations were found in the colorectal cancer and male breast cancer sub-groups. CONCLUSION:Pre-diagnostic use of statins and testosterone replacement therapy showed a survival benefit with reduced mortality in high-grade hormone-related cancer patients (only statins) and aggressive prostate cancer patients in both statistical models. Findings of testosterone replacement therapy use in aggressive prostate cancer settings could facilitate clinical trials. Further studies with extended follow-up periods are needed to substantiate these findings.

OBJECTIVES:Descriptive study focusing on real-world utilization and characteristics of men with prostate cancer tested with the 17-gene Genomic Prostate Score® (GPS™) assay by linking administrative claims and electronic health record (EHR) data with GPS results. METHODS:This retrospective, observational cohort study (January 1, 2013 to December 31, 2020) included men aged 40-80 years with localized prostate cancer claims, continuous enrollment in Optum's Integrated Claims data set, ≥1 day of EHR clinical activity, and a GPS result. Men were classified as undergoing definitive therapy (DT) (prostatectomy, radiation, or focal therapy) or active surveillance (AS). AS and DT distribution were analyzed across GPS results, National Comprehensive Cancer Network® (NCCN®) risk, and race. Costs were assessed 6 months after the first GPS result (index); clinical outcomes and AS persistence were assessed during the variable follow-up. All variables were analyzed descriptively. RESULTS:Of 834 men, 650 (77.9%) underwent AS and 184 (22.1%) DT. Most men had Quan-Charlson comorbidity scores of 1-2 and a tumor stage of T1c (index). The most common Gleason patterns were 3 + 3 (79.6%) (AS cohort) and 3 + 4 (55.9%) (DT cohort). The mean (standard deviation) GPS results at index were 23.2 (11.3) (AS) and 30.9 (12.9) (DT). AS decreased with increasing GPS result and NCCN risk. Differences between races were minimal. Total costs were substantially higher in the DT cohort. CONCLUSIONS:Most men with GPS-tested localized prostate cancer underwent AS, indicating the GPS result can inform clinical management. Decreasing AS with increasing GPS result and NCCN risk suggests the GPS complements NCCN risk stratification.

Background and Aim: For metastatic castrate-resistant prostate cancer (mCRPC), the European Association of Urology recommends multiple therapies as first-line. However, these recommendations do not account for additional cardiotoxicity of the therapies for prior stages of the disease, such as the metastatic hormone-sensitive prostate cancer (mHSPC) stage. We seek to adjudicate the cardiotoxicities of first-line mCRPC therapies assuming history of mHSPC treatment based on the five International Cardio-Oncology Society (IC-OS) cardiotoxicity domains: heart failure, myocarditis, vascular toxicity, hypertension, and arrhythmias. Methods: Ovid Medline, Elsevier Embase, and the Cochrane Library were searched for randomized clinical trials (RCTs) of mCRPC and mHSPC patients from inception until January 2024. Studies reporting at least one first-line therapy and effect size of at least one cardiotoxicity domain were included. Network meta-analyses with indirect treatment comparison with multivariate multi-level analysis were performed for each cardiotoxicity domain to estimate relative risk (RR) with 95% confidence intervals (CI) for mCRPC and mHSPC therapies. A Bayesian model was then constructed using the mHSPC network as a prior for informing the RRs and 95% CIs of mCRPC first-line therapies. Results: Network meta-analyses of mHSPC treatment cardiotoxicity, mCRPC treatment cardiotoxicity assuming no treatment history, and mCRPC treatment cardiotoxicity assuming prior mHSPC treatment are provided in Images 1-2. We did not find any studies assessing myocarditis. For patients with mHSPC treatment history, olaparib (OLA) plus androgen deprivation therapy (ADT) plus abiraterone with prednisone (AA+P) decreased hypertensive risk relative to ADT+AA+P (RR 0.20, 95% CI 0.16-0.26). Conclusion: OLA may offer a protective antihypertensive effect when superimposed on ADT+AA+P for mCRPC treatment after prior androgen deprivation from mHSPC therapy.

PURPOSE:Focal therapy aims to provide a durable oncologic treatment option for men with prostate cancer (PCa), while preserving their quality of life. Most focal therapy modalities rely on the direct tissue effect, resulting in a possible nontargeted approach to ablation. Here, we report the results of the first human feasibility trial utilizing nanoparticle-directed focal photothermal ablation for PCa. MATERIALS AND METHODS:A prospective, open-label, single-arm, multicenter study of men with localized PCa in Gleason Grade Group 1 to 3 was conducted. Men received a single infusion of gold nanoparticles (AuroShells), followed by magnetic resonance (MR)/ultrasound (US) fusion-guided laser excitation of the target tissue to induce photothermal ablation. MRI was used to assess the effectiveness of prostate tissue ablation at 48 to 96 hours, 3 months, and 12 months post treatment. At 3 months, a targeted fusion biopsy of the lesion(s) was conducted. At 12 months, a targeted fusion biopsy and standard templated biopsy were performed. Treatment success was determined based on a negative MR/US fusion biopsy outcome within the treated area. RESULTS:Forty-six men were enrolled in the study, and 44 men with 45 lesions completed nanoparticle infusion and laser treatment. Baseline mean PSA levels were 9.5 ng/mL, with a statistically significant decrease of 5.9 ng/mL at 3 months and 4.7 ng/mL at 12 months (P < .0001). The oncologic success rates at 3 and 12 months resulted in 29 (66%) and 32 (73%) of 44 patients, respectively, being successfully treated, confirmed with negative MR/US fusion biopsies within the ablation zone. Among Gleason Grade Group, maximum lesion diameter on MRI, prostate volume, and Prostate Imaging Reporting and Data System scoring, the maximum lesion diameter was significantly associated with the odds of treatment failure at 12 months (P = .046). CONCLUSIONS:Nanoparticle-directed focal laser ablation of neoplastic prostate tissue resulted in 73% of patients with successful treatment at 12 months post treatment, confirmed by negative MR/US fusion biopsy of the treated lesion and a systematic biopsy.

BACKGROUND:The association between testosterone concentrations and sleep duration is poorly understood. OBJECTIVE:To evaluate the association between sleep duration and quality with serum testosterone concentrations and its variation by sex and age. METHODS:Data were analyzed for 8748 men and women (≥20 years old) who participated in the cycles of the National Health and Nutrition Examination Survey 2011-2016, a cross-sectional study. Total testosterone (ng/dL) was measured and categorized (low, moderate, and high) based on established cut-offs for men and its tertile distribution among women. Sleep duration was classified as ≤6, 7-8, and ≥9 h. Sleep quality was classified as poor or good based on the frequency of trouble falling or staying asleep or sleeping too much. Weighted multivariable adjusted and multinomial logistic regression models were conducted to assess these associations. RESULTS:The association between sleep duration and testosterone concentrations, varied according to sex and age. Sleep deprivation (≤6 h) was associated with high testosterone (odds ratio = 3.62; 95% confidence interval: 1.37, 9.53) among young men (20-40 years old); meanwhile, middle-aged men (41-64 years old) who reported more sleep duration had low testosterone (odds ratio = 2.03; 95% confidence interval: 1.10, 3.73). A J-shaped association between sleep duration and low testosterone (odds ratio≤6 h  = 1.57; 95% confidence interval: 1.10, 2.27; odds ratio≥9  h  = 2.06; 95% confidence interval: 1.18, 3.59) was observed in women aged 41-64 years. We did not find any association with sleep quality. CONCLUSION:The association of sleep duration with serum testosterone concentrations varies with sex and age group. Prospective studies are warranted to confirm these sex and age group differences.

Abstract Metastatic neoplasms to the sinonasal tract are rare. Here, we report the case of a 74-year-old woman with no notable oncological history, presenting to the emergency department with a 3-week history of intermittent epistaxis. CT and MRI revealed a right-sided sinonasal tract mass with histopathological analysis revealing cells of clear cell renal cell carcinoma origin. Full-body CT revealed a 4.9-cm L renal mass for which cytoreductive nephrectomy was performed after immunotherapy. The patient experienced recurrence of the sinonasal mass 14 months from initial discovery, for which they continue to follow with our multidisciplinary cancer care team.

Supplemental Table 1 Supplemental Table 2

224 Background: Common drivers in advanced prostate cancer (PC) involve fusions of the 3’ DNA binding domain-containing region of an Erythroblast Transformation Specific (ETS) transcription factor gene with a 5’ region of another gene, often one that is androgen-regulated. Previous work indicates that PCs harboring TMPRSS2:ERG fusions are more dependent on androgen signaling, and men with such tumors may, therefore, be more responsive to the effects of androgen deprivation therapy than men lacking this fusion. In this study, we examined the frequency of fusions involving ETS-family genes, including TMPRSS2:ERG, and determined how often such fusions would be missed if detection relied solely on DNA sequencing. Methods: To identify fusions and compare DNA-only versus DNA plus RNA sequencing, we utilized the Oncomap ExTra genomic profiling assay. This assay performs whole-exome, whole-transcriptome DNA and RNA sequencing of tumor and matched normal samples to identify somatic alterations in tumors. Single-nucleotide variants, indels, copy number alterations, alternative transcripts, and gene fusions are all detected. We specifically searched for fusions involving ETS transcription factor genes ERG and ETV1- 7. Results: A total of 512 PC patient samples assayed between April 2018 and July 2022 were included in the analysis; 226 ETS fusions were present in 223 (43.6%) patients; 3 patients carried two fusions. There were 196 ERG fusions including 185 (36.1%) patients having the familiar TMPRSS2: ERG fusion and 8 (1.6%) patients with a SLC45A3: ERG fusion, which is known to be associated with particularly poor prognosis. ETV1, 4, and 5 fusions were found in 29 (5.7%) patients and involved 12 different 5’ partner genes, the most common of which were SLC45A3 (6 fusions) and CANT1 (4 fusions). The two partner genes were on the same chromosome in 192 fusions, with 190 requiring a single deletion to create the fusion and 2 requiring a single inversion. For the 34 fusions involving genes on different chromosomes, a single translocation would be sufficient to produce the fusion gene in 23 cases; in 11 cases more than one structural rearrangement would be required. A total of 66 (29.6%) fusions were not detected in the DNA sequencing data, including 40 (21.6%) TMPRSS2: ERG fusions. In addition, 16 fusions were detected only in the DNA data, as RNA could not be sequenced, including 13 TMPRSS2: ERG fusions. Conclusions: In addition to TMPRSS2: ERG, the Oncomap ExTra assay identified several low frequency ETS fusions, all of which could be used to assist patients and physicians to select appropriate treatments. The identification of ETS fusions appears to be limited when using only DNA sequencing. Oncomap ExTra RNA analysis identified 66 additional fusions, representing almost 30% of those present, not identified by whole-exome DNA sequencing, suggesting RNA plus DNA assays detect fusions more reliably than DNA-only assays.

529 Background: For metastatic or unresectable invasive urothelial cancer (UC), standard first-line platinum-based chemotherapy achieved progression-free survival (PFS) of 4–7 months. Complete response (CR) rate is <10%. The minority of patients downstaged after chemotherapy followed by cystectomy still suffer from loss of bladder function and a high risk of recurrence. To improve PFS, CR, and bladder preservation, we explored the use of EV after platinum-based chemotherapy in patients with metastatic or locally advanced UC who desired bladder preservation. Methods: Patients with metastatic or locally advanced unresectable UC who desired bladder preservation and received EV after platinum-based chemotherapy were identified. CR was defined as no evidence of disease identified on both radiology (MRI+CT) and cystoscopy; PFS were calculated from the date of initial treatment (first-line chemotherapy) to the date of last follow-up/death or recurrence via Kaplan-Meier analysis. Results: A total of 12 patients were identified: median age was 69.5 years (range, 52–83); 10 (83%) were men; 9 (75%) partial response and 3 (25%) disease progression were observed from platinum-based chemotherapy. EV was given after platinum-based chemotherapy to all 12 patients who subsequently achieved 100% of response: CR was achieved in 7 (58%) patients, and 4 (33%) remained disease free without ongoing treatment, their disease-free survival (DFS) was 9 months (range, 4–18); 2 patients who achieved CR then recurred as carcinoma in situ (CIS), one of whom had a cystectomy with TisN0 confirmed on final pathology. 2 (17%) patients received radiation to bladder and nodal area. Eleven (92%) patients retained their bladders and no patients died. Median follow-up was 19 months (range, 3.4–53.6). The median duration of EV was 7.5 months (range, 2–20). One-year PFS with bladder intact was 83%. Detailed clinical characteristics and outcome listed on Table. Conclusions: For patients with locally advanced or metastatic UC who desired bladder preservation, platinum-based chemotherapy followed by EV with or without pembrolizumab showed encouraging CR and PFS and deserves to be explored further. [Table: see text]

Purpose:Assessing trainees' surgical proficiency is an important aspect of urological surgical training. The current standard is the Urology Milestone Project, initially implemented in 2013. This evaluation is limited in that it contains only 3 questions on surgical competency per surgical modality with assessments occurring semi-annually without real-time operative feedback. However, since the Urology Milestones Project's inception a plethora of competency-based surgical assessment tools have been described. We aim to perform a comprehensive review of the literature of these available tools and analyze their strengths and weaknesses as a way of providing a repository of available assessment strategies for further development of a more comprehensive and standardized assessment tool.Materials and Methods:A review of the primary literature was performed using key words such as "surgical assessment tools urology," "surgical assessment tools prostate," "bladder surgical assessment tools," "renal surgical assessment tools urology," and "surgical assessment tools urology task specific." Technical and nontechnical skill assessments were included. One reviewer identified and analyzed studies that published assessment tools for use in surgical and urological training.Results:A total of 1,497 articles published between 1997-2022 were identified. Of these, 34 met the inclusion criteria. Eighteen (52.9%) were specialty nonspecific and 16 (47.1%) were specific for urological training. Of the 18 tools developed for general surgical principles, 12 (66.7%) had some form of validity, 9 (50.0%) were significantly reliable, and 2 (11.1%) were externally validated. Of the 16 tools developed specifically for use in urology training, 13 (81.3%) had some form of validity, 7 (43.8%) were significantly reliable, and none were externally validated. Of these 16 tools, 12 (75.0%) were procedure-specific and 4 (25.0%) were developed for general use in endourological procedures.Conclusions:Surgical training is evolving toward a competency-based model, as evidenced by the increase in assessment tools created within the past 10 years. These instruments not only provide objective feedback to trainees, but also monitor progression. However, they are heterogeneous in construct and utilization. There remains a need for the adoption of a standardized, valid, and reliable tool, ie, both procedure-specific and generalizable across multiple procedures for use in urology training.

The role of testosterone (T) deficiency (T ≤ 300 ng/dL) and hypercholesterolemia (total cholesterol ≥ 240 mg/dL) in the risk of all-cause cardiovascular diseases (CVD) and cancer mortality among a nationally representative sample of non-Hispanic White (NHW), non-Hispanic Black (NHB) and Hispanic men remains poorly understood. Data included a full sample (NHANES 1988–1991, 1999–2004, 2011–2014) and subset sample (excluding 2011–2012, no estradiol and SHBG levels available) of 5379 and 3740 men, respectively. Participants were aged ≥ 20 y with serum T and cholesterol data (median follow-up 7.6 years). Weighted multivariable-adjusted Cox proportional hazards models were used in this study. In the overall population of full and subset samples, hypercholesterolemia was inversely associated with all-cause (HR = 0.76, 95% CI, 0.63–0.91) and cancer mortality (HR = 0.56, 95% CI, 0.34–0.90). Similar findings were observed among NHW men, but higher T levels increased the risk of CVD mortality in the subset sample (T3 vs T1, Ptrend = 0.02). Among NHB men in the full and subset samples, T deficiency increased the risk of CVD mortality, but T3 vs. T1 decreased it (Ptrend = 0.03), and hypercholesterolemia decreased cancer mortality. Among Hispanic men in the full and subset samples, T deficiency increased, and hypercholesterolemia decreased the risk of CVD mortality. Hypercholesterolemia was inversely associated with cancer mortality. However, higher levels of T were positively associated with CVD mortality among NHW and were inversely associated with CVD mortality among NHB and Hispanic men. Larger prospective studies are warranted to clarify the underlying relationship between T and cholesterol with mortality among racial and ethnic groups.

You have accessJournal of UrologyCME1 May 2022MP19-17 DEMAND FOR EXPANDED VIRTUAL EDUCATION EVIDENT AMONG UROLOGY TRAINEES TWO YEARS INTO COVID-19 Kyle Blum, Lauren Conroy, Justin Mehr, Skyler Howell, Leyla Akhverdiyeva, David Tuke, and Steven Canfield Kyle BlumKyle Blum More articles by this author , Lauren ConroyLauren Conroy More articles by this author , Justin MehrJustin Mehr More articles by this author , Skyler HowellSkyler Howell More articles by this author , Leyla AkhverdiyevaLeyla Akhverdiyeva More articles by this author , David TukeDavid Tuke More articles by this author , and Steven CanfieldSteven Canfield More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002552.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urology trainees face educational challenges such as decreased operative volume, increased clinical demand, and suspension of traditional in-person didactics due to the COVID-19 pandemic. Training programs responded by organizing globally-available lecture series to pool knowledge and share resources. This study sought to evaluate the utility and satisfaction with national virtual lectures and determine interest in a standardized virtual urology curriculum. METHODS: After IRB approval, a 9 item online survey was distributed to approximately 2,000 urology residents and fellows in all AUA sections between 4/29/2020 and 6/3/2021. Survey items were designed to assess current content usage, perceived utility, and interest in future usage. Items were posed as Likert scale (1-5), binary (yes-no), or free response as appropriate. The final item assessed interest in national standardized lectures that trainees and programs could opt in to as a supplement to existing didactic programs. De-identified responses were collected and automatically summarized. RESULTS: A total of 193 (9.65%) responses were available for review with all trainee levels and AUA sections represented. Routine use of online content increased from 63.2% prepandemic to 96.9% at early pandemic and 100.0% 1 year into pandemic. 83.3% of respondents chose their content based on subject matter; 10.0% chose based on institution reputation, and 6.6% chose by presenter reputation. Overall, 93.9% perceived virtual resources to be useful or very useful. 100.0% reported they were likely or very likely to continue using these resources after the pandemic. 90.0% indicated they would be interested in a standardized national virtual Grand Rounds or Lecture Series accessible to all urology training programs. CONCLUSIONS: Utilization of virtual learning by urology trainees was well-received early in the pandemic and continued to be out to one year, providing a potential solution to decreased in-person learning opportunities. As the COVID-19 pandemic approaches the 2-year mark, virtual lecture series have the ability to increase and spread the equity of expert knowledge to all training programs. Furthermore, the creation of a centralized or standardized grand rounds didactics series is of interest to a large number of trainees surveyed. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e314 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Blum More articles by this author Lauren Conroy More articles by this author Justin Mehr More articles by this author Skyler Howell More articles by this author Leyla Akhverdiyeva More articles by this author David Tuke More articles by this author Steven Canfield More articles by this author Expand All Advertisement PDF DownloadLoading ...

Background: Use of statins and testosterone replacement therapy (TTh) have been independently linked with prostate cancer (PCa) and cardiovascular diseases (CVD). However, there is a research gap about the joint association of statins and TTh with CVD among PCa survivors and a matched cancer-free cohort. Methods: In SEER-Medicare 2007-2015 (N = 35,990 men), we identified 17,995 PCa survivors, and 17,995 age- and index-matched cancer-free men. Pre-diagnostic prescription of statins and TTh was ascertained for this analysis and examined in two matched cohorts. Weighted multivariable-adjusted conditional logistic regression models were used to evaluate the independent and joint associations of statins and TTh with CVD. Results: We found that independently statins (OR = 0.48, 95% CI: 0.44-0.53) and TTh (OR = 0.74, 95% CI: 0.0.61-0.90) were each inversely associated with CVD in the overall sample. TTh plus statins was inversely associated with CVD (OR = 0.50, 95% CI: 0.36-0.70, Pinteraction = 0.03). Similar associations were observed among the matched cancer-free cohort. Among PCa survivors, only statins (OR = 0.62, 95% CI: 0.56-0.68) and combination of TTh plus statins (OR = 0.63, 95% CI: 0.44-0.90) were inversely associated with CVD, but not the independent use of TTh. Conclusion: Pre-diagnostic use of statins and TTh, independent or in combination, were inversely associated with CVD in the overall and cancer-free populations, but among PCa survivors it was mainly use of statins, not TTh. Greater reduced effects on CVD were observed with statins or in combination with statins, but not with TTh. Future studies need to confirm these associations among older men with aggressive PCa.