5091 Background: Prior studies suggest statin use may improve PC outcomes, including PC specific mortality (PCSM) and disease progression in patients receiving ADT. However, prior studies compared patients taking vs not taking statins at the time of ADT, ignoring that many statin non-users initiate statins later on. We evaluated the association between statin use and PC outcomes using both baseline (yes/no) and time-dependent exposure definitions in patients initiating ADT after RP. Methods: We conducted a retrospective cohort study of 9,931 patients with PC treated with RP between 1988 and 2020 at 9 VA hospitals from SEARCH Database. Patients who received ADT for biochemical recurrence after 2000 were included. Those with known metastasis prior to ADT or missing covariates of interest were excluded. Characteristics at ADT were stratified by statin use at time of ADT and compared with rank-sum for continuous variables and chi-square for categorical. Univariable and multivariable Cox models tested associations between statin use at ADT and time to metastasis, castration-resistant PC (CRPC), PCSM and all-cause mortality (ACM), adjusted for clinicopathological variables. As ~50% of non-statin users initiated statins after ADT, additional models treated statin use as time-dependent covariate. Results: Among 1,274 patients treated with ADT, 784 (62%) used statins at time of ADT. Users were older (median 67 vs 65), initiated ADT in more recent years (median 2013 vs 2010), had longer time from RP to ADT (median 39 vs 21 months), and had higher obesity rates (38% vs 25%). PC characteristics were similar between groups, except users had lower rates of positive nodes (11% vs 17%) and seminal vesicle invasion (28% vs 33%). Statin use at ADT was not significantly associated with time to metastasis, CRPC, PCSM or ACM, though HRs indicated lower risk for statin users (all HRs 0.89-0.98, all p>0.2; see table). On time-dependent multivariable analysis, statin use was significantly associated with lower risk of CRPC (p=0.019), PCSM (p=0.020) and ACM (p<0.001). Similar results were seen for metastases, though this did not reach significance (p=0.058) (see table). Conclusions: Statin use at ADT was not associated with PC outcomes after RP. However, accounting for statin initiation during ADT, statin use was associated with notably lower rates of CRPC, PCSM and ACM, with a trend towards reduced metastasis. These findings support the potential role of statins in slowing PC progression and highlight the need for prospective randomized trials of statins in patients initiating ADT. Outcome Statin at ADT, HR (95% CI) p Time-varying statin, HR (95% CI) p Metastasis 0.92 (0.71, 1.20) 0.541 0.74 (0.55, 1.01) 0.058 CRPC 0.95 (0.73, 1.24) 0.702 0.69 (0.51, 0.94) 0.019 PCSM 0.98 (0.70, 1.39) 0.920 0.62 (0.42, 0.93) 0.020 ACM 0.89 (0.73, 1.08) 0.229 0.51 (0.40, 0.64) <0.001

BACKGROUND:Among patients with advanced prostate cancer (aPC), fatigue is a commonly experienced symptom that may be associated with the disease itself or occur as a side effect of treatment. We aimed to develop evidence-based, consensus-driven statements to support shared decision-making for managing fatigue in patients with aPC. METHODS:To identify potential fatigue-management strategies, we performed a targeted literature review followed by expert advisor interviews, and then conducted a modified Delphi panel. In both the interviews and the modified Delphi panel, participants included oncologists, urologists, exercise scientists, psychologists, nutritionists/dietitians, and nurse practitioners/nurses. The modified Delphi panel comprised 2 survey rounds, with a live panel discussion between them, intended to drive consensus on the statements. In determining consensus for the final statements, each strategy's effectiveness, accessibility for patients, and feasibility for both patients and health care providers were taken into account. Consensus was predefined as ≥75% agreement or disagreement with each statement. RESULTS:The targeted literature review identified 14 fatigue-management strategies derived from 32 articles. These strategies were further refined and expanded by the expert advisors and modified Delphi panelists, who ultimately compiled a final list of 15 statements, each achieving ≥75% agreement. The 15 statements were grouped into 4 categories of fatigue-management strategies: exercise (eg, endurance, strength, aerobic, and resistance training), diet and nutrition (eg, hydration and healthy eating), clinical management (eg, counseling and support groups), and "other strategies" (eg, acupuncture and adopting good sleep habits). CONCLUSIONS:These recommendations and considerations provide practical guidance-grounded in evidence and expert opinion-for managing fatigue in patients with aPC, with the goal of improving quality of life. Future research should prioritize high-quality studies evaluating fatigue-management strategies in aPC, particularly in areas where published evidence remains limited.

BACKGROUND:Real-world data on the costs and outcomes of blue light cystoscopy (BLC) for non-muscle-invasive bladder cancer (NMIBC) are limited. We compared healthcare costs and oncologic outcomes associated with BLC versus white light cystoscopy only (WLC) in patients with NMIBC. METHODS:We performed a retrospective cohort study of NMIBC patients treated in the Veterans Affairs (VA) healthcare system between January 1, 1997 and December 31, 2021. Patients exposed to BLC after diagnosis were compared with WLC-only patients. Propensity score matching (1:1) identified 311 BLC-exposed and 311 WLC-only patients. Outcomes included 5-year total and category-specific healthcare costs, NMIBC recurrence, and recurrence-related cost offsets. RESULTS:Among 622 matched patients (311 BLC; 311 WLC), median age was 71 years, and 378 (61%) had high-risk disease. BLC-exposed patients were more likely to receive intravesical BCG (190 [61%] vs. 133 [43%]; p < 0.01) and intravesical chemotherapy (149 [49%] vs. 86 [28%]; p < 0.01). Unadjusted 5-year total costs were higher with BLC ($108,411 vs. $66,734; p < 0.01), primarily due to outpatient costs ($90,788 vs. $55,529; p < 0.01). BLC was associated with decreased risk of recurrence (HR 0.62, 95% CI 0.45 - 0.86). After accounting for recurrence-related cost offsets, the adjusted 5-year cost difference was $721 per patient. CONCLUSIONS:In an equal-access setting, BLC exposure was associated with higher 5-year costs, largely driven by outpatient care. However, lower recurrence rates reduced the net cost difference, resulting in near cost neutrality. These findings highlight the trade-off between higher upfront costs and improved recurrence outcomes when incorporating BLC into NMIBC management.

PURPOSE:Current prognostic assessment of men with biochemical recurrence (BCR) after radical prostatectomy (RP) relies on data from the pre-2000s era when androgen deprivation therapy (ADT) was delayed until metastasis. Most men now initiate ADT at low PSA values before metastases, especially for high-risk disease in which expanded ADT improves metastasis-free survival. We defined rates of cancer progression and mortality in men treated with early ADT for post-RP BCR. MATERIALS AND METHODS:We conducted an observational study of 1108 men with nonmetastatic prostate cancer receiving ADT for BCR after RP from 1988 to 2019 from the Veterans Affairs SEARCH database. Fine and Gray competing risk models quantified risk of metastasis, castrate-resistant prostate cancer (CRPC), and prostate cancer-specific mortality (PCSM) across key predictors. RESULTS:The median follow-up after ADT among men who did not die of prostate cancer was 5.8 years (IQR 3.0-9.9). The median PSA at ADT was 1.3 ng/mL (IQR 0.4-4.9). Across all men, risks of metastasis, CRPC, and PCSM at 15 years after ADT were 28%, 27%, and 19%, respectively. In multivariable models, higher pre-ADT PSA, shorter pre-ADT PSA doubling time, higher pathologic grade group, and seminal vesicle invasion were associated with higher risk of metastasis, CRPC, and PCSM. We created predictive nomograms and tables estimating 3-, 5-, 10-, and 15-year risks of metastasis, CRPC, and PCSM by PSA at ADT, PSA doubling time at ADT, pathologic grade group, and seminal vesicle invasion. Risks of PCSM at 15 years after ADT initiation ranged from 2% to 60% across subgroups. CONCLUSIONS:These contemporary prognostic estimates are more applicable to men receiving early ADT for post-RP BCR and can help identify high-risk patients who are candidates for intensified hormonal therapy.

Multimodal strategies combining primary and metastasis-directed therapy (MDT) with short-term intensified systemic therapy may improve outcomes in oligometastatic castrate-sensitive prostate cancer (omCSPC) while minimizing long-term toxicity. This post hoc analysis of two prospective phase 2 trials, SOLAR (NCT03298087) and SATURN (NCT03902951), evaluated oncologic outcomes in prostate-specific membrane antigen positron emission tomography-defined synchronous and metachronous omCSPC (≤5 M1a-b lesions), respectively. All patients received 6 mo of intensified systemic therapy (leuprolide, abiraterone acetate with prednisone, and apalutamide) and stereotactic body radiotherapy to oligometastases. SOLAR patients were treatment-naïve and also underwent radical prostatectomy (RP) or definitive prostate-directed radiotherapy (dRT). SATURN enrolled patients with post-RP recurrences: among the 26 patients who completed protocol therapy, 12 (46%) had prior androgen deprivation therapy (ADT), six (23%) had prior MDT, and 17 (65%) had one to three prior recurrences. The primary endpoint for both studies was prostate-specific antigen (PSA) response, defined as <0.05 ng/ml after RP or <2 ng/ml after dRT at 6 mo after testosterone recovery (≥150 ng/dl). Secondary endpoints included progression-free survival (PFS) and eugonadal PFS starting from the time of testosterone recovery. Progression was determined biochemically using PSA thresholds of ≥0.05 ng/ml for post-RP and ≥2 ng/ml for post-dRT patients. Among 50 patients (24 synchronous and 26 metachronous), the synchronous omCSPC group had a significantly higher PSA response rate (83% vs 50%; p = 0.018) and significantly longer PFS and eugonadal PFS (p < 0.05). The metachronous subgroup with prior ADT had worse outcomes, suggesting increasing resistance with repeated systemic therapy.

Supplementary Table 1. Demographic and disease characteristics of patients with and without biopsy grade groups

Background: Adverse pathology (AP) is often used as an intermediate end point for long-term outcomes in men with prostate cancer (PCa) who are active surveillance candidates. The association between a commonly used AP definition and long-term outcomes was tested, which identified definitions more strongly linked to a high risk of metastasis. Methods: Data were reviewed from the Shared Equal Access Regional Cancer Hospital cohort of men undergoing radical prostatectomy (RP) from 1988 to 2020 at nine Veterans Affairs hospitals. Men meeting National Comprehensive Cancer Network low-risk and favorable intermediate-risk criteria were included. Men with and without AP were compared; men with AP were defined as having grade groups 3-5 or pathological stage >= pT3a or pN1 at RP (definition 1). Sensitivity analyses were performed for six alternative definitions (definitions 2-7) and their association with biochemical recurrence (BCR), metastasis, PCa-specific mortality (PCSM), and castrate-resistant PCa (CRPC). Results: A total of 2175 men were included: 711 had AP by definition 1. In univariable analyses, all AP definitions were associated with the risk of BCR, metastasis, and PCSM. All but one definition were associated with CRPC. In definitions 1-6, the 10-year event rate for metastasis in those with AP ranged from 3.0% (definition 1) to 7.9% (definition 5). Only in definition 7 was the 10-year event rate for metastasis >10%. However, only 0.5% of patients (11 of 2175) met definition 7. Conclusions: AP was statistically associated with relatively worse outcomes. However, in all but the most stringent definitions, met by <1% of patients, the absolute event rate of metastasis in men with AP was low. This challenges the clinical usefulness of AP as an intermediate end point in men with intermediate- to low-risk PCa.

BACKGROUND AND OBJECTIVE:Prostate cancer (PC) is the second most common cancer and a leading cause of death among males. In this systematic review we evaluated cohort studies and randomized controlled trials (RCTs) on the relationship between dietary patterns and PC risk, progression, mortality, and biomarkers. METHODS:A systematic search of MEDLINE, Embase, and Cochrane Central was conducted through June 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 63 studies (49 cohort studies, 14 RCTs reports) examining dietary patterns and PC outcomes were included. Study quality was assessed using Critical Appraisal Skills Programme checklists. KEY FINDINGS AND LIMITATIONS:Among males without PC at baseline, plant-based and healthy dietary patterns (eg, higher Healthy Eating Index, lower dietary inflammatory and hyperinsulinemic scores) were generally associated with lower total PC risk. Among patients with PC, Mediterranean, plant-based, and low-inflammatory diets were more consistently linked to lower risk of progression and PC-specific mortality. RCTs testing various diet patterns showed mixed effects on prostate-specific antigen or tumor markers. Limitations include variations in diet definitions, outcomes, and follow-up duration, and residual confounding. CONCLUSIONS AND CLINICAL IMPLICATIONS:Healthy dietary patterns that support cardiometabolic health may also benefit PC prevention and management. While evidence appears stronger for diet in slowing PC progression after diagnosis, the impact of diet on reducing the risk of other PC outcomes should not be overlooked (eg, risk of developing PC or risk of PC death). Integrated strategies are needed to promote healthy eating, particularly for patients at risk of PC progression, as this population often has higher risk of cardiovascular disease and metabolic disorders such as diabetes.

The purpose of this study was to compare the impact of blue light cystoscopy (BLC) vs white light cystoscopy (WLC) on the oncologic outcomes of nonmuscle invasive bladder cancer (NMIBC). We identified patients diagnosed with NMIBC between 1997 and 2021 in the Veterans Affairs Healthcare System. A 1:1 propensity score matching algorithm was used, accounting for baseline demographic and clinical variables. The primary objective was to determine recurrence and progression-free survival, using multivariable Cox proportional hazards regression models. Among 626 matched patients (313 BLC and 313 WLC), median age at diagnosis was 71 years, 616 (98%) were male, 381 (61%) were high-risk NMIBC, and 159 (25%) had bladder cancer recurrence. Median follow-up was 3.7 years. Recurrence risk at 3 years was significantly reduced after BLC vs WLC (hazard ratio = 0.62; 95% confidence interval, 0.45-0.86; P < .01). Progression risk at 3 years was reduced; however, this was not statistically significant (hazard ratio = 0.71; 95% confidence interval, 0.37-1.38; P = .32). Compared with WLC patients, BLC patients were significantly more likely to receive intravesical Bacillus Calmette-Guerin (61% vs 43%; P < .01) or intravesical chemotherapy (48% vs 27%, P < .01). No difference in definitive treatment rates (radical cystectomy, radiation therapy, and/or systemic chemotherapy) was observed (8% vs 6%; P = .27) between BLC and WLC patients. In a high-risk NMIBC predominant cohort, the use of BLC was associated with reduced risk of bladder cancer recurrence. BLC use was also associated with increased use of intravesical therapies but not definitive treatment. These findings provide evidence for the oncologic benefits of using BLC.

Introduction Approximately one third of patients with prostate cancer (PC) undergoing radical prostatectomy (RP) develop biochemical recurrence within 10 years. PC in these men is heterogenous, with most following an indolent course, however up to one third will progress to metastatic castrate sensitive disease (mCSPC). Patient and clinical factors associated with progression from non-metastatic PSA recurrence to mCRPC or death include increased age, shorter time from surgery to recurrence, higher Gleason grade (PC specific tumor grade), and shorter PSA doubling time (PSADT). The factors that influence disease progression once patients develop mCSPC are unknown. Methods After obtaining IRB approval, the SEARCH database was created by combining data on 9,928 patients who underwent RP from 1982 to 2020 at eight VA Medical Centers across the U.S. Patients with recurrent mCSPC after RP were selected for analysis. Those treated with preoperative ADT or radiation therapy were excluded, as were patients who developed CRPC prior to metastasis. Patients who received ADT more than 3 months prior to metastasis were excluded. Of the 278 men who met these criteria, 153 were excluded due to missing data. We used multivariable cox proportional hazards regression modeling to assess the association between clinical variables at the time of mCSPC and the primary outcome of overall mortality (OM). Results Of 125 patients with recurrent mCSPC, median age at metastasis was 70. Median time from surgery to metastasis was 61 months. During follow-up, 60 patients (48%) progressed to mCRPC while 56 (45%) died from PC and 81 (65%) died from any cause. Shorter PSADT was the only clinical or pathologic feature associated with progression to OM (HR = 0.98, p < 0.0001). Patients were divided into groups based on PSADT widely used in non-metastatic biochemical recurrence (<3, 3-8.9, >9 months). On multivariable analysis, PSADT <3 months and 3-8.9 months were associated with worse overall survival (OS) than PSADT >9 months (Table 1). Median time to OS and 5-year OS rates were 93 months and 64% for PSADT >9 months, 47 months and 41% for 3-8.9 months, and 25 months and 12% for <3 months. Conclusions Outcomes for patients with recurrent mCSPC after RP were driven primarily by PSADT rather than other clinical features, including Gleason score. Our data demonstrates that patients with PSADT < 9 months have rapidly progressive disease that warrants aggressive treatment and inclusion in clnical trials. In contrast, those with PSADT > 9 months have a more indolent course despite the presence of metastases and may be candidates for deintensificaiton strategies.

64 Background: Therapeutic strategies for oligometastatic castration sensitive prostate cancer (omCSPC) combining treatment of the primary and metastases with short-term intensified systemic therapy aim to improve survival and local control while minimizing toxicity from indefinite systemic therapy. This post-hoc analysis of the SOLAR (NCT03298087) and SATURN (NCT03902951) trials, which evaluated systemic and tumor-directed therapy in PSMA-PET defined oligo-M1 (≤5 metastases) de novo and recurrent omCSPC, respectively, aims to draw inferences on biology and oncologic outcome. Methods: All patients were treated with 6 months of systemic therapy: leuprolide, abiraterone acetate with prednisone, and apalutamide in conjunction with SBRT to oligometastatic sites. SOLAR patients were treatment naïve and underwent either radical prostatectomy (RP) with lymph node dissection followed by post-operative radiotherapy for high-risk features, or definitive radiotherapy (dRT). SATURN patients all had recurrent disease after RP with or without postoperative radiotherapy and may have also had prior hormone or metastasis-directed therapy. The primary endpoint (response rate) was the percentage of patients with an undetectable PSA (<0.05 ng/mL) for post-RP patients, or a PSA <2 ng/mL for post-dRT patients, six months after recovery of testosterone to >150 ng/dl. Secondary endpoints included progression-free survival (PFS) and eugonadal PFS starting from time of testosterone recovery. Kaplan-Meier assessed differences in time-to-event endpoints from initiation of systemic therapy. Fischer’s Exact Test compared proportional outcomes. Results: Analysis included data from 24 SOLAR and 26 SATURN patients. Overall, median follow-up was 32 months (interquartile range 28.25-36.75 months). Response rates were higher for de novo versus oligorecurrent patients (20/24 [83%] versus 13/26 [50%], p=0.018). PFS and eugonadal PFS were also significantly longer (median not reached versus 17 months and median not reached versus 13 months, respectively, p<0.05). PFS was shorter for oligorecurrent patients with prior exposure to hormone therapy (median 10 months versus not reached, p<0.05). There was no PFS difference comparing patients treated in the de novo setting versus the recurrent setting who were naive to hormonal therapy (p=0.23). Conclusions: Patients with recurrent omCSPC PSMA-PET defined M1 disease had a worse response rate and shorter PFS following intensified systemic and metastasis-directed SBRT than those with de novo omCSPC. The difference was driven by recurrent patients with prior exposure to hormonal therapy, suggesting a continuum of treatment resistances over repeated courses of hormonal therapy. The majority of patients with de novo omCSPC remain in remission after gonadal recovery. Clinical trial information: NCT03298087 , NCT03902951 .

Background: We previously reported that outcomes after radical prostatectomy (RP) were similar among non-Hispanic Black, non-Hispanic White, and Hispanic White Veterans Affairs (VA) patients. However, prostate cancer (PC) mortality in Puerto Rican Hispanics (PRH) may be higher than in other Hispanic groups. Data focused on PRH patients is sparse; thus, we tested the association between PR ethnicity and outcomes after RP. Methods: Analysis included men in SEARCH cohort who underwent RP (1988-2020, n = 8311). PRH patients (n = 642) were treated at the PR VA, and outcomes were compared to patients treated in the Continental US regardless of race. Logistic regression was used to test the associations between PRH and PC aggressiveness, adjusting for demographic and clinicopathological features. Multivariable Cox models were used to investigate PRH versus Continental differences in biochemical recurrence (BCR), metastases, castration-resistant PC (CRPC), and PC-specific mortality (PCSM). Results: Compared to Continental patients, PRH patients had lower adjusted odds of pathological grade group >= 2 (p < 0.001), lymph node metastasis (p < 0.001), and positive margins (p < 0.001). In contrast, PRH patients had higher odds of extracapsular extension (p < 0.001). In Cox models, PRH patients had a higher risk for BCR (HR = 1.27, p < 0.001), metastases (HR = 1.49, p = 0.014), CRPC (HR = 1.80, p = 0.001), and PCSM (HR = 1.74, p = 0.011). Further adjustment for extracapsular extension and other pathological variables strengthened these findings. Conclusions: In an equal access setting, PRH RP patients generally had better pathological features, but despite this, they had significantly worse post-treatment outcomes than men from the Continental US, regardless of race. The reasons for the poorer prognosis among PRH men require further research.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP58)1 May 2024MP58-18 DOES EQUAL ACCESS MEAN EQUAL ACCESS TO SECONDARY TREATMENTS AFTER BIOCHEMICAL RECURRENCE (BCR) FOLLOWING RADICAL PROSTATECTOMY (RP) Anael Rizzo, Shakiba Eslamimehr, Christopher L. Amling, William J. Aronson, Christopher Kane, Martha K. Terris, Lourdes Guerrios-Rivera, Matthew R. Cooperberg, Zachary Klaassen, and Stephen Freedland Anael RizzoAnael Rizzo , Shakiba EslamimehrShakiba Eslamimehr , Christopher L. AmlingChristopher L. Amling , William J. AronsonWilliam J. Aronson , Christopher KaneChristopher Kane , Martha K. TerrisMartha K. Terris , Lourdes Guerrios-RiveraLourdes Guerrios-Rivera , Matthew R. CooperbergMatthew R. Cooperberg , Zachary KlaassenZachary Klaassen , and Stephen FreedlandStephen Freedland View All Author Informationhttps://doi.org/10.1097/01.JU.0001008852.83523.41.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: BCR after RP is a common clinical challenge. While secondary treatments can be curative in some, they are not universally used. Moreover, whether there are disparities in use remains unclear as well as drivers of secondary treatments. We investigated predictors of secondary radiation (XRT) and ADT after BCR using data from the SEARCH Database, a cohort of men all treated with RP within the VA. METHODS: Of 9,932 men in SEARCH, 3,024 (30.4%) developed a rising PSA to ≥0.2 ng/ml. Among these, we assessed time to XRT or ADT using Cox models. Risk factors evaluated included demographic, clinical, and pathological features. RESULTS: Time from RP to BCR was 21 months. Median age at BCR was 65 years. During a median post-BCR follow-up up 90 months, 1,381 (46%) underwent salvage radiation and 1,459 (48%) underwent ADT. Among those who underwent XRT, median time to XRT was 7 months. Among those who underwent ADT, median time to ADT was 48 months. On multivariable analysis, predictors of secondary XRT included more recent year of surgery (HR 1.08, p<0.001), higher pathological tumor grade (GG 3 HR 1.27, p=0.017; GG4-5 HR 1.42, p=0.001), positive margins (HR 1.36, p<0.001), while being older (HR 0.97, p<0.001) and positive nodes (HR 0.49, p<0.001) were associated with lower rates of XRT. On multivariable analysis, predictors of secondary ADT included high pre-op log-transformed PSA (HR 1.09, p=0.028), more recent year of surgery (HR 1.02, p<0.001), higher pathological grade (GG 2 HR 1.38, p<0.001; GG3 HR 1.77, p<0.001; GG4-5 HR 3.02, p=0.001), seminal vesical invasion (HR 1.62, p<0.001), positive nodes (HR 2.95, p<0.001), and capsular penetration (HR 1.29, p<0.001) while positive margins (HR 0.81, p=0.001) and not having nodes removed (HR 0.82, p=0.017) both predicted lower risk of ADT. Differences among centers were noted for both XRT and ADT receipt. Importantly, race did not predict receipt of ADT or XRT. CONCLUSIONS: A high percent of men with BCR undergo secondary treatment showing the high burden of this disease state. Importantly, within the equal access environment of the VA, clinical factors drove receipt of secondary treatments while race was unrelated to treatment received. Given the null findings on race, these data support that equal access centers do indeed provide equal access to care. Nonetheless, the high burden of secondary treatments argues that improved methods for initial tumor control are needed. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e954 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Anael Rizzo More articles by this author Shakiba Eslamimehr More articles by this author Christopher L. Amling More articles by this author William J. Aronson More articles by this author Christopher Kane More articles by this author Martha K. Terris More articles by this author Lourdes Guerrios-Rivera More articles by this author Matthew R. Cooperberg More articles by this author Zachary Klaassen More articles by this author Stephen Freedland More articles by this author Expand All Advertisement PDF downloadLoading ...

Importance and objective: Partial gland ablation (PGA) is increasingly popular as a treatment for men with intermediate-risk prostate cancer (IR-PCa) to preserve functional outcomes while controlling their cancer. We aimed to determine the impact of race and clinical characteristics on the risk of upstaging (>= pT2c) and having adverse pathological outcomes including seminal vesicle invasion (SVI), extra prostatic extension (EPE) and lymph node invasion (LNI) at radical prostatectomy (RP) among men with IR disease eligible for PGA with hemi-ablation (HA). Design: Retrospective analysis. Setting: Multicenter. Participants and measures: We studied patients diagnosed with unilateral IR-PCa treated with RP between 1988 and 2020 at 9 different Veterans Affairs hospitals within the SEARCH cohort. We analyzed differences in clinicopathological characteristics and outcome variables (odds of >= pT2c and SVI, EPE and LNI) by race using multivariable logistic regression after adjusting for covariates. Results: Among 3127 patients, 33% were African American (AA) men with unilateral IR-PCa undergoing RP. Compared to non-AA men, AA individuals were younger (61 vs. 65 years, p < 0.001), presented with a higher prostate specific antigen (PSA) category (>= 10 ng/ml; 34 vs. 26%, p < 0.001), and had a lower clinical stage (p < 0.001). Among the 2,798 (89.5%) with >= pT2c stage, AA men exhibited higher >= pT2c rates (93 vs. 89%, p < 0.001), primarily due to increased pT2c staging (64 vs. 57%), where upstaging beyond pT2 was lower than non-AA men (29 vs. 32%). On multivariable analysis, AA men were found to have higher odds of >= pT2c (odds ratio [OR]: 1.39 CI, 1.02-1.88, p = 0.04), lower odds of EPE (OR: 0.73 CI, 0.58-0.91, p < 0.01) and no statistically significant associations with LNI (OR: 0.79 CI, 0.42-1.46, p = 0.45) and SVI (OR: 1 CI, 0.74-1.35, p = 0.99) compared to non-AA men. On multivariable analysis, clinical features associated with higher odds of >= pT2c were pre-operative PSA >= 15 (OR = 2.07, P = 0.01) and higher number of positive cores (HPC) on biopsy (OR = 1.36, P < 0.001). Similarly, PSA >= 15, Gleason grade >= 3 and HPC on biopsy were associated with higher odds of SVI, EPE and LNI, respectively. Conclusions: In men with IR-PCa undergoing RP, AA men demonstrated an overall higher likelihood of >= pT2c with lower upstaging beyond pT2, lower likelihood of EPE and no significant difference in likelihood of SVI and LNI compared to non-AA men. These findings support select AA men to be potential candidates for PGA, such as HA. Clinical factors are predictive of higher pathological stage and adverse pathological outcomes at RP and could be considered when selecting candidates for PGA.

Introduction Recent studies have shown conflicting evidence regarding the utility of blue light cystoscopy;(BLC) guided resection of bladder tumor;and impact on oncologic outcomes. We describe recurrence outcomes among a predominantly high-risk non-muscle invasive bladder cancer (NMIBC) patient cohort that underwent BLC vs. white light cystoscopy (WLC) in an equal access setting. Methods We performed a retrospective cohort study among NMIBC patients within the Veteran Affairs (VA) that underwent BLC versus WLC from January 1, 1991 to January 31, 2023. A total of 337 BLC recipients were first identified and then compared to 337 WLC recipients using 1:1 propensity score matching. The variables that were used to calculate the propensity score between the cohorts included age at diagnosis, gender, race, ethnicity, location of bladder cancer diagnosed (within the;VA;vs. outside the VA), smoking status, clinical grade group, and BCG receipt. We determined recurrence rates following either BLC or WLC from date of bladder cancer diagnosis. We used the Kaplan-Meier method to estimate event-free survival and Cox regression to determine the association between type of cystoscopy (BLC vs. WLC) and recurrence. Results A total of 674 patients in the matched analysis (337 BLC patients and 337 WLC patients) were included. There were 76 (11%) Black and 598 (89%) were non-Black patients, respectively. Median follow-up was 3.4 years and 2.0 years for the BLC and WLC cohorts, respectively. There was a total of 359 (54%) patients with either TaHG or T1 without CIS; 70 (10%) had CIS with or without TaHG or T1; and 245 (36%) had TaLG only. A total of 393 (58%) patients received BCG at any point during the study (Table 1). The risk of recurrence was significantly lower following BLC (Hazard Ratio (HR) 0.67; 95% Confidence Interval (CI) 0.51-0.89) than WLC (Figure 1). There was no significant difference recurrence (HR 1.09; 95% CI 0.70-1.70) by Black vs. non-Black race. Conclusions In this study from an equal access setting in the VA, we observed significantly decreased risk of recurrence in patients who received a BLC compared to patients who only underwent WLC.

BACKGROUND:Certain widely used pathological outcome prediction models that were developed in tertiary centers tend to overpredict outcomes in the community setting; thus, the Michigan Urological-Surgery Improvement Collaborative (MUSIC) model was developed in general urology practice to address this issue. Additionally, the development of these models involved a relatively small proportion of Black men, potentially compromising the accuracy of predictions in this patient group. We tested the validity of the MUSIC and three widely used nomograms to compare their overall and race-stratified predictive performance. METHODS:We extracted data from 4139 (1138 Black) men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database of the Veterans Affairs health system. The predictive performance of the MUSIC model was compared to the Memorial-Sloan Kettering (MSK), Briganti-2012, and Partin-2017 models for predicting lymph-node invasion (LNI), extra-prostatic extension (EPE), and seminal vesicle invasion (SVI). RESULTS:The median PSA of Black men was higher than White men (7.8 vs. 6.8 ng/ml), although they were younger by a median of three years and presented at a lower-stage disease. MUSIC model showed comparable discriminatory capacity (AUC:77.0%) compared to MSK (79.2%), Partin-2017 (74.6%), and Briganti-2012 (76.3%), with better calibration for LNI. AUCs for EPE and SVI were 72.7% and 76.9%, respectively, all comparable to the MSK and Partin models. LNI AUCs for Black and White men were 69.6% and 79.6%, respectively, while EPE and SVI AUCs were comparable between races. EPE and LNI had worse calibration in Black men. Decision curve analysis showed MUSIC superiority over the MSK model in predicting LNI, especially among Black men. CONCLUSION:Although the discriminatory performance of all models was comparable for each outcome, the MUSIC model exhibited superior net benefit to the MSK model in predicting LNI outcomes among Black men in the SEARCH population.