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Broad-based prostate-specific antigen (PSA) screening has saved lives but at a substantial human and financial cost. One way of mitigating this harm, while maintaining and possibly improving the benefit, is by focusing screening efforts on men at higher risk. With age, race, and family history as the only risk factors, many men lack any reliable data to inform their prostate cancer (PCa) screening decisions. Complexities including history of previous negative biopsies, interpretation of negative and/or equivocal mpMRI findings, and patient comorbidities further compound the already complicated decisions surrounding PCa screening and early detection. The authors present cases that provide real-world examples of how a single nucleotide polymorphism-based test can provide patients and providers with personalized PCa risk assessments and allow for development of improved risk-stratified screening regimens.

Objective: To describe patient characteristics and pathological stage at bladder cancer (BCa) diagnosis in a diverse population within a national, equal‐access healthcare system. Methods: This retrospective cohort study identified 15 966 men diagnosed with BCa in the Veterans Affairs (VA) healthcare system from 2000 to 2020. The primary outcome was pathological stage at diagnosis, determined by index transurethral resection of bladder tumour. Logistic regression was used to assess the relationship between race and stage. Competing risk models tested the association between race and BCa‐specific mortality with cumulative incidence estimates. Results: Of 15 966 BCa patients, 12 868 (81%), 1726 (11%), 493 (3%) and 879 (6%) were White, Black, Hispanic and Other race, respectively. Black patients had significantly higher muscle‐invasive bladder cancer (MIBC) rates than White patients (35% vs 32%; P = 0.009). In multivariable analysis, the odds of presenting with MIBC did not differ significantly between Black and White patients (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.98–1.22) or between Hispanic patients (OR 0.82, 95% CI 0.67–1.01) and White patients. Compared to White patients, Black patients had a similar risk of BCa‐specific mortality (hazard ratio [HR] 0.89, 95% CI 0.75–1.06), whereas Hispanic patients had a lower risk (HR 0.56, 95% CI 0.38–0.82). Conclusions: Black patients presented with the highest rates of de novo MIBC. However, in a large, equal‐access healthcare system, this did not result in a difference in BCa‐specific mortality. In contrast, Hispanic patients had lower risks of MIBC and BCa‐specific mortality. [ABSTRACT FROM AUTHOR]

Simple Summary: One barrier to implementing patient-reported outcomes (PROs) during perioperative care for bladder cancer (BLC) patients is the lack of empirical reports of meaningful symptom burden that are associated with postoperative recovery. This study aimed to describe symptom burden and functioning status for 3 months post-radical cystectomy, using a validated disease-specific PRO measure tool, the MD Anderson Symptom Inventory (the MDASI-PeriOp-BLC). We found that the most severe symptom burden at baseline and discharge is associated with poor functional recovery post-radical cystectomy for BLC. These PROs could be used to identify BLC patients at the highest risk for poor functional recovery during the perioperative period. We also found that postoperative functional recovery assessment via PROs is more feasible than an objective performance measure. The completion of MDASI-PeriOp-BLC at preoperative, discharge and end of study was 100%, 79% and 77%, while Timed Up and Go test completion rates were 88%, 54% and 13%, respectively. This is a longitudinal prospective study that tracked multiple symptom burden and functioning status for bladder cancer (BLC) patients for 3 months post-radical cystectomy at The University of Texas MD Anderson Cancer Center, using a validated disease-specific patient-reported outcome measure (PROM) tool, the MD Anderson Symptom Inventory (the MDASI-PeriOp-BLC). The feasibility of collecting an objective measure for physical functioning, using "Timed Up & Go test" (TUGT) and PRO scores at baseline, discharge and end of study, was tested. Patients (n = 52) received care under an ERAS pathway. The more severe scores of fatigue, sleep disturbance, distress, drowsiness, frequent urination and urinary urgency at baseline predicted poor functional recovery postoperatively (OR = 1.661, 1.039–2.655, p = 0.034); other more severe symptoms at discharge (pain, fatigue, sleep disturbance, lack of appetite, drowsiness, bloating/abdominal tightness) predicted poor functional recovery (OR = 1.697, 1.114–2.584, p = 0.014) postoperatively. Compliance rates at preoperative, discharge and end of study were 100%, 79% and 77%, while TUGT completion rates were 88%, 54% and 13%, respectively. This prospective study found that more severe symptom burden at baseline and discharge is associated with poor functional recovery post-radical cystectomy for BLC. The collection of PROs is more feasible than using performance measures (TUGT) of function following radical cystectomy. [ABSTRACT FROM AUTHOR]

Objectives: To describe clinical, imaging, and histopathological characteristics of inflammatory myofibroblastic tumour (IMT) of the urinary bladder and provide initial management and surveillance recommendations. Patients and Methods: We identified patients with IMT of the bladder treated at our facility from 1998 to 2020. Categorical variables were analysed with chi‐square and Fisher's exact tests and continuous variables with the Mann–Whitney U‐test. Kaplan–Meier analysis was performed for recurrence‐free survival. Results: IMT was diagnosed in 35 patients with median (interquartile range [IQR]) follow‐up of 20 (11.5–68.5) months. At initial diagnosis 86% were clinically organ‐confined, 9% locally advanced, and 5% metastatic. Majority of patients (92%) had residual disease on re‐staging transurethral resection (TUR). Of the 15 patients with organ‐confined disease managed initially with TUR alone, five (33%) recurred at a median (IQR) of 5 (3.0–5.5) months from initial diagnosis. Presentation with visible haematuria was associated with recurrence (100% in recurrence vs 40% in non‐recurrence groups, P = 0.044). There were no patients who developed a recurrence beyond 6 months after diagnosis. Partial or radical cystectomy was required in 23% and 9% of patients, respectively. One patient presented with metastatic disease associated with anaplastic lymphoma kinase (ALK) translocation and achieved a durable complete remission with 7 months of crizotinib therapy. Conclusions: No patient with IMT treated with aggressive endoscopic management developed recurrences beyond 6 months. There were additionally no recurrences noted after definitive radical or partial cystectomy. These data support organ sparing therapy with aggressive endoscopic management and short‐term surveillance in patients with localised IMT, with extirpative surgery reserved for refractory cases. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of fibrin clot inhibitor (FCI) use on oncological outcomes in a large contemporary cohort of patients with non‐muscle‐invasive bladder cancer (NMIBC) treated with adequate bacille Calmette–Guérin (BCG). Patients and Methods: We performed an Institutional Review Board‐approved review of patients with NMIBC treated with adequate intravesical BCG, at our institution between 2000 and 2018. FCI use at the time of BCG therapy was recorded for each patient. Patients were stratified according to use of FCI medication. Recurrence‐ and progression‐free survival were analysed using Kaplan–Meier methods and Cox proportional hazard models. Results: Overall, 226 of 526 patients (43.0%) used a FCI: aspirin (205), clopidogrel (38), warfarin (18) and novel oral anticoagulant (NOAC; seven). The use of FCIs did not adversely affect either recurrence‐ or progression‐free survival (P = 0.385 and P = 0.131, respectively). These results did not change when the impact of aspirin, clopidogrel or warfarin/NOAC use on recurrence and progression was evaluated separately. On multivariate analysis, FCI use was neither associated with tumour recurrence nor progression. Conclusion: The use of FCIs was not associated with adverse oncological outcomes in a large contemporary cohort of patients receiving adequate intravesical BCG for NMIBC. Based on these results, FCIs may be safely continued during BCG immunotherapy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of one‐third‐dose (1/3D) bacillus Calmette‐Guérin (BCG) on oncological outcomes in a large cohort of patients with non‐muscle‐invasive bladder cancer (NMIBC) treated with adequate BCG (as defined by the US Food & Drug Administration (FDA)) in a real‐world setting. Patients and Methods: We performed an institutional review board‐approved review of patients with NMIBC treated with adequate BCG at our institution between 2000 and 2020. Patients were stratified according to whether they had received 1/3D BCG or full‐dose (FD) BCG. Time to recurrence, time to progression and cancer‐specific survival were estimated using Kaplan–Meier methods. Results: Of 563 patients with NMIBC treated with adequate BCG, 150 (26.6%) received 1/3D and 413 (73.4%) received FD. The use of 1/3D BCG did not adversely affect time to recurrence (P = 0.449) or time to progression (P = 0.716), and this remained consistent when patients were stratified by individual 2021 European Association of Urology (EAU) prognostic factor risk groups. Cancer‐specific survival was similar in patients receiving 1/3D and those receiving FD BCG (P = 0.320). Conclusion: The use of 1/3D BCG was not associated with adverse oncological outcomes in a large cohort of patients receiving adequate BCG for intermediate‐ and high‐risk NMIBC. Based on this real‐world experience, risk‐stratified split‐vial dosing may represent a valuable approach for other institutions facing BCG shortages whilst also providing reassurance to patients who may be concerned about suboptimal outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The treated natural history of nonmetastatic plasmacytoid variant of bladder cancer (PV-BCa) is poorly understood owing to its rarity. We sought to examine the disease recurrence and metastasis patterns in this select group of patients in order to identify opportunities for intervention., Materials and Methods: We conducted a natural language processing algorithm-augmented retrospective chart review of 56 consecutive patients who were treated with curative intent for nonmetastatic PV-BCa at our institution between 1998 and 2018. Kaplan-Meier and multivariable Cox regression methods were used for survival analyses., Results: The stage at presentation was: ≤ cT2N0 in 22 (39.3%), cT3N0 in 15 (26.8%), cT4N0 in 13 (23.2%), and ≥ cN1 in 6 patients (10.7%). Forty-nine patients (87.5%) received chemotherapy, and 42 (75%) were able to undergo the planned surgery. Notably, only 4 patients (7.2%) had pT0 stage, while 22 (52.4%) had pN+ disease at the time of surgery. At 36-month follow-up, 28.4% of patients (95% CI: 22.1%-34.5%) were alive and 22.2% (95% CI: 16.1%-28.5%) were free of metastatic disease. The benefit of surgical extirpation was stage specific: successful completion of surgery was associated with improved metastasis-free survival (at 36 months 32.4% vs 0%, log-rank P < .001) in patients with localized or locally advanced disease (≤cT2N0/cT3N0); however, in patients with regionally advanced disease (cT4N0/≥cN1), consolidative surgery following chemotherapy was not associated with improved metastasis-free survival (12.5% vs 10% at 36 months, log-rank P = .49). The median time to metastasis from primary treatment end was 6.5 months (IQR: 2.9-14.7). The predominant site of recurrence/metastasis was the peritoneum (76.1%), either in isolation or along with extraperitoneal lesions. Salvage immunotherapy in these patients significantly reduced the risk of death (HR = 0.11, P = .001)., Conclusions: PV-BCa is a disease with high lethality. Despite multimodal treatment, a vast majority of patients develop atypical intraperitoneal metastasis soon after therapy and rapidly succumb to it. Clinical trials evaluating utility of hyperthermic intraperitoneal chemotherapy and/or immunotherapy may be warranted in this high-risk population.