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Purpose: Active surveillance to manage prostate cancer provides an alternative to immediate treatment in men with low risk prostate cancer. We report updated outcomes from a long-standing active surveillance cohort and factors associated with reclassification. Materials and Methods: We retrospectively reviewed data on all men enrolled in the active surveillance cohort at our institution with at least 6 months of followup between 1990 and 2013. Surveillance consisted of quarterly prostate specific antigen testing, repeat imaging with transrectal ultrasound at provider discretion and periodic repeat prostate biopsies. Factors associated with repeat biopsy reclassification and local treatment were determined by multivariate Cox proportional hazards regression. We also analyzed the association of prostate specific antigen density and outcomes stratified by prostate size. Results: A total of 810 men who consented to participate in the research cohort were followed on active surveillance for a median of 60 months. Of these men 556 (69%) met strict criteria for active surveillance. Five-year overall survival was 98%, treatment-free survival was 60% and biopsy reclassification-free survival was 40%. There were no prostate cancer related deaths. On multivariate analysis prostate specific antigen density was positively associated with the risk of biopsy reclassification and treatment while the number of biopsies and time between biopsies were inversely associated with the 2 outcomes (each p

Purpose: Active surveillance to manage prostate cancer provides an alternative to immediate treatment in men with low risk prostate cancer. We report updated outcomes from a long-standing active surveillance cohort and factors associated with reclassification. Materials and Methods: We retrospectively reviewed data on all men enrolled in the active surveillance cohort at our institution with at least 6 months of followup between 1990 and 2013. Surveillance consisted of quarterly prostate specific antigen testing, repeat imaging with transrectal ultrasound at provider discretion and periodic repeat prostate biopsies. Factors associated with repeat biopsy reclassification and local treatment were determined by multivariate Cox proportional hazards regression. We also analyzed the association of prostate specific antigen density and outcomes stratified by prostate size. Results: A total of 810 men who consented to participate in the research cohort were followed on active surveillance for a median of 60 months. Of these men 556 (69%) met strict criteria for active surveillance. Five-year overall survival was 98%, treatment-free survival was 60% and biopsy reclassification-free survival was 40%. There were no prostate cancer related deaths. On multivariate analysis prostate specific antigen density was positively associated with the risk of biopsy reclassification and treatment while the number of biopsies and time between biopsies were inversely associated with the 2 outcomes (each p

BackgroundThe effect of practice guidelines and the European Randomised Screening for Prostate Cancer (ERSPC) and Prostate, Lung, Colorectal and Ovarian (PLCO) trials on PSA screening practices of primary-care physicians (PCPs) is unknown.MethodsWe conducted a national cross-sectional on-line survey of a random sample of 3010 PCPs from July to August 2010. Participants were queried about their knowledge of prostate cancer, PSA screening guidelines, the ERSPC and PLCO trials, and about their PSA screening practices. Factors associated with PSA screening were identified using multivariable linear regression.ResultsA total of 152 (5%) participants opened and 89 completed the on-line survey, yielding a response rate of 58% for those that viewed the invitation. Eighty percent of respondents correctly identified prostate cancer risk factors. In all, 51% and 64% reported that they discuss and order PSA screening for men aged 50-75 years, respectively. Fifty-four percent were most influenced by the US Preventative Services Task Force (USPSTF) guidelines. Also, 21% and 28% of respondents stated that their PSA screening practices were influenced by the ERSPC and PLCO trials, respectively. Medical specialty was the only variable associated with propensity to screen, with family medicine physicians more likely to use PSA screening than internists (β=0.21, P=0.02).ConclusionsHalf of the physicians surveyed did not routinely discuss PSA screening with eligible patients. The impact of the ERSPC and PLCO trials on PSA screening practices was low among US PCPs. USPSTF recommendations for PSA screening continue to be the strongest influence on PCPs' propensity to use PSA screening.

The goals of DIII-D advanced tokamak (AT) experiments are investigation and optimization of the upper limits of energy confinement and MHD stability in a tokamak plasma, and simultaneous maximization of the fraction of non-inductive current drive. Significant overall progress has been made in the past two years, as the performance figure of merit βNH89P of 9 has been achieved in ELMing H mode for over 16τE without sawteeth. The tokamak was also operated at βNH ≈ 7 for over 35τE or 3τR, with the duration limited by the hardware. Real time feedback control of β (at 95% of the stability boundary), optimizing the plasma shape (e.g., δ, divertor strike and X points, double/single null balance) and particle control (ne/nGW ≈ 0.3, Zeff < 2.0) were necessary for the long pulse results. A new quiescent double barrier (QDB) regime with simultaneous inner and edge transport barriers and no ELMs has been discovered with a βNH89P of 7. The QDB regime has been obtained to date only with counter NBI. Further modification and control of internal transport barriers (ITBs) has also been demonstrated with impurity injection (broader barrier), pellets and ECH (strong electron barrier). The new Divertor-2000, a key ingredient in all these discharges, provides effective density, impurity and heat flux control in the high triangularity plasma shapes. Discharges at ne/nGW ≈ 1.4 have been obtained with gas puffing by maintaining the edge pedestal pressure; this operation is easier with Divertor-2000. We are developing several other tools required for AT operation, including real time feedback control of resistive wall modes with external coils and control of neoclassical tearing modes with ECCD.

Objective: To compare continence outcomes in post-prostatectomy patients undergoing supervised in-person versus online pelvic floor muscle training and pelvic floor education (iPMFT vs oPFMT/PFE). Despite the proven benefit of in-person PFMT for urinary incontinence (UI) following prostatectomy, numerous barriers impede access. We developed a comprehensive online program to deliver oPFMT/PFE., Methods: We performed a retrospective review of patients receiving iPFMT versus oPFMT/PFE with minimum 12-month follow-up. Outcomes were assessed at 3 weeks, 3-, 6-, and 12 months following robotic-assisted laparoscopic prostatectomy using validated ICIQ-MLUTS and IIQ-7 questionnaires and additional items (daily pad use [PPD] and satisfaction). The primary study outcome was ICIQ-MLUTS SUI domain score (SDS). Secondary outcomes were PPD, PPD cure (0 PPD at 12 months), SUI cure (12-month SDS=baseline score), and QOL score (IIQ-7 Sum)., Results: Analysis included 41 men. Though men enrolled in oPFMT/PFE demonstrated lower SUI domain scores than iPFMT at most time points (3wk P <.01, 3 mo P = .04, 6 mo P = .15, 12 mo P = .04), the rate of improvement from 3 weeks to other time points was similar between groups (P = NS at all time points). SDS Cure was no different for oPFMT/PFE (75%, 15/20) compared to iPFMT (60%, 12/20, P = .3). PPD and IIQ-7 were also similar at all time points and demonstrated a similar rate of decrease over time through 12 months., Conclusion: Significant and similar improvements in UI and QOL are seen both in men completing iPFMT or oPFMT/PFE programs. Our novel online program provides another option to improve PFMT/PFE access in men undergoing RALP., Competing Interests: Declaration of Competing Interest Dr. Rapp is the owner of HFITNESS, LLC and creator and owner of the website and copyright for educational materials of the reported oPFMT/PFE. Conflict of Interest exemption and related management plan was approved by the UVA COI Committee (2018–17). As part of this plan, enrollment was performed by study research coordinators without Dr. Rapp present. All subjects were informed of Dr. Rapp’s financial interest in HFITNESS, LLC and provided with ombudsperson contact information to approach if they believed that Dr. Rapp’s financial interest interfered with the course of research. Dr. Rapp provided website and program tutorial at program initiation. All outcomes data collection and related database entry, including validated questionnaires, was performed independently by clinical research coordinators. All data and statistical analysis were performed independently by UVA Department of Public Health Sciences. An independent faculty member not participating as a study investigator was also appointed to review project results to ensure data integrity., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Grant funding to Urology has decreased over the last decade. Documented lack of gender and race diversity at the faculty level raises concerns for funding disparities. This study sought to characterize disparities based upon race and gender in National Institutes of Health (NIH) funding data to Urologic faculty., Methods and Materials: Data from 145 ACGME accredited Urology residency programs incorporating faculty gender and underrepresented in medicine (URiM) status was utilized. The NIH Research Portfolio Online Report Tool was queried between 1985 and 2023 for grants related to current Urology faculty. URiM status, gender, years of practice, academic rank, and Doximity residency program rank were factors in multivariable analysis., Results: A total of 2,131 faculty were included. Three hundred one Urologists received 793 urologic grants for a total of $993,919,052 in funding. By race, grants were awarded to: White 72.9%, Asian 21.8%, Hispanic 3.0%, Black 2.1%. Men received 708 grants (89.3%) worth $917,083,475 total. Women received 85 grants (10.7%) worth $76,835,577 total. Likelihood of being awarded a grant was significantly associated with non-URiM status (p < 0.001) and men (p < 0.0001). On multivariable analysis, Doximity rank (p < 0.001) and academic rank (p < 0.001) were significant predictors of receiving a grant; male gender, URiM status, and years of practice were not. Academic rank was also a significant predictor of number of grants received (p = 0.04) and total funding (p = 0.04); years of practice, Doximity rank, URiM status, and gender were not., Conclusions: NIH grants were more likely awarded to higher ranked faculty from higher Doximity ranked institutions with no differences based on URiM status or gender.

Background: Although pelvic floor muscle training (PFMT) is widely shown to improve post-prostatectomy incontinence (PPI), numerous barriers impede access to formal PFMT and include the limited availability of specialized therapists and financial or scheduling barriers. To address these barriers, we developed a novel online program delivering comprehensive long-term PFMT, pelvic floor education (PFE), and dietary/behavioral modification education. This study is a prospective interim analysis of online PFMT/PFE (oPFMT/PFE), with focus on feasibility, satisfaction, and continence outcomes., Methods: Patients anticipating robotic-assisted laparoscopic prostatectomy (RALP) were recruited (6/2021-9/2022) for oPFMT/PFE. oPFMT/PFE comprises a 12-month program of 3 phases, including multiple exercises with varied contraction types and duration, and comprehensive dietary and behavioral technique education. Incontinence and quality of life (QOL) outcomes are assessed at 3 weeks, 3, 6, and 12 months following RALP using validated International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and Incontinence Impact Questionnaire (IIQ-7) questionnaires and additional items assessing satisfaction, improvement, and daily pad use. Primary study outcomes included ICIQ-MLUTS stress urinary incontinence (SUI) domain score (SDS) and SUI cure [ICIQ SUI domain score (SDS) =0]. Interim 6-month analysis was performed using mixed effects linear regression and mixed effects Poisson regression., Results: Analysis included 21 men (64±6 years). At 6-month follow-up, men undergoing oPFMT/PFE showed significant improvement in SDS compared to the 3-week time point [mean ± standard error (SE) =1.05±0.24 vs. 0.45±0.17, P=0.011], but still experienced higher scores than at baseline (P=0.017). Six-month patient-reported improvement averaged 7.42±0.74 (10-point Likert scale). All (100%) of 19 respondents (2 missing data) found the program easy to use, educational, and would recommend it to others, with 89% expressing satisfaction with the program. During patient interview at 6-month follow-up, no men reported inability to access the program online or any adverse events. Finally, IIQ-7 score improved significantly from the 3-week timepoint (4.47±1.10) at both time points (3-month 1.14±0.44, P<0.001 and 6-month 1.10±0.37, P<0.001), and neither 3- nor 6-month scores differed from baseline (P=0.808 and P=0.444, respectively)., Conclusions: Our novel oPFMT/PFE yields significant improvements to validated urinary incontinence (UI) and QOL measures, providing a valuable and accessible treatment option for PPI., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-23-436/coif). D.E.R. is the owner of HFITNESS, LLC and creator and owner of the website and copyright for educational materials of the reported oPFMT/PFE. Conflict of Interest exemption and related management plan was approved by the UVA COI Committee (2018-17). As part of this plan, enrollment was performed by study research coordinators without D.E.R. present. All subjects were informed of D.E.R.’s financial interest in HFITNESS, LLC and provided with ombudsperson contact information to approach if they believed that D.E.R.’s financial interest interfered with the course of research. D.E.R. provided website and program tutorial at program initiation. All outcome data collection and related database entry, including validated questionnaires, was performed independently by clinical research coordinators. All data and statistical analysis were performed independently by UVA Department of Public Health Sciences. An independent faculty member not participating as a study investigator was also appointed to review project results in order to ensure data integrity. The other authors have no conflicts of interest to declare., (2023 Translational Andrology and Urology. All rights reserved.)

Objective: To characterize academic productivity for underrepresented minorities (URMs) vs non-URMs and by gender in Urology., Methods: A database was created from 145 Urology residency programs. URM status was determined by origin of name, photo, biography, Twitter, LinkedIn, and Doximity. A PubMed query was performed for publication output. URM status, gender, post-graduate year/years of practice, and Doximity residency rank were factors in multivariable analysis., Results: For residents, the median total publications was 2 [1,5] for URMs and 2 [1,5] for non-URMs (P=.54). The median first/last author publications was 1 [0,2] for URMs and 1 [0,2] for non-URMs (P=.79). The median total publications was 2 [0,4] for women and 2 [1,6] for men (P=.003). The median first/last author publications was 1 [0,2] for women and 1 [0,2] for men (P=.14). For faculty, the median total publications was 12 [3,32] for URMs and 19 [6,45] for non-URMs (P=.0002). The median first/last author publications was 4.5 [1,12] for URMs and 7 [2,20] for non-URM faculty (P=.0002). The median total publications was 11 [5,25] for women and 20 [6,49] for men (P<.0001). The median first/last author publications was 4 [1,11] for women and 8 [2,22] for men (P<.0001). On multivariable analysis, there was no difference in total publications and first/last author publications for URMs vs non-URMs. There remained a difference between genders for residents and faculty with total publications but not first/last author publications (P=.002/P=.10 residents, P=.004/P=.07 faculty)., Conclusion: Academic productivity was not different in URMs and non-URMs for both residents and faculty. Men residents and faculty had more total publications compared to women., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To compare comprehensive continence outcomes in patients receiving pelvic floor muscle training (PFMT) vs standard unsupervised home pelvic floor exercise therapy (UPFE)., Methods: As part of the UVA prostatectomy functional outcomes program, participating patients complete a 12-month PFMT program under FPMRS specialist supervision. We performed a retrospective review of prospectively collected longitudinal outcomes in patients receiving PFMT vs UPFE through 12-month follow-up. Primary study outcome was ICIQ-MLUTS SUI domain score (SDS). Secondary outcomes included daily pad use (PPD), SUI Cure (SDS=0), and quality of life score (IIQ-7). Multilevel mixed effects linear regression was used to model SDS over time., Results: Analysis included 40 men. No difference in patient characteristics was seen in comparison of PFMT vs UPFE cohorts (P = NS, all comparisons). Mean predicted SDS was significantly better in the PFMT vs UPFE cohorts at 6-month (0.81 ± 0.21 vs 1.75 ± 0.34, respectively) (P = .014) and 12-month (0.72 ± 0.17 vs 1.67 ± 0.30, respectively) (P = .004) time points. At 12-month follow-up, 11 (55%) vs 4 (20%) patients reported absence of SUI in PFMT vs UPFE cohorts, respectively. Predicted probabilities of SUI cure in PFMT vs UPFE cohorts at 12months were 0.52 ± 0.14 vs 0.23 ± 0.13, respectively (P = .14). At 12-month follow-up, the mean predicted PPD and IIQ score was 0.19 ± 0.10 vs 0.79 ± 0.33 and 2.86 ± 0.86 vs 2.55 ± 1.07 in PFMT vs UPFE cohorts, respectively (P = NS)., Conclusion: In-person, FMPRS-directed PFMT is associated with improved SUI domain scores following robotic-assisted laparoscopic prostatectomy, a finding durable through 12-month follow-up., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: We characterize factors associated with recruitment of underrepresented in medicine urology trainees and faculty to academic institutions given the excessive disparity between urology and other fields of medicine., Methods: A database of urology faculty and residents in Accreditation Council for Graduate Medical Education programs was created. Demographic data were obtained from departmental websites, Twitter, LinkedIn, and Doximity. Program prestige was defined by U.S. News and World Report rankings. Program location and city size were determined using the U.S. Census data. Multivariable analysis was performed assessing the association of gender, AUA section, city size, and rankings on underrepresented in medicine recruitment., Results: Of urologists in this study 8.7% were underrepresented in medicine status. More women urologists were underrepresented in medicine (31.4%) than non-underrepresented in medicine (21.3%; P < .001). Factors predictive of more underrepresented in medicine urologists were practice in South Central AUA section (OR 2.1, P = .04), and medium metro areas (OR 1.6, P < .01). Among residents, factors predictive of more underrepresented in medicine urologists were female gender ( P < .001), living in medium metro areas ( P = .03), and training in top 10 programs ( P = .001). Underrepresented in medicine faculty were more likely to be women compared to non-underrepresented in medicine faculty ( P = .05). Pearson correlation test found no association between the presence of underrepresented in medicine faculty and underrepresented in medicine residents (r = 0.20)., Conclusions: Underrepresented in medicine urology residents and faculty were more likely to be women, compared to non-underrepresented in medicine residents and faculty. Underrepresented in medicine residents are more prevalent in medium metro areas and in top 10 programs. More underrepresented in medicine faculty status was not associated with more underrepresented in medicine residents.

Objective: To determine the outcomes and eventual career paths for unmatched applicants by evaluating a historical cohort of unmatched applicants in the Urology Match., Methods: The 2008-2014 AUA Match lists were obtained from the Society of Academic Urologists and 730 unique applicants were identified with at least one unmatched result. Additional information such as preliminary training and eventual specialty choice were obtained from publicly available sources. Comparative analysis with univariable and multivariable analysis was performed between eventual urologists and those who chose alternative career paths., Results: Overall, 43.5% (318/730) of unmatched urology applicants subsequently continued their interest in Urology and 77.4% (246/317) of initially unsuccessful applicants eventually became urologists. Males (80.9%, P = .01), Doctor of Osteopathy (DO) degree (62.5%, P = <.001), and those undergoing a research year compared to a preliminary surgery year (85.2% vs 72.0% respectively, P = .047) had an increased likelihood of successfully becoming a urologist. The most common alternative specialty choices were Internal Medicine (13.8%), General Surgery (12.9%) and Anesthesiology (11.9%)., Conclusion: Urology is a competitive surgical sub-specialty. Surprisingly, approximately 3 in 4 unmatched urology applicants who continue their interest in urology will eventually obtain a residency position. However, only 33.7% of initially unmatched students ultimately became urologists. Unmatched applicants have several viable pathways to obtain a urological residency position. Male gender, a DO degree, and a research year are associated with successfully obtaining a urology residency position., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose of Review: Extirpative surgery can play an important role in the management strategies for locally advanced urothelial carcinoma. The current review is intended to relay current information reported in the literature over the past 12 months regarding the usage of surgical resection in advanced urothelial cancers of the bladder and upper tracts, document operative outcomes, and oncologic efficacy., Recent Findings: Multimodal therapy is key to long-term overall survival for advanced urothelial carcinoma. Radical cystectomy with bilateral pelvic lymph node dissection can be performed after an observable response to chemotherapy or immunotherapy for cT4 or cN2 and higher node-positive disease of the bladder. Moreover, radical cystectomy after trimodal therapy similarly yields durable local response. For upper tract disease, nephroureterectomy with regional lymphadenectomy is the primary surgical modality used often in conjunction with perioperative cisplatin-based chemotherapy., Summary: Surgical resection as a monotherapy is not curative in patients with locally advanced urothelial carcinoma. However, its use in combination with systemic agents can potentiate durable long-term survival in a subset of patients. Future studies investigating patient-reported outcomes among those receiving consolidative surgery for locally advanced disease are warranted to guide clinical recommendations., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Our objective is to assess the impact of the virtual interview (VI) format on urology residency interviews during the COVID-19 pandemic from the perspectives of program directors (PDs)., Methods: An anonymous survey was sent to PDs of American Council for Graduate Medical Education-accredited urology residency programs. Questions were designed to evaluate how VIs affected programs' assessment of applicants, interview logistics, and overall perspectives regarding in-person and virtual interviews., Results: A total of 42 PDs (31%) responded to our survey. VIs negatively affected programs' ability to assess applicants' fit with their residency program (71%), commitment to urology along with their ability to function as a resident (67%), and personality and communication skills (71%) when compared to in-person interviews. Fifty percent of PDs reported that they relied more heavily on objective metrics when ranking applicants, compared to prior years. VIs were more economical than in-person interviews for all participating programs, with each program saving an average of $3,135 in interview-related costs. Additionally, 33% of PDs reported that VIs were less time-consuming when compared to in-person interviews, with 26% of PDs reporting that they were able to interview more applicants. Only 19% of PDs reported that VIs were better than in-person interviews. Given the option, 60% of PDs intend on hosting both virtual and in-person interviews moving forward, while 9% and 31% of programs intend to exclusively host virtual and in-person interviews, respectively., Conclusions: PDs perceived VIs to be less reliable than in-person interviews for subjective evaluation of applicants; however, many PDs still desire to integrate VIs in future application cycles.

Objective: To evaluate multidisciplinary female representation at urologic oncology conferences, we reviewed speakership trends at contemporary Society of Urologic Oncology (SUO) and American Society of Clinical Oncology Genitourinary Symposium (GU-ASCO) annual meetings., Methods: Meeting programs from SUO and GU-ASCO from 2015 to 2019 were analyzed. Biographical information was determined by querying institutional websites and social/professional media platforms. Statistical analyses were performed to assess for differences and relationships between male and female authorship based on gender, specialty, professional, and educational factors., Results: We identified 1102 speakers at genitourinary oncology conferences. Overall, 222 (20%) were female. There was no significant difference between female speakership rates at SUO and GU-ASCO. The overall proportion of female speakers increased over time, but not when analyzing each individual subspecialty conference separately. Several professional and educational differences were noted between genders. Female speakers were more likely to be medical oncologists (P <.001), have more recent years of graduation (2001 vs 1996, P <.001), hold an additional advanced degree (OR 2.09, P = .005), and speak in sessions where other women served as chair (OR 1.42, P = .044). Conversely, female speakers had lower odds of delivering a plenary or keynote address (OR 0.28, P = .015)., Conclusion: We identified a significantly positive trend towards increased female representation within contemporary genitourinary conferences over time; these trends did not remain significant when analyzing each meeting separately. Several important disparities between men and women speakers were identified. Our data suggests that inclusion of women in planning committees may help reduce gender bias and promote diversity within urologic oncology., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To analyze differences in length of stay, opioid use, and other perioperative outcomes in patients undergoing radical cystectomy with urinary diversion who received either liposomal bupivacaine (LB) or epidural analgesia., Methods: This was a single center, retrospective cohort study of patients undergoing open radical cystectomy with urinary diversion from 2015-2019 in the early recovery after surgery (ERAS) pathway. Patients received either LB or epidural catheter analgesia for post-operative pain control. LB was injected at the time of fascial closure to provide up to 72 hours of local analgesia. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative opioid use, time to solid food, time to ambulation, and direct hospitalization costs. Multivariable Cox proportional hazards regression was used to determine associations between analgesia type and discharge., Results: LB use was independently associated with shorter post-operative length of stay compared to epidural use (median (IQR) 4.9 days (3.9-5.8) vs 5.9 days (4.9-7.9), P<.001), less total opioid use (mean 188.3 vs 612.2 OME, P <.001), earlier diet advancement (mean 1.6 vs 2.4 days, P <.001), and decreased overall direct costs ($23,188 vs $29,628, P <.001). 45% of patients who received LB were opioid-free after surgery, none in the epidural group. On multivariable Cox proportional hazards regression modeling, LB use was independently associated with earlier discharge (HR 2.1, IQR 1.0-4.5)., Conclusion: Use of LB in open radical cystectomy is associated with reduced LOS, less opioid exposure, and earlier diet advancement., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: Coronavirus disease (COVID-19) has profoundly impacted residency training and education. To date, there has not been any broad assessment of urological surgery residency changes and concerns during the COVID-19 pandemic., Materials and Methods: The Society of Academic Urologists distributed a questionnaire to urology residency program directors on March 30, 2020 exploring residency program changes related to the COVID-19 pandemic. Descriptive statistics are presented. A qualitative analysis of free response questions was undertaken. A post hoc analysis of differences related to local COVID-19 incidence is described., Results: The survey was distributed to 144 residency programs with 65 responses for a 45% response rate. Reserve staffing had started in 80% of programs. Patient contact time had decreased significantly from 4.7 to 2.1 days per week (p <0.001). Redeployment was reported by 26% of programs. Sixty percent of programs reported concern that residents will not meet case minimums due to COVID-19. Wellness activities centered on increased communication. All programs had begun to use videoconferencing and the majority planned to continue. Programs in states with a higher incidence of COVID-19 were more likely to report resident redeployment (48% vs 11%, p=0.002) and exposure to COVID-19 positive patients (70% vs 40%, p=0.03), and were less likely to report concerns regarding exposure (78% vs 97%, p=0.02) and personal protective equipment availability (62% vs 89%, p=0.02)., Conclusions: As of April 1, 2020 the COVID-19 pandemic had resulted in significant changes in urology residency programs. These findings inform a rapidly changing landscape and aid in the development of best practices.

Introduction: COVID-19 has brought unprecedented challenges to the delivery of urological care. Following rapid implementation of remote video visits at our tertiary academic medical center serving a large rural population we describe and assess our experience with planned video visits and ongoing scheduling efforts., Methods: Patients scheduled for video visits between April 14 and April 27, 2020 were included. Prospective and retrospective data were collected on patient and clinical characteristics as well as telemedicine outcomes. Multivariable logistic regression was performed to evaluate factors influencing video visit success. Concurrently scheduling data were collected from a separate cohort regarding patient access to technology and willingness to participate in video visits., Results: A total of 209 patients were included with an overall video visit success rate of 67%. Of video visits that failed (69) reasons included no-show (35%), inability to connect to the telemedicine platform (23%) and lack of Internet access (10%). Nearly half of failed video visits (46.4%) were completed as phone visits. After adjustment for patient demographics commercial insurance was significantly associated with video visit success. In assessment of scheduling outcomes 179 patients were contacted to offer video visits. Of these patients 6.7% reported not having Internet access. Of those with Internet access 87% agreed to proceed with a video visit in lieu of visiting in person., Conclusions: Our experience indicates that rapid implementation of video telemedicine is feasible and highly accepted by patients. Efforts focused on standardized pre-visit patient education may further optimize successful telemedicine visits.

Although no tobacco products are safe, tobacco companies in the United States may request regulatory authorization to make certain "modified risk tobacco product" (MRTP) claims in their marketing. However, few qualitative studies have explored consumer perceptions and understanding of comparative risk messages and wordings. We examined consumer perceptions of statements indicating reduced risks and exposure to chemicals from snus and e-cigarettes relative to smoking. We conducted 12 focus groups with adult smokers (ages 21-66) and young adult (YA) non-smokers (ages 18-25) ( n = 57) in the USA in 2019. Participants shared reactions to modified risk and exposure messages and message variations. Participants largely understood claims, including language about "switching completely." However, participants expressed desire for more message specificity, evidence, risk reduction reasons, and statistics/quantitative information. Claim believability and acceptance was also limited by existing negative product beliefs and experiences, negative media reports, and skepticism about message source. YAs did not express product interest based on message exposure. Some YAs suggested the included "smoker" language made the messages less interesting/relevant. Given existing proposals for and use of MRTP messages, additional research on their wording, framing, delivery, and effects may help inform regulatory or organizational decisions about such messages, optimize potential benefits, and mitigate unintended consequences.

OBJECTIVE. The purpose of this study was to determine the diagnostic accuracy of 68 Ga-labeled prostate-specific membrane antigen 11 (PSMA-11) PET for disease detection in patients with prostate cancer who have biochemically recurrent disease after radiation therapy or prostatectomy. SUBJECTS AND METHODS. One hundred fifty patients underwent 68 Ga-PSMA-11 PET/CT or PET/MRI, and the images were interpreted by two blinded board-certified radiologists. Each reader evaluated for the presence or absence of PSMA-positive disease within the prostate bed, pelvic lymph nodes, bones, and soft tissues (extrapelvic lymph nodes and visceral structures). The presence or absence of disease was confirmed by histopathologic analysis if available. For patients who did not have pathologic analysis, a composite of imaging and clinical follow-up was used as the reference standard. RESULTS. The median prostate-specific antigen level was 2.1 ng/mL. Forty-three patients had pathologic correlation, and for 29 patients a composite of imaging and follow-up was used to determine the presence or absence of disease. With substantial to almost perfect interreader reliability by region (κ = 0.78-0.87), 68 Ga-PSMA-11 PET had high sensitivity per region (up to 100%) and per patient (up to 89.8%). It also had high positive predictive value per region (up to 100%) and per patient (up to 91.5%). Sensitivity was highest for bone metastases and lowest for soft-tissue metastases. Positive predictive value was highest for bone metastases and lowest for prostate bed recurrence. CONCLUSION. Gallium-68-labeled PSMA-11 PET is sensitive for prostate cancer metastases in patients with biochemically recurrent prostate cancer. It has high positive predictive value and substantial to almost perfect interrater reliability.

Agents targeting prostate-specific membrane antigen (PSMA) comprise a rapidly emerging class of radiopharmaceuticals for diagnostic imaging of prostate cancer. Unlike most other PSMA agents with a urea backbone, CTT1057 is based on a phosphoramidate scaffold that irreversibly binds to PSMA. We conducted a first-in-humans phase I study of CTT1057 in patients with localized and metastatic prostate cancer. Methods: Two patient cohorts were recruited. Cohort A patients had biopsy-proven localized prostate cancer preceding radical prostatectomy, and cohort B patients had metastatic castration-resistant prostate cancer. Cohort A patients were imaged at multiple time points after intravenous injection with 362 ± 8 MBq of CTT1057 to evaluate the kinetics of CTT1057 and estimate radiation dose profiles. Mean organ-absorbed doses and effective doses were calculated. CTT1057 uptake in the prostate gland and regional lymph nodes was correlated with pathology, PSMA staining, and the results of conventional imaging. In cohort B, patients were imaged 60-120 min after injection of CTT1057. PET images were assessed for overall image quality, and areas of abnormal uptake were contrasted with conventional imaging. Results: In cohort A ( n = 5), the average total effective dose was 0.023 mSv/MBq. The kidneys exhibited the highest absorbed dose, 0.067 mGy/MBq. The absorbed dose of the salivary glands was 0.015 mGy/MBq. For cohort B ( n = 15), CTT1057 PET detected 97 metastatic lesions, and 44 of 56 bone metastases detected on CTT1057 PET (78.5%) were also detectable on bone scanning. Eight of 32 lymph nodes positive on CTT1057 PET (25%) were enlarged by size criteria on CT. Conclusion: CTT1057 is a promising novel phosphoramidate PSMA-targeting 18 F-labeled PET radiopharmaceutical that demonstrates similar biodistribution to urea-based PSMA-targeted agents, with lower exposure to the kidneys and salivary glands. Metastatic lesions are detected with higher sensitivity on CTT1057 imaging than on conventional imaging. Further prospective studies with CTT1057 are warranted to elucidate its role in cancer imaging., (© 2019 by the Society of Nuclear Medicine and Molecular Imaging.)

Background: Androgen deprivation therapy (ADT) has been shown to improve survival for men with intermediate and high-risk prostate cancer undergoing external-beam radiation therapy (EBRT). Using data from a community-based prospective disease registry, we investigated usage of EBRT with or without neoadjuvant ADT., Methods: The CaPSURE database contains 14,863 men with prostate cancer, including 1337 men diagnosed between 1990 and 2014 with localized disease who received EBRT as primary treatment. Prostate cancer risk was calculated using the CAPRA score. Patient characteristics were compared using the Mantel-Haenszel chi-square test for trend and analysis of variance., Results: Between 1990 and 2014, 14,010 men were diagnosed with localized disease within the CaPSURE registry. Of those, 1337 underwent EBRT. Patients had a median age of 71 years. The use of ADT in addition to EBRT increased from 24% in 1990 to 60% in 1996 with a decrease seen to 47% in 2011. Men receiving ADT have differing clinical characteristics including higher PSA at diagnosis, higher Gleason grade, and higher CAPRA scores. Median ADT duration was 4 months., Conclusions: The use of ADT in conjunction with primary EBRT has increased in frequency and duration since 1990. Men receiving ADT have higher risk characteristics than those receiving EBRT alone. There is substantial variability in use of ADT in clinical practice.

Introduction: Workforce disparities in medicine have been well documented. Early medical school exposures have been shown to highly influence career choice. We hypothesized that gender and racial disparities exist in early medical school exposures to urology., Methods: We surveyed urology residency applicants who interviewed at our institution from 2016 to 2017. Student demographics were collected in addition to forms of urology exposures (clinical and research). Early urology exposure was defined as occurring before the 3rd year of medical school. Early exposures were compared by gender and racial/ethnic groups underrepresented in medicine., Results: During the study period 72 interviewees were invited to participate and 71 completed the survey (response rate 98.6%). The majority of participants were male (54, 76%). Thirteen participants (18%) met the criteria for underrepresented in medicine. Fewer female applicants discovered urology (41% vs 75%, p=0.01), first shadowed a urologist (35% vs 68%, p=0.02), first operated with a urologist (29% vs 60%, p=0.03) and began research (0% vs 49%, p <0.001) before the 3rd year of medical school compared to male applicants. Fewer applicants underrepresented in medicine had shadowed a urologist before the 3rd year of medical school (31% vs 67%, p=0.02). We found no other statistical differences between those underrepresented in medicine and those not underrepresented in medicine in terms of other early urology exposures, medical school urology opportunities or personal exposures., Conclusions: Disparities in early urology exposures, especially research exposure, exist by gender and less so among applicants underrepresented in medicine. Identifying these disparities may uncover systemic bias within career trajectories and provide targets for earlier interventions in medical school training.

Purpose To compare the diagnostic accuracy of gallium 68 ( 68 Ga)-labeled prostate-specific membrane antigen (PSMA)-11 PET/MRI with that of multiparametric MRI in the detection of prostate cancer. Materials and Methods The authors performed a retrospective study of men with biopsy-proven prostate cancer who underwent simultaneous 68 Ga-PSMA-11 PET/MRI before radical prostatectomy between December 2015 and June 2017. The reference standard was whole-mount pathologic examination. Readers were blinded to radiologic and pathologic findings. Tumor localization was based on 30 anatomic regions. Region-specific sensitivity and specificity were calculated for PET/MRI and multiparametric MRI by using raw stringent and alternative neighboring approaches. Maximum standardized uptake value (SUV max ) in the tumor and Prostate Imaging Reporting and Data System (PI-RADS) version 2 grade were compared with tumor Gleason score. Generalized estimating equations were used to estimate population-averaged sensitivity and specificity and to determine the association between tumor characteristics and SUV max or PI-RADS score. Results Thirty-two men (median age, 68 years; interquartile range: 62-71 years) were imaged. The region-specific sensitivities of PET/MRI and multiparametric MRI were 74% (95% confidence interval [CI]: 70%, 77%) and 50% (95% CI: 45%, 0.54%), respectively, with the alternative neighboring approach (P < .001 for both) and 73% (95% CI: 68%, 79%) and 69% (95% CI: 62%, 75%), respectively, with the population-averaged generalized estimating equation (P = .04). Region-specific specificity of PET/MRI was similar to that of multiparametric MRI with the alternative neighboring approach (88% [95% CI: 85%, 91%] vs 90% [95% CI: 87%, 92%], P = .99) and in population-averaged estimates (70% [95% CI: 64%, 76%] vs 70% [95% CI: 64%, 75%], P = .99). SUV max was associated with a Gleason score of 7 and higher (odds ratio: 1.71 [95% CI: 1.27, 2.31], P < .001). Conclusion The sensitivity of gallium 68-labeled prostate-specific membrane antigen-11 PET/MRI in the detection of prostate cancer is better than that of multiparametric MRI. © RSNA, 2018 See also the editorial by Civelek in this issue.

[This corrects the article DOI: 10.18632/oncotarget.16598.].

Objective: To further explore the issue of work parity between male and female urologists in the context of demographics, practice characteristics, subspecialty affiliation, and planned retirement., Materials and Methods: We analyzed data from the 2014 American Urological Association census, which is a specialty wide survey distributed to the entire urology community in the United States. A total of 2204 census samples were weighted to represent 11,703 urologists who practiced in the United States in 2014. We compared clinical and nonclinical hours worked by gender after adjusting for age, practice setting, fellowship type, and whether or not the urologist performed inpatient operations., Results: Of the 11,703 practicing urologists in the United States, female urologists make up approximately 7.7% of the workforce (n ~ 897). Female practicing urologists were younger (66.4%, <45 years old), had shorter training intervals, and a younger planned retirement age than their male counterparts (63 years vs 68.5 years, P <.001). More women were fellowship-trained in a urologic subspecialty (54.9% vs 34.9%, P <.001) and more were in academic practices (33.2% vs 21.9%, P = .03). After adjusting for age, practice type, subspecialty, and inpatient operations performed, there was no difference in hours worked between women and men (beta-coefficient -2.8, 95% confidence interval -6.4 to 0.7, P = .12)., Conclusion: Gender does not appear to drive the number of hours urologists work per week. There is work hour parity between women and men practicing urologists in both clinical and nonclinical hours. Women are proportionately more likely to pursue fellowship training and hold academic positions., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Graduate medical education (GME), through fellowship training, plays a critical role in preparing new rheumatologists for our workforce and is an essential component when addressing the gap of excess demand for adult rheumatology care. This study was undertaken to assess the demographic characteristics and employment trends of new entrants entering the rheumatology workforce and the impact this will have on the supply of rheumatologits over the next 15 years., Methods: Primary and secondary data sources were used to develop an integrated workforce model. Factors specific to new graduates entering the workforce included available and filled fellowship positions, gender shifts, planned work schedules (part-time or full-time), practice settings (academic or non-academic, private practice), and number of international medical graduates (IMGs) anticipating US practice., Results: In 2015, there were 113 adult rheumatology programs, with 431 of 468 available positions filled. Using the 215 actual positions available annually in fellowship programs as a starting point, after all factors were applied, the projected clinical full-time equivalent number entering the workforce each year was 107; this number was affected significantly by gender and generational trends. In addition, 17% of IMGs self-identified their plan to practice outside the US. Confounding predictions included a large proportion of current rheumatologists planning retirement with substantially reduced patient loads by 2030., Conclusion: The current US adult rheumatology workforce is in jeopardy of accelerated decline at a time when demands on the workforce face tremendous growth. The current GME training structure cannot support the increased demand. Potential strategies to address this gap include innovative mechanisms for GME funding to increase fellowship training positions, incentives for pursuing rheumatology training (e.g., loan repayment programs), and novel means for recruitment of care to underserved areas of the US., (© 2018, American College of Rheumatology.)

The purpose of this prospective study was to estimate the effect of 68 Ga-labeled prostate-specific membrane antigen (PSMA)-11 PET on the intended management of patients with biochemically recurrent prostate cancer. Methods: Pre- and postimaging surveys were filled out by the referring providers for patients with biochemical recurrence who were imaged using 68 Ga-PSMA-11 PET. The inclusion criterion for this study was a prostate-specific antigen (PSA) doubling time of less than 12 mo after initial treatment (NCT02611882). Of the 150 consecutive patients imaged, 126 surveys were completed (84% response rate). The responses were categorized as major change, minor change, no change, or unknown change. Results: There were 103 patients (82%) with disease detected on 68 Ga-PSMA-11 PET. On the basis of the survey results, there were 67 patients (53.2%) with major changes in management and 8 patients (6.4%) with minor changes. The proportion of cases resulting in a change in management did not significantly differ by baseline PSA level. In patients with PSA levels below 0.2 ng/dL, 7 of 12 patients had disease detected on 68 Ga-PSMA-11 PET, 5 of whom had a major change in management. Conclusion: 68 Ga-PSMA-11 PET resulted in a major change in management in 53% of patients with biochemical recurrence. Further studies are warranted to investigate whether PSMA-based management strategies result in improved outcomes for patients., (© 2017 by the Society of Nuclear Medicine and Molecular Imaging.)

The purpose of this study was to characterize prostate cancer (PCa) based on multiparametric MR (mpMR) measures derived from MRI, diffusion, spectroscopy, and dynamic contrast-enhanced (DCE) MRI, and to validate mpMRI in detecting PCa and predicting PCa aggressiveness by correlating mpMRI findings with whole-mount histopathology. Seventy-eight men with untreated PCa received 3 T mpMR scans prior to radical prostatectomy. Cancerous regions were outlined, graded, and cancer amount estimated on whole-mount histology. Regions of interest were manually drawn on T 2 -weighted images based on histopathology. Logistic regression was used to identify optimal combinations of parameters for the peripheral zone and transition zone to separate: (i) benign from malignant tissues; (ii) Gleason score (GS) ≤3 + 3 disease from ≥GS3 + 4; and (iii) ≤ GS3 + 4 from ≥GS4 + 3 cancers. The performance of the models was assessed using repeated fourfold cross-validation. Additionally, the performance of the logistic regression models created under the assumption that one or more modality has not been acquired was evaluated. Logistic regression models yielded areas under the curve (AUCs) of 1.0 and 0.99 when separating benign from malignant tissues in the peripheral zone and the transition zone, respectively. Within the peripheral zone, combining choline, maximal enhancement slope, apparent diffusion coefficient (ADC), and citrate measures for separating ≤GS3 + 3 from ≥GS3 + 4 PCa yielded AUC = 0.84. Combining creatine, choline, and washout slope yielded AUC = 0.81 for discriminating ≤GS3 + 4 from ≥GS4 + 3 disease. Within the transition zone, combining washout slope, ADC, and creatine yielded AUC = 0.93 for discriminating ≤GS3 + 3 and ≥GS3 + 4 cancers. When separating ≤GS3 + 4 from ≥GS4 + 3 PCa, combining choline and washout slope yielded AUC = 0.92. MpMRI provides excellent separation between benign tissues and PCa, and across PCa tissues of different aggressiveness. The final models prominently feature spectroscopy and DCE-derived metrics, underlining their value within a comprehensive mpMRI examination., (Copyright © 2017 John Wiley & Sons, Ltd.)

Introduction: The gender demographics within urology are changing as more women are entering the workforce. Since research productivity strongly influence career advancement, we aim to characterize gender differences in scholarly productivity and promotions in a cohort of graduated academic urologists., Materials and Methods: Urologists who graduated between 2002 and 2008 from 34 residency programs affiliated with the top 50 urology hospitals as ranked in 2009 by U.S. News & World Report were followed longitudinally. Only urologists affiliated with an academic teaching hospital were included for analysis., Results: A total of 543 residents graduated, 459 (84.5%) males and 84 (15.5%) females. Of these, 173 entered academia, 137 (79.2%) males and 36 (20.8%) females. Women had fewer publications compared to men (mean 19.3 versus 61.7, p = 0.001). Fewer women compared to men were promoted from assistant professor 11 (30.6%) versus 83 (60.6%), p = 0.005. Fewer women achieved associate professor 10 (27.8%) versus 67 (48.9%), p = 0.005 or professor ranks 1 (2.8%) versus 16 (11.7%), p = 0.005 respectively compared to men. In a multivariate logistic regression analysis, after controlling for the number of total publications and number of years since graduation, gender was not predictive of achieving promotion, OR = 0.81 (95% CI 0.31-2.13), p = 0.673., Conclusions: Women are underrepresented in senior faculty roles in urology. Scholarly productivity seems to play a major role in academic promotion within urology. With increasing women in academic urology, further studies are needed to explore predictors of promotion and how women can achieve higher leadership roles in the field.

Background: PET/MRI can be used for the detection of disease in biochemical recurrence (BCR) patients imaged with 68 Ga-PSMA-11 PET. This study was designed to determine the optimal MRI sequences to localize positive findings on 68 Ga-PSMA-11 PET of patients with BCR after definitive therapy. Fifty-five consecutive prostate cancer patients with BCR imaged with 68 Ga-PSMA-11 3.0T PET/MRI were retrospectively analyzed. Mean PSA was 7.9 ± 12.9 ng/ml, and mean PSA doubling time was 7.1 ± 6.6 months. Detection rates of anatomic correlates for prostate-specific membrane antigen (PSMA)-positive foci were evaluated on small field of view (FOV) T2, T1 post-contrast, and diffusion-weighted images. For prostate bed recurrences, the detection rate of dynamic contrast-enhanced (DCE) imaging for PSMA-positive foci was evaluated. Finally, the detection sensitivity for PSMA-avid foci on 3- and 8-min PET acquisitions was compared., Results: PSMA-positive foci were detected in 89.1% (49/55) of patients evaluated. Small FOV T2 performed best for lymph nodes and detected correlates for all PSMA-avid lymph nodes. DCE imaging performed the best for suspected prostate bed recurrence, detecting correlates for 87.5% (14/16) of PSMA-positive prostate bed foci. The 8-min PET acquisition performed better than the 3-min acquisition for lymph nodes smaller than 1 cm, detecting 100% (57/57) of lymph nodes less than 1 cm, compared to 78.9% (45/57) for the 3-min acquisition., Conclusion: PSMA PET/MRI performed well for the detection of sites of suspected recurrent disease in patients with BCR. Of the MRI sequences obtained for localization, small FOV T2 images detected the greatest proportion of PSMA-positive abdominopelvic lymph nodes and DCE imaging detected the greatest proportion of PSMA-positive prostate bed foci. The 8-min PET acquisition was superior to the 3 min acquisition for detection of small lymph nodes.

The most frequent alteration in the prostate oncogenome is loss of chromosome (chr) 8p21 that has been associated with loss of NKX3.1 homeobox gene. Chr8p21 deletions increase significantly with tumor grade and are associated with poor prognosis in prostate cancer (PCa), suggesting critical involvement of this region in tumor progression. Recent studies suggest that apart from NKX3.1, this region harbors alternative tumor suppressors that are yet undefined. We proposed a novel, paradigm shifting hypothesis that this locus is associated with a miRNA gene cluster-miR-3622a/b- that plays a crucial suppressive role in PCa. Here we demonstrate the crucial role of miR-3622a in prostate cancer epithelial-to-mesenchymal transition (EMT). MicroRNA expression profiling in microdissected human PCa clinical tissues showed that miR-3622a expression is widely downregulated and is significantly correlated with poor survival outcome and tumor progression. To understand the functional significance of miR-3622a, knockdown and overexpression was performed using non-transformed prostate epithelial and PCa cell lines, respectively, followed by functional assays. Our data demonstrate that endogenous miR-3622a expression is vital to maintain the epithelial state of normal and untransformed prostate cells. miR-3622a expression inhibits EMT, progression and metastasis of PCa in vitro and in vivo. Further, we found that miR-3622a directly targets EMT effectors ZEB1 and SNAI2. In view of these data, we propose that frequent loss of miR-3622a at chr8p21 region leads to induction of EMT states that in turn, promotes PCa progression and metastasis. This study has potentially significant implications in the field of prostate cancer as it identifies an important miRNA component of a frequently lost chromosomal region with critical roles in prostate carcinogenesis which is a highly significant step towards understanding the mechanistic involvement of this locus. Also, our study indicates that miR-3622a is a novel PCa biomarker and potential drug target for developing therapeutic regimens against advanced PCa.

Cytochrome P450 1B1 (CYP1B1) is recognized as a universal tumor biomarker and a feasible therapeutic target due to its specific overexpression in cancer tissues. Despite its up-regulation in prostate cancer (PCa), biological significance and clinicopathological features of CYP1B1 are still elusive. Here, we show that overexpression or hyperactivation of CYP1B1 stimulated proliferative, migratory and invasive potential of non-tumorigenic PCa cells. Attenuation of CYP1B1 with its specific small hairpin (sh) RNAs greatly reduced proliferation through apoptotic cell death and impaired migration and invasion in PCa cells. Intratumoral injection of CYP1B1 shRNA attenuated growth of pre-existing tumors. The antitumor effect of CYP1B1 shRNA was also observed in prostate tumor xenograft mouse models. Among the genes altered by CYP1B1 knockdown, reduction of caspase-1 (CASP1) activity attenuated the antitumor effect of CYP1B1 inhibition. Indeed, CYP1B1 regulates CASP1 expression or activity. Finally, CYP1B1 expression was increased in higher grades of PCa and overall survival was significantly reduced in patients with high levels of CYP1B1 protein. CYP1B1 expression was reversely associated with CASP1 expression in clinical tissue samples. Together, our results demonstrate that CYP1B1 regulates PCa tumorigenesis by inhibiting CASP1 activation. Thus, the CYP1B1-CASP1 axis may be useful as a potential biomarker and a therapeutic target for PCa.

Purpose: We evaluated whether placement of a retropubic urethral sling fashioned from autologous vas deferens during robotic assisted radical prostatectomy would improve recovery of continence., Materials and Methods: In a phase 2, single blind trial age stratified patients were randomized to undergo robotic assisted radical prostatectomy by multiple surgeons with or without sling placement. The outcomes were complete continence (0 urinary pads of any type) and near continence (0, an occasional or 1 pad per day) at 6 months, which was assessed by the Fisher exact test and logistic regression. The Kaplan-Meier method and the log rank test were used to evaluate time to continence. EPIC-UIN (Expanded Prostate Cancer Index Composite-Urinary Inventory) and I-PSS (International Prostate Symptom Score) 1, 3 and 6 months after catheter removal were evaluated by mixed models for repeated measures., Results: Of 203 patients who were recruited 95 and 100 were randomized to undergo sling and no sling placement, respectively, and completed postoperative interviews. Six months after surgery the proportions reporting complete and near continence (66% and 87%, respectively) and times to complete and near continence were similar in the groups. Younger age was associated with a higher likelihood of complete continence (OR 1.74 per decreasing 5-year interval, 95% CI 1.23-2.48, p <0.01) and near continence (OR 2.18 per decreasing 5-year interval, 95% CI 1.21-3.92, p <0.01) adjusting for clinical, urinary and surgical factors. Adjusted EPIC-UIN and I-PSS scores changed with time but did not differ between the groups. No serious adverse events were observed., Conclusions: This trial failed to demonstrate a benefit of autologous urethral sling placement at robotic assisted radical prostatectomy on early return of continence at 6 months. Continence was related to patient age in adjusted models., (Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer., Methods: We enrolled 257 men with clinically localized prostate cancer (prostate-specific antigen <20; Gleason score 6 or 7) seen by urologists (primarily residents and fellows) in 4 Veterans Affairs medical centers. We measured patients' baseline preferences prior to their urology appointments, including initial treatment preference, cancer-related anxiety, and interest in sex. In longitudinal follow-up, we determined which treatment patients received. We used hierarchical logistic regression to determine the factors that predicted treatment received (active treatment v. active surveillance) and urologist recommendations. We also conducted a directed content analysis of recorded clinical encounters to determine if urologists discussed patients' interest in sex., Results: Patients' initial treatment preferences did not predict receipt of active treatment versus surveillance, Δχ 2 (4) = 3.67, P = 0.45. Instead, receipt of active treatment was predicted primarily by urologists' recommendations, Δχ 2 (2) = 32.81, P < 0.001. Urologists' recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but were unrelated to patient preferences, Δχ 2 (6) = 0, P = 1. Urologists rarely discussed patients' interest in sex (<15% of appointments)., Conclusions: Patients' treatment decisions were based largely on urologists' recommendations, which, in turn, were based on medical factors (age and Gleason score) and not on patients' personal views of the relative pros and cons of treatment alternatives., (© The Author(s) 2016.)

Objective: To examine mild cognitive impairment (MCI) in a young and older adult urology population, and which external factors were associated with diminished cognitive status at baseline., Methods: We enrolled patients >18 years of age presenting to a large, urban tertiary care center for a wide variety of urologic complaints. Cognitive status was determined by the Montreal Cognitive Assessment (MoCA) screening test. A score of 26-30 on the MoCA is considered cognitively intact, whereas <26 indicates MCI. Patient charts were retrospectively reviewed; a backwards-stepwise logistic regression was constructed to compare MCI with potential risk factors., Results: One hundred ninety-seven patients were included. There were 10/33 (30%) patients aged 18-40 who had MCI. Moreover, 32/68 (47%) patients aged 41-64 had MCI. Of older adults age 65+, MCI was seen in 65/96 (68%) patients. Factors associated with MCI in age group 41-64 included opioid use. Patients with stone disease were less likely to demonstrate MCI, when compared to other general categories of urologic chief complaints. For patients in age group 65+, associations with MCI included a cancer-related chief complaint, increased age, depressive symptoms, and less education. There were no significant associations with MCI in age group 18-40., Conclusion: These results demonstrate a significant prevalence of MCI in an adult urology population and factors that may be associated with its prevalence. We believe that this study lays the groundwork for urology providers to be able to identify patients who may have MCI at baseline., (Copyright © 2016 Elsevier Inc. All rights reserved.)