Faculty Bibliography

PURPOSE/UNASSIGNED:Underutilization of genetic testing among Hispanic males results in higher rates of variants of uncertain significance (VUS). We examined the impact of VUS on decision making and behavioral intentions. METHODS/UNASSIGNED:We conducted a nationwide survey of 807 US Hispanic males aged ≥40 in English and Spanish on perspectives about genetic testing results. Logistic regression was used to examine predictors of worry and behavior change with a hypothetical VUS result. RESULTS/UNASSIGNED:Over half of Hispanic male participants would still participate in genetic testing with a 1 in 5 chance of VUS. However, 36% were at least somewhat likely to regret testing and 49.9% would worry about cancer risk with VUS results. In addition, 56.3% were somewhat or very likely to change behavior due to a VUS, such as getting checked by the doctor more often or telling family members to get checked. Younger age and college education were associated with more worry and intended behavior change. CONCLUSION/UNASSIGNED:Although many Hispanic males are interested in genetic testing despite the higher likelihood of VUS, potential consequences include decisional regret, anxiety, and even changes in behavior. Effective counseling and support are important for minoritized groups undergoing genetic evaluation to avoid the potential to exacerbate health disparities.

BACKGROUND:Prostate cancer survivors often experience reduced health-related quality of life (QOL). Diet is related to QOL in the general population and prostate cancer survivors, with benefits observed from greater consumption of a plant-based diet post-treatment. We examined whether post-diagnostic Western and prudent dietary patterns were associated with cancer-specific QOL. METHODS:We studied 1,032 participants in the Health Professionals Follow-up Study diagnosed with non-metastatic prostate cancer (2005-2014). Diet scores were cumulatively averaged from validated food frequency questionnaires post-diagnosis. QOL was assessed with the Expanded Prostate Cancer Index Composite Short Form (EPIC-26) 2-5 years after diagnosis/treatment (2010-2016). We assessed associations between the two diet patterns and cancer-specific QOL domains (sexual function, urinary irritation/obstruction, urinary incontinence, bowel function, hormonal/vitality function), adjusting for patient, tumor, and lifestyle characteristics. RESULTS:Median age at diagnosis was 75 years; 93% had clinically localized cancer. Higher Western diet scores were associated with worse bowel function by 3 points (p-trend=0.02), below the 4-6 point threshold for clinical relevance, with suggestive trends among radiation-treated patients (p-trend=0.07). Higher prudent diet scores tended to be associated with better bowel function (p-trend=0.09). Neither diet score was associated with bowel function among patients receiving radical prostatectomy or active surveillance. There were no associations with sexual, urinary, or hormonal/vitality function. CONCLUSIONS:Among survivors of non-metastatic prostate cancer, dietary patterns were largely unrelated to cancer-specific QOL across domains and treatment subgroups. IMPACT/CONCLUSIONS:In the 2-5-year window, QOL was largely unaffected by post-diagnostic dietary patterns, warranting further research with longer follow-up to assess potential latency.

Prostate-specific membrane antigen (PSMA) PET is a powerful tool for prostate cancer staging and restaging, providing higher sensitivity and specificity than conventional imaging. The recognition of interpretive pitfalls led to the development of various scoring systems and frameworks, which in turn created challenges for consistent interpretation. The Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) version 2 classification integrates the five-point PRIMARY score for assessing local disease, the molecular imaging TNM stage for disease extent, and the PSMA expression score to assess eligibility for PSMA-targeted radioligand therapy. The PSMA Reporting and Data System (PSMA-RADS) classifies PSMA PET/CT findings on the basis of the likelihood of presence of prostate cancer. For assessing therapy response, PSMA PET Progression (PPP) criteria focus on new lesions and clinical or biochemical progression, whereas Response Evaluation Criteria in PSMA PET/CT (RECIP 1.0) assess new lesions and changes in total PSMA-positive total tumor volume. The European Association of Nuclear Medicine (EANM) E-PSMA guideline and EANM-Society of Nuclear Medicine and Molecular Imaging procedure guidelines provide standardized reporting recommendations, incorporating elements from existing systems such as PROMISE, PSMA-RADS, and PPP. Nevertheless, such systems can be essential for optimizing prostate cancer management and facilitating communication among imaging professionals, clinicians, and patients. This article outlines these systems and discusses potential strengths and weaknesses.

Social media can benefit prostate cancer care through education and empowerment, but also have the potential for exposure to misinformation, leading to adverse health and/or economic impacts for patients and damaging the patient-physician relationship. Clinicians should promote digital health literacy and provide recommended sources of reliable online content for additional information.

BACKGROUND AND OBJECTIVE/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/UNASSIGNED: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/CONCLUSIONS: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.

BACKGROUND AND OBJECTIVE/OBJECTIVE:The health care sector is a significant contributor to greenhouse gas (GHG) emissions, and assessments of the environmental impacts of health services are essential. We aimed to evaluate the environmental impact of a highly common but controversial urology-specific blood test: the prostate-specific antigen (PSA) test. METHODS:e). The secondary outcome was the health impact attributed to the environmental harm of the test. KEY FINDINGS AND LIMITATIONS/UNASSIGNED:e, equivalent to driving 14.5 million miles, with a resulting human health impact of 6.6 disability-adjusted life years annually. This study focused on the PSA test itself, and not on emissions from staff, patient, or sample transportation; building infrastructure; or cleaning. CONCLUSIONS AND CLINICAL IMPLICATIONS/CONCLUSIONS:Although the carbon footprint of a single PSA test is small, the cumulative impact of the estimated total of 30 million PSA tests performed annually in the USA is substantial, especially when considering that a notable proportion of these tests may be performed on men who are unlikely to benefit.

Inaccurate information about prostate cancer is widespread on online social networks in English and Spanish and spans a variety of topics from prevention and screening to treatment and survivorship. Clinicians should raise awareness that social media can be a source of misinformation about prostate cancer, preemptively address prevalent myths, and actively participate in public dissemination of evidence-based information.

BACKGROUND:Germline genetic variants are important for prostate cancer (PCa) management and hereditary cancer risk assessment, but testing is underused. Furthermore, patients are often unaware of the genetic connections to PCa. Social media is increasingly serving as a source of awareness for health information and a method to gather data from a large population. OBJECTIVE:There were three objectives: to (1) create and test social media messages related to PCa genetics and genetic testing, (2) determine which social media message was most engaging, and (3) assess knowledge of and attitudes toward PCa genetic testing through an online survey using the most engaging social media message. METHODS:A paid social media campaign was developed to disseminate targeted messages about PCa and genetics. We tested combinations of 8 images and 8 messages that were created or selected by the research team and reviewed by a study-specific advisory board. We targeted men and women older than 35 years living in the United States. The campaign was launched on Facebook for 6 days (June 3-8, 2023). We tracked the reach and impressions of each post. The survey, administered directly after someone viewed a post, assessed knowledge about PCa and cancer genetics as well as beliefs about cancer risk and genetic testing. Descriptive and multivariable analyses were used to analyze survey data. RESULTS:Most posts were viewed by women (13,675/16,224, 84.3% of impressions) and people over the age of 55 years (19,997/22,906, 87.3% of impressions). The 2 most engaging images were a group of men of different races and ethnicities (reach: 28,151 people; impressions: 33,727 views), followed by a Hispanic family (reach: 16,026 people; impressions: 20,113 views). The following message had the most engagement: "Breast cancer and prostate cancer may be related because they can arise from the same gene mutation in a family" (reach: 58,980 people; impressions: 74,834 views). A total of 875 people (n=796, 91% male; mean age 43.42, SD 14.1 years; n=224, 25.6% Black or African American individuals; n=255, 29.1% Hispanic individuals) completed the survey. In total, 75.2% (658/875) strongly or somewhat agreed that genetics play a role in the development of PCa, and 84% (735/875) would want to know if they had a genetic predisposition to PCa. CONCLUSIONS:It is feasible to use social media platforms to test and disseminate messages that raise awareness about PCa genetics and the connection with other cancers (eg, breast cancer), as well as to deploy surveys that reach a wide audience.